MAN'S QUESTIONNAIRE

Survey Contents Confidential by Statistical Law

IDENTIFICATION

CLUSTER NUMBER ___

HOUSEHOLD NUMBER __

NAME OF HOUSEHOLD HEAD ________________________

NAME AND LINE NUMBER OF MAN _____________________ __

TELEPHONE/MOBILE NUMBER (IF AVAILABLE) _________

INTERVIEWER VISITS

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*

TOTAL NUMBER OF VISITS

SUPERVISOR
NAME ____________
NUMBER ____

OFFICE EDITOR
NUMBER ____

INTRODUCTION AND CONSENT

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?

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) How long have you been living continuously in (NAME OF CURRENT GOVERNORATE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

103) Just before you moved here, did you live in another governorate?

104) Which governorate did you live in?

105) In what month and year were you born?

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Have you ever attended school?

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?

109) What is the highest GRADE you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

110) CHECK 108:

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?

112) CHECK 111:

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

114) Do you listen to the radio at least once a week, less than once a week or not at all?

115) Do you watch television at least once a week, less than once a week or not at all?

116) Do you own a mobile or smart phone?

117) Do you use your mobile phone for any financial transactions?

118) Do you have an account in a bank or other financial institution that you yourself use?

118A) Do you have a personal credit card?

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

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?

123A) What is your nationality?

SECTION 2. REPRODUCTION

200A) Are you currently married?

200B) Have you ever been married?

200C) What is your marital status now: are you widowed, divorced, or separated?

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?

202) Do you have any sons or daughters that you have fathered who are now living with you?

203)

204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?

205)

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?

207)

208) SUM ALL ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

209) CHECK 208:

210) Did all of the children you have fathered have the same biological mother?

211) CHECK 208

HAS HAD MORE THAN ONE CHILD

HAS HAD ONLY ONE CHILD

212) CHECK 203 ANS 205:

213) CHECK 203 AND 205:

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?

217) Were you ever present during any of those antenatal check-ups?

218) Was (NAME) born in a hospital or health facility?

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?

SECTION 3. CONTRACEPTION

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)?

302) In the last few months have you:

303) In the last few months, have you discussed family planning with a health worker or health professional?

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?

305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

307) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

307A) Do you approve or disapprove couples that use a method of contraception?

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

400A) CHECK 200A, 200B:

404) Is your wife living with you now or is she staying elsewhere?

405) Do you have other wives?

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

408) IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, ASK 408 FOR EACH PERSON.

How old was (NAME) on her last birthday?

409) CHECK 407:

410) Have you been married only once or more than once?

411) CHECK 405 AND 410:

BOTH ARE CODE '2'

OTHER

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.

415A) The last time you had sexual intercourse, was a condom used?

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.

437) The last time you had sex did you or your partner use any method other than condom to avoid or prevent a pregnancy?

438) The last time you had sex did you or your partner use any method to avoid or prevent a pregnancy?

439) What method did you or your partner use?

PROBE: Did you or your partner use any method to prevent pregnancy?

RECORD ALL MENTIONED.

440) Do you know of a place where you can obtain a method of family planning?

SECTION 5. FERTILITY PREFERENCES

501) CHECK 22A, 200B:

502) CHECK 439:

503) CHECK 407:

504) Is your wife currently pregnant?

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?

506) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

507) CHECK 208:

HAS FATHERED CHILDREN

HAS NOT FATHERED CHILDREN

508) CHECK 208:

HAS FATHERED CHILDREN

HAS NOT FATHERED CHILDREN

509) Are any of your wives currently pregnant?

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?

511) After the birth of the child you are expecting now, how long would you wait before the birth of another child?

514) CHECK 203 AND 205:
PROBE FOR A NUMERIC RESPONSE.

HAS LIVING CHILDREN

NOT ASKED OR NO LIVING CHILDREN

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?

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?

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?

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?

607) CHECK 220A:

608)CHECK 606A:

609) Who usually decides how the money you earn will be used: you, your wife, or you and your wife jointly?

610) Who usually makes decisions about health care for yourself: you, your wife, you and your wife jointly, or someone else?

611) Who usually makes decisions about making major household purchases?

612) Do you own this house or any other house either alone or jointly with someone else?

615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

618) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

SECTION 7. HIV/AIDS

701) Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

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?

703) Can people get HIV from mosquito bites?

704) Can people reduce their chance of getting HIV by using a condom every time they have sex?

705) Can people get HIV by sharing food with a person who has HIV?

705A) Can people get the AIDS virus by shaking hands with or hugging a person who has AIDS?

705B) Can people get the AIDS virus by sharing razors or blades when shaving their beard or having their hair cut?

707) Is it possible for a healthy-looking person to have HIV?

708) Can HIV be transmitted from a mother to her baby:

709) CHECK 708:

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?

716) Do you know of a place where people can go to get an HIV test?

717) Where is that?

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.

720) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

721) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

727) CHECK 701:

HEARD ABOUT HIV OR AIDS

NOT HEARD ABOUT HIV OR AIDS

728) CHECK 200A, 200B:

729) CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

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?

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?

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?

SECTION 8. OTHER HEALTH ISSUES

808) Do you currently smoke tobacco every day, some days, or not at all?

809) In the past, have you smoked tobacco every day?

810) In the past, have you ever smoked tobacco every day, some days, or not at all?

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?

817) What types of health insurance are you covered by?

RECORD ALL INSURANCES MENTIONED.

818) RECORD THE TIME.

INTERVIWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

______________________________________________________________________________

COMMENTS ON SPECIFIC QUESTIONS:

______________________________________________________________________________

ANY OTHER COMMENTS:

______________________________________________________________________________

SUPERVISOR'S OBSERVATIONS

_______________________________________________________________________

EDITOR'S OBSERVATIONS

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