Literal question
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is ______ and I am working with the Ministry of Planning. We are conducting a national survey about men's, women's, and children's health. We would very much appreciate your participation in this survey. I would like to ask you some questions about your health (and your children's health). The information will help the government to plan health services. The questions usually take about 20 to 45 minutes. Whatever information you provide will be kept strictly confidential and will not be shared with anyone.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
SIGNATURE OF INTERVIEWER: _____________
DATE: __________
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
101) RECORD THE TIME.
HOUR ____
MINUTES ____