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["Participant Information Sheet and Verbal Consent Form\nConducting survey of Women who recently met with an ASHA about Family Planning\n(To be read to participant prior to the interview)\n\nStudy Title:  SPARQ Project \nSPARQ: Strengthening Person-Centered Accessibility, Respect, and Quality \n\nIntroduction:  Hello. My name is ____________________.  I work for Population Sciences International (PSI). We are trying to improve the health of mothers and children in this area. We are carrying out this study in collaboration with researchers at the University of California, San Francisco. \nPurpose of the study: We are carrying out a study to understand about the care that you have received during recent visits with your ASHA.  \nRisks and benefits of participation: We would like to invite you take part in this survey. Before you decide whether you want to take part, it is important to listen to the following information carefully and discuss it with others if you wish. Ask us if there is anything that is not clear or if you would like more information. \n\nIf you agree to take part, we would ask you questions in private about your family planning experiences. The interview will take approximately 15 to 30 minutes. \n\nPrivacy and confidentiality: The information collected through the surveys will be kept confidential and used only for study purposes. Your name or the location of your house and other information that could reveal your identity will be removed before the results of the study are made public or shared between people other than the main researchers working on the project.  Your data will be transferred to computers protected by passwords. We will not speak about anything that you personally have said unless you indicate that there is a real risk to your own or your baby's health. The information you tell us is strictly confidential and will not be shared with the ASHA or any health provider or facility and we are not affiliated with any facility. If during the interview, you are not feeling well, I will immediately help you seek care at the closest health facility.\n\nWithdrawal: You should only participate if you want to; choosing not to take part will not disadvantage you in any way.  It is up to you to decide whether to take part or not. If you decide to take part you are still free to withdraw at any time and without giving a reason.  \nWould you like to participate? 0Yes 0No [If no, thank them for their time and stop recruitment/survey]\n\nQUESTIONS\nIf you have any questions or concerns at a later time, you may contact the SPARQ Co-investigator, Kali Prosad Roy at +91.11.47312200/10 or via email at kaliprosad@psi.org.in. If you have additional questions about your rights as a research subject, you can contact the UCSF Institutional Review Board at +001.415.476.1814. You may also contact the PSI offices directly:\n\nSPARQ India: Population Services International \nCo-Principal Investigator: Kali Prosad Roy\nPSI New Delhi\nC-445, \nChittaranjan Park\nNew Delhi-110019\n+91.11.47312200/10\n\nSTATEMENT OF CONSENT\nI have read this form or had it read to me. I have discussed the information with study staff.  My questions have been answered. I understand that my decision whether or not to take part in the study is voluntary. I understand that if I decide to join the study I may withdraw at any time. By giving my verbal consent, I do not give up any rights that I have as a research participant. \n\nI verbally consent to participate in this ready study.  0Yes 0No\n\n[Data collector enter response. If no, end pre-consent recruitment. If yes, move onto post-consent survey]\n\n"]
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["Demographics"]
["Question #","Question","Response options ","Programming/Code notes"]
[1,"How old were you at your last birthday?",null,"years"]
[2,"What is your current marital status?","single | married | widowed | divorced"]
[3,"Can you read/write?","Yes, and attended school |\nYes, but did not attend schoool |\t\nNo"]
[4,"What is your current occupation?","Unemployed\nself_employed (for eg business, milk business, own's shop etc)\ngovernment_employee\nprivate_employee\nfarmer_(own_land)\nfarmer_(leased_land)\nSkilled_labour\nUnskilled_labour\ntraditional_worker\nother","skip pattern"]
[5,"What is your current occupation? Other (Specify)"]
[6,"Do you know your husband's occupation? ","Yes | no","skip pattern"]
[7,"What is your husband's occupation? ","Unemployed\nself_employed (for eg business, milk business, own's shop etc)\ngovernment_employee\nprivate_employee\nfarmer_(own_land)\nfarmer_(leased_land)\nSkilled_labour\nUnskilled_labour\ntraditional_worker\nother","skip pattern"]
[8,"10.3 What is your husband's occupation? Other (Specify)",null,"skip pattern"]
[9,"What is your religion?","Hindu | Muslim | Christian | other","skip pattern"]
[10,"What is your religion? - Other",null,"skip pattern"]
[11,"To what tribe/caste do you belong?","Scheduled caste |\nScheduled Tribe |\nOBC |\nGeneral |\nOther","skip pattern"]
[12,"To what tribe/caste do you belong? Other (Specify)",null,"skip pattern"]
[13,"Do you have any children?","Yes | no","skip pattern"]
[14,"How many children (age and sex)?","xx girls | xx boys","drop down to enter numbers of sons and daughters"]
[15,"Would you like to have another child or would you prefer not to have any more children? ","HAVE (A/ANOTHER) CHILD, NO MORE/NONE, SAYS SHE CAN'T GET PREGNANT, UNDECIDED/DON'T KNOW"]
[null,"ASHA interaction"]
[16,"When did you last have a visit from your ASHA [insert ASHA name here]?",null,"numerical, days, weeks, months, years, never"]
[17,"How many times has an ASHA visted you in the last 3 months?",null,"numerical value - respondent to specify no. of times"]
[18,"When the ASHA came, did she talk to you about family planning?","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        "]
[19,"How do you feel about how involved your ASHA was with helping you choose a family planning method?","I wish my ASHA had been less involved/\nMy ASHA was involved exactly the right amount/ \nI wish my ASHA had been more involved/"]
[20,"During the visit, who made the decision about what family planning method you would use? (Check all that apply)","My health provider |\nMy partner |\nMy parents/in-laws|\nMe |\nOther (specify) |: ________________"]
[21,"Did your ASHA have a preference for what birth control method you should use?","No preference | \nSlight preference | \nModerate preference| \nStrong preference |\nExtremely strong preference |\nDon't know"]
[null,"PCFP Scale"]
[null,"Now I will ask you some questions about your experiences with the ASHA. Thinking back on your last visit with the ASHA, tell me if the following things happened all the time, most of the time, a few times, or it never happened. \n \n You can say a few times if it happened one or two times, and most of the time will be if it happened 3 or more times, but not always.     As a reminder, none of the responses that you give will be shared with your ASHA. We ask that you are honest in your responses so that we may understand how ASHAs may provide the best care to their clients. \n \n (PROBE FOR ALL QUESTIONS: if respondent just responds, yes, ask them: Did this occur a few times, most of the time, or all the time)"]
[22,"Did the ASHA introduce herself to you when she came to see you? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[23,"Did the ASHA treat you with respect? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[24,"Did you feel the ASHA wanted the best for you?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[25,"Were you given enough information about your care in order for you to feel like you understood what happened?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[26,"Did you feel like the ASHA involved you in decisions about your care? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[27,"Did you feel the ASHA clearly explained things to you?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[28,"When you had questions, did the ASHA answer in a way you could understand?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[29,"Did the ASHA support your anxieties and fears about your family planning procedure or your choice?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[30,"Did you feel you could ask the ASHA any questions you had?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[31,"Did you feel you were allowed to have someone you wanted to stay with you during your visit?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[32,"Did the ASHA ask you or your family for money other than the official cost?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[33,"Is the ASHA available to you when you want to speak to her, have questions, or need support? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[34,"Did you feel the ASHA took the best care of you?","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[35,"Did you feel the ASHA cared about you as a person? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[36,"Did you feel you had complete trust in the ASHA with regards to your care? ","0, 0 No, never |\n1, 1 Yes, a few times |\n2, 2 Yes, most of the time |\n3, 3 Yes, all the time                                            "]
[null,"MII"]
[37,"Were you informed about other methods?","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        ","mii1"]
[38,"Were you informed about side effects?","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        ","mii2"]
[39,"Were you told what to do if you experienced side effects?","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        ","mii3"]
[null,"FP methods and reasons"]
[40,"Have you adopted a family planning method in the last 3 months? ","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        ","skip pattern; if response is no, go to 53 and end survey"]
[41,"What method/s did you adopt? ","Oral pills\nCondoms\nIUD/Copper-T\nInjectables                                Other (specify)                                                   ","select all that apply (and then next series questions for each method)"]
[42,"Are you still using this method? ","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember","skip pattern; if yes skip to 45.  If no, skip questions 49-54 "]
[43,"Why did you discontinue the method? ","Side effects from the FP method(s) |\nNot having sex | \nInfrequent sex |\nMy husband or family do not want me to |\nMenopausal/ hysterectomy |\nCosts too much |\nCan't get pregnant |\nNot menstruated since last birth |\nBreastfeeding |\nIt's up to God or fate|\nOther (specify) "]
[44,"Other reason why not continue method:"]
[45,"Where did you get this method?","Pharmacy\nGovt. PHC\nGovt. CHC\nGovt. FRU\nGovt. DWH\nPrivate clinic\nPrivate hospital\nASHA\nAngawadi Center\nNGO (both outreach worker and mobile unit)\nI don't know, my husband got me the FP method\nOther","select all that apply; by the method"]
[46,"Other location for method"]
[47,"Did the ASHA go with you to the facility to get this method?","0, 0 No |\n1, 1 Yes  | \n77, 77 I don't remember                        "]
[48,"Why did you decide to adopt this method? (choose all that apply)","I want to wait to have my first child\nI want to wait before having another child \nI have health related reasons\nI do not have money to support a child/children\ndo not want to have any more children |\nother (specify) "]
[49,"Why did you decide not to adopt a FP method?","Side effects from the FP method(s) |\nNot having sex |\t\nInfrequent sex |\nMy husband or family do not want me to |\nMenopausal/ hysterectomy |\nCosts too much |\nCan't get pregnant |\nNot menstruated since last birth |\nBreastfeeding |\nIt's up to God or fate|\nOther (specify) "]
[50,"Other reason why decided to not adopt FP method:"]
[51,"Do you think that you will continue using this method?","yes, no, unsure"]
[51,"If you don't think you will continue with this method, why not? ","Side effects from the FP method(s) |\nNot having sex |\t\nInfrequent sex |\nMy husband or family do not want me to |\nMenopausal/ hysterectomy |\nCosts too much |\nCan't get pregnant |\nNot menstruated since last birth |\nBreastfeeding |\nIt's up to God or fate|\nOther (specify) ","select all that apply; by the method"]
[52,"Other reason why not continue method:"]
[53,"Have you ever used a FP method in the past, if so, what method? (select all that apply)","Oral pills\nCondoms\nIUD/Copper-T\nInjectables\nOther (specify)"]
[54,"Other method you have used in the past:"]
[null,"End Survey"]
[55,"This is the end of the survey. Thank you for your time"]
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