if respondent is not head of household

Comments

Transcription

if respondent is not head of household
Study ID
(101-108)
Resp. No.
(109-112)
Interviewer No.
(116-119)
Interview Length
(120-121)
No. Of Queries
(122-123)
Reference No.
(124-127)
81027-PVT
Nielsen Indonesia
15/F Mayapada Tower
Jl. Jenderal Sudirman Kav. 28
Jakarta 12920 Indonesia
Name of Respondent : ________________________
Address : __________________________________
__________________________________
__________________________________
Phone # : __________________________________
Interviewer's Name : _________________________
Date of Interview : ______ - __________ - ________
Start : ________ Finish : ________
SCREENING
IF RESPONDENT IS NOT HEAD OF HOUSEHOLD WHO ACTS AS A BREADWINNER THEN ASK POLITELY
TO THE ELIGIBLE ONE
Q1
Q2
JOB S C R E E N I N G
So we are sure that we are speaking to a broad cross section of the community, do you
or any one in your family or any of your close friends work in any of the following industry
sectors? [MA]
Code
(128)
Route
Advertising Agency
1
CLOSE
Research Agency
2
CLOSE
Public Relations
3
CLOSE
Mass media
4
CLOSE
Manufacturer/distributor of toilets (WC)
5
CLOSE
Manufacturer/distributor of craft tools
6
CLOSE
Journalist
7
CLOSE
None of the above
8
ASK ALL
Have you been interviewed like this in the past 6 months? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(129)
Route
Yes
1
CLOSE
No
2
Page 1 of 63
Q3a
SHOW CARD
Which of the following monthly household expenditure groups do you belong to? (That is : total daily
expenditure in a month on food, tuition, electricity, water, cigarettes, servants' salaries, gasoline, etc;
excluding major purchases). [SA]
Q3b
How much, approximately, is the monthly income of this household from all sources in the household? [SA]
Q3c
And how much is approximately your monthly personal income ? [SA]
Q3a
Household
Expenditure
(130)
Q3b
Household
Income
(133)
Q3c
Personal
Income
(136)
Less than Rp.50.000
01
01
01
Rp. 50.001 - 75.000
02
02
02
Rp. 75.001 - 100.000
03
03
03
Rp. 100.001 - 150.000
04
04
04
Rp. 150.001 - 200.000
05
05
05
Rp. 200.001 - 250.000
06
06
06
Rp. 250.001 - 300.000
07
07
07
Rp. 300.001 - 350.000
08
08
08
Rp. 350.001 - 400.000
09
09
09
Rp. 400.001 - 450.000
10
10
10
Rp. 450.001 - 500.000
11
11
11
Rp. 500.001 - 600.000
12
12
12
Rp. 600.001 - 700.000
13
13
13
Rp. 700.001 - 800.000
14
14
14
Rp. 800.001 - 900.000
15
15
15
Rp. 900.001 - 1.000.000
16
16
16
Rp. 1.000.001 - 1.250.000
17
17
17
Rp. 1.250.001 - 1.500.000
18
18
18
Rp. 1.500.001 - 1.750.000
19
19
19
Rp. 1.750.001 - 2.000.000
20
20
20
Rp. 2.000.001 - 2.250.000
21
21
21
Rp. 2.250.001 - 2.500.000
22
22
22
Rp. 2.500.001 - 3.500.000
23
23
23
Rp. 3.500.001 - 4.000.000
24
24
24
Rp. 4.000.001 - 5.000.000
25
25
25
Rp. 5.000.001 - 10.000.000
26
26
26
Above 10.000.000
27
27
27
81027-PVT Private Time (1 July, 2008)
Page 2 of 63
TRANSFER FROM Q3
SEC classification [SA]
Q4
Code
(139)
Route
A1 : More than Rp 3,500,000
1
CLOSE
A2 : Rp 2,500,001 - Rp 3,500,000
2
CLOSE
B : Rp 1,750,001 - Rp 2,500,000
3
CLOSE
C1 : Rp 1,250,001 - Rp 1,750,000
4
C2 : Rp 900,001 - Rp 1,250,000
5
D : Rp 600,001 - Rp 900,000
6
E : Less than Rp 600,000
7
CLOSE
DEMOGRAPHICS
Who is the main income earner in this household? [SA]
Q5
Code
(140)
01
Husband
Wife
02
Daughter
03
Brother
04
Grandfather
05
Grandmother
06
Others (specify _________________________ )
07
None
98
Don't know
99
Route
TANYAKAN KEPADA KEPALA RUMAH TANGGA YANG MENCARI NAFKAH
May I know how old you are?
Q6
RECORD: Date/Month/Year ____/____/____
Exact Age
(R1)
Q7
TRANSFER FROM Q6
81027-PVT Private Time (1 July, 2008)
(150-151)
Code
(152)
01
55 years old or above
50 - 54 years old
02
45 - 49 years old
03
40 - 44 years old
04
35 - 39 years old
05
30 - 34 years old
06
25 - 29 years old
07
20 - 24 years old
08
18 - 19 years old
09
Route
Page 3 of 63
Q7
TRANSFER FROM Q6
Q8
SHOW CARD
Can you read, write, or both?[SA]
Code
(152)
10
15 - 17 years old
Route
Code
(153)
Route
Read fluently
1
Can read but having difficulty
2
Can not read
3
Q9a
SHOWCARD
What is the highest level of education you have completed ? [SA]
Q9b
Among all member of this household, what is the highest education that have completed?[SA]
Q9a
Head of HH
education
Q10
(154)
Q9b
Highest
education
among family
member
(155)
Doctoral (S3)
1
1
Post graduates (S2)
2
2
Bachelor (S1)
3
3
Academy/Diploma
4
4
Senior High
5
5
Junior High
6
6
Elementary
7
7
Elementary not finished
8
8
No formal education
9
9
ASK ALL
What is your main occupation? [SA]
Code
(156)
Staff (administration, typist)
01
Skilled laborer (in the office)
02
Unskilled laborer (in the office)
03
Skilled laborer (in the factory/shop)
04
Unskilled laborer (in the factory/shop)
05
Farmer/fisherman
06
Student (college, high school)
07
Retiree
08
No job/looking for a job
09
Housewife
10
81027-PVT Private Time (1 July, 2008)
Route
Page 4 of 63
ASK ALL
What is your main occupation? [SA]
Q10
Code
(156)
Refused to answer
11
Other specify _________
12
_____________________
13
_____________________
14
Route
Could you please tell me, how many hours you worked in the past 7 days. What we mean by working is
that you received some form of payment for what you did. it can be salary or wages or you could have
gained or exchanged from what you did (i.e.trading)
Q11
Total Hours
(R1)
(166-167)
How many people live in your house? (Including those staying at least 3 months in the past 12 months
including children, adult relatives)
Q12
INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE
Number of people
(R1)
Q13a
(168-170)
Please mention the number of male and female for each age group living in your household including you,
other adults, children and infants but excluding helper or guests.
INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE
a) MALE
Q13b
b) FEMALE
0-4
(R1)
5-9
(R2)
10-14
(R3)
15-19
(R4)
20-24
(R5)
25-29
(R6)
81027-PVT Private Time (1 July, 2008)
Q13a
Q13b
Male
Female
(171-172)
(240-241)
__
__
(173-174)
(242-243)
__
__
(175-176)
(244-245)
__
__
(177-178)
(246-247)
__
__
(179-180)
(248-249)
__
__
(216-217)
(250-251)
__
__
Page 5 of 63
Q13b
Male
Female
(218-219)
(252-253)
__
__
(220-221)
(254-255)
__
__
(222-223)
(256-257)
__
__
(224-225)
(258-259)
__
__
(226-227)
(260-261)
__
__
(228-229)
(262-263)
__
__
(230-231)
(264-265)
__
__
(232-233)
(266-267)
__
__
(234-235)
(268-269)
__
__
(236-237)
(270-271)
__
__
(238-239)
(272-273)
__
__
30-34
(R7)
35-39
(R8)
40-44
(R9)
45-49
(R10)
50-54
(R11)
55-59
(R12)
60-64
(R13)
65-69
(R14)
70-74
(R15)
75+
(R16)
Total
(R17)
Q14
Q13a
May I know your religion?[SA]
Code
(274)
1
Moslem
Christian
2
Catholic
3
Buddha
4
Hindu
5
Other _____________
6
Route
HOUSING INFORMATION
Q15
ASK ALL
Can you tell me the ownership status of the house you are living in right now?[SA]
Code
(275)
Rent
1
Owned, with my name on the land certificate
2
Owned, with my parents name on the land certificate
3
81027-PVT Private Time (1 July, 2008)
Route
Page 6 of 63
Q15
Q16
ASK ALL
Can you tell me the ownership status of the house you are living in right now?[SA]
Owned, with my family/ relative on the land certificate
4
Others, _____________________________
5
Land size of house (m2)
(276-279)
Does your house get some electricity supply?[SA]
Code
(280)
1
Yes
No
Q18
Q19
Route
ASK ALL
What is the land size of the house you are living in at the moment?
(R1)
Q17
Code
(275)
ASK Q18AND Q19IF CODE 1 IS CIRCLED IN Q17
SHOWCARD
And from which source do you get electricity supply?[MA]
Q18
2
Q20
Code
(316)
Route
PLN
1
Genset
2
Other household
3
SHOWCARD
In past one month, which statement describe you the best about the electricity supply in
your house?[SA]
Route
Code
(317)
I always get electricity supply
01
I get electricity supply only in certain time
02
I can not predict when my house get electricity supply
03
Other _________________________
04
Don't know
99
Route
RESPONDENT CLASSIFICATION
Q20
ASK ALL
Does this house own a toilet/ water closet?
What we mean by toilet/ water closet is a place where you usually defecate. [SA]
81027-PVT Private Time (1 July, 2008)
Code
(327)
Route
Yes
1
Q22
No
2
Q21
Page 7 of 63
Q21
Q22
Q23
Q24
Q25
ASK IF RESPONDENT DON'T HAVE TOILET IN THEIR HOUSE (CODED 2 IN Q20 )
Where do you usually defecate? [SA]
Code
(328)
Route
In the open
01
Q26
River
02
Q26
Wood
03
Q26
Bush
04
Q26
Other Open site (Please Mention
05
Public Place
41
Q26
Public Toilet
42
Q26
Toilet that belong to my neighbour/
43
Q26
Code
(333)
Route
Yes
1
Q26
No
2
Q23
Code
(334)
Route
to a digged hole
01
Q24
to the river
02
Q26
to the gutter
03
Q26
Others, _____________________
04
Q26
Code
(344)
Route
Yes
1
Q25
No
2
Q26
Code
(345)
Route
ASK IF RESPONDENT HAVE THEIR OWN TOILET/WC (CODED 1 IN Q20 )
You mentioned earlier that you have a toilet/ water closet. Does your toilet/ water closet
have a septic-tank?
What we mean by septic-tank is a proper facility to store feces. [SA]
ASK IF CODED 2 IN Q22
Earlier you mentioned that the toilet/ water closet you own in your household do not
have a septic-tank as a basin to store feces. If so, then where does the disposal channel
lead to? [SA]
ASK IF CODED 1 IN Q23
If you previously digged a hole, is the hole closed shut ? [SA]
ASK IF THE HOLE CLOSED SHUT (CODE 1 IN Q24)
What material do you use to shut the hole closed?[SA]
81027-PVT Private Time (1 July, 2008)
Leaves (Unimproved)
1
Wood slab (Unimproved)
2
Bricks (Improved)
3
Rock Slab (Improved)
4
Cement Slab (Improved)
5
Page 8 of 63
Q26
Classification using the Following procedure
Code
(346)
Route
1. If Q20 Code 2 and Q21 Code 1 - 40; Classified as Open Defecator (CODE 1)
2. If Q20 Code 2 and Q21 Code 41 etc Classified as Sharer (CODE 2)
3. If Q20 Code 1 and Q22 Code 1; Classified as Owner Improved (CODE 3)
4. IfQ20 Code 1 and Q22 Code 2; and Q23 code 1; and Q24 Code 1; and Q25 Code 35; Classified as Owner Improved (CODE 3)
5. If Q20 Code1 and Q22 Code 2; and Q23 code 2 and up; Classified as Owner
Unimproved (CODE 4)
6. IfQ20 Code1 and Q22 Code 2; and Q23 Code 1; and Q24 Code 2; and Q25 Code 1-2;
Classified as Owner Unimproved (CODE 4) [SA]
Open Defecator
1
Sharer
2
Owner Improved
3
Owner Unimproved
4
Q27a
ASK ALL
I have a list of activities that someone might buy/ do whenever they have extra money. Should you have
extra money, what will you do first? [SA]
Q27b
And what next? what next?[MA]
Q27a
First Do
Q28
(347)
Q27b
Other
Priorities
(349)
Pay debt
01
01
Buy the necessity for my children
02
02
Buy the household appliances
03
03
Buy a Color TV
04
04
Buy a VCD/DVD player
05
05
Buy a Motorcycle
06
06
Buy a Computer
07
07
Buy a Mobile phone
08
08
Buy a Fixed-line telephone
09
09
Buy a Radio cassette
10
10
Renovate the House
11
11
Other Needs
12
12
Build/ Renovate the Toilet/ Water Closet
13
13
ASK ALL
Had you or your family for any reasons, defecate and store the stools in a container
before throw it away?
[SA]
81027-PVT Private Time (1 July, 2008)
Code
(351)
Route
Yes
1
Q29
No
2
Q32
Page 9 of 63
Q29
Q30
ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28)
When did the last time you/your family member do that?
[SA]
Code
(352)
Today
1
Yesterday
2
Within this week
3
Within this month
4
A few months ago
5
Forgot
6
ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28)
Why did you/ your family do that?
[MA]
Code
(353)
It was in the middle of the night
01
I/ We were in the middle of a trip
02
It was rainy
03
Diarrhea
04
Afraid of the dark
05
Other (Specify ___________________________ )
06
_____________________________
07
_____________________________
08
_____________________________
09
81027-PVT Private Time (1 July, 2008)
Route
Route
Page 10 of 63
Q31a
Who did it in the past 1 month?[MA]
Q31b
And who did it latest?[SA]
Q31a
Q31b
Head Husba Child Parent Other Head Husba Child Parent Others
of
nd/
s
of
nd/
s
House Wife
House Wife
hold
hold
(363)
(532)
(R1)
Adult Woman
1
2
3
4
5
(364)
(R2)
School Aged Female
1
Adult Man
1
2
3
4
5
School Aged Male
1
2
3
4
5
Pre School Child
1
2
3
4
5
1
2
3
4
5
Q32
1
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
2
3
4
5
2
3
4
5
(537)
2
3
4
5
(369)
(R7)
5
(536)
(368)
Other
________________________
(R6)
__
4
(535)
(367)
(R5)
3
(534)
(366)
(R4)
2
(533)
(365)
(R3)
1
1
(538)
2
3
4
5
1
ASK ALL
Speaking about your habit in defecate, where was the last time you defecate?[SA]
Code
(666)
At toilet/ water closet in my house
01
At toilet/ water closet in my neighbour
02
At public toilet/ water closet
03
In the river
04
In the bushes
05
In the woods
06
Other (Specify __________________________ )
07
Tidak ada
98
Tidak tahu
99
81027-PVT Private Time (1 July, 2008)
Route
Page 11 of 63
SECTION 1
ASK THIS SECTION TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26 )
Q33
Q34
Q35
SHOWCARD
How satisfied are you with your current habit in defecate? [SA]
Very dissatisfied
1
Dissatisfied
2
Neither satisfied nor dissatisfied
3
Satisfied
4
Very satisfied
5
Do you share your toilet/ water closet (where you usually defecate) with your neighbor or
other families?[SA]
Code
(677)
Route
Yes
1
Q35
No
2
Q36
Number of Family
(678-679)
Within the past 1 year, Had you defecate in the open, such as in the river or woods? [SA] Code
(680)
1
Yes
No
Q37
Q38
Route
ASK IF CODED 1 IN Q34
Earlier you mentioned that you share toilet/ water closet with your neighbor or other families. According to
you, how many families do you share that toilet/ water closet with?
(R1)
Q36
Code
(676)
Route
Q37
2
Q43
Code
(716)
Route
Yes
1
Q38
No
2
Q39
ASK IF EVER DEFECATE IN THE OPEN (CODED 1 IN Q36)
Do you regularly defecate in the open?[SA]
ASK IF DEFECATE REGULARLY IN THE OPEN (CODED 1 IN Q37)
Why do you still defecate in the open regularly?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(717-766)
81027-PVT Private Time (1 July, 2008)
Page 12 of 63
Q39
Q40
Q41
Q42
ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 )
Where in the open do you usually defecate?[SA]
Code
(767)
In the river
01
In the woods
02
In the bushes
03
Others, ________________________
04
ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36)
Where was the last time you defecate in the open?[SA]
Code
(777)
In the river
01
In the woods
02
In the bushes
03
Other (Specify ______________________________ )
04
ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 )
Earlier you mentioned that you have defecated in the open, when was the last time you
defecated in the open?[SA]
Code
(822)
Today
1
Yesterday
2
Within this week
3
Within this month
4
A few months ago
5
Forgot
6
ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 )
Can you tell me your reasons for defecating in open air?[MA]
PROBE What other reason? What other reason?
Code
(823)
There's no toilet in the place where I work
01
Can not hold any longer
02
As a social time
03
My own toilet is dirty
04
Others ___________________________________________
05
81027-PVT Private Time (1 July, 2008)
Route
Route
Route
Route
Page 13 of 63
Q43
TANYAKAN SEMUA
Earlier you mentioned that you have your own toilet/ water closet in the house. When did
you build it?[SA]
Code
(833)
Route
1 month ago
01
Q44
2-3 months ago
02
Q44
4-5 months ago
03
Q44
6-12 months ago
04
Q44
The toilet/ water closet is already in the house when we moved in
05
Q50
Others, ______________________________
06
Q44a
ASK THE FOLLOWING QUESTIONS AMONG THOSE WHO JUST RECENTLY BUILT THEIR TOILET
(CODE 1-4 AT Q43 )
Can you tell me your main reason for building a toilet/ water closet for your house? [SA]
Q44b
What other reason? What other reason?[MA]
Q44a
Main Reason
(843)
Q44b
Other
Reasons
(853)
Privacy
01
01
Avoid sharing with others
02
02
Avoid disturbing neighbours
03
03
Avoid embarrasment/ humiliation
04
04
Higher pride and status for my family
05
05
Accepted as part of the community in my area
06
06
My family is thought to have more cultural values
07
07
Personal discretion
08
08
Safety
09
09
Satisfaction
10
10
Can become a good host when guests visit
11
11
Convenience
12
12
Easy to defecate more cleanly
13
13
Cleaner and healthier living
14
14
Avoid contaminating the environment
15
15
For good health/ Avoid disease
16
16
Other (Specify ________________________ )
17
17
________________________
18
18
________________________
19
19
________________________
20
20
None
98
98
Don't Know
99
99
81027-PVT Private Time (1 July, 2008)
Page 14 of 63
Q45
(R1)
Q46
Q47
Q48
How much does the construction cost you?
Cost (Record in Thousands)
(863-866)
Where did you know about different options for the toilet, such as the features, the types
and other information before you make your toilet?[MA]
Code
(867)
Neighbourhood
01
Friends
02
Mason/ Building coolie
03
Building supplier
04
Government
05
Environmental Health Officer
06
Mass Media : TV
07
Radio
08
Newspaper
09
Other (Mention ____________________________ )
10
Where did you know about different options for the toilet, such as the features, the types
and other information before you make your toilet?[MA]
Code
(877)
Neighbourhood
01
Friends
02
Mason/ Building coolie
03
Building supplier
04
Government
05
Environmental Health Officer
06
Mass Media : TV
07
Radio
08
Newspaper
09
Other (Mention ____________________________ )
10
How easy or difficult was it to make a new latrine? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(922)
1
Very easy
Easy
2
Neutral
3
Difficult
4
Very difficult
5
Route
Route
Route
Page 15 of 63
Q49
You said earlier that it is ____________________ [INTERVIEWER: MENTION THE ANSWER FROM Q48
] to build a latrine for your household. Why did you say it?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(923-972)
Q50
ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT
Q26)
Code
(973)
Route
Yes
1
Q51
No
2
Q53
Had you renovate/ add something to your existing toilet/ build new facility?
[SA]
Q51a
ASK IF RESPONDENTS HAD RENOVATE/ BUILD NEW FACILITY FOR THEIR TOILET (CODE 1 IN
Q50)
What did you do to your toilet/ water closet?
[MA]
Q51b
ASK Q51b IF RESPONDENTS ANSWERS ARE MORE THAN 1 ANSWER
And which one is the latest?[SA]
Q51a
Things that
have been
done
(974)
Q51b
The latest
thing that has
been done
(1019)
Install a new closet
01
01
Install the new tile for the toilet
02
02
Put the roof for the toilet
03
03
Build a new wall for the toilet
04
04
Paint the wall
05
05
Install a lockable door
06
06
Build a new "stool" storage
07
07
Shut the hole and dig a new one
08
08
Others (Specify ____________________ )
09
09
____________________
10
10
____________________
11
11
____________________
12
12
81027-PVT Private Time (1 July, 2008)
Page 16 of 63
Q52
ASK TO THOSE WHO HAD RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET
(CODE 1 IN Q50)
Why do you _______________________ (Interviewer: Respondent answer in Q51) ?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1029-1078)
Q53
ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT
Q26)
Code
(1079)
Route
Yes
1
Q54
No
2
Q58
Code
(1080)
Route
Do you plan to renovate/build new facilities to your toilet/ water closet?[SA]
Q54
ASK IF RESPONDENTS PLAN TO RENOVATE/ BUILD NEW FACILITY FOR THEIR
TOILET (CODE 1 IN Q53)
What will you do to your toilet/ water closet?
[MA]
Install a new closet
01
Install the new tile for the toilet
02
Put the roof for the toilet
03
Build a new wall for the toilet
04
Paint the wall
05
Install a lockable door
06
Build a new "stool" storage
07
Shut the hole and dig a new one
08
Others (Specify ____________________ )
09
____________________
10
____________________
11
____________________
12
81027-PVT Private Time (1 July, 2008)
Page 17 of 63
Q55
ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET
(CODE 1 IN Q53)
Why do you want to _______________________ (Interviewer: Respondent answer in Q54) ?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1125-1174)
Q56
ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET
(CODE 1 IN Q53)
How much money would you be willing to spare if you intend to do the renovation?
(Interviewer: record in thousands)
(R1)
Q57
Actual budget
(1175-1178)
ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN Code
(1179)
THEIR TOILET (CODE 1 IN Q53)
Route
Earlier you had a plan to renovate for your toilet/ water closet? Approximately when do
you think that plan can be realized? [SA]
Q58
In 1 month ahead
1
In 2-3 months ahead
2
In 4-5 months ahead
3
In 6-12 months ahead
4
In more than 1 year ahead
5
Could not say the exact time
6
Earlier you mentioned that you own a toilet/ water closet in your household. How often
do you or your family members clean the toilet/ water closet?[SA]
Code
(1180)
Every time after using it
1
Everyday
2
4-5 times a week
3
2-3 times a week
4
Once a week
5
2-3 times in a month
6
Once a month
7
Rarely, only on certain occasions
8
81027-PVT Private Time (1 July, 2008)
Route
Page 18 of 63
Q59
Q60
Q61
ASK TO THOSE WHO HAVE SEPTIC TANK FOR THEIR TOILET (CODE 3 IN Q26)
Have you ever emptying your septic tank/ feces storage?[SA]
Code
(1216)
Route
Yes
1
Q60
No
2
Q61
Code
(1217)
Route
ASK TO THOSE WHO HAVE EVER EMPTYING THEIR SEPTIC TANK (CODE 1 IN
Q59)
When was the last time you emptied your septic tank/ feces storage?[SA]
What is your opinion on people who still defecate in open air?[MA]
Within this week
1
Witihin this month
2
A month ago
3
2 months ago
4
3 months ago
5
6 months ago
6
1 year ago
7
More than 1 year ago
8
Code
(1218)
01
They are dirty
They are poor
02
They are Causing Disturbance - sometimes they use our latrine
03
They are uneducated
04
They are people that we should avoided
05
They are people that have a lower status than us
06
They are people that we feel sorry for
07
They are people that should be understand
08
They are like us
09
They do it because they accustomized to it
10
Nothing wrong with them
11
Other (Specify _____________________ )
12
_________________________
13
_________________________
14
_________________________
15
None
98
Don't Know
99
81027-PVT Private Time (1 July, 2008)
Route
Page 19 of 63
SECTION 2
ASK THESE QUESTIONS TO THE SHARER (CODED 2 IN Q26)
Q62
Q63
SHOWCARD
How satisfied are you with your current habit in defecate? [SA]
Very dissatisfied
1
Dissatisfied
2
Neither satisfied nor dissatisfied
3
Satisfied
4
Very satisfied
5
Number of Family
(1229-1231)
In the last 1 year, had you defecate in the open, such as in the river or woods? [SA]
Code
(1232)
1
Yes
No
Q65
Q66
Route
Earlier you mentioned that you/ your family member use the public toilet for defecate. May I know how
many family who use that public toilet?
(R1)
Q64
Code
(1228)
ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64)
Where in the open do you usually defecate?[SA]
Q69
Code
(1233)
Route
01
In the woods
02
In the bushes
03
Others, ________________________
04
Code
(1243)
In the river
01
In the woods
02
In the bushes
03
Others, ________________________
04
81027-PVT Private Time (1 July, 2008)
Q65
2
In the river
ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64)
Where was the last time you defecate in the open?[SA]
Route
Route
Page 20 of 63
Q67
Q68
Q69
ASK TO RESPONDENT WHO EVER DEFECATE IN OPEN (CODE 1 IN Q64)
Earlier you mentioned that you have defecated in the open, when was the last time you
defecated in the open?[SA]
Code
(1253)
Today
1
Yesterday
2
Within this week
3
Within this month
4
A few months ago
5
Forgot
6
Can you tell me your reasons for defecating in open air?[MA]
PROBE What other reason? What other reason?
Code
(1254)
There's no toilet in the place where I work
01
Can not hold any longer
02
As a social time
03
Others, ___________________________________________
04
What is your opinion on people who still defecate in open air?[MA]
Code
(1264)
01
They are dirty
They are poor
02
They are Causing Disturbance - sometimes they use our latrine
03
They are uneducated
04
They are people that we should avoided
05
They are people that have a lower status than us
06
They are people that we feel sorry for
07
They are people that should be understand
08
They are like us
09
They do it because they accustomed to it
10
Nothing wrong with them
11
Other (Specify _____________________ )
12
__________________________________
13
__________________________________
14
__________________________________
15
None
98
Don't Know
99
81027-PVT Private Time (1 July, 2008)
Route
Route
Route
Page 21 of 63
Q70
Q71
Q72
SHOWCARD
What is your opinion on people who have their own toilet? [MA]
Code
(1274)
They are clean
01
They are reach
02
They think we are causing disturbance (We sometimes/ always use their latrine)
03
They are educated
04
They would shun us
05
They would look down on us
06
They would feel sorry for us
07
Others (Specify ____________________ )
08
None
98
Don't know
99
Speaking of toilet/ water closet ownership in your household, can you tell me your
reasons for not having your own toilet? [MA]
Code
(1319)
Tenant
01
No space
02
Don't have money
03
Can use neighbours
04
Others (Specify __________________________ )
05
__________________________
06
__________________________
07
__________________________
08
None
98
Don't Know
99
Does your house have an adequate land size to build a toilet/ water closet?[SA]
Code
(1329)
1
Yes
No
Q73
Do you wish to own a place to defecate/ toilet/ water closet/ for your household? [SA]
81027-PVT Private Time (1 July, 2008)
Route
Route
2
Code
(1330)
1
Yes
No
Route
2
Route
Q74
Q81
Page 22 of 63
Q74a
ASK Q74- Q79 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q73 )
Earlier you mentioned that you intend to own a place to defecate/ toilet/ water closet for your household.
Can you tell me your main reason? [SA]
Q74b
What other reason? What other reason?[MA]
Q74a
Main Reason
Q75
(1331)
Q74b
Other
Reasons
(1341)
Privacy
01
01
Avoid sharing with others
02
02
Avoid disturbing neighbours
03
03
Avoid embarrasment/ humiliation
04
04
Higher pride and status for my family
05
05
Accepted as part of the community in my area
06
06
My family is thought to have more cultural values
07
07
Personal discretion
08
08
Safety
09
09
Satisfaction
10
10
Can become a good host when guests visit
11
11
Convenience
12
12
Easy to defecate more cleanly
13
13
Cleaner and healthier living
14
14
Avoid contaminating the environment
15
15
For good health/ Avoid disease
16
16
Other (Specify ________________________ )
17
17
___________________
18
18
________________
19
19
________________
20
20
None
98
98
Don't know
99
99
SHOWCARD
What kind of latrine do you want to build? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(1351)
1
Type 1
Type 2
2
Type 3
3
Type 4
4
Type 5
5
Type 6
6
Route
Page 23 of 63
Q75
SHOWCARD
What kind of latrine do you want to build? [SA]
Q76
SHOWCARD
What kind of feces disposal that you wish to build?
[SA]
Q77
(R1)
Q78
Q79
Code
(1351)
7
Not yet decided
Route
Code
(1352)
Route
Type 1
1
Type 2
2
Type 3
3
Type 4
4
Type 5
5
Not yet decided
6
How much money would you be willing to spare if you intend to build a toilet/ water closet for your
household?
Actual Budget
(1353-1356)
Earlier you had a plan to build a toilet/ water closet. Approximately when do you think
that plan can be realized?[SA]
Code
(1357)
In 1 month ahead
1
In 2-3 months ahead
2
In 4-5 months ahead
3
In 6-12 months ahead
4
In more than 1 year ahead
5
Could not say the exact time
6
Will you borrow money to build this toilet/ water closet for your household?[SA]
Code
(1358)
1
Yes
No
Q80
ASK IF CODED 1 IN Q79
Earlier you mentioned that you will borrow money to build your toilet/ water closet, who
will you borrow the money from?[MA]
Route
Q80
2
Q81
Code
(1359)
Route
Neighbor
01
Relative
02
Bank
03
Cooperation
04
Others ______________________
05
________________________
06
81027-PVT Private Time (1 July, 2008)
Route
Page 24 of 63
Q81
Q82
Q83
Q84
ASK ALL
Code
Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a (1369)
toilet/ water closet? [SA]
Route
Yes
1
Q82
No
2
Q83
Code
(1370)
Route
Yes
1
Q83
No
2
Q83
ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q81)
Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet
exist in your neighbourhood?[SA]
ASK ALL
Code
Would you be interested in using this SAVING SYSTEM that provide financial assistance (1371)
to build a toilet/ water closet? [SA]
Route
Yes
1
Q84
No
2
Q84
ASK FOR THOSE INTERESTED AND NOT INTERESTED
Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT
ANSWER IN Q83) in using this SAVING SYSTEM, can you tell me your reasons?
(R1) Reason of interest
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1372-1456)
(R2) Reason of not interested
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1457-1541)
81027-PVT Private Time (1 July, 2008)
Page 25 of 63
Q85a
ASK ALL
Does your local government provide subsidies for building materials to build a toilet/ water closet for the
people in your area? [SA]
Q85b
Does your local government care about sanitation and environmental health problems in your area? [SA]
Q85a
Q85b
Subsidies
Care
(1542)
(1543)
Yes
1
1
No
2
2
Don't Know
3
3
(R1)
(R2)
(R3)
Q86
Q87
What might prevent you from building a toilet/ water closet in your house?
[MA]
Code
(1544)
Cost of the Latrine
01
Hard to Find a Mason
02
Hard to Find the Materials
03
Water Table/Soil Conditions
04
Don't Have the Money
05
Nothing
06
Don't Know
07
Other ( Specify _____________________ )
08
______________________________
09
______________________________
10
______________________________
11
ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN
TOILET (Q73 CODE 2)
Earlier you mentioned that you do not intend to own a toilet/ water closet for your
household, can you tell me the reason?[MA]
Code
(1554)
Tenant
01
No Space
02
Don't have money
03
Can use Neighbours
04
Others (Specify ___________________ )
05
81027-PVT Private Time (1 July, 2008)
Route
Route
Page 26 of 63
SECTION 3
ASK THIS SECTION TO THE OPEN DEFECATOR (CODED 1 IN Q26)
Q88a
What is your main reason why do you still defecate in the open?[SA]
Q88b
What are the other reasons why do you still defecate in the open?[MA]
Q88a
Main Reason
Q89
(1564)
Q88b
Other
Reasons
(1574)
As a socialization time
01
01
Have become accustomed to defecate in the open
02
02
Never thought before to defecate in toilet/ water closet
03
03
I have no toilet/ water closet in my house
04
04
More practical
05
05
Still can use my neighbour's toilet
06
06
Other (Specify __________________ )
07
07
_______________________________
08
08
_______________________________
09
09
_______________________________
10
10
SHOWCARD
How satisfied are you with your current habit in defecate? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(1619)
Very dissatisfied
1
Dissatisfied
2
Neither satisfied nor dissatisfied
3
Satisfied
4
Very satisfied
5
Route
Page 27 of 63
Q90
Q91
Q92
SHOWCARD
What is your opinion on people who have their own toilet?[MA]
Code
(1620)
They are clean
01
They are reach
02
They think we are causing disturbance (We sometimes/ always use their latrine)
03
They are educated
04
They would shun us
05
They would look down on us
06
They would feel sorry for us
07
Others (Specify ____________________ )
08
________________________
09
________________________
10
________________________
11
None
98
Don't Know
99
Have you tried to use a toilet before?
[SA]
Code
(1630)
Route
Yes
1
Q92
No
2
Q95
Code
(1631)
Route
ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91)
When was the last time you used toilet? [SA]
81027-PVT Private Time (1 July, 2008)
Route
Today
1
Within this week
2
Within this month
3
2-3 months ago
4
3-4 months ago
5
4-6 months ago
6
6 months ago or more
7
Forgot
8
Page 28 of 63
Q93
Q94
Q95
Q96
ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91)
Where the last time do you use the toilet?
[MA]
Code
(1632)
One of my neighbour
01
Public toilet
02
Toilet in my working place
03
Other (Specify _____________________ )
04
_______________________
05
_______________________
06
_______________________
07
ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91)
SHOWCARD
In the last time you used a toilet, what kind of toilet do you use? [MA]
Code
(1642)
Type 1
1
Type 2
2
Type 3
3
Type 4
4
Type 5
5
Type 6
6
TANYAKAN SEMUA
Speaking of toilet/ water closet ownership in your household, can you tell me your
reasons for not having your own toilet?[MA]
Code
(1643)
Tenant
01
No space
02
Do not have enough money
03
Can use neighbours
04
Others (Specify _________________________ )
05
_____________________________
06
_____________________________
07
_____________________________
08
None
98
Don't Know
99
ASK ALL
Does your house have an adequate land size to build a toilet/ water closet?[SA]
81027-PVT Private Time (1 July, 2008)
Code
(1653)
Yes
1
No
2
Route
Route
Route
Route
Page 29 of 63
Q97
Do you wish to own a toilet/ water closet for your household? [SA]
Code
(1654)
1
Yes
No
2
Route
Q98
Q105
Q98a
ASK Q98 - Q103 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q97 )
Earlier you mentioned that you intend to own a toilet/ water closet for your household. Can you tell me your
main reason? [SA]
Q98b
What other reason? What other reason?[MA]
Q98a
Main Reason
(1655)
Q98b
Other
Reasons
(1665)
Privacy
01
01
Avoid sharing with others
02
02
Avoid disturbing neighbours
03
03
Avoid embarrasment/ humiliation
04
04
Higher pride and status for my family
05
05
Accepted as part of the community in my area
06
06
My family is thought to have more cultural values
07
07
Personal discretion
08
08
Safety
09
09
Satisfaction
10
10
Can become a good host when guests visit
11
11
Convenience
12
12
Easy to defecate more cleanly
13
13
Cleaner and healthier living
14
14
Avoid contaminating the environment
15
15
For good health/ Avoid disease
16
16
Other (Specify ________________________ )
17
17
________________________
18
18
________________________
19
19
________________________
20
20
None
98
98
Don't Know
99
99
81027-PVT Private Time (1 July, 2008)
Page 30 of 63
Q99
Q100
Q101
SHOWCARD
What kind of latrine do you want to build? [SA]
Code
(1675)
Type 1
1
Type 2
2
Type 3
3
Type 4
4
Type 5
5
Type 6
6
Not yet decided
7
SHOWCARD
What kind of feces disposal that you wish to build?
[SA]
Code
(1676)
Type 1
1
Type 2
2
Type 3
3
Type 4
4
Type 5
5
Not yet decided
6
Route
Route
How much money would you be willing to spare if you intend to build a toilet/ water closet for your
household?
(Interviewer: record in thousands)
(R1)
Q102
Q103
Actual budget
(1677-1680)
Earlier you had a plan to build a toilet/ water closet. Approximately when do you think
that plan can be realized?[SA]
Code
(1716)
In 1 month ahead
1
In 2-3 months ahead
2
In 4-5 months ahead
3
In 6-12 months ahead
4
In more than 1 year ahead
5
Could not say the exact time
6
Will you borrow money to build this toilet/ water closet for your household?[SA]
Code
(1717)
1
Yes
No
81027-PVT Private Time (1 July, 2008)
2
Route
Route
Q104
Q105
Page 31 of 63
Q104
Q105
Q106
Q107
ASK IF CODED 1 IN Q103
Earlier you mentioned that you will borrow money to build your toilet/ water closet, who
will you borrow the money from?[MA]
Code
(1718)
Neighbor
01
Relative
02
Bank
03
Cooperation
04
Others ______________________
05
_____________________
06
.
07
.
08
.
09
.
10
ASK ALL
Code
Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a (1728)
toilet/ water closet? [SA]
Route
Yes
1
Q106
No
2
Q107
Code
(1729)
Route
Yes
1
Q107
No
2
Q107
ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q105)
Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet
exist in your neighbourhood?[SA]
ASK ALL
Code
Would you be interested in using this SAVING SYSTEM that provide financial assistance (1730)
to build a toilet/ water closet? [SA]
81027-PVT Private Time (1 July, 2008)
Route
Route
Yes
1
Q108
No
2
Q108
Page 32 of 63
Q108
ASK FOR THOSE INTERESTED AND NOT INTERESTED
Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT
ANSWER IN Q107) in using this SAVING SYSTEM, can you tell me your reasons?
(R1) Reason of interest
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1731-1780)
(R2) Reason of not interested
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(1816-1865)
Q109a ASK ALL
Does your local government provide subsidies for building materials to build a toilet/ water closet for the
people in your area? [SA]
Q109b Does your local government care about sanitation and environmental health problems in your area? [SA]
(R1)
(R2)
(R3)
81027-PVT Private Time (1 July, 2008)
Q109a
Q109b
Subsidies
Care
(1866)
(1867)
Yes
1
1
No
2
2
Don't Know
3
3
Page 33 of 63
Q110
Q111
What might prevent you from building a toilet/ water closet in your house?
[MA]
Code
(1868)
Cost of the Latrine
01
Hard to Find a Mason
02
Hard to Find the Materials
03
Water Table/Soil Conditions
04
No Access to Credit
05
Don't Have the Money
06
Nothing
07
Don't Know
08
Other ( Specify _____________________ )
09
____________________________
10
____________________________
11
____________________________
12
None
98
Don't Know
99
ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN
TOILET ( Q97CODE 2)
Earlier you mentioned that you do not intend to own a toilet/ water closet for your
household, can you tell me the reason?[SA]
Code
(1878)
Tenant
01
No Space
02
Don't have enough money
03
Can Use Neighbours
04
Others (Specify ____________________ )
05
________________________
06
________________________
07
________________________
08
________________________
09
None
98
Don't Know
99
81027-PVT Private Time (1 July, 2008)
Route
Route
Page 34 of 63
SECTION 4
HABIT, KNOWLEDGE, AND ATTITUDE
DAILY HABITS
Q112
ASK ALL
On what occasions do you usually wash your hands?[MA]
PROBE What other occasions? What other occasions?
Code
(1923)
After I urinate
01
After I defecate
02
Before eating
03
After eating
04
Before cooking
05
Others, _______________________________
06
_____________________________
07
Never
99
Route
Q113a ASK IF NOT CODED 99 IN Q112
RECORD FIRST MENTION AND OTHER MENTIONS SEPARATELY
Why do you wash your hands after these activities?
INTERVIEWER:
Write down separately between the first answer and other answer [SA]
Q113b What other reason? What other reason?
[MA]
Q113a
Q113b
1st Mention Other Mention
(1933)
(1943)
Want to get rid of the smell
01
01
Want to be cleaned from dirt
02
02
Want to get rid of germs/ bacteria
03
03
To be protected from disease
04
04
Others, ______________________________
05
05
________________________________
06
06
________________________________
07
07
81027-PVT Private Time (1 July, 2008)
Page 35 of 63
Q114
Q115
Q116
Q117
Do you usually use other substances when washing your hands? If yes, what is the
name of the substance you use?[SA]
Code
(1953)
Special soap to wash hand
01
Bath soap
02
"Sabun Colek"/ Cream soap
03
Others, _____________________________
04
None
98
Don't Know
99
Where do you usually wash your hands?[SA]
Code
(1963)
01
Lavatory
Kitchen
02
Premises
03
Other _________________
04
______________________
05
______________________
06
______________________
07
.
08
.
09
.
10
Where else do you usually wash your hands?[MA]
PROBE where else? where else?
Code
(1973)
Lavatory
01
Kitchen
02
Premises
03
Other __________________
04
_______________________
05
_______________________
06
_______________________
07
.
08
.
09
.
10
In those places that you usually wash your hands, do soap always available?[SA]
Code
(2018)
1
Yes
No
81027-PVT Private Time (1 July, 2008)
Route
Route
Route
Route
2
Page 36 of 63
Q118
How do you clean yourself after you defecate? [MA]
Code
(2019)
01
Wipe with leaves
Wipe with paper
02
Wipe with fiber
03
Rinse with water that is in a container
04
Rinse with water that flows
05
Rinse with soap and water
06
Others, _________________________
07
________________________________
08
.
09
.
10
Route
SOURCE OF WATER
Q119a ASK ALL
What is the source of water that your household use for cooking and for drinking water during the rainy
season? [MA]
Q119b What is the source of water that your household use for cooking and for drinking water during the dry
season? [MA]
Q120
Q119a
Rainy season
(2029)
Q119b
Dry season
(2039)
River
01
01
Well
02
02
Water pump
03
03
Dew
04
04
PAM, the municipal water supplier
05
05
Others, _____________________
06
06
.
07
07
.
08
08
.
09
09
.
10
10
Does your source of water for cooking and drinking located around your house? [SA]
Code
(2049)
1
Yes
No
2
Route
Q125
Q121
ASK Q121 - Q124 IF RESPONDENTS' SOURCE OF WATER FOR DRINKING AND COOKING IS NOT IN
THEIR HOUSE/ PREMISES (CODED 1 IN Q120)
81027-PVT Private Time (1 July, 2008)
Page 37 of 63
Q121
How long does it take from your house to reach the water supply, take the water and then go back to your
house?
Distance (in Minute)
(R1)
Q122
(R1)
(2050-2052)
And who usually get the water from the water supply for your household need?[SA]
Adult Woman
Head of
Household
(2053)
Spouse
Children
Parents
Other
1
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
(2054)
(R2)
School Aged Female
1
(2055)
(R3)
Adult Man
1
(2056)
(R4)
School Aged Male
1
(2057)
(R5)
Pre School Child
1
(2058)
(R6)
Other __________________________
1
(2059)
(R7)
1
(2060)
(R8)
1
(2061)
(R9)
1
(2062)
(R10)
Q123
1
In what type of container is the water carried from your main source?[MA]
Code
(2222)
01
Gallon
Bucket
02
Drum
03
Other ______________________
04
___________________________
05
_________________________________
06
_________________________________
07
_________________________________
08
_________________________________
09
_________________________________
10
81027-PVT Private Time (1 July, 2008)
Route
Page 38 of 63
Q124
How many times in a week do you go to get the water for cooking and drinking from the water source?
Times in week
(R1)
Q125
Q126
Q127
(2232-2234)
ASK ALL
Do you have any difficulties to obtain clean water during the dry season?[SA]
Code
(2235)
Route
Yes
1
Q126
No
2
Q127
Code
(2236)
Route
ASK IF CODED 1 IN Q125
Earlier you mentioned that have difficulties in obtaining clean water during the dry
season. What actions do you undertake to overcome the water crisis during dry
season?[MA]
Store water in a container during rainy season
01
Obtain water from dew
02
Use water from the river
03
Others, _____________________________
04
____________________________________
05
____________________________________
06
None
98
Don't know
99
ASK ALL
Does your water supply that your household use for bathing and washing is the same
from your water supply for cooking and drinking? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(2246)
Route
Yes
1
Q134
No
2
Q128
Page 39 of 63
Q128a ASK IF CODED 2 IN Q127
What is the source of water that your household use for bathing and washing during the rainy season?
[MA]
Q128b What is the source of water that your household use for bathing and washing during the dry season?
[MA]
Q129
Q128a
Rainy season
(2247)
Q128b
Dry season
(2257)
River
01
01
Well
02
02
Water pump
03
03
Dew
04
04
PAM, the municipal water supplier
05
05
Others, _________________________
06
06
07
07
08
08
09
09
10
10
ASK IF CODED 2 IN Q127
Does your source of water that your household use for bathing and washing is in your
house/ premise? [SA]
Code
(2267)
Route
Yes
1
Q134
No
2
Q130
ASK Q130 - Q133 IF SOURCE OF WATER FOR BATHING AND WASHING IS NOT IN THEIR HOUSE/
PREMISE (CODED 2 IN Q129 )
Q130
(R1)
How long does it take from your house to reach the water supply, take the water and then go back to your
house?
Distance (in Minute)
81027-PVT Private Time (1 July, 2008)
(2268-2270)
Page 40 of 63
Q131
(R1)
And who usually get the water from the water supply for your household need?[SA]
Adult Woman
Head of
Household
(2271)
Spouse
Children
Parents
Other
1
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
(2272)
(R2)
School Aged Female
1
(2273)
(R3)
Adult Man
1
(2274)
(R4)
School Aged Male
1
(2275)
(R5)
Pre School Child
1
(2276)
(R6)
Other __________________________
1
(2277)
(R7)
1
(2278)
(R8)
1
(2279)
(R9)
1
(2280)
(R10)
Q132
1
In what type of container is the water carried from your main source?[MA]
Code
(2440)
01
Gallon
Bucket
02
Drum
03
Other ______________________
04
Route
05
06
07
08
09
10
Q133
How many times in a week do you go to get the water for bathing and washing from the water source?
Times in a week
(R1)
81027-PVT Private Time (1 July, 2008)
(2450-2452)
Page 41 of 63
Q134
Q135
Q136
Q137
ASK ALL
Do you have any difficulties to obtain clean water for bathing and washing during the dry
season? [SA]
Code
(2453)
Route
Yes
1
Q135
No
2
Q137
Code
(2454)
Route
ASK IF CODED 1 IN Q134
Earlier you mentioned that have difficulties in obtaining clean water during the dry
season. What actions do you undertake to overcome the water crisis during dry
season?[MA]
Store water in a container during rainy season
01
Obtain water from dew
02
Use water from the river
03
Others, _____________________________
04
____________________________________
05
____________________________________
06
____________________________________
07
____________________________________
08
____________________________________
09
____________________________________
10
ASK IF CODED 1 IN Q134
When you experience water crisis during the dry season, does it affect any of your
routine activities? If yes, can you tell me what activities are affected by the water crisis?
[MA]
Code
(2464)
Take a bath less frequently
01
Do not take a bath during the water crisis
02
Defecate in the river or the woods
03
Wash clothes in the river
04
Do not wash clothes
05
Others, ________________________
06
____________________________________
07
____________________________________
08
None
98
Don't Know
99
ASK ALL
Does your area have a water source that is enough to supply water for your toilet/ water
closet? [SA]
81027-PVT Private Time (1 July, 2008)
Code
(2474)
Yes
1
No
2
Route
Route
Page 42 of 63
KNOWLEDGE ON HEALTH
Q138
Q139
ASK ALL
Do you have a child below 5 year old in your household?[SA]
Code
(2475)
Route
Yes
1
Q139
No
2
Q141
Code
(2476)
Route
ASK IF HAVE CHILD UNDER 5 YEARS OLD
The last time your youngest child defecate, how did you dispose your child's feces? [SA]
My child defecated in the toilet/ water closet
01
Dispose my child's feces in the toilet/ water closet
02
Dispose it into the gutter
03
Dispose it into the wastebasket
04
Bury it under ground
05
Dispose it outside the house
06
Others, _____________________________
07
98
99
Q140
ASK IF HAVE CHILD UNDER 5 YEARS OLD
Why do you do that, can you explain it to me? ( ___________________ INTERVIEWER: MENTION THE
ANSWER FROM Q139 )
PROBE What other reason? What other reason?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2521-2570)
Q141a Does your under 5 y.o child got diarrhea within past 2 weeks? [SA]
Q141b Does any child within your neighbourhood got diarrhea?[SA]
Q141a
Q141b
Own children Neighbourhoo
(in the last 2
d children
weeks)
(2571)
(2572)
81027-PVT Private Time (1 July, 2008)
Yes
1
1
No
2
2
DK
3
3
Page 43 of 63
Q142
ASK ALL
According to you, what causes diarrhea? Please explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2573-2657)
Q143
In your opinion, how could you / someone prevented from diarrhea?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2658-2742)
Q144
ASK ALL
INTERVIEWERS: ASK THIS QUESTION CAREFULLY REFER TO RESPONDENT
CATEGORY (CHECK Q26 )
(Ask if coded 1 in Q26) You mention earlier that you defecated in the open, do you
think the feces might have impact to people around you?
Code
(2743)
Route
Yes
1
Q145
No
2
Q146
Don't Know
3
Q146
(Ask if coded 4 in Q26) You mention earlier that although you have toilet but the feces
will go to the open, do you think the feces might have impact to people around you?
(Ask if coded 2/3 in Q26) Some people still dispose in open, do you think the feces
might have impact to people around you? [SA]
81027-PVT Private Time (1 July, 2008)
Page 44 of 63
Q145
ASK IF RESPONDENT THINK THAT FECES WILL IMPACT ENVIRONMENT (Q144 CODE 1)
What is the impact for people around you?
PROBE What else? What else?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(2744-2828)
Q146
Has anybody or any institution explained to you about sanitation issues, defecating in
open air, and habits of clean living?[SA]
Code
(2829)
Yes
1
No
2
Route
Q147a Where did you know/ get information about sanitation issues? [MA]
Q147b Where do you hope to get more information on sanitation issues? [MA]
Q147a
Source of
information
Husband
Wife
Child
Friend that visits house
Family that visits house
At school
At work
At RT/RW meeting
Through mass media (radio & TV)
From religious leader (ustad)
From village head
From heath officer
From construction coolie
Others, _____________________
__________________________________
__________________________________
Tidak ada
Tidak tahu
81027-PVT Private Time (1 July, 2008)
(2830)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
98
99
Q147b
Expected
source of
information
(2840)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
98
99
Page 45 of 63
ACCESS
Q148
Q149
If there's a plan to build toilet/ water closet for your household, Who will be the decision
maker for the building process ?[SA]
Code
(2850)
Myself
01
Spouse
02
My children
03
Me with my spouse
04
All of the family member
05
Other _______________________
06
If you decided to build a toilet for your household, who will build the toilet?[SA]
Code
(2860)
01
Myself
Spouse
02
My Children
03
Building Coolie
04
Other ___________________
05
Route
Route
Q150a Are there masons who specialized in building the whole component of the toilet within the neighborhood?
[SA]
Q150b Is there any building material shop within the neighborhood which provide the material for building the
toilet? [SA]
Q150a
Mason
availability
(2870)
Q150b
Material shop
availability
(2871)
Yes
1
1
No
2
2
Don't Know
3
3
Q151a Do you think you have adequate land within your household to build the toilet? [SA]
Q151b Do you think that the neighbourhood have an adequate water supply for any toilet related activity (anal
cleansing and pour flush) ? [SA]
Q151a
Adequate land
81027-PVT Private Time (1 July, 2008)
(2872)
Q151b
Adequate
water
(2873)
Yes
1
1
No
2
2
Page 46 of 63
Q152a If you decide to build a toilet/ water closet, who will decide the type of the middle structure of the latrine
such as the type of the slab and the material of the slab? [MA]
Q152b And who will decide the type of the sub structure of the latrine such as the type of the hole, the wall for the
hole and others related to feces disposal? [MA]
Q153
Q154
(R1)
Q155
Q152a
Middle
Structure
(2874)
Q152b
Sub Structure
Myself
01
01
My spouse
02
02
My child
03
03
Both with my spouse
04
04
Building coolie
05
05
Others _____________________
06
06
(2919)
SHOWCARD
Code
How is the selling price given by the building material, spare part and toilet supply in your (2929)
area? [SA]
Very expensive
1
Expensive
2
Neither expensive nor reasonable
3
Reasonable
4
Very reasonable
5
Don't Know
6
Route
In your opinion, how much is the minimum total cost for building a latrine for your household in this
neighbourhood?
Minimum Cost
(2930-2933)
SHOWCARD
How is the product quality offered by the supplier for building material, spare part and
toilet in your area?[SA]
81027-PVT Private Time (1 July, 2008)
Code
(2934)
Unacceptable
1
Fair
2
Acceptable
3
Route
Page 47 of 63
Q156
Where do you know about the best type of toilet/ water closet for your household?[MA]
Code
(2935)
01
Neighbor
Relative
02
Building coolie
03
Health officer
04
Others, ______________________
05
__________________________
06
__________________________
07
None
98
Don't Know
99
Route
HYGIENE PRACTICE
ASK THIS SECTION TO RESPONDENTS WHO HAVE UNDER 5 y.o CHILD
Q157
In your opinion, if your child get sick, could it be caused by the drinking water? [SA]
Code
(2945)
1
Yes
No
Q158
ASK IF CHILD ILLNESS COULD BE CAUSED BY DRINKING WATER (CODED IN
Q157 )
What illness/ disease that caused by the drinking water?
Route
Q158
2
Q159
Code
(2946)
Route
INTERVIEWER: Do not read answers, circle all the respondents answer. [MA]
PROBE What else? What else?
Q159
Diarrhea
01
Cholera
02
Thypoid
03
Influenza
04
Cough
05
Other (Specify ____________________ )
06
_________________________________
07
_________________________________
08
_________________________________
09
Tidak ada
98
Tidak tahu
99
In your opinion, if your child get sick, could it be caused by not washing hands?[SA]
Code
(2956)
1
Yes
No
81027-PVT Private Time (1 July, 2008)
2
Route
Q160
Q161
Page 48 of 63
Q160
ASK IF CHILD DISEASE CAUSED BY NOT WASHING HANDS (CODED 1 IN Q159 )
What illness/ disease that caused by not washing hands?
Code
(2957)
Route
INTERVIEWER: Do not read answers, circle all respondent answers.[MA]
PROBE What else? What else?
Q161
Diarrhea
01
Cholera
02
Thypoid
03
Influenza
04
Cough
05
Other (Specify ____________________ )
06
_________________________________
07
_________________________________
08
_________________________________
09
Tidak ada
98
Tidak tahu
99
What can you do to prevent your child from diarrhea?
Code
(2967)
Route
INTERVIEWER: Do not read answers, circle all respondents answers.
[MA]
PROBE What else? What else?
Cook the water first before drinking
01
Drink water containing chlorine
02
Use other way/ certain way to clean the water
03
Clean the house
04
Clean the neighbourhood
05
Defecating in toilet
06
Wash hands with soap
07
Wash the fruits/ vegetables
08
Prepare a well cooked food
09
Other (Specify ________________________ )
10
_____________________________________
11
_____________________________________
12
_____________________________________
13
Tidak ada
98
Tidak tahu
99
81027-PVT Private Time (1 July, 2008)
Page 49 of 63
Q162
In your opinion, could diarrhea be the caused of under 5 y.o. child death?[SA]
Code
(2977)
1
Yes
No
Route
2
IMAGERY QUESTION
Q163a READ DAN ROTATE STATEMENT
I will read you several statements. Please give a value according to the best condition you know/ see in
your surroundings, where 1 means STRONGLY DISAGREE and a score of 5 means STRONGLY AGREE.
You are free to give an assessment, there is no right or wrong answer. [SA]
Disagree
Q163a
Neither
disagree
or agree
Agree
Strongly
Agree
(2978)
1
2
3
4
5
(2979)
1
2
3
4
5
(2980)
1
2
3
4
5
(3016)
1
2
3
4
5
(3017)
1
2
3
4
5
(3018)
1
2
3
4
5
(3019)
1
2
3
4
5
(3020)
1
2
3
4
5
(3021)
1
2
3
4
5
(3022)
1
2
3
4
5
(3023)
1
2
3
4
5
(3024)
1
2
3
4
5
Strongly
Disagree
(R1)
(SC) It is very easy to get emptying service
within my neighbourhood
(R2)
(F) Having my own toilet/ water closet facility
will avoid my family as the subject of gossip
(R3)
(B) Those who defecate in the open have
certain disadvantages, such as parts of the
body can be seen by others
(R4)
(E) A toilet/ water closet facility will make a
village resident much better because they will
not pollute the environment
(R5)
(B) Those who defecate in the river becomes
vulnerable towards disease because of the
contaminated water in the river
(SC) I know a person who had a skill in deciding
(R6)
where to site a latrine
(R7)
(S) Majority of those I know usually defecate in
the toilet/ water closet
(B) Those who defecate in the open pollute the
(R8)
environment
(R9)
(B) Those who defecate in the river can be in
danger, e.g. carried by the current
(E) Having a toilet/ water closet facility at homes
(R10)
means giving the best for the family
(S) If our grandfathers/ parents/ ancestors
(R11) defecated in the open, then it is OK for us today
(SC) Most the emptying service that I am aware
(R12) of have an adequate facility and skill to do their
81027-PVT Private Time (1 July, 2008)
Page 50 of 63
Disagree
Q163a
Neither
disagree
or agree
Agree
Strongly
Agree
(3025)
1
2
3
4
5
(3026)
1
2
3
4
5
(3027)
1
2
3
4
5
(3028)
1
2
3
4
5
(3029)
1
2
3
4
5
(3030)
1
2
3
4
5
2
3
4
5
2
3
4
5
(3033)
1
2
3
4
5
(3034)
1
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
(3038)
1
2
3
4
5
(3039)
1
2
3
4
5
(3040)
1
2
3
4
5
(3041)
1
2
3
4
5
(3042)
1
2
3
4
5
Strongly
Disagree
job
(R13)
(E) Having a toilet/ water closet facility will raise
our status by being a modern family
(R14)
(B) River is an ideal location to defecate
because there is water current
(E) Having a toilet/ water closet facility will make
(R15)
defecating process more pleasant
(R16)
(S) Defecating in the river is common and
acceptable because feces will be eaten by the
fish
(R17)
(F) Having my own toilet/ water closet facility
will bring comfort to me/ my family
(E) Having a toilet/ water closet facility will raise
our status in the community by being an
(R18)
educated family
(R19)
(S) It is not civilized to defecate in the open
(R20)
(F) Having my own toilet/ water closet facility
will add value to my house
(R21)
(SC) I know a person who is very good in
building a latrine sub-structure
(R22)
(S) Those who defecate in open air are very
dirty people
(R23)
(S) It is not acceptable to defecate in the open
(R24)
(SC) I control my own destiny (internal)
(F) Having my own toilet/ water closet facility
will prevent me/ my family from disease such as
(R25)
diarrhea
(R26)
(B) Water that flows in the river can clean dirt
after defecating in the river
(R27)
(S) Defecating in the river is common, and
everybody is doing so
(R28)
(S) Defecating in the open will not endanger
others
(R29)
(SC) One should not empty latrines into public
spaces
(R30)
(F) Having my own toilet/ water closet facility
(3031)
1
(3032)
1
(3035)
1
(3036)
1
(3037)
1
81027-PVT Private Time (1 July, 2008)
Page 51 of 63
Disagree
Q163a
Neither
disagree
or agree
Agree
Strongly
Agree
(3043)
1
2
3
4
5
(3044)
1
2
3
4
5
(3045)
1
2
3
4
5
(3046)
1
2
3
4
5
(3047)
1
2
3
4
5
(3048)
1
2
3
4
5
(3049)
1
2
3
4
5
(3050)
1
2
3
4
5
(3051)
1
2
3
4
5
(3052)
1
2
3
4
5
(3053)
1
2
3
4
5
(3054)
1
2
3
4
5
(3055)
1
2
3
4
5
Strongly
Disagree
will allow me to protect my family
(R31)
(S) It is acceptable for young children to
defecate in the open.
(R32)
(S) Those who defecate in open air will
endanger the community they live in
(R33)
(F) Having my own toilet/ water closet facility
will bring personal discretion to me/ my family
(R34)
(B) Defecating in the open is very
uncomfortable because you can catch the rain
(R35)
(S) It is acceptable to defecate in the open if
you can not access a toilet
(R36)
(B) Open air (river/ bushes/ woods) is a place to
comfortably defecate
(R37)
(F) Having my own toilet/ water closet allows
me to be a better host to guests
(F) Having my own toilet/ water closet facility
(R38) will make my house become more comfortable
(R39)
(SC) It is very important that every house must
have a latrine
(R40)
(S) Those who defecate in open air will not be
accepted in the community they live in
(SC) A good latrine must have a hand washing
(R41)
station nearby
(R42)
(E) A toilet/ water closet facility will raise family's
pride, e.g. when guests visit
(R43)
(B) Those who defecate in the open can be in
danger, e.g. attacked or bit by animals
81027-PVT Private Time (1 July, 2008)
Page 52 of 63
TANYAKAN KEPADA OPEN DEFECATOR, SHARER, OWNER UNIMPROVED (TERKODE 1 ATAU 2 ATAU 4
DI Q26)
INTERVIEWER: Berikan setiap PHOTOCARD beserta dengan SHOWCARD skala, beri nilai untuk setiap nilai
keinginan responden pada setiap kombinasi pada PHOTOCARD.
Q164a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26)
SHOWCARD AND PHOTOCARD
Here I have several photocard describing about combinations of toilet and its septic tank. In every
Photocard, there's a price to buy the material and cost for the mason. Please give your score about how
much you want the toilet for your household, septic tank with the consideration about the price. You can
give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your
household. [SA]
(R1)
Photocard 1
(R2)
Photocard 2
(R3)
Photocard 3
(R4)
Photocard 4
(R5)
Photocard 5
(R6)
Photocard 6
(R7)
Photocard 7
(R8)
Photocard 8
(R9)
Photocard 9
(R10)
Photocard 10
(R11)
Photocard 11
(R12)
Photocard 12
(R13)
Photocard 13
(R14)
Photocard 14
(R15)
Photocard 15
(R16)
Photocard 16
Don't
have
willing
ness
at all
(3056)
01
(3057)
01
(3058)
01
(3059)
01
(3060)
01
(3061)
01
(3062)
01
(3063)
01
(3064)
01
(3065)
01
(3066)
01
(3067)
01
(3068)
01
(3069)
01
(3070)
01
(3071)
01
2
3
4
Q164a
5
6
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
81027-PVT Private Time (1 July, 2008)
7
8
9
10 Really
have
willingne
ss
Page 53 of 63
Q165a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26)
SHOWCARD AND PHOTOCARD
Here I have other several photocard describing about combinations of toilet and its septic tank. In every
Photocard, there's a price to buy the material and cost for the mason. Please give your score about how
much you want the toilet for your household, septic tank with the consideration about the price. You can
give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your
household. [SA]
Q165a
(R1)
Photocard 1
1Don't
have
willing
ness
at all
(3072)
2
3
4
5
6
7
8
9
10 Really
have
willingne
ss
01
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
02
03
04
05
06
07
08
09
10
(3073)
(R2)
Photocard 2
01
(3074)
(R3)
Photocard 3
01
(3075)
(R4)
Photocard 4
01
(3076)
(R5)
Photocard 5
01
(3077)
(R6)
Photocard 6
01
(3078)
(R7)
Photocard 7
01
(3079)
(R8)
Photocard 8
01
(3080)
(R9)
Photocard 9
01
81027-PVT Private Time (1 July, 2008)
Page 54 of 63
MEDIA EXPOSURE & COMMUNICATION CHANNEL
Q166
Q167
TANYAKAN SEMUA
Do you like to listen to Radio?[SA]
Code
(3116)
Route
Yes
1
Q167
No
2
Q169
Code
(3117)
Route
ASK IF CODED 1 IN Q166
What time do you usually listen to the radio most often?[MA]
05.00 - 05.59 am
01
06.00 - 07.59 am
02
08.00 - 10.59 am
03
11.00 - 12.59 am
04
01.00 - 02.59 pm
05
03.00 - 04.59 pm
06
05.00 - 05.59 pm
07
06.00 - 06.59 pm
08
07.00 - 08.59 pm
09
09.00 - 09.59 pm
10
10.00 - 10.59 pm
11
11.00 - 11.59 pm
12
12.00 - 01.59 am
13
02.00 - 03.59 am
14
Q168a What is the name of the radio station you have ever listened to?[MA]
Q168b Name of radio station most often listened to?[SA]
.
.
.
.
.
.
.
.
.
.
81027-PVT Private Time (1 July, 2008)
Q168a
Q168b
Ever listened Most listened
to
to
(3119)
(3129)
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
99
99
Page 55 of 63
Q169
Do you like to watch Television? [SA]
Code
(3139)
1
Yes
No
Q170
ASK IF CODED 1 IN Q169
What time do you usually watch TV most often? [MA]
05.00 - 05.59 am
06.00 - 07.59 am
08.00 - 10.59 am
11.00 - 12.59 am
01.00 - 02.59 pm
03.00 - 04.59 pm
05.00 - 05.59 pm
06.00 - 06.59 pm
07.00 - 08.59 pm
09.00 - 09.59 pm
10.00 - 10.59 pm
11.00 - 11.59 pm
12.00 - 01.59 am
02.00 - 03.59 am
Route
Q170
2
Q172
Code
(3140)
Route
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Q171a What is the name of the TV station you have ever watched?[MA]
Q171b Name of TV station most often watched?[SA]
TVRI
RCTI
SCTV
TPI
Trans TV
Global TV
Trans 7
Indosiar
TV One
ANTV
Lativi
Metro TV
JTV
Space Toon
Deli TV
TV Borobudur/ TV B
Makassar TV
O Channel
STV
Other, specify ____________________________
____________________________
____________________________
Tidak Ada
Tidak Tahu
81027-PVT Private Time (1 July, 2008)
Q171a
Q171b
Ever watched Watched most
often
(3142)
(3152)
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
98
98
99
99
Page 56 of 63
Q172a What is the name of the newspaper you have ever read?[MA]
Q172b Name of newspaper that you read most often?[SA]
Q172a
Ever read
(3162)
Q172b
Most often
read
(3172)
Agrobur
01
01
Analisa
02
02
Banjarmasin Post
03
03
Berita Kota
04
04
Berita Kota Makasar ( BKM)
05
05
bina baru
06
06
Bisnis Indonesia
07
07
B'Post
08
08
Fajar
09
09
Galamedia
10
10
Jawa Pos
11
11
Kompas
12
12
Koran Pendidikan
13
13
Koran Tempo
14
14
Lampu Merah
15
15
Medan Pos
16
16
Media Indonesia
17
17
Merdeka
18
18
Meteor
19
19
Metro Bandung
20
20
Metro Banjar
21
21
Momerandum
22
22
Pedoman Rakyat
23
23
Pikiran Rakyat
24
24
Pos Kota
25
25
Pos Metro
26
26
Pos metro Medan
27
27
Radar Banjarmasin
28
28
Radar Surabaya
29
29
Republika
30
30
Seputar Indonesia
31
31
Serambi
32
32
81027-PVT Private Time (1 July, 2008)
Page 57 of 63
Q172a
Ever read
Sinar Indonesia Baru
33
Q172b
Most often
read
33
Suara Karya
34
34
Suara Merdeka
35
35
Suara Pembaruan
36
36
Sumut Pos
37
37
Surya
38
38
Terbit
39
39
Top Score
40
40
Tribun Jabar
41
41
Tribun Timur
42
42
Ujung Pandang Expres
43
43
Warta Kota
44
44
Waspada
45
45
Wawasan
46
46
Other, ___________________________
47
47
___________________________________
48
48
None
98
98
Don't Know
99
99
81027-PVT Private Time (1 July, 2008)
Page 58 of 63
PRODUCT RANGE ASSESSMENT
Q173
ASK ALL
SHOWCARD
Of all the durables listed below, which ones does your household own? [MA]
PROBE What else? What else?
Code
(3217)
Black & White TV
01
Colour TV
02
Bicycle
03
Motorcycle
04
Car
05
Livestock
06
VCD/ DVD Player
07
Radio
08
Radio Cassette
09
AC
10
Camera
11
Video Camera
12
Washing Machine
13
Credit Card
14
Computer
15
Microwave/ Oven
16
Handphone
17
Home Phone
18
Internet
19
Electric Fan
20
Electric Water Pump
21
Mixer/ Blender
22
Rice Cooker
23
Magic Jar
24
Refrigerator
25
Gas Stove
26
Kerosene Stove
27
Route
INTERVIEW FINISHED. SAY THANK YOU TO RESPONDENTS
81027-PVT Private Time (1 July, 2008)
Page 59 of 63
Q174
Q175
Q176
Quality Control done by : [MA]
Code
(3220)
1
Coordinator/RFM/FE
3
Quality Controller
4
Checker
5
Witnessed
1
Recalled
2
Slip collected
3
Checked on the spot
4
Telephone
5
Checked Questionnaire
6
Route
Start
Start
(3222-3225)
Finish
(3226-3229)
DATE/MONTH
(3230-3233)
Finish
Date/month of interview
(R1)
Q179
Team Leader
Code
(3221)
(R1)
Q178
2
Quality Control, action taken :
[SA]
(R1)
Q177
Supervisor
Route
Day of interviewing [SA]
81027-PVT Private Time (1 July, 2008)
Code
(3234)
1
Monday
Tuesday
2
Wednesday
3
Thursday
4
Friday
5
Saturday
6
Sunday
7
Route
Page 60 of 63
Q180
INTERVIEWER :
Code
(3235)
Route
ASK YOUR SUPERVISOR TO FILL THIS CODE
PSU [SA]
ORIGINAL
1
SUBSTITUTE
2
ADDITIONAL
3
Q181a Filled by Supervisor/ Leader/ Quality Control
Witnessed/ Recalled [MA]
Q181b Spv/ Leader/ QC Number
Q181a
Q181b
QC that has
been done
(3236)
4 Digits
(3237-3240)
1
____
Witness
(R1)
(3241-3244)
Recall
(R2)
2
____
(3245-3248)
Slip
(R3)
3
____
(3249-3252)
On the spot
(R4)
4
____
(3253-3256)
Check
(R5)
Q182
5
____
FILLED IN BY CODERS/SPV/LEADER
TYPE OF MISTAKES [MA]
Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Type 8 Type 9 Type
10
(3257)
Mistakes
(R1)
Q183
02
03
04
05
06
07
08
09
10
No PSU
No PSU
(R1)
Q184
01
Method[SA]
(3258-3263)
Code
(3264)
1
Random PSU
Substitute
81027-PVT Private Time (1 July, 2008)
Route
2
Page 61 of 63
Q185
Coders
(R1)
(R2)
R1
(3265-3267)
R2
(3268-3270)
Q186
Coder [SA]
Code
(3271)
1
.
Route
Q187
coders [MA]
Code
(3272)
1
.
Route
Q188
.
2
.
3
.
4
.
5
.
6
.
7
.
8
Interviewer Number
Interviewer No.
(R1)
(3277-3317)
"Herewith I declare that the interview done and recorded by me today, is correct and with accurate data, according
to survey methods, given instructions, and to ESOMAR standard."
Interviewer :
Date of interview :
time :
FIELD :
THIS PAGE SHOULD BE COPIED SEPARATELY
CODERS/DATA ENTRY :
AFTER FINISH CODED AND ENTRY, THIS PAGE SHOULD BE SEPARATED
Q189
Would you like to participate in our future survey?[SA]
Code
(3318)
1
Yes
No
Q190
Do you have a phone number?[SA]
Code
(3319)
1
Yes
No
81027-PVT Private Time (1 July, 2008)
2
2
Route
Q190
CLOSE
Route
Q192
Page 62 of 63
Q191a Ingatkan Responden bahwa semua data akan digunakan secara rahasia dan bukan untuk komersil
RECORD : Respondent's Phone number
Area code
Q191b Phone no.
Q191a
Q191b
Area code
Phone no.
(3320-3323)
(3324-3333)
____
________
__
.
(R1)
Q192
Code
(3334)
1
Yes
Do you have a personal cell phone?[SA]
No
Q193
(R1)
(R2)
Q194
Q193
Q194
2
HP no.
Cellular Number
(3335-3346)
Cellular Number
(3347-3358)
Code
(3359)
1
Yes
Do you have a personal e-mail address?[MA]
No
Q195
Route
2
Route
Q195
Q196
Would you please tell me your personal email address that you access most often?
RECORD : Respondent's e-mail address (if any)
Only most often used address
(R1)
Q196
Name
(3360-3363)
Name
(3419-3422)
What is your full name?
RECORD : Respondent's Name
(R1)
81027-PVT Private Time (1 July, 2008)
Page 63 of 63

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