The Hashemite Kingdom of Jordan
JORDAN POPULATION AND FAMILY HEALTH SURVEY 2017
MAN'S QUESTIONNAIRE
Survey Contents Confidential by Statistical Law
CLUSTER NUMBER ___
HOUSEHOLD NUMBER __
NAME OF HOUSEHOLD HEAD ________________________
NAME AND LINE NUMBER OF MAN _____________________ __
TELEPHONE/MOBILE NUMBER (IF AVAILABLE) _________
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
DAY
MONTH
YEAR
INT. NO
RESULT*
SUPERVISOR
NAME ____________
NUMBER ____
Hello. My name is _____________. I am working with the Department of Statistics. We are conducting a survey about health and other topics all over JORDAN. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need some more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions?
May I begin the interview now?
DATE ________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101) RECORD THE TIME
MINUTES ___
102) How long have you been living continuously in (NAME OF CURRENT GOVERNORATE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)
103) Just before you moved here, did you live in another governorate?
NO 2 (SKIP TO 105)
104) Which governorate did you live in?
BALQA 02
ZARQA 03
MADABA 04
IRBID 05
MAFRAQ 06
JARASH 07
ALJOUM 08
KARAK 09
TAFIELA 10
MA'AN 11
AQABA 12
OUTSIDE JORDAN 96
105) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (SKIP TO 111)
108) What is the highest level of school you attend: old elementary; old preparatory, old secondary, new basic, new secondary, intermediate diploma, bachelor, or higher?
PREPARATORY 2
SECONDARY 3
SECONDARY 5
BACHELOR 7
HIGHER 8
109) What is the highest GRADE you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
HIGHER (SKIP TO 113)
111) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ________________ 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED (SKIP TO 114)
113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE AWEEK 2
NOT AT ALL 3
114) Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE AWEEK 2
NOT AT ALL 3
115) Do you watch television at least once a week, less than once a week or not at all?
LESS THAN ONCE AWEEK 2
NOT AT ALL 3
116) Do you own a mobile or smart phone?
NO 2 (SKIP TO 118)
117) Do you use your mobile phone for any financial transactions?
NO 2
118) Do you have an account in a bank or other financial institution that you yourself use?
NO 2 (SKIP TO 119)
118A) Do you have a personal credit card?
NO 2
119) Have you ever used the internet?
NO 2 (SKIP TO 123A)
120) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (SKIP TO 123A)
121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
123A) What is your nationality?
EGYPTIAN 2
SYRIAN 3
IRAQI 4
OTHER ARAB NATIONALITIES 5
NON ARAB NATIONALITIES 6
200A) Are you currently married?
NO, NOT MARRIED 3
200B) Have you ever been married?
NO 2 (SKIP TO 301)
200C) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours. Have you ever fathered any children with any wife?
NO 2 (SKIP TO 206)
202) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (SKIP TO 204)
204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?
NO 2 (SKIP TO 206)
206) Have you ever fathered a son or daughter who was born alive but died later?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
NO 2 (SKIP TO 208)
DON'T KNOW 8 (SKIP TO 208)
208) SUM ALL ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAD HAD ONLY ONE CHILD (SKIP TO 211)
HAS NOT HAD ANY CHILDREN (SKIP TO 301)
210) Did all of the children you have fathered have the same biological mother?
NO 2
HAS HAD MORE THAN ONE CHILD
HAS HAD ONLY ONE CHILD
NO LIVING CHILDREN (SKIP TO 301)
MORE THAN MORE LIVING CHILD
ONLY ONE LIVING CHILD
216) When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?
NO 2 (SKIP TP 218)
DON'T KNOW (SKIP TO 218)
217) Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
218) Was (NAME) born in a hospital or health facility?
OTHER 2
219) When a child had diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
YES, TRADITIONAL METHOD (SPECIFY) ___________B
NO Y
302) In the last few months have you:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
303) In the last few months, have you discussed family planning with a health worker or health professional?
NO 2
304) Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?
NO 2 (SKIP TO 306)
DON'T KNOW 8 (SKIP TO 306)
305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _______________ 6
DON'T KNOW 8
306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
307) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
DISAGREE 2
DK 8
DISAGREE 2
DK 3
307A) Do you approve or disapprove couples that use a method of contraception?
NO 2
DON'T KNOW/NO OPINION 8
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
400A) CHECK 200A, 200B:
200B = YES WIDOWED, SEPARATED, DIVORCED (SKIP TO 410)
200B = NO NEVER MARRIED (SKIP TO 514)
404) Is your wife living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
NO (ONLY ONE WIFE) 2 (SKIP TO 407)
406) Altogether, how many wives do you have?
407) CHECK 405:
RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE.
ONE WIFE
LINE NUMBER _______________
LINE NUMBER _______________
408) IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, ASK 408 FOR EACH PERSON.
How old was (NAME) on her last birthday?
MORE THAN ONE WIFE (SKIP TO 411)
410) Have you been married only once or more than once?
ONLY ONCE 2
BOTH ARE CODE '2'
DON'T KNOW MONTH 98
YEAR ______ (SKIP TO 413)
DON'T KNOW YEAR 9998
OTHER
DON'T KNOW MONTH 98
YEAR ______ (SKIP TO 413)
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE
415) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 __________
MONTHS AGO 3 _________
YEARS AGO 4 __________ (SKIP TO 438)
415A) The last time you had sexual intercourse, was a condom used?
NO 2 (SKIP TP 438)
436) From where did you obtain the condom the last?
PROBE TO IDENTIFY TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12
GOVERNMENT MCH 13
UNIVERSITY HOSPITAL/CLINIC 14
ROYAL MEDICAL SERVICES 15
OTHER PUBLIC (SPECIFY) _______________ 16
PRIVATE DOCTOR 22
PHARMACY 23
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) 24
INSTITUTE FOR FAMILY HEALTH (IFH) 25
INTERNATIONAL RESCUE COMMITTEE (IRC) 26
UNRWA CLINIC 27
UNHCR/OTHER NG 28
OTHER PRIVATE (SPECIFY) ________________ 29
OTHER (SPECIFY) __________________ 96
437) The last time you had sex did you or your partner use any method other than condom to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
438) The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?
NO 2 (SKIP TO 440)
DON'T KNOW 8 (SKIP TO 440)
439) What method did you or your partner use?
PROBE: Did you or your partner use any method to prevent pregnancy?
RECORD ALL MENTIONED.
MALE STERILIZATION B (SKIP TO 501)
IUD C (SKIP TO 501)
INJECTABLES D (SKIP TO 501)
IMPLANTS E (SKIP TO 501)
PILL F (SKIP TO 501)
CONDOM G (SKIP TO 501)
FEMALE CONDOM H (SKIP TO 501)
EMERGENCY CONTRACEPTION I (SKIP TO 501)
LACTATIONAL AMENORRHEA METHOD J (SKIP TO 501)
RHYTHM METHOD K (SKIP TO 501)
WITHDRAWL L (SKIP TO 501)
OTHER MODERN METHOD X (SKIP TO 501)
OTHER TRADITIONAL METHOD Y (SKIP TO 501)
440) Do you know of a place where you can obtain a method of family planning?
NO 2
SECTION 5. FERTILITY PREFERENCES
501) CHECK 22A, 200B:
200B: YES WIDOWED, SEPARATED, DIVORCED (SKIP TO 514)
MAN STERILIZED (SKIP TO 514)
MORE THAN ONE WIFE (SKIP TO 509)
504) Is your wife currently pregnant?
NO 2 (SKIP TO 507)
DON'T KNOW 8 (SKIP TO 507)
505) Now I have some questions about the future. After the child you and your wife are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
506) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 _____ (SKIP TO 514)
SOON/NOW 9993 (SKIP TO 514)
OTHER (SPECIFY) ___________ 996
DON'T KNOW 998
HAS FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS NOT FATHERED CHILDREN
NO MORE/NONE 2 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 3 (SKIP TO 514)
WIFE STERILIZED 4 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
HAS FATHERED CHILDREN
YEARS 2 ____ (SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER (SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
HAS NOT FATHERED CHILDREN
YEARS 2 ____ (SKIP TO 514)
SOON/NOW 993 (SKIP TO 514)
SAYS COUPLE CAN'T GET PREGNANT 994 (SKIP TO 514)
OTHER (SPECIFY) 996 (SKIP TO 514)
DON'T KNOW 998 (SKIP TO 514)
509) Are any of your wives currently pregnant?
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)
510) Now I have some questions about the future. After the (child/children) you and your wives are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (SKIP TO 514)
UNDECIDED/DON'T KNOW 8 (SKIP TO 514)
511) After the birth of the child you are expecting now, how long would you wait before the birth of another child?
YEARS 2 _____
SOON/NOW 993
SAYS COUPLE CAN'T GET PREGNANT 994
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
514) CHECK 203 AND 205:
PROBE FOR A NUMERIC RESPONSE.
HAS LIVING CHILDREN
NUMBER _____
OTHER (SPECIFY) ____________ 96 (SKIP TO 601)
NOT ASKED OR NO LIVING CHILDREN
NUMBER _____
OTHER (SPECIFY) ____________ 96 (SKIP TO 601)
515) How many of these children would you like to be boys, how many would you like to be girls, and how many would it not matter if it's a boy or a girl?
NUMBER OF GIRLS _____
EITHER ___
OTHER (SPECIFY) _________ 96
SECTION 6. EMPLOYMENT AND GENDER ROLES
601) Have you done any work in the last seven days, even for one hour? By "work", I mean any paid work, any work in business completely or partially owned by yourself, any work in a business owned by the household without payment, or work in other business?
NO 2
602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?
NO 2 (SKIP TO 607)
604) What is your occupation? That is, what kind of work do you mainly do?
_______________________________________________________________
606A) What is your employment status: are you an employee, an employer, are you self-employed, are you working for your family without payment, or are you working for someone else without payment?
EMPLOYER 2
SELF-EMPLOYED 3
UNPAID FAMILY WORKER 4
UNPAID WORKER 5
200A = NO NEVER MARRIED WIDOWED/SEPARATED/DIVORCED (SKIP TO 612)
606A NOT ASKED OR CODE '4' OR '5' (SKIP TO 610)
609) Who usually decides how the money you earn will be used: you, your wife, or you and your wife jointly?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
OTHER (SPECIFY) ______________6
610) Who usually makes decisions about health care for yourself: you, your wife, you and your wife jointly, or someone else?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER 6
611) Who usually makes decisions about making major household purchases?
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER 6
612) Do you own this house or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
618) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
701) Now I would like to talk about something else. Have you ever heard of HIV or AIDS?
NO2 (SKIP TO 727)
702) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703) Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
704) Can people reduce their chance of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
705A) Can people get the AIDS virus by shaking hands with or hugging a person who has AIDS?
NO 2
DON'T KNOW 8
705B) Can people get the AIDS virus by sharing razors or blades when shaving their beard or having their hair cut?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
708) Can HIV be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (SKIP TO 716)
710) Are there any special drugs that a doctor or nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
716) Do you know of a place where people can go to get an HIV test?
NO 2 (SKIP TO 720)
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNAVAILABLE TO DETERMINE IF PUBLIC OR RPIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER B
GOVERNMENT MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNSELING CENTER F
OTHER PUBLIC SECTOR (SPECIFY) _______________ G
PRIVATE DOCTOR I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOVERNMENT ORGANIZATION L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________________ M
720) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT HIV OR AIDS
NO 2
NOT HEARD ABOUT HIV OR AIDS
NO 2
200 B = YES EVER MARRIED (CONTINUE)
200 B = NO NEVER MARRIED (SKIP TO 736)
729) CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 736)
730) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
736) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom, when they have sex?
NO 2
DON'T KNOW 8
737) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women, or women other than his wives?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
808) Do you currently smoke tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 810)
809) In the past, have you smoked tobacco every day?
NO 2 (SKIP TO 812)
810) In the past, have you ever smoked tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 816)
811) On average, how many of the following products do you currently smoke each day? Also let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
812) On average, how many of the following products do you currently smoke each week? Also let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.
816) Are you covered by any health insurance?
NO 2 (SKIP TO 818)
817) What types of health insurance are you covered by?
RECORD ALL INSURANCES MENTIONED.
ROYAL/MILITARY HEALTH INSURANCE B
UNIVERSITY HOSPITAL INSURANCE C
UNRWA INSURANCE D
UNHCR INSURANCE E
NGO INSURANCE F
PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE G
PRIVATE SECTOR INDURANCE H
OTHER (SPECIFY) _____________ X
MINUTES __
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW:
______________________________________________________________________________
COMMENTS ON SPECIFIC QUESTIONS:
______________________________________________________________________________
ANY OTHER COMMENTS:
______________________________________________________________________________
_______________________________________________________________________
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