3. Materials_Questionnaire Main.pdf

7/24/2019 3. Materials_Questionnaire Main.pdf

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Follow-Up Questionnaire: Client Beneficiaries

F1 Pakisulat ang mga sumusunod na impormasyon tungkol sa kalahok:

Please note the following information about the respondent

[F1.1]Pangalan:

First Name: __ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___

[F1.2] Apelyido:

Last Name: __ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___

[F1.3] Respondent ID Code :

(Not pass ID number) __ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___

[F1.4] Numero ng

Telepono/Cellphone:

Landline/Cellphone No.:__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___

Sa tagapanayam:Una, bisitahin ang tutugon o respondent sa kanyang tirahan na nakatukoy. Kung wala ang tutugon,

ipagtanong sa kanyang mga kapitbahay, barangay at kapamilya na maaaring makausap.

Dear Interviewer:First, visit respondent at the address provided. If respondent cannot be found, then please try to find

the person by asking neighbors in surrounding area, barangay hall officials/records, and family members that can be

reached.

ID ng

Interviewer

Interviewer ID

Petsa ng

Pagbisita

Date of Visit

Oras ng

Pagdalaw

Time of

Visit

Oras na

natapos ang

panayam

Ending time of

interview

Lugar kung saan

ginanap ang panayam

Place where interview

was conducted

May iba pa bang may

edad na kaharap nang

ginanap ang panayam?

Were other adult persons

presen t during interv ie w?

[F2.1] [F2.2] [F2.3] [F2.4] [F2.5] [F2. 6]

Ex. 12 04/18/15 1:10pm 2:50pm at business no

F3 GPS measures:Please note longitude, latitude, and altitude

Longitude: [F3.1] Latitude : [F3.2] Altitude: [F3.3]

F4 Komentaryo ng tagapanayam (Kung may pangangambalang naganap sa panayam o kung hindi naganap ang

panayam) Interviewer Comments(if disturbances during interview occur or if respondent cannot be

interviewed)


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Survey on Health and Health Behavior in Metro Manila

[INTERVIEWER: PLEASE ENSURE THAT INTERVIEW IS CONDUCTED IN PRIVATE]

Sa Kalahok,

Dear study participant,

Ang panayam na ito ay bahagi ng isang pag-aaral ng dalawang pamantasan sa Vienna (Austria) kasama ng Kasagana-ka Development Center Inc.

(KASAGANA-KA) tungkol sa kalusugan at ang mga pananaw kaugnay nito. Nais po naming maunawaan ang ibat ibang paraan ng pagpapabuti ng

kalusugan ng komunidad. Malaki po ang maitutulong ninyo sa paglahok sa panayam na ito. Aabutin ng 60-90 na minuto ang pagsagot dito.

Matapos nito ay makakatanggap po kayo ng PHP50. Maaari po kayong magtanong sa gitna ng panayam o hindi sumagot sa kahit anong tanong.

Bilang kalahok, dumaan po kayo sa sistema ng pagpili mula sa lahat ng mga Client Beneficiaries (CBs) ng KASAGANA-KA. May 1100 na CBs ang

kakapanayamin sa loob ng isang buwan. Karamihan po sa mga kalahok ay amin na pong nakapanayam noong nakaraang taon. Ang follow-up

study na ito ay tutulong po sa ating mapag-aralan ang mga pagbabago sa inyong sitwasyon at pag-uugali tungkol sa kalusugan mula noong

nakaraang taon hanggang ngayon.

[ATTRACT RESPONDENTS ATTENTION!] Lahat po ng inyong tugon sa pag-aaral na ito ay ituturing na kumpidensyal. Hindi po ihahayag ang

pangalan ninyo kaugnay ng inyong mga sagot. Ang mga tagapanayam ay HINDIempleyado ng KASAGANA-KA at hindi po malalaman ng kahit sino

sa KASAGANA-KA ang mga ibibigay ninyong impormasyon. Mangyari lamang pong maging tapat at huwag itago ang inyong mga opinyon. Sa

tuwing sasagot ng mga katanungan, sikapin pong ibatay ang inyong mga tugon sa inyong sariling sitwasyon at mga pag-uugali. Huwag po ninyong

alalahanin kung paano ito sasagutin ng iba, o sa kung anong tingin ninyong tama o mali. Mahalaga po na matugunan ng tapat ang lahat ng

katanungan.

Pagkatapos po ng pag-aaral na ito, ipaparating po namin sa lahat ng lumahok ang resulta sa pamamagitan ng KASAGANA-KA. Kung mayroon po

kayong katanungan, maaari niyo kaming tawagan sa 0908-621-5280 o magpadala ng email sa [email protected] ngalan po ng mga kabilang sa proyektong ito, taos-puso kaming nagpapasalamat sa inyo.

This survey is conducted as part of a non-commercial research project on health and health behavior by the University of Vienna (Austria) in

cooperation with the Kasagana-ka Development Center Inc. (KASAGANA-KA). In particular, we are interested in finding ways to improve the health

of community members. With this interview you can make an important contribution to the success of this study. Answering the survey questions

will take approximately 60-90 minutes. You will receive PHP100 after completing this questionnaire. Of course you can always interrupt the

interview or skip a question.

As a respondent of this study you were randomly selected among all Kasagana-Ka client beneficiaries of your KASAGANA-KA center. In total, 1100

participants are interviewed in this month. The majority of our participants were already interviewed for the first time about a year ago. This

follow-up study allows us to analyze changes in our respondents health situation and behavior over the course of the last year.

[ATTRACT RESPONDENTS ATTENTION!] All responses that you give during the study are anonymous and will be treated confidentially. At no time,

your name and address will be saved together with your survey responses. The interviews are conducted by interviewers who are not staff-

members of Kasagana-Ka and your individual information will not be accessible by Kasagana-Ka. Please do not hide any information or opinionfrom us. When answering the questions please do always think of your own situation and behavior. Do not base your answers on what your think

others would answer, or what is right or wrong. It is very important that you answer honestly to all questions.

After the completion of the study in a year the results of the study will be provided to the participants by KASAGANA-KA. If you have any questions

or comments please contact us via e-mail ([email protected]) or call us under 09086215280.

On behalf of all project members I would like to thank you very much for your support!

Bago mag-umpisa ang panayam, kinakailangan lang makuha ang inyong pagsang-ayon.

Sumasang-ayon ako na lumahok sa pag-aaral na ito tungkol sa kalusugan ng aking komunidad. Nauunawaan ko na proyekto ito ng mga

mananaliksik mula sa pamantasan ay walang kinalaman, sa kahit anong paraan, sa pribadong interes, pamamahala ng buwis, o sa kahit sino sa

gobyerno ng Pilipinas. Sumasang-ayon ako na ang datos na aking ibibigay ay gagamitin para lamang sa pananaliksik at sa pagpabuti ang mga

alituntunin kaugnay sa kalusugan. Batid ko na ang impormasyon na ibibigay ko ay ituturing na kumpidensyal, at ang aking pangalan ay hindi

isasama sa ulat ng pag-aaral na ito. Batid ko rin na ang mga tagapanayam ay hindi mga empleyado ng KASAGANA-KA at hindi malalaman ng

KASAGANA-KA kung ano ang aking mga naging sagot. Maglalahad ako ng mga totoong impormasyon lamang.

Before starting with the interview, I would like you to confirm a short consent form.

I am willingly participating in this research activity about health in Metro Manila and surrounding areas. I understand that this research project is

run by university researchers and that it is not related to any private interest, the tax administration, or anybody from the Philippine government.

I agree that the data I am providing will be used only for scientific purposes and policy improvements regarding health. I understand that the

information I provide is strictly confidential, and that my name will not be included in any report of the study. Also, I understand that the

interviewers are not KASAGANA-KAstaff members and that KASAGANA-KAis not able to trace back the given answers to the respondent. I will be

providing truthful information.

Nauunawaan ko ang nakasaad sa taas at sumasang-ayon ako rito:

I understood the aforementioned and I agree to participate:O Hindi No O Oo Yes


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A.

KASAGANA-KA ServicesNais kong mag-umpisa sa ilang mga tanong tungkol sa iyong karanasan sa Kasagana-ka.

I would like to start with a couple of questions concerning your experiences with Kasagana-Ka.

1. Narinig mo na ba ang programang K-Kalusugan? Have you heard of the K-Kalusugan program?

1 Hindi No 2 Oo Yes [IF HINDI/NO GO TO Q 3]

2.

Anong mga serbisyo at produkto ang kasama sa programang K-Kalusugan? Which services do you know that areoffered as part of the K-Kalusugan program?

________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___ -77 Dont know

3. Ang K-Kalusugan ay programa ng Kasagana-ka na naglalayon na mapabuti ang kalusugan ng mga CBs. Ikaw ba o ang

iyong kapamilya ay nakagamit nang maski anong serbisyo/produkto ng K-Kalusugan katulad ng Health Dev lab

package? Maaaring higit sa isa ang sagot. K-Kalusugan is the Kasagana-Ka health program, which aims at

improving the health of the client beneficiaries. Have you or one of your household members used any services of

the K-Kalusugan program or any of the Health Dev lab packages yet? Multiple answers are possible.

[3.1] 1.Wala sa aking pamilya/kasama sa bahay ang gumamit na ng programang

ito Nobody in household used health program [IF WALA/ NO GO TO Q 6]

[3.2] 1.Nagamit ko na ang K-Kalusugan

Used health program personal ly

[3.3] 1. Ang ibang kasama sa bahay ko ay nagamit na ang K -KalusuganOther household member used health program

4. [SHOW SHEET 1 LAB PACKAGES] Ano sa mga Lab Package ang nagamit mo at ng pamilya mo? Maaaring higit sa

isa ang sagot. [SHOW SHEET 1 LAB PACKAGES] Which of the lab packages did you or another member of your

household use? Multiple answers are possible.

[4.X.1]

CB mismo ang nakagamit

ng package

Used package personally

[4.X.2]Nagamit ng aking pamilya Other

fa mi ly me mb ers us ed pac ka ge

[4.1] 1.

Package A (Window 1) 1 1

[4.2] 2. Package B (Window 1) 1 1

[4.3] 3. Package C (Window 1) 1 1

[4.4] 4.

Package D (Window 1) 1 1

5. Kung ikaw o ang pamilya mo ay gumamit ng isa sa mga lab package, ilang beses ito nagamit at kailan? If you

pe rsonal ly or one of your household member s used on e of the lab pa ckag es , ho w many times have yo u used it an d

when did you use them?

Personal usage [5.X.1] [5.X.2] Household usage [5.X.3] [5.X.4]

[5.1] 1 lab testBuwan

MonthTaon

Year 1 lab test

Buwan

Month

Taon

Year


MonthTaon

Year 2 lab test

Buwan

Month

Taon

Year


MonthTaon

Year 3 lab test

Buwan

Month

Taon

Year

6. [SHOW SHEET 2 SCALE A] [USERS]: Batay sa iyong mga karanasan sa Health Dev lab tests, paano mo susukatin

ang mga sumusunod na aspe to mula 1 Masamang-masama hanggang 5 Mabuting-mabuti?[NON-USERS]:Batay

sa iyong mga narinig na karanasan ng iba sa Health Dev lab tests, paano mo susukatin ang mga sumusunod naaspeto mula 1 Masamang-masama hanggang 5 Mabuting-mabuti? [SHOW SHEET 2 SCALE A] [USERS:]

Thinking about your experiences with the Health Dev lab tests, how would you rate the following aspects on a

scale from 1 Very bad to 5 Very good? [NON-USER]S: From what you have heard about the Health Dev lab

tests how would you rate rate the following aspects on a scale from 1 Very bad to 5 Very good?

Masama

ng -

masama

Very bad

Masa

ma

Bad

Katamta

man

Fair

Ma b

uti

Good

Mabuting-

mabuti

Very good

Hindi

alam/Walan

g tugon

Dont know

/ No re pl y

[6.1]

Dali ng pagpunta o pag-abot sa lugar kung saan isinasagawa ang

mga lab tests

Reachability and accessibility of venue where tests are conducted

1 2 3 4 5 -77


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[6.2] Oras na inilalaan para sa mga lab tests Time taken for the tests 1 2 3 4 5 -77

[6.3] Oras na inilalaan para sa paghihintay Waiting time 1 2 3 4 5 -77

[6.4]

Personal na pakikitungo ng mga medical staff habang

isinasagawa ang lab tests

Personal manner of the medical staff during testing

1 2 3 4 5 -77

[6.5]Pagiging pribado ng pagsasagawa ng lab tests

Privacy during testing1 2 3 4 5 -77

[6.6]Halagang ibininabayad sa lab test

Price of the lab test

1 2 3 4 5 -77

[6.7]Pagiging kapaki-pakinabang ng lab tests para sa iyong kalusugan

Usefulness of the lab tests for your health 1 2 3 4 5 -77

7. NON-USERS:BAKIT hindi pa po kayo nagpapa-Health Dev lab test?

NON-USERS:WHY have you not used the Health Dev lab tests yet?

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ___ __ __ __ __ __ __ _

8. Mayroon akong babanggitin na mga tests. [1] Maaari mo bang ipaliwanag kung paano isinasagawa ito? [2] Anong

sakit ang maaaring makita sa test na ito?

Do you know the following medical tests that are performed during the health dev lab tests? [1] Can you explain

the method to me and [2] name at least one disease that can be detected with the method?

[8.X.1] Explanation [8.X.2] Disease

[8.1] Electro Cardio Graph (ECG) 1 Dont know 2 Wrong explan. 3 Correct explan. 1 Knows disease

[8.2] Pap Smear 1 Dont know 2 Wrong explan. 3 Correct explan. 1 Knows disease[8.3] Blood Sugar Test 1 Dont know 2 Wrong explan. 3 Correct explan. 1 Knows disease

[8.4] Urinalysis 1 Dont know 2 Wrong explan. 3 Correct explan. 1 Knows disease

9. [SHOW SHEET 3 SCALE B] Sa tingin mo ba ay gagamitin mong (muli) ang programang K- Kalusugan sa susunod na

12 buwan? Mangyaring subukan magbigay ng makatotohanang sagot. [SHOW SHEET 3 SCALE B] Do you think you

will personally undergo a health dev lab test (again) in the next 12 months? Please try to give a realistic answer.

Tiyak na hindi na gagamiting

(muli )

Will certainly not use it

Tiyak na gagamiting (mul i )

Wil l use it with certainty

0 1 2 3 4 5 6 7 8 9 10

10. Maliban sa lab-tests ng K-Kalusugan, ikaw ba ay na-examine nitong nakaraang 12-buwan simula April 2014 ng

isang doktor o propesyunal na tagabigay ng medikal na serbisyo kahit na walang sakit o mga sintomas nanararamdaman? [PREGNANCY CHECK-UP ONLY IF NO OTHER CHECK-UP] Apart from the K- Ka lusu ga n lab tests,

were you examined in the last 12 months since April 2014 by a doctor or other health care provider for a medical

or laboratory routine check-up without being sick or without having any symptoms ? [PREGNANCY CHECK-UP

ONLY IF NO OTHER CHECK-UP]

1 Hindi No 2 Oo Yes, other check-up 3 Pregnancy check-up IF HINDI/NO GO TO Q 1 2

11.

Anu-anong mga tests ang ginawa sa iyong checkup? [READ ANSWERS] [MA]

Which tests were performed during the check-up?[READ ANSWERS] [MA]

[11.1] 1 Urine sample [11.2] 1 Blood sample[11.3] 1 Blood pressure [11.4] 1 Stool sample

[11.5] 1 Other tests: _____________________________________________________________________________ [11.6]

12. Nitong nakaraang 2 taon simula 2013, mayroon ka bang sakit na natuklasan sa pamamagitan ng iyong routine checkups kasama na

pati ang sa KASAGANA-KA? Did you learn about a disease you have not been aware of through one of your routine check-ups in thepast 2 years since 2013 including KASAGANA-KA check-ups?

1 Hindi No 2 Oo Ye s -77 No routine check-ups I f HINDI/NO GO TO Q 14

13. [USE SHEET 4REACTION] Anu-anong mga sakit ang natuklasan sa iyong routine check-ups at ano ang ginawa mo ukol rito?

[PROMPT:] Nagpakonsulta po ba kayo sa isang health professional tungkol sa inyong sakit pagkatapos ng inyong lab test?

[USE SHEET 4 REACTION] About which diseases did you find out in the routine check-ups and what did you do

about it? [PROMPT:] Did you consult a health professional concerning your disease after the lab test?

Description of disease condit ion [13.X.1] Reaction [13.X.2] Fol low up [13.X .2]

[13.1] Disease 1 1 Hindi No 2 Oo Ye s




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14 . Kailan ka huling nakuhanan ng blood pressure? When was your blood pressure measured for the last time? [ALSO

SELF-MEASUREMENT]

Month: [14.1] Year: [14.2] IF > 6 MONTHS GO TO B

15. Nitong nakaraang 6 buwan simula October 2014, gaano kadalas ka regular na nakukuhanan ng blood pressure? [READ ANSWERS]

Ap prox imately, ho w re gula rly was yo ur bl ood pressu re measur ed in the pa st 6 months si nce Oc tober 2014 ? [READ

ANSWERS]

Maraming beses

kada linggoMultiple times a

week

Isang beses kadalinggo

Ab ou t on ce a we ek

Isang beses kadadalawang linggo

Every second week

Isang beses kada buwanAb out on ce a

month

Isang beses kada 3buwan

Every 3 months

Hindi masyadongmadalas

Less often

1 2 3 4 5 6

B. Socio-Demographics: Personal InformationNgayon naman po ay may ilan akong katanungan tungkol sa personal niyong mga katangian.

Now I have some questions concerning your personal characteristics.

16. Ano ang iyong relihiyon? Isipin lamang po ang kasalukuyan po ninyong pinaniniwalaan. What is your religion?

Please think of your main confession.

1 No religion IF 1 GO TO Q 20 2 Catholic

3 Protestant (Lutheran, Baptist, etc.) 4 Protestant (Born again)

5 Iglesia ni Cristo 6 Moslem7 Buddhist 8 Other [SPECIFY]): ___________________________________ [16.2]

17. Gaano kadalas kang magsimba? [READ ANSWERS] How often do you go to church? [READ ANSWERS]

Araw-arawDaily

Maraming beses

kada linggoMultiple times

a week

Isang beses

kada linggoAb ou t on ce a

week

Isang beses kada

dalawang linggoEvery second

week

Isang beses kada

buwanAb ou t on ce a

month

Isang beses kada 3

buwanEvery 3 months

Hindi masyadong

madalasLess often

1 2 3 4 5 6 7

18. Bukod sa pagsisimba, gaano ka kadalas magdasal nang lampas 15 minutos kapag ikaw ay nasa iyong bahay? [READ

ANSWERS]Apart from going to the church, how often do you continuously pray for at least 15 minutes when you

are at home? [READ ANSWERS]

Araw-araw

Daily

Maraming beses

kada linggo

Multiple timesa week

Isang beses

kada linggo

Ab ou t on ce aweek

Isang beses kada

dalawang linggo

Every secondweek

Isang beses kada

buwan

Ab ou t on ce amonth

Isang beses kada 3

buwanEvery 3 months

Hindi masyadong

madalasLess often

1 2 3 4 5 6 7

19. Itinuturing mo ba ang iyong sarili na isang relihiyosong tao? [READ ANSWERS]

Do you consider yourself a religious person? [READ ANSWERS]

Sobrang relihiyoso

Very religious

Medyo relihiyoso

Somewhat religious

Hindi masyadong relihiyoso

Not very rel igious

Hindi relihiyoso

Not at al l rel igious

1 2 3 4

20. Ano ang pinagkakakitaan? Ano ang kasalukuyang kalagayan mo sa paghahanap-buhay? [READ ANSWERS] [MA]

What do you do for living? What is your current employment status? [READ ANSWERS] [MA]

[20.1] 1. May trabaho at sahod Employed for pay[20.2] 1. Naghahanap-buhay, saril ing sikap Self-employed

[20.3] 1.

May trabaho subali t kabahagi ng negosyo ng pamilya

Working, but not for pay, at a family-owned job o r business

[20.4] 1. Naghahanap, walang trabaho Looking for work, unemployed [IF ONLY NAGHAHANAP GO TO C]

[20.5] 1. Estudyante Student [IF ONLY ESTUDYANTE GO TO C]

[20.6] 1. Retirado Retired [IF ONLY RETIRADO GO TO C]

-77 Walang sagot / hindi alam No reply/ dont know

21. Ilang oras ka naghahanapbuhay sa isang linggo (sa isang karaniwang linggo)?

How many hours do you usually work for income per week (in a typical week)?

Humigit kumulang about Oras kada l inggo hours per week


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C.

Neighborhood and Health InfrastructurePag-usapan naman natin ang barangay kung saan kayo nakatira. Nais naming malaman ang lagay ng sistemang

pangkalusugan sa inyong komunidad. Af ter ha ving ta lked abou t you as a person, I woul d li ke to sh if t the fo cus t o the

neighborhood you live in. Particularly, I am interested in the health infrastructure of your neighborhood.

22 . Kung mayroong isa sa inyong pamamahay ang may katanungan o problema sa kalusugan, may kilala ka bang

kapamilya, kaibigan, o kakilalang mas may alam tungkol sa kalusugan kaysa sa iyo na maaaring hingan ng

mapagkakatiwalaang at tamang payo? Isipin lamang po ang mga taong kilala mo. If someone in your household

had a question about a health problem, would you know somebody in your circl e of family, friends and

acquaintances who knows more about health than you do to ask for qualified advice or help ? Please think only ofpe rsons you know personal ly.

1. Hindi No 2. Oo Ye s [IF HINDI/NO, GO TO Q 24]

23. [USE SHEET 3 - REACTION] Kung mayroon kang katanungan o problema tungkol sa iyong kalusugan, kanino sa mga

kapamilya, kaibigan, o kakilala ka pinakaunang hihingi ng mapagkakatiwalaang at tamang payo? [USE SHEET 3 -

REACTION] If you had a question whom among your family, friends and acquaintances would you ask for qualified

advice first?

NAME/RELATIONSHIP [23.1] Consultation code: [23.2]

24. Ngayon naman po, isipin ninyo ang mga kaibigan at kakilala. Maliban sa iyong mga kapamilya, meron ka bang

maiisip na taong Please think now of your friends and acquaintances, but not your relatives. Among these is

there at least one person who

[24.1]

Palaging nagbibigay ng puna o payo sa iyo tungkol sa iyong mga gawain at pag-uugali

kaugnay sa kalusugan?

Often crizizes you or gives y ou advices on your health practices/behavior?

1 Hindi N o 2 Oo Ye s

[24.2]

Aktibo at regular na nagbabahagi sa iyo ng kaniyang kaalaman tungkol sa kalusugan at

mga sakit?

Ac ti vel y and re gu lar ly sh ar es kn ow led ge abo ut he al th to pi cs an d di se as es wi th yo u?


[24.3]Regular na naghihikayat sa iyong magpa-routine checkup, kahit walang sakit?

Encourages you regularly to undergo routine check-ups, even i f you are not sick?1 Hindi N o 2 Oo Ye s

[24.4]Naghihikayat sa iyong magpatingin sa isang health professional kung ikaw ay maysakit?

Encourages you to seek help from a health professional i f you are sick?1 Hindi N o 2 Oo Ye s

25. Kung ikaw ay may problemang pangkalusugan, sino sa mga miyembro ng Kasagana-ka ang maaari mong hingan ng

tulong o payo? If you had a health problem, who in your Kasagana-ka center would you ask for help or advice?

First name:[25.1]

Surname:[25.2]

-77 Dont know IF -77 GO TO Q27

26. Gaano kahirap maabot ang tao o lugar na nabanggit sa huling tanong kapag kailangan ng impormasyon tungkol sa

kalusugan? [READ ANSWERS] In general, how difficult is it to reach the person you mentioned in the previous

question when health information is needed? [READ ANSWERS]

Napakadali

Very easy

Madali

Easy

Hindi gaanong mahirap

Not too difficult

Mahirap

Difficult

Napakahirap

Very difficult

Hindi alam/Walang tugon

Dont know /No reply

1 2 3 4 5 -77

27. Ang personal health care provider ay isang propesyunal na kilala kang mabuti at pamilyar sa iyong kalusugan at

medical history. Maaari itong isang doktor, espesyalista, nars, pharmacist, barangay health worker (BHW) o kahit

sinong makakapagbigay ng serbisyong pangkalusugan. Mayroon ka bang maiisip na taong maituturing mong

health care provider? Kung mayroon, sino? A person al heal th care pr ovid er is a heal th prof ession al who knows

you well and is familiar with your medical history. This can be a general doctor, a specialist doctor, a nurse

pr acti tion er , a ph armacist, a heal th co mmu nity worker , or an other ty pe of prov ider . Do yo u ha ve on e or morepe rsons you th ink of as your person al heal th care pr ovider? If th er e is , who?

1. Wala No 2. Meron Yes, who? [USE SHEET REACTION] [27.2]

28. Mayroon pong iba-ibang pananaw ang mga tao tungkol sa health infrastructure sa inyong barangay. Interesado

po kaming malaman kung sinasalamin ba ng mga babanggitin kong pahayag ang inyong opinion at sitwasyon sa

buhay. [SHOW SHEET 5 - SCALE C] Mangyari po lamang na sabihin sa akin kung kayo ay: lubos na di sang-ayon, di

sang-ayon, hindi sumasang-ayon o tumututol, sang-ayon, at lubos na sang-ayon. Sa inyong pagtugon, mangyari po

lamang na maging tapat; walang tama o maling kasagutan. Ang health infrastructure po ay tumutukoy sa

anumang serbisyong pangkalusugang natanggap mula sa isang propesyunal o di propesyunal na health worker

mula sa pampubliko at pribadong organisasyon, o NGO.

People have different opinions about the health infrastructure in the Barangay. We have prepared statements for

you reflecting these different opinions. We are interested how much these statements reflect your own situation.


7/18

- 7 -

[SHOW SHEET 5 - SCALE C] Please tell me if you strongly disagree, disagree a little, neither agree nor disagree ,

agree a little, or st rongly agree with each statement. When t elling me your opinion please be as honest and

accurate as you can, there is no right or wrong answer. With health infrastructure we mean any service that is

pr ovided by ei ther a profession al or no n-p rofess iona l healt h work er fr om a publ ic , pr ivat e, or non- governmental

organization.

Hindi

talaga,

Lubos na

di Sang-

ayon No,

strongly

disagree

Medyo

hindi, Di

sang-ayon

No,

disagree

a little

Hindi

sumasang-

ayon o

tumututol

Neither

agree nor

disagree

Medyo

oo, Sang-

ayon

Yes,

agree alittle

Oo talaga,

Lubos na

Sang-ayon

Yes,

stronglyagree

[28.1]

Kung kayo ay may problemang pangkalusugan, alam niyo

kung saan kukuha ng mapagkakatiwalaang a t tamang payo

ukol r i to. I f you had a h ealth problem, you would know

whom to contact to get qual i f ied advice.

1 2 3 4 5

[28.2]

Hindi niyo kayang bayaran ang maayos na serbisyong

pangkalusugan. Good health care is not affordable for

you.

1 2 3 4 5

[28.3]

Minsan hindi niyo alam kung saan hihingi ng tulong kung

may problemang pangkalusugan kayo o ang inyong

pamilya.

Sometimes you do not knxow where to f ind help i f y ou or

somebody in your family has a health problem.

1 2 3 4 5

[28.4]

Wala kayong t iwala sa kaalaman ng mga health

professionals sa aming komunidad . You have no trust inthe knowledge of the health professionals here in your

community.

1 2 3 4 5

29. Sa bahaging ito, interesado kami sa iyong mga kaibigan, kamag-anak, at kakilala. [SHOW SHEET 5 SCALE C]

Gaano ka sumasang-ayon o hindi sumasang-ayon sa mga sumusunod pahayag? Mangyari po lamang na sabihin sa

akin kung kayo ay: lubos na di sang-ayon, di sang-ayon, hindi sumasang-ayon o tumututol, sang-ayon, at lubos na

sang-ayon. Mangyari lamang na maging tapat; walang tama o maling kasagutan. Isipin niyo na hindi magkakaugnay

ang mga pangugusap. In the following we are interested in your network of friends, relatives, and aquaintances.

[SHOW SHEET 5SCALE C] How strongly do you agree or disagree with the following statements? Please tell me if

you strongly disagree, disagree a little, neither agree nor disagree, agree a little, or strongly agree with each

statement. Please be as honest and accurate as you can, there is no right or wrong answer. Think about each

statement on its own.

Hindi talaga,

Lubos na diSang-ayon

No, strongly

disagree

Medyo

hindi, Di

sang-ayon

No,

d isagree

a little

Hindi sumasang-ayon o tumututol

Neither agree

nor disagree

Medyo oo,Sang-ayon

Yes, agree

a little

Oo talaga,

Lubos naSang-ayon

Yes,

strongly

agree

[29.1]

Maraming tao kayong pinagkakatiwalaang tutulong sa

paglutas ng inyong mga problema. There are several

pe op le th at you tr us t to he lp sol ve you r pr ob le ms .

1 2 3 4 5

[29.2]

Wala kayong mapagsabihan ng mga personal kong

problema. There is no one that you feel comfortable

to talk about intimate personal problems.

1 2 3 4 5

[29.3]

Pakiramdam niyo, wala kayong mapagsabihan ng mga pribado

niyong alalahanin at mga takot sa buhay. You feel that there is

no one you can share your most private worries and fears with. 1 2 3 4 5

[29.4]Mayroon kayong mahihingan ng payo tungkol sa pagdadala ngproblema tungkol sa aking kalusugan. There is a person you can

turn to for advice about handling problems with your health. 1 2 3 4 5

30. Nitong nakaraang 12 buwan simula April 2014, gaano kadalas ka humingi ng medikal na pangangalaga o payo para

sa sarili o sa kasama sa bahay... In the past 12 months since April 2014, how often did you seek medical care or

advice [PERSONAL & HOUSEHOLD]

[30.1]...sa health center sa inyong barangay?

at the health center in your Barangay?beses

tmes

[30.2]...sa ospital?

at a hospital?beses

t imes


8/18

- 8 -

D.

Individual Health ConstitutionSa pag-aaral na ito, nais naming maunawaan ang kalagayan ng inyong kalusugan at ang salik na kaugnay nito. Maaari

pong sumagot nang tapat at huwag magmadali sa pagsagot. In our r esearch we are interested in your health constitution

and factors contributing to it. I now would like to talk about your experiences with your health. Please answer honestly

and take your time for each question.

31 . [SHOW SHEET 6 SCALE D] Ang 0 ay nangangahulugan ng Napakasamang kalagayan at ang 10 ay Napakabuting

kalagayang pangkalusugan. Paano niyo bibigyan ng grado ang inyong kasalukuyang kalusugan? [SHOW SHEET 6

SCALE D] Please think of a scale from 0 Very bad health state to 10 Very good health state. How would you

classify your own health these days on this scale?

Napakasamang kalagayan

Very bad health

Napakabuting kalagayan

Very good health

0 1 2 3 4 5 6 7 8 9 10

32. [SHOW SHEET 7 SCALE E] Kung ikukumpara sa nakaraang taon mula 2014, masasabi mo bang lalong napabuti o

lalong napasama ang lagay ng iyong kalusugan? [SHOW SHEET 7 SCALE E] Compared to one year ago since April

2014 would you say that your health improved or got worse?

Lalong napasama

Got much worse

Pareho lamang

Stayed the same Lalong napabuti

Got much better

-5 -4 -3 -2 -1 0 1 2 3 4 5

33.

Sa kasalukuyan, mayroon ka bang sakit or karamdamang na-diagnoseng doktor? [PROBE]Anu-ano ang mga ito? Do you have any diagnoseddiseases? Which ones? [PROBE]

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ____

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ____

34. Mayroon ka bang hypertension o high blood?

Do you have any problems with hypertension or high blood?

1 Oo Ye s 2 Hindi No IF YES, ANSWER 35 ONLY FOR HYPERTENSION, OTHERWISE FOR MOST SEVERE DISEASE

35. Sa bahaging ito, interesado po kami sa kung paano niyo hinaharap ang inyong [SAKIT]. May babasahin akong mga

aspeto ng pagharap sa inyong sakit. [SHOW SHEET 2 SCALE A] Mangyari po lamang na sabihin sa akin kung paano

ninyo igagrado ang inyong abilidad sa pa gharap sa inyong sakit mula 1 Masamang masama hanggang 5

Mabuting-mabuti. Mangyari po lamang na maging tapat, walang tama o maling sagot. Isipin na hindimagkakaugnay ang bawat aspeto na aking babanggitin.Isipin lamang ang inyong [SAKIT] sa pagsagot sa mga

susunod na tanong.

We are interested in how well you are able to cope with your [DISEASE]. I will read to you a list with different

aspects of how you can handle your disease. Please think only of [DISEASE] when answering the questions. [SHOW

SHEET 2 SCALE A] Please tell me how you would rate your ability to hande the different aspect of your disease

care on a scale from 1 Very bad to 5 V ery good. Please be as honest and accurate as you can, there is no right

or wrong answer. Think about each aspect on its own.

Masamang-

masama

Very bad

Masama

Bad

Katamtaman

Fair

Mabuti

Good

Mabuting-

mabuti

Very good

[35.1]

Dalas ng pagpapatingin mo sa iyong medical practitioner para

sa paggaling ng iyong [SAKIT]Regularity of seeing your medical

practitioner(s) for [DISEASE] care

1 2 3 4 5

[35.2]Kaalaman mo tungkol sa iyong [SAKIT]

Your knowledge about your [DISEASE] 1 2 3 4 5

[35.3]

Pamamaraan mo ng pagpapagaling sa iyong [SAKIT]. Your self-

management of [DISEASE] care/Measures you do to make

yourself better from your [DISEASE]

1 2 3 4 5

[35.4]

Pagtatabi ng mga record (resulta, reseta) tungkol sa iyong

kondisyon at mga pagpapatingin na ginawa mo ukol sa iyong

[SAKIT] Your record keeping about your medical condition and

treatments related to your [DISEASE]

1 2 3 4 5

36. May regular ka bang iniinom na gamot?

Do you currently take any medicine regularly?

1 Hindi No 2 Oo Ye s IF Hindi / NO GO TO Q 39


9/18

- 9 -

37 . Para sa anong sakit/karamdaman mo regular na iniinom ang gamot? [NO VITAMINS]

Ag ainst which symptoms or di seases do you regu larly take medicine? [NO VI TAMINS]

__ ______ ______ ______ ______ ______ ______ ______ __ _ 1 Hypertension IF 1 ANSWER Q 38 ONLY FOR HYPER

38. Isipin ang gamot na iyong regular na iniinom para sa iyong [SAKIT] sa mga sumusunod na tanong:

Please think of the medicine that you have to take most regularly for your [DISEASE]

[38.1] Sinusunod mo ba ang r iseta ng iyong gamot? Do you take y our medicine as prescribed? 1 Hindi No 2 Oo Ye s

[38.2]May pagkakataon bang nakalimutan mong inumin ang iyong gamot?

Have you ever forgotten to take the medicine?

1 Hindi No 2 Oo Ye s

[38.3]

Tinitigil mo ba ang pag-inom ng iyong gamot sa tuwing bumubuti na ang iyong

pakiramdam kahit na hindi pa dapat? When you feel better, do you sometimes stop

taking your medicine before completing the prescribed course of treatment?


[38.4]Tinitigil mo ba ang pag-inom ng gamot kapag lumala ang iyong pakiramdam?

Sometimes, i f you feel worse when you take your medicine, do you stop taking it?1 Hindi No 2 Oo Ye s

39. [SHOW SHEET 8 & 9] Mayroon akong ipapakitang listahan ng mga sintomas at kalendaryo. Pag-aralan natin ang

mga ito mabuti. Isipin ang huling pagkakataong ikaw ay nagkasakit nang higit sa 2 araw, maaaring magkakasunod

o patlang-patlang na paulit-ulit. [2] Anu-anong mga sintomas ang iyong naranasan sa naturang pagkakasakit?

[GIVE 30 SEC] [3] Humigit kumulang ilang araw mo naranasan ang mga sintomas at sakit? [4] Anong buwan

nagsimula ang sakit? [5] SHOW SHEET 10 SCALE F] Gaano kalubha ang iyong karamdaman noong ikaw ay

nagsakit kung susukatin mula 0 to 10? [USE SHEET 4 REACTION] Ano ang iyong ginawa upang gumaling sa sakit?

INTERVIEWER REPEAT FOR PREVIOUS/ALL SICKNESSES: Isipin naman ang iba mo pang naging sakit nitong

nakaraang taon. IF DOES NOT REMEMBER ANY MORE SICKNESSES: Mangyari lamang pong pakibalikan ang listahan

ng mga sintomas sakaling may nakaligtaang banggitin. Isama rin po natin maski mga hindi malalang pagkakasakit. [AFTER HAVING NOTED ALL DISEASES PROBING]: May kinonsulta ka ba tungkol sa iyong sakit/karamdaman?

[SHOW SHEET 8 & 9] I am now going to show you a list with different symptoms and a calendar. Please consider

them carefully. Please think back the last time you have been sick for more than 2 days continuously or recurring.

[X.1-5] Which symptoms did you experience when you felt sick for the last time? [GIVE 30 SEC] [2] Approximately

fo r ho w many days di d the si ckness includ ing al l symptoms last ? [ 3] In which mont h did th e si ckness st art? [ 4]

[SHOW SHEET 10 SCALE F] How sick did you feel on the pain assesment scale from 0 to 10? [5] [USE SHEET 4

REACTION] And how did you treat the sickness and what did you do? [INTERVIEWER REPEAT FOR PREVIOUS/ALL

SICKNESSES: Think about the other sicknesses you had last year. [IF DOES NOT REMEMBER ANY MORE

SICKNESSES:] Please try to go through the list of symptoms again thoroughly, in case you might have missed

anything. Please do also consider mild sicknesses [AFTER HAVING NOTED ALL DISEASES PROBING]: Did you

consult anybody about the specific sickness?

Sickness identif ier Disease Condition & Symptoms

Duration of

sickness in

days?

Month

Severity

of

sickness

Treatment

Reaction

Consult

Sponta

neous

Consult

PROBE

[39.X.1] [3 9 .X.2 [3 9 .X.3] [3 9 .X.4] [3 9 .X.5] [3 9 .X.6] [3 9 .X.7]

[39.1] Sickness P1

[39.1] Sickness P2

[39.1] Sickness P3

[39.1] Sickness P4

[39.1] Sickness P5

[39.1] Sickness P6

[39.1] Sickness P7

[39.1] Sickness P8

[39.1] Sickness P9

[39.1] Sickness P10


10/18

- 10 -

40 . Noong nakalipas na 12 buwan mula April 2014, may miyembro ba ng inyong tahanan ang nagkaroon ng sakit na

higit sa 2 araw? Kung oo [1] Sino ang miyembrong nagkasakit? [USE SHEET 11 - RELATION][2] Anong buwan siya

nagsimulang magkasakit? [3] [USE SHEET 4 - REACTION] Anong ginawa ninyo upang gumaling siya ang kaniyang

sakit? INTERVIEWER REPEAT FOR ALL SICKNESSES

In the past 12 months since April 2014 did another household member get sick at any time for more than 2 days?

If yes [1] who was that household member? [USE SHEET 1 1 RELATION][2] In which month did the sickness start?

[3] [USE SHEET 4 - REACTION] And ho w di d you treat th e si ck ness? IN TE RVIEWER RE PEAT FOR AL L SICKNE SSE S

Sickness identif ierWho?

[USE SHEET 11 - RELATION]Month Treatment - Reaction

Consult

Spontaneous

[40.X.1] [40.X.2] [40.X .3] [40.X.4]

[40.1] Sickness H1

[40.1] Sickness H2

[40.1] Sickness H3

[40.1] Sickness H4

[40.1] Sickness H5

[40.1] Sickness H6

[40.1] Sickness H7

[40.1] Sickness H8

[40.1] Sickness H9

[44401] Sickness H10

41. Narinig mo na ba ang K-Kalusugan Kadet o KKK? Have you heard of K-Kalusugan Kadets or KKK before?

1 Hindi No 2 Oo Yes [IF HINDI/NO GO TO Q 44]

42. Maaari mo bang ilarawan sa akin kung ano ang isang K-Kalusugan Kadet o KKK at kung ano ang kanyang tungkulin? Can you describe

to me what a Health Kadet is and what her role is?

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___ - 77 Dont know

43 . May health kadet ba ang iyong sentro sa KASAGANA-KA?Does your KASAGANA-KA center have a health kadet?

1 Hindi No 2 Oo Ye s - 77 Dont know

44 . Ang health kadet po ay miyembro sa inyong sentro na nakakatanggap na community health training mula sa Kasagana-Ka.

Interesado ka rin bang maging health kadet balang araw? A health kadet is a member from your center who receives a short

community health training by Kasagana-Ka. Would you personally be interested in becoming a health kadet one day?


KKK.IF CENTER HAS HEALTH KADET (INDEPENDENT OF RESPONSE TO Q 41) ANSWER EXTRA SHEET CENTER WITH KKK

DO NOT ANSWER KKK IF RE SPONDENT IS A HEALTH KADET!!!

45 . [SHOW SHEET 14 SCALE I] Babasahin ko sa iyo ang ilang kwento tungkol sa mga taong may ibat ibang antas ng

problemang pangkalusugan. Nais kong isipin mo na ang tao sa kwento ay ikaw. Matapos kong basahin ang bawat

kwento, nais kong malaman ang inyong opinyon tungkol rito at kung gaano kalala ang kanilang problemang

pangkalusugan. [USE SHEET 4 - REACTION] Ano ang inyong magiging reaksyon kung sa inyo ito mangyari? Isipin

niyo na ang tao sa kwento ay kapareho niyo ng edad at kalagayan sa buhay.

[SHOW SHEET 14 SCALE I] This next section requires additional concentration. I will read to you some stories

about people with varying levels of health problems. I want you to try to think about these peoples experiences

as if they were your own. Once I have finished reading e ach story I would like to know how you view each story

and how severe the experienced health problem or difficulty in your opinion is. [USE SHEET 4 - REACTION] How

would you react to it? Think of the person in the story as someone who is of your age and so cioeconomic

background.

Severity ReactionConsult

Spontaneous

[45.1]

Tumama ang tuhod ni Anna sa mesa. Masakit ito sa una ngunit nawala rin agad ang sakit. Matapos

ang 3 araw, wala nang markang makikita sa kanyang tuhod.An na hi t he r kn ee on th e ta bl e. In th e fi rs t mo me nt it is ve ry pai nf ul , bu t th e pa in

quickly goes away. After three days no more marks are visible

[45.2]

Nanghihina si Florentina nitong nakaraang 2 linggo. Madalas siyang umuubo at may

nararamdamang sakit s a dibdib at l ikod. Nang siya ay magtimbang, nabawasan siya

ng 2 ki lo. Florentina has been feel ing very weak for the last 2 weeks. She coughs

often and feels pain in her breast and back. She has lost about two ki los of her

weight.


11/18

- 11 -

[45.3]

2 araw nang may lagnat at nagtatae ang 5 taong gulang na anak ni Maria. Sa pangatlong araw,

uhaw na uhaw at nanunuyo na ang bibig ng bata.Marias 5 year old daughter has fever and diarrhea for 2 days. On the third day the

chi ld is very thirsty and has a dry mouth.

[45.4]

Madalas na nakararamdam ng lubos na pagkalungkot si Susana. Madalas siyang umiiyak at

nawawalan ng pag-asa sa kanyang hinaharap. Pakiramdam niya ay pabigat siya sa iba.Susana feels depressed most of the t ime. She weeps frequently and feels hopeless

about the future. She feels that she has become a bu rden on others.

E.

Health Behavior, Prevention, and AttitudesSa susunod na bahagi, pag-usapan natin ang iyong pananaw at gawain kaugnay sa kalusugan.

In the next section of the survey I would like to talk to you about your health behavior and attitudes.

46. Ano ang iyong ginagawa upang kayo ay maging malusog at makaiwas kayo sa sakit? [PROBE]

In general, what do you do to stay healthy and to prevent diseases? [PROBE]

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ____________ ______ ___

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ____________ ______ ___

47. Anong mga gawain ang madalas kayong maghugas ng kamay bago o matapos niyo ito gawin? Kung maaari,

magbigay ng eksaktong kasagutan.

Af ter or befo re which ac tivi ti es do yo u usual ly wash your ha nds? Please be as pr ec is e as poss ib le.

____ ____ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ____ ______ ______ ____

________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___ __ ___

48. Itinatabi niyo ba ang mga tala tungkol sa inyong medical history o resulta ng mga pagpapagamot o kahit anong

impormasyon o dokumentasyon kaugnay sa inyong kalusugan? [PROBE IF THEY USE KDCI HEALTH DIARY]

Do you keep records about your medical history or ab out health treatments, that is any information,

documentation related to your pe rsonal health and medical treatments e.g. about medical check -ups? [PROBE]

1.

Hindi No 2 .

Oo Yes, Kasagana-Ka health diaries 3 Yes, other booklet IF HINDI / NO GO TO Q 50

49. Pwede niyo bang ipakita sa akin ang lugar kung saan niyo tinatago ang inyong health records?

Could you please show me the folder or place where you keep your health records?

[49.1]

Aabutin po kayo ng mga 3 minuto para maipakita sa akin ang l ugar o folder

kung saan ninyo itinatabi ang inyong mga health records?

Would it take you longer than 3 minutes to show me the place or folder

where you keep your health records?

1 Hindi No 2 Oo Ye s IF NO GO TO Q 50

[INTERVIEWER DO NOT READ OUT LOUD THE FOLLOWING QUESTIONS]

[49.2]Gaano katagal bago naipakita ng kalahok ang mga materyal?How long did i t take the respondent to f ind/show the materials?

Seconds

[49.3]Nakatago ba ang mga materyal sa isang folder?Ar e th e ma te ri al s ke pt in a fo ld er ?


[49.4]Gaano kaayos a ng mga materyal?How wel l -organized are the materials?

1 Very well 2 Somewha t 3 Not at all

50. Bukod sa mineral water, uminom po ba kayo ng tubig mula sa gripo, nitong nakaraang 3 araw?

As id e from dr inking mine ra l water, did yo u dr ink water from anot her so urce , su ch as ta p water, in the pa st 3 da ys?

1 Hindi No 2 Oo Yes [IF HINDI/NO, GO TO Q 52]

52. Regular o isang beses kada 2 buwan ka bang naghahanap ng impormasyon tungkol sa kalusugan? (Halimbawa:

impormasyon tungkol sa posibleng sakit o gamot) Do you regularly at least once every 2 months actively seek

information about health issues and topics, e.g. about health threats or t reatments?

2 Hindi No 2 Oo Yes [IF HINDI/NO, GO TO Q 54]

51.

Dumadaan ba sa proseso ang tubig bago ito inumin o gamitin?

Did you treat or filter the water in any way before you drank or consumed it?

1Hindi

N o2

Oo

Ye s

how?[51.2]

1 Proper fi lter 2 Purified/Treat ment solution 3 Improvised filtering

3 Boi l ing 4 Other: __________________________________


12/18

- 12 -

53 . [NOT READ ANSWERS] Saan mo madalas nakukuha ang mga impormasyon tungkol sa kalusugan?

[NOT READ ANSWERS] From which sources do you usually obtain information about health topics?

[53.1] 1. TV [53.2] 1. Radio

[53.3] 1. Internet [53.4] 1. Newspaper, magazines

[53.5] 1. Health kadet [53.6] 1. Health professional / health center

[53.7] 1. Relatives friends, neighbors [53.8] 1. Other: _____________________________________ [53.9]

54. Nitong nakaraang 6 buwan simula October 2014, may nakuha ba kayong bagong impormasyon tungkol sa mga

posibleng sakit na hindi mo alam dati? Kung mayroon, para sa aling mga sakit? Did you receive any new

information about diseases or h ealth threats in the past 6 months since October 2014 that you were not aware of

before?

1 Hindi No 2 Oo Ye s for what di seas es: ____________________________________________ [54.2]

55 . Ilang taon ka na? How old are you?

taong gulang years old

56 . [1] Anu-anong mga family planning methods ang alam niyo o narinig niyo na? [2- 5] Babasahin ko sa inyo ang ibat

ibang family planning methods. Kung okay lang sa inyo, maaari niyo po bang sabihin sa akin kung narinig niyo na

ang method na mababanggit, kung nagamit niyo na ito, [IF AGE < 50]?at kung ginagamit niyo ito sa kasalukuyan

[1] Which family planning methods have you heard of? [2 -5] I will now read you a list of different family planning

methods. If you do not mind, could you please tell me if you have ever heard of the method, if you ever used it, [I F

AGE < 50] an d if you ar e cu rr ently us ing it ?[56.X.1] [56.X.2] [56 .X.3] [56.X.4]

Spontaneo

us?Ever heard? Ever used? Current use?

[56.1] Pil l 1 1 1 1

[56.2] IUD (Intrauterine Device) 1 1 1 1

[56.3] Inject ion/Inject ible (Depo Provera) 1 1 1 1

[56.4] Implant (NoRPLANT) 1 1 1 1

[56.5] Condom 1 1 1 1

[56.6] Pagpapatali Steri l ization (Ligation, Vasectomy) 1 1 1 1

[56.7] Rhythm, Calendar Methods 1 1 1 1

[56.8] Rhythm, Temperature, Symptoms 1 1 1 1

[56.9] Breastfeeding / LAM as fami ly planning method (only) 1 1 1 1

[56.10] Bi l l ings Ovulat ion Method (BOM) 1 1 1 1[56.11] Withdrawal 1 1 1 1

[56.12] Other: ____________________________[56 .13.] 1 1 1 1

57. Nitong nakalipas na 12 buwan, nakatanggap ka ba o naghanap ng impormasyon tungkol sa family planning

methods? In the past 12 months did you receive or actively seek information about family planning methods?

1.

Hindi No 2.

Oo Ye s

58. May nakausap ka ba na ibang miyembro ng iyong sentro tungkol sa natural o artificial na family planning

methods? Have you ever talked to other members of your kasagana-ka center about family planning methods?

1. Hindi No 2. Oo Yes

59. Anu-ano ang mga maaari mong gawin upang mapabuti ang kalusugan ng bagong panganak na sanggol edad 12 buwan pababa?

[PROBE] What can you do to improve the health of a newborn child of less than 12 months of age? [PROBE]

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ _ - 77 Dont know

60 . May alam po ba kayong mga technique kung papano makakapagpagatas ang isang inang may bagong silang na

sanggol? [PROBE] Kung mayroon, anu-ano ang mga ito? Do you know any techniques how mothers of newborn

children can increase their milk production? [PROBE]

1.

Hindi No 2 .

Oo Yes, which ones? __ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ [ 60.2]

61. Alam mo ba kung ano ang breast self-examination?

Do you know what breast self-examination is?

1.

Hindi No 2.

Oo Yes IF HINDI/NO GO TO Q 6 4


13/18

- 13 -

62 . [1] Maaari mo bang ipaliwanag ito sa akin? [2] Sa anong panahon pinakamainam magsagawa ng breast self-

examination? [1] Can you explain it to me? [2] At which time should you practice breast self-examination?

Explanation [62.1] Timing [62.2]

1 Hindi No 2Oo, mali ang paliwanag

Yes, wrong explanation3

Oo, tama ang pal iwanag

Yes, correct explantion 1 After menstruation

63. Nitong nakalipas na 12 buwan simula April 2014, ginawa mo ba ang breast self-examination?

In the past 12 months since April 2014, did you once self -examine your breasts?

1 Hindi No 2 Oo Yes

64. Regular o isang beses kada linggo ka bang naglalaro ng sports o may pisikal na gawain (tulad ng pagsayaw)? Kung

oo, anong ginagawa mo? Do you regularly at l east once a week do physical training or sports (including dancing)?

1.

Hindi No 2.

Oo Yes, what kind of exercise: __ ______ ______ ______ ______ ______ ______ ___

65. Gaano kayo katangkad at ano ang inyong timbang (kg)? How tall are you and what is your weight in kg?

Height:inches[65.1]

Weight:pound[65.2]

Height:Cm[65.3]

Weight:Kg[65.4]

66. Ilang araw sa isang linggo ka nakakakain ng mga sumusunod

On how many days of a week do you normally eat at l east once

[66.1] Prutas fr ui t? on araw kada linggo days of the week

[66.2] Chichirya o matatamis Chips or sweets? on araw kada linggo days of the week

67. Mayroon pong iba-ibang pananaw ang mga tao tungkol sa kalusugan at pangangalaga nito. Interesado po kaming

malaman kung sinasalamin ba ng mga babanggitin kong pahayag ang inyong opinion at paniniwala ukol sa

kalusugan. [SHOW SHEET 5 - SCALE C] Mangyari po lamang na sabihin sa akin kung kayo ay: lubos na di sang-ayon,

di sang-ayon, hindi sumasang-ayon o tumututol, sang-ayon, at lubos na sang-ayon. Sa inyong pagtugon, mangyari

po lamang na maging tapat; walang tama o maling kasagutan. People have different opinions and beliefs about

health and health care. We have prepared statements for you reflecting different opinions and beliefs on health.

[SHOW SHEET 5 - SCALE C] Please tell me if you strongly disagree, disagree a little, neither agree nor disagree,

agree a little, or st rongly agree with each statement. When telling me your opinion please be as honest and

accurate as you can, there is no right or wrong answer.

Hindi

talaga,

Lubos nadi Sang-

ayon No,

strongly

disagree

Medyo

hindi, Di

sang-ayonNo,

d isagree a

little

Hindi

sumasang-ayono tumututol

Neither agree

nor disagree

Medyo

oo, Sang-ayon

Yes, agree

a little

Oo talaga,

Lubos na

Sang-ayon

Yes,

strongly

agree

[67.1]

Minsan nahihirapan kayong kumain ayon sa masustansiya at

tamang diet. Sometimes you have a hard t ime keeping a

healthy diet.

1 2 3 4 5

[67.2]Marami kayong alam tungkol sa pagkain nang tama.

You know a lot about healthy eating.1 2 3 4 5

[67.3]

Madalas na hindi nakakatulong sa paggaling sa sakit ang

pagkonsulta sa propesyunal. Seeking help from health

pr of ess io na ls oft en do es no t he lp in cu ri ng di sea se s .

1 2 3 4 5

[67.4]

Kung magkakasakit kayo, magkakasakit kayo kahit

anong gawin ninyo. No matter what you do, i f you're

going to get sick, you wi l l get sick

1 2 3 4 5

[67.5]

Hindi na kailangang magpa-checkup kung wala namang

nararamdamang sakit.

I f you do not feel s ick, you do not need to go to a check.up

1 2 3 4 5

[67.6]Kung itoy nakatakda para sa inyo, magiging malusog kayo.

If it is meant to be, you will stay healthy1 2 3 4 5

[67.7]

Bago kayo humingi ng tulong sa mga health professionals,

susubukan niyo munang bigyang lunas ang inyong

karamdaman. Before seeking help from a health professional

you try to cure diseases by yourself.

1 2 3 4 5

[67.8]Mababago niyo ang inyong kalusugan sa inyong mga gawi.

You are able to change your health through your behavior1 2 3 4 5

[67.9] Hawak niyo ang sa kalusugan niyo. You are in control of your health. 1 2 3 4 5


14/18

- 14 -

[67.10]

Kung masama ang inyong pakiramdam, madalas na mag-

antay muna kayo ng i sang l inggo bago komunsulta sa isang

health professional. I f you feel s ick, you usual ly wait at least

a week before you seek help from a health professional .

1 2 3 4 5

[67.11]Ang magandang kalusugan ay nakaayon sa magandang

kapalaran Good health is largely a matter of good fortune.1 2 3 4 5

[67.12]

Anumang mangyari sa kalusugan niyo ay resulta ng kung

anong ginagawa niyo The main thing which affects your

health is what you yourself do.

1 2 3 4 5

[67.13]

Kapalaran ang nagtatakda kung kai lan ka gagal ing sa iyong

sakit. . Luck plays a big part in determining how soon you

will recover from an il lness.

1 2 3 4 5

[67.14]Nakaayon sa Panginoon ang kalagayan ng inyong kalusugan.

Whether or not your health improves is up to God1 2 3 4 5

F.

Health knowledgePag-usapan natin ngayon ang alam mo tungkol sa kalusugan at kung paano maiiwasan ang sakit.

I would now like to talk to you about things you know about human health and health prevention

68. [SHOW SHEET 2 SCALE A] Paano mo igagrado ang iyong sarili pagdating sa kaalaman tungkol sa sakit at ang mga

lunas nito? [SHOW SHEET 2SCALE A] How would you grade your knowledge about diseases and health treatments?

Masamang-masama

Very bad

Masama

Bad

Katamtaman

Fair

Mabuti

Good

Mabuting-mabuti

Very good

1 2 3 4 5

69.

Sa mga sumusunod na tanong, i nteresado kami sa inyong kaalaman tungkol sa ibat ibang sakit. In the following Iam interested in your knowledge about different diseases.

[69.1]Alam niyo ba kung ano ang UTI?

Do you know what UTI is?1 Hindi No 2 Oo Ye s IF NO GO TO 69.4

[69.2]Nakakahawa ba ito?

Is it a contagious disease?1 Hindi No 2 Oo Ye s -77 Dont know

[69.3]Anu-ano ang mga sintomas ng UTI?

What are symptoms of UTI? [PROBE]

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

-77 Dont know

[69.4]Alam niyo ba kung ano ang TB?

Do you know what Tuberculosis is?1 Hindi No 2 Oo Ye s IF NO GO TO 69.9



[69.6]

Magkano ang isang package ng gamot

ng TB sa health center? PHP -77 Dont know

[69.7]

Alam niyo ba ang TB DOTS? Maaari

niyo po bang ipaliwanag ito sa akin?

Do you know what TB DOTS is? Can

you explain it to me?

1 Hindi No 2Yes, wrong

explanation3

Yes, correct

explanation-77 Dont know

[69.8]Anu-ano ang mga sintomas ng TB?

What are symptoms of TB? [PROBE]

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

-77 Dont know

[69.9]

Alam niyo ba kung ano ang

hypertension or high blood?

Do you know what hypertension is?

1 Hindi No 2 Oo Ye s IF NO GO TO Q 70



[69.11] Paano ito maiiwasan? [PROBE]How can you prevent the illness?

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

__ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

-77 Dont know

70. Maaari bang gumamit ng antibiotics para mapigilan ang pinsalang dulot ng viral infection tulad ng sipon o

trangkaso? Can you use antibiotics to reduce the harmful effects of a viral infection, such as a cold or flu?

1 Hindi No 2 Oo Yes -77 Dont know

71. Anong problemang idinidulot ng palagiang paggamit ng antibiotics?

What is the problem if you take antibiotics too often?

1 Threat of resistance 2 Other answer -77 Dont know


15/18

- 15 -

72 . Mayroon ka bang alam na mga sakit na maaaring makuha mula sa pakikipagtalik? Kung oo, anu-ano ang mga ito?

Do you know any diseases you can get from having sex? If yes , which ones? [PROBE]

1 Hindi No 2 Oo yes, which ones: ____________________________________________ [72.1] -77Dont

know

G.

HouseholdAng susunod na bahagi ay tutuon sa inyong mga kasama sa bahay. Ang kasama sa bahay ang nangangahulugang lahat

ng kasalukuyan at permanenteng kasama sa inyong bahay na nakikinabang sa inyong kita at sa taga pagtaguyod ng

pamilya.The following section is focused on your household. By household we mean all people who permanently live

together with you at the moment and who share their income and expenditures with each other and

acknowledge the authority of a man or woman who is the head of household.

73. Sa kabuuan, ilan ang iyong maituturing na kasama sa bahay kasama ang iyong sarili?

Al togeth er , ho w many persons includ ing your self li ve in yo ur ho usehold at the moment ?

Tao Persons

74 .

Ilan sa mga ito How many of these

[74.1]ang menor de edad ( 21 GO TO Q 78

76. Isipin ang bunsong anak. Laban sa anu-anong mga sakit ito nabigyan ng bakuna? INTERVIEWER: [81.X.1] [RECORD

FIRST SPONTANEOUS ANSWER, [81.X.2] THEN READ DISEASES ASK FOR VACCINATION PASS IF AVAILABLE]

Please think of your youngest child. Against which diseases did your youngest child receive vaccination?

[76.X.1] [76.X.2] [76.X.1] [76.X.2]

Spontaneous? After reading? Spontaneous? After reading?

[76.1] Tetanus, diphtheria, and pertussis (DPT) 1 1 [76.5] Polyo Polio 1 1

[76.2]Tigdas, beke (MMR)

Measles, Mumps, Rubella 1 1

[76.6]Hepatitis (A,B,C) 1 1

[76.3] Numonya Pneumococci 1 1 [76.7] Rabis Rabies 1 1

[76.4] Bacillus Calmette-Gurin (BCG) / TB 1 1 [76.8] Influenza 1 1

77. Nitong nakaraang taon ng 2014, mayroon ba sa inyong mga anak edad 20 pababa ang nakapagpacheckup kahit

walang sakit o sintomas ng pagkakasakit? Did you have any of your children below age 21 undergo a routine lab

examination in the past year of 2014 without being sick or having any disease symptoms?

1 Hindi No 2 Oo Yes

78. Ang mga sumusunod na tanong ay tungkol sa health insurance. In the following I have some questions about health insurance.

[78.1]Kayo po ba ay miyembro at nagbabayad ng kontribusyon sa PhilHealth?

Are you personally a registered member of PhilHealth who is paying contributions?1 Hindi N o 2 Oo Ye s 3 Applied

[78.2]

KUNG MIYEMBRO: Maaari niyo bang ipakita sa akin ang inyong PhilHealth

number/card? IF MEMBER: Can you show me your Phil Health membership

number?


[78.3] Ang asawa niyo po ba ay miyembro ng PhilHealth?Is your partner/spouse a Phil Health Member?

1 Hindi N o 2 Oo Ye s 3 Single

[78.4]

May health insurance ba kayo mula sa ibang pribadong

institusyon/organisasyon? [HINDI KASAMA ANG KASAGANA-KA O KMBA]Are

you personally insured by a private health maintenance organization

[KASAGANA-KA OR KMBA DO NOT COUNT]?


[78.5]

Bukod sa mga Philhealth Office, saan pa maaaring mag-apply para maging

miyembro ng Philhealth? Through which channels can you apply for a Phil Health

membership aside from going directly to the Phil Health Office?

1 KASAGANA-KA 1 Health Center 1 Other

[78.6]

Sa hospitalization o hospital confinement na pagkakasakit lang ba makakatanggap

ng benepisyo mula sa PhilHealth? Are only those diseases covered by PhilHealth

for which you are stationarily hospitalized?

1Hindi

N o 2 Oo Ye s -77

Dont

know


16/18

- 16 -

[78.7]

Kung ikaw ay miyembro ng Philhealth, sino ang maaaring mong maging mga

beneficiaries? If you are PhilHealth member, who can be covered with you

through your membership as beneficiary?

1 Anak 2 Asawa 3 Magulang -77Dont

know

[78.8]

Nakadepende ba ang halaga ng kontribusyon sa Philhealth sa halaga

ng iyong kinikita? Does the PhilHealth contribution depend on your

income?

1Hindi

N o 2 Oo Ye s -77

Dont

know

[78.9]

Kailangan mo pa ba magpakita ng birth certificate upang makapag-

apply sa Philhealth? Do you need to provide a birth certificate to

become a Philhealth member?

1Hindi

N o 2 Oo Ye s -77

Dont

know

H.

Financial Situation and RestrictionsBago natin talakayin ang huling bahagi, pag-usapan natin ang kalagayang pampinansyal ng inyong pamamahay.

Pakitandaan po na lahat ng inyong sagot ay ituturing na lihim. Before coming to the last section, I want to talk to you

about the financial situation of your household and financial restrictions that you experience in your e veryday life.

Please remember, all your answers are confidential.

79 . Pag-aari ba ninyo itong bahay na inyong tinitirahan? Do you/does your household own the house you are living in?

1.

Hindi No 2.

Oo Yes 3 Mortgage

80. Pag-aari ba ninyo itong lupang kinatatayuan ng inyong bahay?

Do you/does your household own the land on which this house you are living in is built?

1 Hindi No 2 Oo Yes 3 Mortgage

81. Ang inyong pamamahay ba ay nagmamay-ari ng mga sumusunod:

Does your household own any of the following vehicles and appliances?

[81.1] 1 Bisikleta Bicycle (with and without sidecar) [81.15] 1Pressure cooker/turbo broiler/blender/other

expensive specialized cooking gadgets

[81.2] 1 Motorsiklo Motorcycle/motorbike [81.16] 1 TV, without cable connection

[81.3] 1 Sasakyan C ar [81.17] 1 TV, with cable connection

[81.4] 1 Dyip Je ep /j ee pn ey /m ul ti ca b [81.18] 1 VCR (Betamax, VHS, VCD/DVD)

[81.5] 1 Water Dispenser [81.19] 1 CD player or cassette recorder

[81.6] 1 Plantsa Electric iron [81.20] 1 Karaoke/Videoke

[81.7] 1 Electric fan [81.21] 1 Computer, without internet access

[81.8] 1 Air conditioner [81.22] 1 Computer, with internet access

[81.9] 1 Panahian Sewing machine [81.23] 1 Washing machine

[81.10]1 Kalan na gumagamit ng LPG o kuryente Gas

(LPG)/electric stove [81.24] 1Kalan na gumagamit ng kerosene Kerosene

stove

[81.11] 1 Refrigerator [81.25] 1 Digital camera or video camera

[81.12] 1Hurno na gumagamit ng LPG o kuryente

Gas (LPG)/electric oven [81.26] 1 Video games (playstation, xbox, etc)

[81.13] 1 Rice cooker [81.27] 1 Smartphone, phone with touch screen

[81.14] 1 Microwave oven [81.27] 1 Tablet PCs

82. Magkano ang nagagastos ng buong pamamahay kada linggo (upa, pagkain, para sa pag-aaral, baon, atbp.)?

How much does your household spend on average per week for living (rent, food, tuition , allowance etc.)?

aboutPHP kada linggo

PHP per week-77

Hindi alam / walang sagot

Dont know / no reply

83. Kung ipagsasama-sama ang lahat ng kinikita ng pamamahay (kasama ang ipinapadala ng kasama sa bahay na

OFW), magkano ang kabuuang kita nito kada linggo (yung wala pang ikinakaltas na buwis at ibang gastusin)?

Taking the income (before taxes) of all household members together (including OFW remittances), how much isthe gross income (before taxes) of your household every week? (Without subtraction of any costs of living)

aboutPHP kada linggo

PHP per week-77

Hindi alam / walang sagot

Dont know / no reply

84. May natitira pa bang pera ang pamamahay kada buwan para ipunin at ipambayad sa malalaking gastusin,

maaaring para sa emergency o pambili ng lupa/bahay? Kung oo, magkano?

Does your household usually has an amount of money left over at the end of the month that you can save for

larger purchases, which may be for emergency expenses or to acquire wealth? If yes, how much?

1. Hindi No 2 . Oo Ye s Kung oo, magkano?

I f yes, how much?

PHP kada buwan [84.2]

PHP per month


17/18

- 17 -

85 . Halimbawa, mangangailangan ka ng Php10,000 para sa agarang pagpapagamot, makakayanan bang makalikom ng

ganitong halaga ang iyong pamamahay na hindi humihingi ng tulong sa iba? [READ ANSWERS]

Imagine you needed 10,000 PHP for an urgent medical treatment, would your household be able to come up with

the money without external help? [READ ANSWERS]

1. Hindi No 2. Oo, baka kalahati Yes, about half of i t 3. Oo, buong Php10,000. Yes, al l of i t

86. Nitong nakaraang 12 buwan, ikaw ba o ang isa sa iyong kasambahay ay nagpasya na hindi magpagamot dahil sa

dahilang pinansyal? In the past 12 months, did you or a household member ever decide not to go to the doctor or

seek medical treatment, help, or advice because of financial constraints?

1.

Hindi No 2.

Oo Ye s

87. Narinig niyo na po ba ang tungkol sa Project NOAH na inilunsad ng DOST? Maaari niyo po bang ipaliwanag ito

sa akin? Have you heard of the Project NOAH that was implemented by the Department of Science and

Technology? Can you explain to me what it is?

1.

No 2. Yes, wrong explan. 3 Yes, correct explan. IF HINDI / NO GO TO Q 89

88. Saan niyo narinig ang tungkol sa Project NOAH?[PROBE] Where did you hear about Project NOAH? [PROBE]

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ _______ ____ ______ ______ ______ ___

89. Narinig niyo na ba ang katagang Climate Change/Pagbabago ng klima? Maaari niyo ba itong ipaliwanag sa akin?

Have you ever heard the term Climate Change and can you explain to me what it means?

1 No, dont know 2 Yes, wrong explanation 3 Ye s, correct explanation IF NO, DONT KNOW GO TO Q 92

90. [SHOW SHEET 15 - SCALE J] Sa inyong palagay, gaano kalubhang problema ng Pilipinas ang climate change/pagbabago ng klima?

[SHOW SHEET 15 - SCALE J] How serious a problem do you think climate change is for the Philippines?

Hindi malubhang problemaNot a serious problem at al l

Malubhang-malubhang problemaAn ext re mely se ri ou s pr ob le m

0 1 2 3 4 5 6 7 8 9 10

91. [READ ANSWERS] Ano sa tingin niyo ang mga sanhi ng climate change/pagbabago ng klima? [MA]

[READ ANSWERS] What do you think are the causes for climate change? [MA]

[91.1] 1 Natural na proseso Natural processes [91.2] 1 Gawa ng tao Human activity

[91.3] 1Kagustuhan ng Diyos Supernatural processes,

Gods wil l [91.4] 1 Other: _____________________________ [91.5]

92. Mayroon ka bang ginagawang mga gawain para maprotektahan/mapangalagaan ang kalikasan? [PROBE]

Do you personally undertake any activities to protect the environment? [PROBE]

__ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ _______ ____ _ - 77 No activities

I. Information about Kasagana-Ka centerPag-usapan po natin ngayon ang tungkol sa inyong sentro at ang ugnayan niyo sa ibang mga miyembro ng sentro .

I would now like to talk to you about your KASAGANA-KAcenter and yourrelationship to the other center members.

93 . Nitong nakalipas na 4 linggo/buwan ng Marso, ilang pulong ng inyong sentro sa KASAGANA-KA ang hindi niyo napuntahan dahil sa

ibang mga obligasyon? In the past 4 weeks/month of March, how many meetings of your KASAGANA-KA center did you have to miss

because of other obligations?

meetings

94. [SHOW SHEET KASAGANA-KA CENTER, USE SHEET - ANSWERS KASAGANA-KA CENTER] Bilang panghuli, mayroon

akong ipapakitang listahan ng lahat ng mga miyembro sa inyong sentro. Interesado po kami sa iyong pakikitungo

sa ibang miyembro ng inyong sentro. [1] Maaari niyo po bang sabihin sa akin kung sino sa listahan ang itinuturing

niyong malapit na kaibigan? [2] Sino sa mga miyembro ang inyong nakikita kada linggo (bukod sa pulong sa

inyong sentro) ng lampas sa 30 minuto? [3] Sino naman sa mga miyembro ang itinuturing ninyo bilang bahagi ng

5 pinakamatalik na kaibigan sa tanang buhay ninyo? [4] Sino naman sa mga miyembro ang nakakausap ninyo

tungkol sa inyong mga personal na problema?

[SHOW SHEET KASAGANA-KA CENTER, USE SHEET - ANSWERS KASAGANA-KA CENTER] I am now going to show

you a sheet with the names of all members of your KASAGANA-KA center. I am interested in your relationship to

the other center members. [1] Could you please tell me who of the members on this list you consider to be your


18/18

pe rson al fr iend ? [2] An d who of the members do yo u meet at least once ever y week besides the reg ular cent er

meetings for at least 30 minutes? [3] Who of the members do you consider to be one of your 5 best friends? [4] To

whom of the members do you speak about your very personal, intimate problems?

95. Ikaw ba o ang iyong kasama sa bahay ay Ar e you or so meb od y el se in th e ho usehold cu rrently

[95.1] Buntis pr eg na nt 1 Oo Ye s 2 Hindi No IF YES LEAVE EXTRA SHEET PREGNANCY

[95.2]Kapapanganak lamang

having a baby < 12 months1 Oo Ye s 2 Hindi No IF YES LEAVE EXTRA SHEET NEWBORN

Maraming salamat sa inyong paglahok!

[INTERVIEWER: (1) PLEASE CHECK FOR COMPLETENESS, (2) PAY INCENTIVE,

(3) ASK FOR PARTICIPANTS SIGNATURE]

J.

Interviewer ObservationsPLEASE DO NOT READ

96. Ano ang iyong pagtingin sa katapatan ng kasagutan ng kalahok? What is your evaluation of the honesty of the

informant's answers?

Mabuting-mabuti

Very good

Mabuti

Good

Katamtaman

Fair

Masama

Bad

Masamang-masama

Very bad

1 2 3 4 5

97.

Gaano kalinis ang kabahayan ng kalahok?

What is the general condition of the house with respect to cleanness?

Maruming-marumi

Very dirty

Marumi

Dirty

Malinis

Clean

Malinis na malinis

Very clean

1 2 3 4

98. Napaliligaran ba ng basura ang kabahayan ng kalahok?

What is the general condition of the area immediately around the house with respect to garbage disposal?

Maraming basura

Lots of uncol lected grbage

Medyo may ilang basura

Some uncol lected garbage

Konting-konting basura

Very l i tt le garbage

Walang basura

No garbage visible

1 2 3 4

99. May mga hayop ba sa loob o malapit (5)

May 3-5 hayop

Some animals (3-5)

May 1-2 hayop

Few animals (1-2)

Walang hayop

No animals

1 2 3 4

Documents

3. Materials_Questionnaire Main.pdf