Literal question
INTRODUCTION AND CONSENT
Hello. My name is ___. I am working with the Central Statistical Office/ZIMSTAT. We are conducting a survey about health and other topics all over Zimbabwe. The information we collect will help the government to plan health services. Your household was randomly selected for the survey. I would like to ask you some questions about your household. The questions usually take about 15-20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. Participation in the survey is voluntary. It's up to you if you want 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 more information about the survey, you may contact the person listed on this card.
GIVE CARD WITH CONTACT INFORMATION
Do you have any questions?
Do you agree to participate in the survey? May I begin the interview now?
SIGNATURE OF INTERVIEWER CONFIRMING CONSENT STATEMENT HAS BEEN READ TO THE RESPONDENT ___
DATE ___
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 100)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)