Appendix 1. Sampling Procedures

Evaluation of the Green Path Campaign

Appendix 1. Sampling Procedures.

Discussion In general, the goal of the sampling procedure was to select women for inclusion such that it would provide a representative cross-section of the target population within the marz (region). Methodological concerns include selection criteria that might result in a biased selection of women such that their use/knowledge of family planning methods is different (higher or lower) than the target population or selects them from specific socio- demographic groups. Logistical considerations include the efficient use of limited personnel resources; limited time for implementation, and the availability of the required information/resources to carry out the process. Thus the two primary factors driving the decision for an acceptable sampling strategy are the methodological rigor and the feasibility/cost of implementation.

The methods used must assure sufficient sample size for detecting urban/rural differences, and differences among regions receiving the supplemental campaigns from those receiving only the national campaign. Sufficient numbers were sampled so as to allow for those declining to participate in the study, those selected but disqualified, and those lost to follow-up over the duration of the study.

In terms of sampling strategy, three basic approaches were considered: multi-stage cluster sampling (probability proportional to size/PPS), random digit dialing, and random household selection. After an assessment of the extant data underlying each of the approaches and reviewing methods used for similar rigorous studies in the country immediately prior to this project, cluster sampling was selected.

Cluster Sampling Cluster sampling is an efficient use of resources of particular utility when viable sampling frames for simple random sampling (SRS) are not available. Such is the case in Armenia where the population has undergone tremendous transition in recent years, including large-scale migration/emigration, further complicated by the renaming of

AUA Center for Health Services Research Evaluation of the Green Path Campaign streets and addresses at the time of independence, and the destruction of several towns and villages due to an earthquake in 1988.

Two extant data sources, both presumed to be equitably distributed throughout the population in question and thus suitable for use in selecting clusters, are medical rosters and administrative rosters. With the collapse of the Soviet Union and consequently the Armenian economy, the medical system remains largely in disarray. While adults may forgo medical treatment, the pediatric component of the medical system remains the most viable. Its rosters of children have been used as the basis for cluster sampling in the past with good success.

The administrative district roster, in theory, offers an advantage that it is geographically based. Each district headquarters has a record of each address (household) within the administrative district. This could provide a non-biased and non-medically influenced selection of households. The reality is, however, that these records are poorly maintained, are incomplete, and have not been updated to reflect the changes in street/village names or the destruction of some towns/ villages. This introduces unknown and potentially systematic biases in selection, which cannot be adjusted for. Therefore, this promising approach is not as desirable as the clinic rosters.

In opting to use the pediatric clinic rosters, the potential bias toward the selection of households forgoing family planning must be addressed. The very fact that the household has a child may imply a set of family planning practices different from the general population. Thus, selecting a household for inclusion in every cluster on this basis would bias the sample with respect to a key outcome of interest - family planning practices. To assure that the cluster selection criteria do not preferentially select for or against users of family planning methods, the cluster starting point was offset an Nth unit away from the address randomly selected from the children’s roster. The methodology still permitted the referent household to be included in the sample through the procedures for completing the cluster without introducing a bias or counter-bias with respect to the presence of young children in the home.

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In addition, the typical cluster sampling procedure of selecting adjacent households was further modified to assure that proximal households were not included as the literature clearly shows that neighbors can influence each other's use of health care and this may include family planning choices. The process used reflects a cluster sampling methodology that attempts to more closely mimic a simple random sample design by increasing the catchment area of the cluster. This approach presumably increasing the within-cluster heterogeneity and preserves the power of the sample size.

Random Digit Dialing Random Digit Dialing (RDD) has been used in Yerevan with limited success. The poor condition of the phone system (such that it can be difficult to call/connect to certain parts/districts of the city where the phone system is extremely poor) as well as the socioeconomic bias introduced by selecting for the presence of a phone introduce significant biases of concern for this study. Furthermore, this strategy is not feasible for the outlying regions where access to phone service is even more limited. It would not be prudent to mix sampling methodologies between Yerevan and the regions without some understanding of the differing biases that might be introduced. Additionally, RDD selection for a survey that requires a face-to-face interview would add a significant unnecessary administrative burden.

Random Selection While the gold standard for selection, simple random selection (SRS) is virtually impossible in Armenia, as no viable, unbiased, complete sampling frames currently exist. Attempts at approaching this ideal would be extremely costly and time consuming with little appreciable gain in analytic power over the PPS cluster sampling.

Sample size

The use of PPS sampling in this case is based on several assumptions. 1. Patterns of emigration are uniform across Armenia. 2. A cluster size of 6 coupled with skipping adjacent households effectively minimizes heterogeneity bias.

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3. The population is uniformly distributed across geographic areas with respect to key socio-demographic variables.

Extant data and prior research indicate that these assumptions are reasonable for Armenia at this time.

The sample size of 1212 is comparable to similar studies and supported by simple sample size calculations (5), which indicate a minimum of 200 observations for each comparison unit [n= 2z2pq/d2 where z = 1.96, p=0.4 (based on prior research and erring toward a more conservative sample size estimate), q = 0.6, and d = 0.1 (minimal practically significant difference to detect)]. The methods used assured sufficient sample size for detecting urban/rural differences, and differences among regions receiving the supplemental campaigns from those receiving only the national campaign. Sufficient numbers were sampled so as to allow for those declining to participate in the study, those selected but disqualified, and those lost to follow-up over the duration of the study.

Sampling Procedures Preparatory Phase For this study, the cluster size was set at 6. This is a reasonably small cluster size (minimizes homogeneity bias) and represents the total number of interviews expected from one interviewer per full day.

1. For each region (city in the case of Yerevan), a list of all pediatric polyclinics (or equivalent) was compiled. The population served by each Polyclinic was tabulated in an ordered manner. A random starting point was selected and then cluster starting points systematically drawn from the ordered list (presented later in this Appendix). The number of clusters to be drawn form each policlinic was influenced by the size of the population served by the clinic. Thus, some polyclinics had more cluster starting points than others. Similarly, starting points near the geographic boundary of a polyclinic catchment area, could lead to a cluster drawn from households residing in several polyclinic catchment areas.

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2. When visiting the polyclinic for its records, those clinics selected more than once had that many of its districts randomly sampled. As districts (physician/nurse team) usually serve similar sized populations, the listing of districts were randomly selected in lieu of the more intensive process of weighted sampling described for the selection of polyclinics.

3. For each selected district, a random address was selected from the roster using a random number generator and the number of addresses in the roster. For purposes of this study, the roster of registered births for 1997 was used.

4. A list of the 84 cluster starting points was produced for Yerevan. A similar process was used to sample from the intervention regions (Lori & Vayots Dzor). Here, the organization was slightly different, with 2-6 shrjans (districts) in each region. Identification of the cities/regional centers/villages to be selected within each of these marzes was performed as the first level of selection. After that, the number of the clusters that should be taken from each city/regional center/village within the shrjan, based on the population, was enumerated. Smaller towns and villages did not have a polyclinic, but a smaller, comparable unit such as an ambulatory clinic or a FAP (see Table 1 in this Appendix).

5. A database of the starting addresses was created to facilitate administration of the survey.

Implementation Phase The interviewer proceeded to the cluster start address and then counted off the offset (5 houses/units to the right/up). The interviewers were working individually and were completing 6 surveys within the cluster following the protocol below.

1. If there was at least on eligible, willing respondent at the address, the interviewers completed the survey.

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2. Once a survey was completed or if the household yielded no respondents, the next household was selected as follows:

Direction of movement: Direction of movement for the cluster was decided by a coin toss (heads = right/up, tails = left/down). Magnitude of Movement: Last household resulted in: • Completed survey: skip 5 doors • Non-respondent/unwilling respondent: next household in the direction chosen by a coin toss. 3. Repeat the previous steps until a total of six households were surveyed in the cluster

Notes 1) If there were more than one eligible woman in the household, the interviewers had to make a random choice with help of the selection of the respondent table (see below) 2) In the absence of other eligible respondents in the household, incomplete interviews were considered equivalent to non-respondents and the next household was attempted. 2) In the absence of other eligible respondents in the household, for those interviews where it became clear during the interview that the respondent was incorrectly ruled as eligible and should have been excluded, the household was considered a non-respondent and the next household attempted. 3) If other eligible respondents were in the household of situations 1 or 2 above, selection from among the remaining respondents was attempted (as described in selection criteria) before declaring the household a non- respondent.

This technique of selection was slightly modified for rural villages where only 1 cluster was taken. In such cases because of organizational factors and in order to make the

AUA Center for Health Services Research Evaluation of the Green Path Campaign selection process well organized and less time-consuming, the interviewers worked in teams of two, each of them conducting three interviews in the cluster. For these cases the interviewers each moved in opposite directions from the referent address.

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Selection of Respondent

1. How many women between the ages of 18 and 35 live in this flat/house? __ __ females

2. For each of these women could you give me the following information:

LIST FROM OLDEST TO YOUNGEST

Line First name Age Marital status

1 ______2 ______3 ______4 ______5 ______6 ______

Codes: 1 Married - Registered 2 Married - Unregistered 3 Married (Registered or unregistered) but living apart for more than 30 days 4 Divorced 5 Widowed 6 Single (Never married)

SELECTION OF INDIVIDUAL RESPONDENT: (Exclude women who are in Marital status categories 3-6)

LAST DIGIT OF THE VISIT NUMBER IN THE CLUSTER Eligible Respondents 0 1 2 3 4 5 6 7 8 9

2 1 2 1 2 1 2 1 2 1 2 3 3 1 2 3 1 2 3 1 2 3 4 3 4 1 2 3 4 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 6 6 1 2 3 4 5 6 1 2 3

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2.4 Human Subjects: All participants were provided with and had explained to them a notice approved by the Human Subject Review committees of both the AUA and JHU outlining the purpose of the study, the uses of the data, and their right to choose not to participate. This notice was accompanied by endorsement letters/letters of introduction from the Ministry of Health and the AUA. As identifying information was needed in order to link pre and post intervention data, an explanation of the safeguards used to protect identities was included. The verbal consent form in English as approved by the relevant committees and its translation into Armenian and Russian is presented below.

VERBAL CONSENT FORM

Evaluation of IEC Impact under the Family Health Campaign Project, Armenia, 2000

Good Morning/afternoon/evening. My name is . Thank you for taking the time to talk with me. The American University of Armenia is conducting this study on behalf of the Ministry of Health. This study will address the knowledge of, attitudes about, and practices of family planning. Your responses will help support new programs for women’s health, so please be as truthful and complete as possible. This is not an exam or a test. The interview will last about 30 to 45 minutes.

In about six months, you may be visited again to talk about these issues and to see how you feel then. Any information you provide will remain anonymous. Your participation in this study is voluntary. Nothing will happen to you if you do not participate in the survey. You can stop whenever you want. Your responses will remain confidential and will not be available to anyone other than University’s research team.

You will be given a card with contact information for the research team. If you have any questions or problems please feel free to contact the office.

May I continue?

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Tables 1. Cluster sampling for Yerevan Yerevan Children Policlynics #chld (0-14) # of clusters "Manuk" CP 10964 3 Emerg.3 CP 21230 6 4th CP 11568 3 "Arabkir" CP 21838 6 1st CP 10760 3 2nd CP 23944 6 3rd CP 16123 5 4th CP 28823 7 5th CP 28806 8 6th CP 17590 5 7th CP 11220 3 8th CP 22980 6 9th CP 17061 5 5th pol.'s CD 4086 1 8th pol.'s CD 11910 3 17th pol.'s CD 10026 3 18th pol.'s CD 8845 2 20th pol.'s CD 11674 3 21st pol.'s CD 2950 1 22nd pol.'s CD 10110 3 23rd pol.'s CD 2794 1 Sari Taghi CP 5073 1 Total 310375 84

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2. Cluster sampling for regions Lory/Vayots Dzor Marz/areas #of clusters # of policlinics/HC LORI Vanadsor 32 5 Arjut 1 1 Gugark 1 1 Debet 1 1 Margahovit 1 1 Shahumian 1 1 SPITAK/ Spitak 4 1 Arevashogh 1 1 Lernatsk 1 1 Katnajur 1 1 Mets Parni 1 1 Jrashen 1 1 Saramej 1 1 TASHIR/Tashir 2 1 Artsni 1 1 Medovka 1 1 Metsavan 1 1 Norashen 1 1 Sarchapet 1 1 TUMANYAN/ Alaverdi 4 1 Akhtala 1 1 Shamlugh 1 1 Akor 1 1 Katchatchakut 1 1 Pokr Airum 1 1 Jiliza 1 1 Odzun 1 1 STEPANAVAN 7 1 Vayots Dzor YEGHEGNADZOR/ Yeghegnadzor 2 1 Areni 1 1 Getap 1 1 Yelpin 1 1 Malishka 1 1 Chiva 1 1 VAYK/ Jermuk 2 1 Vayk 2 1 Zaritap 1 1

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Sampling in Vanadzor # of Vanadsor CP-s Total # of children clusters

#1 Pol.'s CD 5470 5 #2 Pol.'s CD 6597 7 #3 CP 9166 8 #4 CP 5420 5 #5 Pol.'s CD 6339 7 Total 32992 32

Armavir # of Armavir clusters Armavir 5 Metzamor 1 Aygeshat 1 Armavir 1 Getashen 1 Lenukhi 1 Hatsik 1 Margara 1 Nalbandian 1 Janfida 1 Pshatavan 1 Ejmiatsin 7 Aghavnatun 1 Aragats 1 Artimed 1 Griboedov 1 Tsaqghkalanj 1 Merdzavan 1 Norakert 1 Jrarat 1 Parakar 1 Bagaran 1 Lernagog 1 Qarakert 1 Total 34

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APPENDIX 2. SURVEY INSTRUMENTS

APPENDIX 2A BASELINE QUESTIONNAIRE ID NUMBER* ______

INTERVIEWER’S NAME ______

Identification / Location Information

A. Region ______

B. District ______

C. City / Town / Village ______

D. Address ______

E. Respondent’s name ______

F. Respondent’s age ______

G. Phone number ______

*The coding for ID number:

Digit 1 Response status (1 = completed survey, 0 = incomplete) Digit 2 Region code (1 =Yerevan, 2 = Lori, 3 = Vayots Dzor, 4 = Armavir) Digit 3-4 Cluster number Digit 5-6 Visit number (number of attempted household/person in a cluster) Note: Use Journal form for writing this number

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TIME STARTED: __ __: __ __ ID NUMBER ______

Background characteristics

100. In what month and year were you born? Month __ __ Year 19__ __

101. How old are you? __ __ years old

IF AGE AND DATE OF BIRTH DO NOT CORRESPOND, FIND OUT WHY NOT AND RECONCILE Q100 AND Q101. MAKE SURE THAT RESPONDENT IS BETWEEN 18 AND 35 YEARS OF AGE.

102. Are you currently married, living with a man as if married (unregistered marriage), separated, divorced, widowed, or single?

1 Married 2 In unregistered marriage 3 Married (registered or unregistered) but living apart (for at least 30 days) Thank respondent for her time. Check for 4 Divorced another respondent 5 Widowed in same household 6 Single and begin again

103. What is the highest level of education you completed, not counting the current grade you are in?

1. School (less than 10 years) 2. School (10 years) 3. Professional technical education (10 – 13 years) 4. Institute / University 5. Postgraduate

104. What is the highest level of education that your husband/partner completed, not counting the current grade he is in? (NI: current one)

1. School (less than 10 years) 2. School (10 years) 3. Professional technical education (10 – 13 years) 4. Institute / University 5. Postgraduate 88. Don’t know/don’t remember

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NI: SHOW THE LOGOS TO THE RESPONDENT

LOGO 105. (Spontaneous recall) 106. What does it mean? RECORD 107. Where # Have you ever seen these THE ANSWER FOR EACH primarily have you logos? (DO NOT PROMPT, RECOGNIZED LOGO seen it? (See codes CIRCLE YES OR NO FOR below) EACH LOGO) 1 1 Yes ------2 No --> Q200 ______2 1 Yes ______------2 No --> Q200 3 1 Yes ______------2 No --> Q200 4 1 Yes ______------2 No --> Q200

Codes for Q107

1. Pharmacy 2. Gynecological/Family Planning cabinet 3. Policlinic/Hospital (other than gynecological/family planning cabinet) 4. Armenian TV channel 5. Russia/Moldova/Georgia TV channel 6. Newspapers 7. Magazines 8. Posters 9. Brochures 10. Other (identify) ______88. Don’t know/don’t remember

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SEXUALLY TRANSMITTED DISEASES/AIDS

200. Have you ever heard of the virus HIV or an illness called AIDS?

1. Yes 2. No ! GO TO Q202

201. Can you tell me all the ways you know a person can get infected with the AIDS virus? (DO NOT READ, CIRCLE ALL THAT APPLY)

1. From a toilet seat 2. Using public bathrooms 3. Sharing needles 4. Shaking hands 5. Donating blood 6. Blood transfusion 7. Undergoing surgical procedures with contaminated instruments 8. From mosquito bites 9. Through unprotected sex 10. Kissing on the mouth 11. Using objects of a person with AIDS 12. Other ______88. Don’t know

202. What kind of protection do you think condoms provide against infection with sexually transmitted diseases (STDs)? (READ CHOICES)

1. Excellent 2. Good 3. Fair 4. Poor 88. Don't know

203. Do you think a person can be infected with an STD and not have any symptoms or signs of the disease? 1. Yes 2. No 88. Don't know

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204. In a woman, what signs and symptoms would lead you to think that she has such an infection? (DO NOT READ OPTIONS, RECORD ALL MENTIONED) PROBE: Any others? RECORD ALL MENTIONED.

A Abdominal pain B genital discharge/dripping C foul smelling discharge D burning pain on urination E redness/inflammation in genital area F swelling in genital area G genital sores/ulcers H genital warts I blood in urine J loss of weight K inability to give birth L night sweats M no symptoms N Other______88 Don’t know

205. Has a health care provider ever talked to you about preventing sexually transmitted diseases (STDs)?

1 Yes 2 No 88 Don’t remember

206. In general, what has been your most trusted source of information for about STDs and/or AIDS or HIV? (DO NOT PROMPT OR READ – CIRCLE CODE FOR THE METHOD MENTIONED)

1. Mother 11. Pharmacist 2. Father 12. Books 3. Relative 13. Newspapers 4. Boyfriend 14. Radio 5. Friend 15. Brochures 6. Co-worker 16. Posters 7. Partner / husband 17. TV 8. Doctor 18. Own experience 9. Nurse/ Midwife 19. Other (specify) ______10. Teacher 88. Don’t know

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WOMEN'S HEALTH

300. How old were you at the time you first had sexual intercourse, if ever?

__ __ years 77= Never had sexual intercourse – GO TO Q303 88=Don't remember

301. Did you or your partner use a contraceptive method or do anything to prevent pregnancy at that time (the time when you first had sexual intercourse)?

1. Yes 2. No ! GO TO Q303 88. Don't know/Don’t remember !GO TO Q303

302. What method? (DO NOT PROMPT OR READ – CIRCLE CODE FOR METHOD MENTIONED).

1. Pills 2. IUD 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Condoms + spermicide 7. Emergency contraception, “Morning-after” pill 8. Tubal ligation 9. Vasectomy 10. Abortion 12. Safe period method (calendar/ mucous check) 13. Withdrawal 14. Douching 16. Other______88. Don’t know/ don’t remember

303. When was the last time you had a gynecologic exam that was not pregnancy-related?

1. Never had gynecologic exam 2. Less than 1 year ago 3. 1-2 years ago 4. More than 2 years ago 88. Don’t remember

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Fertility/Pregnancy

400. Are you currently pregnant?

1. Yes 2. No------>GO TO Q404 3. Not sure------>GO TO Q404

401. At the time you became pregnant, did you want to become pregnant then, did you want to get pregnant later, or did you not want to ever get pregnant?

1. Wanted to get pregnant then 2. Wanted to get pregnant later 3. Did not want to get pregnant then or any time in the future 88. Don’t know/don’t remember

402. Is this your first pregnancy?

1. Yes 2. No ------> GO TO Q405 3. Not sure

403. Have you ever had a miscarriage, induced abortion, ectopic pregnancy or stillbirth?

1. Yes------>GO TO PREGNANCY HISTORY – (Q408) 2. No------>GO TO Q500a (FAMILY PLANNING MODULE) 3. Not sure------>GO TO Q500a (FAMILY PLANNING MODULE)

404. Have you ever been pregnant?

1. Yes 2. No------>GO TO Q406 3. Not sure------>GO TO Q406

405. How many times have you been pregnant in the last 5 years?

______times ------>GO TO Q407

406. Have you ever had a miscarriage, induced abortion, ectopic pregnancy or stillbirth?

1. Yes------>GO TO PREGNANCY HISTORY - (Q408) 2. No------>GO TO Q500a (FAMILY PLANNING MODULE) 3. Not sure------>GO TO Q500a (FAMILY PLANNING MODULE)

407. How many live-born children do you have, including those who do not live with you?

______children

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NOW ASK WHETHER THE RESPONDENT HAD PREGNANCIES THAT ENDED AFTER JANUARY 1996 OR NOT. IF NO, GO TO FAMILY PLANNING MODULE (Q500a). IF YES, CONTINUE WITH PREGNANCY HISTORY

PREGNANCY HISTORY (Truncate to pregnancies that ended after January 1996). Now I would like to talk to you about your past pregnancies (if currently pregnant, not including the current one). Please make sure you include all pregnancies, regardless of how they ended, whether in a live birth, an abortion, a miscarriage, or a stillbirth. Starting with your most recent pregnancy, please give me the following information: DO NOT INCLUDE CURRENT PREGNANCY. 408 409 410 411 412

How did that pregnancy end? How many weeks or Thinking back to when you became LINE When did that months had you been Was this child pregnant, did you want to become pregnant No. pregnancy end? pregnant when that a boy or a girl? at that time, want to get pregnant later, or (month & year) pregnancy ended? not want to have any more children? NI::record answer in weeks 1 Live birth (single) 1 __ __ weeks 1 Wanted to get pregnant then 2 Live birth (multiple) A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ 88 Don’t know/don’t 3 Both 88 Don’t know/don’t remember 5 Stillbirth (multiple) 20 __ __ remember 6 Miscarriage 7 Induced abortion 88 Don’t If 408>3, skip to 412 8 Ectopic Pregnancy remember

1 Live birth (single) 2 __ __weeks 1 Wanted to get pregnant then 2 Live birth (multiple) A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ 88 Don’t know/don’t 3 Both 88 Don’t know/don’t remember 5 Stillbirth (multiple) 20 __ __ remember 6 Miscarriage 7 Induced abortion 88 Don’t If 408>3, skip to412 8 Ectopic Pregnancy remember

1 Live birth (single) __ __weeks 1 Wanted to get pregnant then 2 Live birth (multiple) 3 A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ 88 Don’t know/don’t 3 Both 88 Don’t know/don’t remember 5 Stillbirth (multiple) 20 __ __ remember 6 Miscarriage 7 Induced abortion 88 Don’t If 408>3, skip to 412 8 Ectopic Pregnancy remember

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408 409 410 411 412

How did that pregnancy end? How many weeks or Thinking back to when you became LINE When did that months had you been Was this child pregnant, did you want to become pregnant No. pregnancy end? pregnant when that a boy or a girl? at that time, want to get pregnant later, or (month & year) pregnancy ended? not want to have any more children? NI::record answer in weeks 1 Live birth (single) 4 __ __ weeks 1 Wanted to get pregnant then 2 Live birth (multiple) A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ 88 Don’t know/don’t 3 Both 88 Don’t know/don’t remember 5 Stillbirth (multiple) 20 __ __ remember 6 Miscarriage 7 Induced abortion 88 Don’t If 408>3, skip to 412 8 Ectopic Pregnancy remember

1 Live birth (single) 5 __ __weeks 1 Wanted to get pregnant then 2 Live birth (multiple) A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 88 Don’t know/don’t 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ remember 3 Both) 88 Don’t knnow/don’t remember 5 Stillbirth (multiple) 20 __ __ 6 Miscarriage If 408>3, skip to 412 7 Induced abortion 88 Don’t 8 Ectopic Pregnancy remember

1 Live birth (single) 6 __ __weeks 1 Wanted to get pregnant then 2 Live birth (multiple) A. Month __ __ 1 Boy 2 Wanted to get pregnant later 3 Multiple (LB with SB) 88 Don’t know/don’t 2 Girl 3 Wanted no more children 4 Stillbirth (single) B. Year 19 __ __ remember 3 Both 88 Don’t know/don’t remember 5 Stillbirth (multiple) 20 __ __ 6 Miscarriage If 408>3, skip to 412 7 Induced abortion 88 Don’t 8 Ectopic Pregnancy remember

IF NUMBER OF PREGNANCIES THAT ENDED AFTER JANUARY 1996 IS LESS THAN 6, GO TO Q413

412a. Did you have more than 6 pregnancies that ended after January 1996?

1. Yes 2. No ------>GO TO Q413 88. Don’t know/Don’t remember ------>GO TO Q413

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412b. If yes, how many more?

RECORD THE NUMBER ______

412c. How many of those ___(put the number of pregnancies from 412b) were induced abortions?

RECORD THE NUMBER ______

THE FOLLOWING QUESTIONS REFER ONLY TO PREGNANCIES THAT ENDED AFTER JANUARY 1996

413. CHECK Q408 and Q412a, b. RECORD THE TOTAL NUMBER OF PREGNANCIES THAT ENDED AFTER JANUARY 1996.

______TOTAL PREGNANCIES

414. CHECK Q408 and 412c, RECORD HOW MANY INDUCED ABORTIONS AFTER JANUARY 1996:

______TOTAL INDUCED ABORTIONS (Q408 - # 7)

IF NO INDUCED ABORTIONS GO TO Q429. OTHERWISE, FILL IN THE TABLE BELOW FOR THE MOST RECENT ABORTION.

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415. Type 416. What was the 417. Where was that 418. How many nights 419. Who was the of principal reason you abortion performed? did you spend in the primary person that abortion decided to have this health facility after that performed this abortion? DO NOT READ abortion? (If any) abortion? - CIRCLE CODE FOR THE REASON MENTIONED 1 Induced 1 Dangerous to life/health 1 Hospital 1.OB/GYN 2 Self 2 Risk of fetal abnormality 2 Maternity house __ __ nights 2. Other physician induced 3 Socioeconomic /preference 3. Private clinic/physician 3. Nurse/ midwife reasons 4. Not at medical facility - 88 Don’t remember 4. Lay person 4 Did not have GO TO Q419 5. Self-induced GO TO husband/partner 88. Don’t know/Don’t Include readmissions Q429 5 Partner wanted abortion remember - GO TO Q419 within 30 days 88 Don’t know/ Don’t 6 Respondent did not want remember - GO TO children Q429 7 Other ______88 Don’t know/don’t remember

420. How much did 421. Did you take any 422. Within 30 days of the you pay for this antibiotics after the abortion, did you have any abortion? abortion? problems related to the abortion? ______drams 1 Yes 1 Yes 00 no charge 2 No 2 No - GO TO 424 77 gifts 88 Don’t know/ Don’t 88 Don’t know/ Don’t remember 88 Don’t know/don’t remember remember

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423. What problems 424. Either before or after 425.After this abortion, did 426. Did you use the 427. Did you want 428. After that abortion, did you have? (DO this abortion, did a health you receive a method of method that you a contraceptive did a health provider refer NOT READ THE provider talk to you about contraception, or a were given/ method at that you to another clinic or ANSWERS - ways to avoid another prescription? prescribed? time? consultation for CIRCLE ALL unplanned pregnancy? contraceptive counseling THAT APPLY) or services? PROBE: Any other problems? (CIRCLE ALL THAT APPLY) A Perforation 1 Yes 1 Got a method 1 Yes 1 Yes 1 Yes B Severe bleeding 2 No 2 Got a prescription for a 2 No 2 No 2 No C Fever 88 Don’t know/ Don’t method 88 Don’t know/Don’t 88 Don’t now/Don’t 88 Don’t know/Don’t D Infection remember 3 No - GO TO Q427 remember remember remember E Pelvic pain 88 Don’t now/don’t F other______remember - GO TO Q427 88 Don’t know/don’t remember

429. IDENTIFY THE MONTH AND THE YEAR OF THE MOST RECENT LIVE BIRTH (CHECK Q. 408 IN PREGNANCY TABLE FOR # 1, #2 and #3). Month __ __ Year ______

IF THE DATE IS LATER THAN JANUARY 1998, GO ON TO Q. 430 AND FILL OUT THE TABLE. OTHERWISE GO TO Q. 500a (FAMILY PLANNING MODULE)

AUA Center for Health Services Research Evaluation of the Green Path Campaign

430. Did you receive any 431.During what 432.How many prenatal 433.Where did you 434. During those visits, on what topics did you receive prenatal care from a doctor, month of your visits did you make receive most of any information: (DO NOT READ, CIRCLE ALL nurse or midwife during this pregnancy did you during that pregnancy? your prenatal care? THAT APPLY) pregnancy (Identify make your first (Include home visits) (CIRCLE ONLY PROBE: Any others? (CIRCLE ALL THAT year/month from Q429) prenatal visit? ONE ITEM !) APPLY) (Include home visits) NI: not the calendar month, but month of the pregnancy

__ __ visits 1 Hospital 1 Yes __ month 77=Don't remember, 2 Maternity house A Nutrition 1 0 2 No--->GO TO Q. 435 but was definitely at 3 Woman’s B Smoking during pregnancy 1 0 C Drinking alcohol during pregnancy 88 Don’t know/don’t least 5 consultation 1 0 D Breastfeeding remember 88=Don't know/ don’t 4 MCH Center E Delivery 1 0 remember 5 Private F Contraception 1 0 clinic/office G Warning signs of complications 1 0 6 Home H Postnatal care 1 0 7 Other______I Newborn care 1 0 88 Don’t J Other ______1 0 know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

435. During the first 6 weeks 436. During those visits on what 437. Following your most recent 438.Before you left the hospital, did you receive a after birth, did you visit /were topics did you receive any birth did a doctor/midwife/nurse contraceptive method or a prescription for a visited by a doctor or a nurse information: talk to you about or offer to talk contraceptive method? for a post-natal care checkup? (DO NOT READ, CIRCLE ALL to you about contraception? THAT APPLY) PROBE: Any others? (CIRCLE ALL THAT APPLY) 1 Got method 1 Yes A. Breastfeeding 1 0 1 Yes 2 Got prescription for contraceptive method 2 No--->GO TO Q437 B. Breast care 1 0 2 No 3 Neither! GO TO Q440 88 Don’t remember---> GO C. Newborn care 1 0 88 Don't remember 88 Don’t remember! GO TO Q440 TO Q437 D. Immunization 1 0 E. Nutrition 1 0 F. Your own care 1 0 G. Other ______1 0

439. Did you try this method 440. How long after birth that you were given or did you resume sexual prescribed? relations? NI: convert the respondent’s answer to weeks 1 Yes __ __ weeks 2 No 77=Not yet 88 Don't remember 88=Don't remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

CONTRACEPTION: FAMILY PLANNING MODULE

500a. (Spontaneous recall) 500b. Have you 501. Do you 502. Have 503. Do you 504. What Which contraceptive ever heard of it? know how to you (you or know where was your METHOD methods have you ever (READ use it? partner) ever to get it? source of heard about? Please, METHODS used it? information identify (DO NOT NOT about this PROMPT, CIRCLE YES RECALLED method? (See FOR EACH METHOD SPONTA- codes below) RECALLED). KEEP NEOUSLY) PROBING (any others?) A. Pills – Women can 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q503 1 Yes-- take a pill every day. 3 No--->B 2 No--->Q502 2 No--->Q503 >Q504 ------2 No-->Q504 B. IUD – Women can 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q503 1 Yes-- have a loop or coil 3 No--->C 2 No--->Q502 2 No--->Q503 >Q504 placed inside them by a 2 No-->Q504 ------doctor or a nurse. C. Depo-Provera/ 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q503 1 Yes-- Injections – Women 3 No--->D 2 No--->Q502 2 No--->Q503 >Q504 can have an injection by 2 No-->Q504 a doctor or nurse, which ------stops them from becoming pregnant for several months. D. Male Condoms – 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q503 1 Yes-- Men can put a rubber 3 No--->E 2 No--->Q502 2 No--->Q503 >Q504 sheath on their penis 2 No-->Q504 ------before sexual intercourse. E. 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q503 1 Yes-- Spermicides/Cream – 3 No--->F 2 No--->Q502 2 No--->Q503 >Q504 2 No-->Q504 Women can place a ------suppository, jelly, or cream in their vagina before intercourse. F. Female 1 Yes--> Q501 2 Yes-->Q502 1 Yes-->Q503 1 Yes-- Sterilization – Women 3 No--->G 2 No--->Q503 >Q504 2 No-->Q504 can have an operation to ------avoid having any more children. G. Male Sterilization 1 Yes--> Q501 2 Yes-->Q502 1 Yes-->Q503 1 Yes-- – men can have an 3 No--->H 2 No--->Q503 >Q504 operation to avoid 2 No-->Q504 having any more ------children. (Vasectomy) H. Emergency 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q303 1 Yes-- Contraception – the 3 No--->I 2 No--->Q502 2 No--->Q303 >Q504 “morning after” pills – 2 No-->Q504 Women can take pills ------within 3 days after unprotected sexual intercourse to avoid becoming pregnant.

AUA Center for Health Services Research Evaluation of the Green Path Campaign

500a. (Spontaneous recall) 500b. 501. 502. 503. 504. What METHOD Which contraceptive Have you ever Do you Have you Do you was your methods have you ever heard of it? know how to (you or know where source of heard about? Please, (READ NOT use it? partner) ever to get it? information identify (DO NOT RECALLED used it? about this PROMPT, CIRCLE YES SPONTA- method? (see OR NO FOR EACH NEOUSLY) codes below) METHOD) KEEP PROBING (any others?) I. Safe period 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q504 methods – Every month 3 No--->J 2 No--->Q502 2 No--->Q504 ------that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant. J. Lactational 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q504 amenhorrhoea method 3 No--->K 2 No--->Q502 2 No--->Q504 ------– up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently day and night and that her mentrual period has not returned. K. Withdrawal – Men 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q504 can be careful and pull 3 No--->L 2 No--->Q502 2 No--->Q504 out before climax. ------L. Douching - A 1 Yes--> Q501 2 Yes-->Q501 1 Yes-->Q502 1 Yes-->Q504 woman can use a 3 No--->M 2 No--->Q502 2 No--->Q504 “douche” and wash herself after having sex ------with her partner M. Abstinence – no 1 Yes--> Q501 2 Yes-->Q502 1 Yes-->Q504 sex 3 No--->GO TO N 2 No--->Q504 ------or Q505 N. Other traditional 1 Yes--> Q501 1 Yes-->Q502 1 Yes-->Q504 method (describe) 2 No--->Q502 2 No--->Q504

------

CODES FOR Q504 – (DO NOT READ)

AUA Center for Health Services Research Evaluation of the Green Path Campaign

505. RECORD WHETHER RESPONDENT HAS EVER USED ANY METHOD (ANY 1 FOR Q502)

1 NEVER USED 2 EVER USED---->GO TO Q507

506. So, you have said that you or your partner have never used any method to prevent pregnancy, is this correct?

1 Never used----->GO TO Q519 2 Ever used--->CORRECT Q502 AND GO TO Q507

507. Are you (or your partner) currently using any method to prevent pregnancy?

1 Yes 2 No--->GO TO Q519

508. What is the one PRIMARY method of contraception that you are currently using? DO NOT PROMPT OR READ – CIRCLE ONE CODE FOR THE METHOD MENTIONED.

1. Pills 2. IUD GO TO Q510 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Condoms + spermicide 7. Emergency contraception, “Morning-after” pill 8. Tubal ligation 9. Vasectomy GO TO Q510 10. Abortion 11. Lactational Amenorrhea Method 12. Safe period method (calendar/ mucous check) 13. Withdrawal 14. Douching 15. Abstinence GO TO Q510 16. Other traditional methods______88. Don’t know

509. In the past 30 days how often did you / your partner use this method (READ 1-3)

1. Always, at each sexual intercourse 2. Almost always 3. Sometimes 88. Don’t know/ Don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

510. What was your most trusted source of information about this primary method? (DO NOT PROMPT OR READ – CIRCLE ONE CODE FOR THE SOURCE MENTIONED)

511. Why did you choose this method? (DO NOT READ THE ANSWERS -CIRCLE ALL THAT APPLY)

1. Doctor recommended 2. Cost 3. Very effective 4. Very safe (few side effects) 5. Saw ads (TV, radio, press, brochure) 6. Easy to use 7. Partner prefers it 8. Knows somebody who uses it 9. Curiosity / wanted to try it 10. Allows spontaneity during intercourse 11. Other______88. Don’t know

If Q508 is 1-9, or 88, Go to Q514; If she uses traditional methods or abortion (Q508 = 10 to 16), continue with 512

512. Please tell me whether each of the following reasons was very important, somewhat important, or not important at all in your decision to use ______(CODE FROM Q508) instead of a modern method:

Very Somewhat Not Not Sure Important Important Important A. Little knowledge of modern methods 1238 B. Difficult to get a modern method 1238 C. Cost of these modern methods 1238 D. Fear of or experience with side effects 1238 E. Husband / Partner preference 1238 F. Religious beliefs 1238 G. Doctor’s recommendations 1238 H. Other person advice 1238

AUA Center for Health Services Research Evaluation of the Green Path Campaign

513. How effective at preventing pregnancy do you think ______- (CODE FROM Q508) is compared to the methods, like the pill or the IUD? (READ 1-3)

1. Modern methods more effective 2. About equally effective 3. Modern methods less effective 88. Don’t know

514. Do you have problems or concerns with using your current method?

1. Yes 2. No ----->GO TO Q516

515. What is the most important problem? (DO NOT PROMPT OR READ, CIRCLE CODE FOR THE PROBLEM MENTIONED)

1. Side effects/ Health concerns 2. Method not effective 3. Access / availability 4. Cost 5. Sometimes forget to use 6. Sometimes difficult/ inconvenient to use 7. Other ______88. Don’t know

516. Would you prefer to use a different method of family planning from the one that you are currently using? 1. Yes 2. No----->GO TO Q523 88. Don’t know

517. What method would you prefer to use? (DO NOT PROMPT OR READ – CIRCLE CODE FOR METHOD MENTIONED).

1. Pills 2. IUD 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Condoms + spermicide 7. Emergency contraception, “Morning-after” pill 8. Tubal ligation 9. Vasectomy 10. Abortion 11. Lactational Amenorrhea Method 12. Safe period method (calendar/ mucous check) 13. Withdrawal 14. Douching 15. Abstinence 16. Other traditional methods______88. Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

518. What are the reasons that you do not use that method? (DO NOT PROMPT, BUT RECORD ALL ANSWERS MENTIONED BY CIRCLING APPROPRIATE CODE)

PROBE: Any others? (CIRCLE ALL THAT APPLY)

1. Doctor does not prescribe it 2. Cost 3. Unreliable supplies / difficult to obtain 4. Too far away from the place where she lives 5. Do not know how / where to obtain it 6. Husband / partner objects to it 7. Religious reasons 8. Fear of side effects 9. Has not yet made up her mind 10. Difficult to use 11. Fear of surgical procedure (IUD, etc.) 12. Other ______

NOW CHECK WHETHER A RESPONDENT USES TADITIONAL OR MODERN METHOD (Q508). MODERN METHOD USERS (CODE FROM Q508 __) SKIP TO Q523. TRADITIONAL METHOD AND ABORTION USERS (CODE FROM Q508 __) CONTINUE.

519. What is the main reason that you or your partner are not currently using a modern contraceptive method? (DO NOT PROMPT OR READ – CIRCLE CODE FOR THE METHOD MENTIONED).

1. Not sexually active in the last month 2. Trying to get pregnant 3. Postpartum/ breastfeeding 4. Currently pregnant 5. Hysterectomy / menopause 6. Fear of side effects 7. Lovemaking would be interrupted 8. Didn’t think about it / neglected 9. Cannot afford birth control (costs too much) 10. Birth control is the partner’s responsibility 11. Birth control is not (very) effective 12. Respondent does not want to use a method 13. Partner objects to using method 14. Objects due to religious reasons 15. Does not know where to get modern method 16. Does not know how to use birth control methods 17. Respondent does not think she can get pregnant 18. Other (specify) ______88. Don’t know

520. Do you think that you will use a modern contraceptive method during the next 12 months?

1. Yes 2. No - GO TO Q523 3. 88. Don’t know - GO TO Q523

AUA Center for Health Services Research Evaluation of the Green Path Campaign

521. What modern method are you most likely to start using in the next 12 months?( DO NOT PROMPT OR READ – CIRCLE CODE FOR THE METHOD MENTIONED).

522. On average, how much are you willing to pay for contraception, per month?

______Drams 77 = As much as needed

523. Who is responsible for making the decision about family size in your family?

1. Husband 2. Wife 3. Husband and Wife 4. Neither 5. Other ______88. Don’t know

524. Who is responsible for making the decision about contraception in your family?

1. Husband 2. Wife 3. Husband and Wife 4. Neither 5. Other ______88. Don’t know

525. During the last year, how often did you talk about contraception with your husband/partner? (READ 1 - 3)

1. Never 2. One or two times 3. Three times or more 88. Don’t remember

526. Of 10 married women you know the best how many do you think are using modern contraceptives? (not abortions)

______women

AUA Center for Health Services Research Evaluation of the Green Path Campaign

CONTRACEPTIVE COUNSELING

527. Have you ever received a family planning care/counseling services in the last year?

1. Yes 2. No→ GO TO Q532 88. Don't remember →GO TO Q532

528. Please, identify the name of the facility where you got those services (NI: Check the name of the facility on the code list).

1. Governmental Family Planning Cabinet Specify (codes) __ __ 2. Other______88. Don’t know/don’t remember

529. Did you select the method you received, was it selected by the Health Provider, was it selected by both of you, or by someone else?

1. Respondent 2. Provider 3. Both 4. Someone else 5. Did not receive a method 88. Don’t know/don’t remember

530. Did the Health Provider explain the possible side effects of any contraceptive method?

1. Yes 2. No 88. Don't know/don’t remember

531. Overall, would you say you have been very satisfied, somewhat satisfied, or not satisfied with the family planning services you have received?

1. Very satisfied 2. Somewhat satisfied 3. Not at all satisfied 88. Don’t know/ Don’t remember

532. Have you changed your pattern of contraceptive usage in the last 6 months?

1 Yes 2 No GO TO Q600 88 Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

533. What of the following best describes this change?

1. Switched to different method 2. Started using contraception after not using a method 3. Stopped using a method altogether. 4. Other ______88. Don’t know

534. What was the primary reason to make this change? (DO NOT PROMPT OR READ, CIRCLE CODE FOR THE METHOD MENTIONED).

1. Usual method was not effective 2. Wanted to try new method 3. Did not like usual method or partner did not like usual method 4. Could not obtain usual method 5. Could not afford usual method 6. Wanted to get pregnant 7. Side effects 8. Other reason______88.Don’t know

535. Did economic conditions play any role in your decision to make this change?

1 Yes 2 No 88 Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

INFORMATION, EDUCATION, AND COMMUNICATION

600. Within the past 6 months have you seen anything on television on any channel about modern contraceptives?

1 Yes 2 No →GO TO Q602 88 Don’t know/don’t remember →GO TO Q602

601. What did you see? (CIRCLE ALL THAT APPLY)

1. Advertisement 2. Health program 3. Other ______88. Don’t know/don’t remember

602. Within the past 6 months have you heard anything on radio on any channel about modern contraceptives?

1 Yes 2 No →GO TO Q604 88 Don’t know/don’t remember →GO TO Q604

603. What did you hear? (CIRCLE ALL THAT APPLY)

1. Advertisement 2. Health program 3. Other ______88. Don’t know/don’t remember

604. Within the past 6 months have you read anything in newspapers or magazines about modern contraceptives?

1 Yes 2 No → GO TO Q606 88. Don’t know/don’t remember →GO TO Q606

605. What did you read? (CIRCLE ALL THAT APPLY)

1. Advertisement 2. Health article 3. Other ______88. Don’t know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

606. What is the source of information about family planning and contraceptives you trust the most? (DO NOT PROMPT OR READ – CIRCLE CODE FOR THE OPTION MENTIONED).

CONTRACEPTIVE IMAGE

On a scale from 1 to 5, please rate each of the following contraceptive methods according to each of the characteristics I will mention:

607. First, rate each of the following with regard to safety and health effects? (1=extremely unsafe, 5=completely safe)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

608. How would you rate each of the following with regard to effectiveness at preventing pregnancy? (1=completely ineffective, 5=completely effective)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Withdrawal 1 2 3 4 5 88=DK

609. How would you rate each of the following with regard to cost? (1=very inexpensive, 5=very expensive)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

AUA Center for Health Services Research Evaluation of the Green Path Campaign

610. Overall, how much do you like each of the methods of preventing births? (1=dislike very much, 5=like very much)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

AUA Center for Health Services Research Evaluation of the Green Path Campaign

SOCIOECONOMIC CHARACTERISTICS

700. Are you currently employed either part-time or full-time outside the home?

1. Yes 2. Yes, but on maternity/pregnancy leave 3. No

701. Please tell me whether this household or any member of it has the following working items:

Yes No A. Indoor bathroom/toilet 1 2 B. Hot water tank 1 2 C. Color television 1 2 D. VCR 1 2 E. Automobile 1 2 F. Auto Washing machine 1 2 G. Telephone 1 2 H. Personal computer 1 2 I. Cable aerial/satellite 1 2 J. Cellular phone 1 2 K. Vacation home/villa 1 2

702. Last month the approximate amount of household income spent by all of your household members was: 1. Less than $50 ( < 25,000drams) 2. From $50 – 99 (25,000 – 50,000drams) 3. From $100 – 500 (51,000-250,000drams) 4. Above $500 (>250,000drams) 88. Don’t know

703. Is the monthly income enough to meet your needs and the need of the family?

1. Yes 2. No 88. Don’t know

Thank the woman for her cooperation.

END OF INTERVIEW

TIME INTERVIEW ENDED __ __ : __ __

INTERVIEWED BY:______

QUESTIONNAIRE REVIEWED BY:______

DATA ENTRY OPERATOR # ___

AUA Center for Health Services Research Evaluation of the Green Path Campaign APPENDIX 2B FOLLOW-UP QUESTIONAIRE ID NUMBER 1 ______

TIME STARTED: __ __: __ __

BACKGROUND CHARACTERISTICS

1. Has your marital situation changed since the time of our previous visit?

1. Yes 2. No ----->GO TO Q 3

2. Please describe your current marital status

1. Changed the partner (husband) 2. Married (registered or unregistered) but living apart (for at least 30 days) Thank respondent for 3. Divorced her time. Explain that 4. Widowed this survey is for married women only and leave.

WOMEN'S HEALTH

3. How many times have you had a gynecologic exam that was not pregnancy-related since June 1, 2000?

__ __ times 88. Don’t remember

FERTILITY/PREGNANCY

4. Were you pregnant at the time of the baseline interview (April/May 2000)?

1. Yes ----->GO TO Q 6 (PREGNANCY HISTORY) 2. No 88. Don’t remember

5. Have you become pregnant since the time of the baseline interview (April/May 2000)?

1. Yes 2. No -----> GO TO Q 12 (FAMILY PLANNING MODULE) 88. Don’t remember-----> GO TO Q 12 (FAMILY PLANNING MODULE)

AUA Center for Health Services Research Evaluation of the Green Path Campaign

PREGNANCY HISTORY

6 7 8 9 10 How did that pregnancy end? How many weeks or Thinking back to When did that Was this months had you been when you became pregnancy end? child a pregnant when that pregnant, did you (month & year) boy or a pregnancy ended? want to become girl? NI: record answer in pregnant at that time, weeks want to get pregnant later, or not want to have any more children? 1. Still pregnant – GO to Q 10 A. Month ______weeks 1 Boy 1 Wanted to get 2. Live birth (single) 2 Girl pregnant then 3. Live birth (multiple) B. Year 20 __ __ 88 Don’t know/ 3 Both 2 Wanted to get 4. Multiple (LB with SB) don’t remember pregnant later 5. Stillbirth (single) 88 Don’t remember 3 Wanted no more 6. Stillbirth (multiple) IF Q6>4, SKIP TO 10 children 7. Miscarriage 88 Don’t know/don’t 8. Induced abortion remember 9. Ectopic Pregnancy

IF THE RESPONDENT REPORTED AN ABORTION IN Q6, PROCEDE TO QUESTION 11; IF NO ABORTION, SKIP TO Q12.

11. What was the principal reason you decided to have this abortion? (DO NOT READ - CIRCLE CODE FOR THE REASON MENTIONED)

1. Dangerous to life/health 2. Risk of fetal abnormality 3. Socioeconomic /preference reasons 4. Did not have husband/partner 5. Partner wanted abortion 6. Respondent did not want children 7. Other ______88. Don’t know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

CONTRACEPTION: FAMILY PLANNING MODULE 12. Have you sought 13. (For those methods 14. Have you METHOD information since June 1, identified in Q12) What (or partner) 2000 about this was the main source from used this contraceptive method? which you sought method since CIRCLE YES OR NO information about this June 1, 2000? FOR EACH METHOD method? (SEE CODES BELOW) A. Pills – Women can take a pill every day. 1 Yes 1 Yes ------2 No--> Q14 2 No B. IUD – Women can have a loop or coil placed 1 Yes 1 Yes ------inside them by a doctor or a nurse. 2 No--> Q14 2 No C. Depo-Provera/ Injections – Women can have 1 Yes 1 Yes an injection by a doctor or nurse, which stops 2 No--> Q14 ------2 No them from becoming pregnant for several months. D. Male Condoms – Men can put a rubber sheath 1 Yes 1 Yes ------on their penis before sexual intercourse. 2 No--> Q14 2 No E. Spermicides/Cream – Women can place a 1 Yes 1 Yes suppository, jelly, or cream in their vagina before 2 No--> Q14 ------2 No intercourse. F. Female Sterilization – Women can have an 1 Yes 1 Yes operation to avoid having any more children. 2 No--> Q14 ------2 No G. Male Sterilization – men can have an 1 Yes 1 Yes operation to avoid having any more children 2 No--> Q14 ------2 No (Vasectomy) H. Emergency Contraception – the “morning 1 Yes 1 Yes after” pills – Women can take pills within 3 days 2 No--> Q14 2 No after unprotected sexual intercourse to avoid ------becoming pregnant. I. Safe period methods – Every month that a 1 Yes 1 Yes ------woman is sexually active she can avoid pregnancy 2 No--> Q14 2 No by not having sexual intercourse on the days of the month she is most likely to get pregnant. J. Lactational amenhorrhea method – up to 6 1 Yes 1 Yes months after childbirth, a woman can use a 2 No--> Q14 ------2 No method that requires that she breastfeeds frequently day and night and that her menstrual period has not returned. K. Withdrawal – Men can be careful and pull out 1 Yes 1 Yes ------before climax. 2 No--> Q14 2 No L. Douching - A woman can use a “douche” and 1 Yes 1 Yes ------wash herself after having sex with her partner 2 No--> Q14 2 No M. Abstinence – no sex 1 Yes 1 Yes ------2 No--> Q14 2 No N. Other method (RECORD if a woman mentions 1 Yes 1 Yes any) ______2 No--> Q14 ------2 No

AUA Center for Health Services Research Evaluation of the Green Path Campaign

CODES FOR Q13 – (DO NOT READ)

15. RECORD WHETHER RESPONDENT HAS USED ANY METHOD SINCE JUNE 1, 2000 (ANY 1 FOR Q14)

1. NOT USED 2. HAS USED---->GO TO Q17

16. So, you have said that you or your partner haven’t used any method to prevent pregnancy since June 1, 2000, is this correct?

1. Not used----->GO TO Q29 2. Used---> CORRECT Q14 AND 15 AND GO TO Q17

17. Are you (or your partner) currently using any method to prevent pregnancy?

1. Yes 2. No--->GO TO Q29

AUA Center for Health Services Research Evaluation of the Green Path Campaign

18. What is the one PRIMARY method of contraception that you are currently using? DO NOT PROMPT OR READ – CIRCLE ONE CODE FOR THE METHOD MENTIONED.

1. Pills 2. IUD GO TO Q20 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Condoms + spermicide 7. Emergency contraception, “Morning-after” pill 8. Tubal ligation 9. Vasectomy GO TO Q20 10. Abortion 11. Lactational Amenorrhea Method 12. Safe period method (calendar/ mucous check) 13. Withdrawal 14. Douching 15. Abstinence GO TO Q20 16. Other traditional methods______88. Don’t know

19. In the past 30 days how often did you / your partner use this method (READ 1-3)

1. Always, at each sexual intercourse 2. Almost always 3. Sometimes 88. Don’t know/ Don’t remember

20. Does the use of this method represent a change since our previous interview?

1. Yes 2. No ----> GO TO Q26 88. Don’t know/don’t remember----> GO TO Q26

AUA Center for Health Services Research Evaluation of the Green Path Campaign

21. What was the primary reason to make this change? (DO NOT PROMPT OR READ, CIRCLE CODE FOR THE METHOD MENTIONED).

22. What was your most trusted source of information about this primary method? (DO NOT PROMPT OR READ – CIRCLE ONE CODE FOR THE SOURCE MENTIONED)

23. Why did you choose this method? (DO NOT READ THE ANSWERS -CIRCLE ALL THAT APPLY)

1. Doctor recommended 2. Cost 3. Very effective 4. Very safe (few side effects) 5. Saw campaign materials (TV, radio, posters, brochures, “cue cards”) 6. Read about it in press 7. Easy to use 8. Partner prefers it 9. Knows somebody who uses it 10. Curiosity / wanted to try it 11. Allows spontaneity during intercourse 12. Other______88. Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

24. Do you have problems or concerns with using your current method?

1. Yes 2. No ----->GO TO Q26 88. Don’t know----->GO TO Q26

25. What is the most important problem? (DO NOT PROMPT OR READ, CIRCLE CODE FOR THE PROBLEM MENTIONED)

1. Side effects/ Health concerns 2. Method not effective 3. Access / availability 4. Cost 5. Sometimes forget to use 6. Sometimes difficult/ inconvenient to use 7. Other ______88. Don’t know

26. Would you prefer to use a different method of family planning from the one that you are currently using?

1. Yes 2. No----->GO TO THE INSTRUCTIONS BEFORE Q29 88. Don’t know

27. What method would you prefer to use? (DO NOT PROMPT OR READ – CIRCLE CODE FOR METHOD MENTIONED).

1. Pills 2. IUD 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Condoms + spermicide 7. Emergency contraception, “Morning-after” pill 8. Tubal ligation 9. Vasectomy 10. Abortion 11. Lactational Amenorrhea Method 12. Safe period method (calendar/ mucous check) 13. Withdrawal 14. Douching 15. Abstinence 16. Other traditional methods______88. Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

28. What are the reasons that you do not use that method? (DO NOT PROMPT, BUT RECORD ALL ANSWERS MENTIONED BY CIRCLING APPROPRIATE CODE)

PROBE: Any others? (CIRCLE ALL THAT APPLY)

NOW CHECK WHETHER A RESPONDENT USES TRADITIONAL (10-16, Q18) OR MODERN METHOD (codes 1-9, Q18). MODERN METHOD USERS (CODE FROM Q18__) SKIP TO Q31. TRADITIONAL METHOD AND ABORTION USERS (CODE FROM Q18__) CONTINUE.

29. Do you think that you will use a modern contraceptive method during the next 12 months?

1. Yes 2. No → GO TO Q31 88. Don’t know →GO TO Q31

30. What modern method are you most likely to start using in the next 12 months?( DO NOT PROMPT OR READ – CIRCLE CODE FOR THE METHOD MENTIONED).

AUA Center for Health Services Research Evaluation of the Green Path Campaign

31. On average, how much are you willing to pay for contraception, per month?

______Drams 77 = As much as needed 88 = Don’t know

32. Since June 2000, how often did you talk about contraception with your husband/partner?

__ __ times 88. Don’t remember

33. Of 10 married women you know the best how many do you think are using modern contraceptives (not abortions)?

______women

34. Since June 2000 has anyone personally advocated/recommended FP cabinets to you?

1. Yes 2. No 88. Don’t remember

35. Since June 2000 have you personally advocated/recommended FP cabinets to anybody?

1. Yes 2. No 88. Don’t remember

CONTRACEPTIVE COUNSELLING

36. Have you received family planning care/counseling services since June 2000?

1. Yes 2. No → GO TO Q48 88. Don't remember →GO TO Q48

37. What prompted you to seek out services? (READ THE ANSWERS)

1. Media messages 2. Recommended by a doctor 3. Recommended by a pharmacist 4. Recommended by a friend/family 5. Recommended by someone who already visited FP cabinet 6. Other ______88. Don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

38. Please, identify the name of the facility where you got those services (NI: Check the name of the facility on the code list).

1. Governmental Family Planning Cabinet Specify (codes) __ __ 2. Pharmacy SKIP TO Q 48 3. Other______88. Don’t know/don’t remember

39. Did you receive counseling on contraceptive methods?

1. Yes 2. No→ GO TO Q43 88. Don't know/don’t remember

40. Did the Health Provider explain the benefits of contraceptive methods?

1. Yes 2. No 88. Don't know/don’t remember

41. Did the Health Provider explain the possible side effects of any contraceptive method?

1. Yes 2. No 88. Don't know/don’t remember

42. Were you charged for the counseling?

1. Yes 2. No 88. Don't know/don’t remember

43. Did you select the method you received, was it selected by the Health Provider, was it selected by both of you, or by someone else?

1. Respondent 2. Provider 3. Both 4. Someone else 5. Did not receive a method → GO TO Q46 88. Don’t know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

44. What method did you receive?

1. Pills 2. IUD 3. DepoProvera/Injections 4. Male Condoms 5. Spermicide / Cream / Jelly 6. Emergency contraception, “Morning-after” pill 7. Other ______88. Don’t know/don’t remember

45. Were you charged for the method you received?

1. Yes 2. No 88. Don't know/don’t remember

46. Overall, would you say you have been very satisfied, somewhat satisfied, or not satisfied with the family planning services you have received?

1. Very satisfied 2. Somewhat satisfied 3. Not at all satisfied 88. Don’t know/ don’t remember

47. How did you hear about the FP cabinet? (CHECK ALL THAT APPLY)

AUA Center for Health Services Research Evaluation of the Green Path Campaign

INFORMATION, EDUCATION, AND COMMUNICATION

• EXPOSURE TO THE LOGO AND SLOGAN OF THE CAMPAIGN

NI: SHOW THE LOGO SHEET TO THE RESPONDENT

LOGO 48. (Spontaneous recall) 49. What does it mean? RECORD 50. Where have # Have you ever seen these THE ANSWER FOR EACH you seen it? (see logos? (DO NOT RECOGNIZED LOGO codes below, PROMPT, CIRCLE YES CIRCLE ALL OR NO FOR EACH THAT APPLY) LOGO) 1 1 Yes ______------2 No --> Q51 2 1 Yes ______------2 No --> Q51 3 1 Yes ______------2 No --> Q51 4 1 Yes ______------2 No --> Q51

Codes for Q50

1. Pharmacy 2. Gynecological/Family Planning cabinet 3. Policlinic/Hospital (other than gynecological/family planning cabinet) 4. TV 5. Newspapers 6. Magazines 7. Posters 8. Brochures 9. Other (identify) ______88. Don’t know/don’t remember

NI: SHOW THE SLOGAN TO THE RESPONDENT AND READ IT ALOUD

51. Have you ever seen/ heard 52. What does it mean? RECORD 53. Where have you seen/ heard this slogan? THE ANSWER it? (See codes below, CIRCLE ALL THAT APPLY)

1 Yes ______------2 No --> Q54

AUA Center for Health Services Research Evaluation of the Green Path Campaign

Codes for Q53

1. Pharmacy 2. Gynecological/Family Planning cabinet 3. Policlinic/Hospital (other than gynecological/family planning cabinet) 4. TV 5. Newspapers 6. Magazines 7. Posters 8. Brochures 9. Radio 10. Other (identify) ______88. Don’t know/don’t remember

54. How much television do you typically watch?

1. None/hardly any 2. 1 hour or less per day 3. 1 to 2 hours per day 4. 2 to 4 hours per day 5. More than 4 hours per day 88. Don’t know/don’t remember

55. Since June 2000 have you seen anything on television on any channel about modern contraceptives/Family Planning?

1 Yes 2 No →GO TO Q64 88 Don’t know/don’t remember →GO TO Q64

56. What did you see? (READ, CIRCLE YES OR NO FOR EACH OPTION)

Yes No DK 1. Advertisement of Family Planning cabinets 1 2 88 2. Health program 1 2 88 3. TV catalog show 1 2 88 4. Other ______1 2 88

NI: IF OPTION 1 IS YES, CONTINUE WITH Q57, IF NOT – GO TO Q64

AUA Center for Health Services Research Evaluation of the Green Path Campaign

57. What were the main messages of the advertisements? (DON’T READ, CIRCLE ALL THAT APPLY) PROBE: any other?

1. Family planning – the Right Path for your Family 2. Visit your family planning cabinet. 3. For more information on reliable methods of contraception, visit your family planning cabinet. 4. Contraceptives are provided free of charge. 5. To avoid abortions, use modern methods of contraception 6. Abortion is dangerous for your health 7. Births should be spaced two years apart 8. Visit participating pharmacies for information and contraceptives 9. Other ______88. Don’t know/don’t remember

58. What attitude toward the campaign and FP cabinets did the TV spots leave you with? (READ THE ANSWERS)

1. Positive 2. Negative 3. Neutral 88. Don’t know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

EXPOSURE TO “GREEN PATH” TV COMMERCIALS SPOT 59. What spots 60. Have you 61. Appro- 62. What is your 63. What is have you seen? seen this spot? ximately how opinion about your opinion DO NOT (SHORTLY many times the frequency about the PROMPT, CIRCLE DESCRIBE have you seen with which this quality of this ‘MENTIONED’ THE SPOT) this commercial television spot is television spot? FOR EACH on the (was) shown on (READ THE SPOT television in television? ANSWERS) RECALLED. total? (READ PROBE: OPTIONS) (any others?) A. Gayane in 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent The Park GO TO Q61 3. No →GO TO 2. 11-20 more than 2. Good Gayane meets B 3. 21-30 necessary 3. Normal her friend Anna 88. Don’t 4. 31-40 2. Spot is shown 4. Poor in a summer remember →GO 5. 41-50 less than necessary 5. Very poor café. Anna TO B 6. More than 50 3. Spot is shown as 88. Don’t know advises her to 88. Don’t often as necessary visit Family remember 88. Don’t know Planning cabinet B. Gayane at 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent Home GO TO Q61 3. No →GO TO 2. 11-20 more than 2. Good Gayane is C 3. 21-30 necessary 3. Normal discussing family 88. Don’t 4. 31-40 2. Spot is shown 4. Poor planning issues remember →GO 5. 41-50 less than necessary 5. Very poor with her TO C 6. More than 50 3. Spot is shown as 88. Don’t know husband at 88. Don’t often as necessary home. remember 88. Don’t know C. List of 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent Family GO TO Q61 3. No→GO TO 2. 11-20 more than 2. Good Planning D 3. 21-30 necessary 3. Normal Cabinets 88. Don’t 4. 31-40 2. Spot is shown 4. Poor Located remember →GO 5. 41-50 less than necessary 5. Very poor Throughout TO D 6. More than 50 3. Spot is shown as 88. Don’t know Armenia 88. Don’t often as necessary The addresses of remember 88. Don’t know the FP cabinets are shown on blue background D.In the Family 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent Planning GO TO Q61 3. No →GO TO 2. 11-20 more than 2. Good Cabinet With E 3. 21-30 necessary 3. Normal Gynecologists 88. Don’t 4. 31-40 2. Spot is shown 4. Poor Gynecologists remember →GO 5. 41-50 less than necessary 5. Very poor introduce FP TO E 6. More than 50 3. Spot is shown as 88. Don’t know cabinets and 88. Don’t often as necessary explain their remember 88. Don’t know services

AUA Center for Health Services Research Evaluation of the Green Path Campaign

SPOT 59. What spots 60. Have you 61. Appro- 62. What is your 63. What is have you seen? seen this spot? ximately how opinion about your opinion DO NOT (SHORTLY many times the frequency about the PROMPT, CIRCLE DESCRIBE have you seen with which this quality of this ‘MENTIONED’ THE SPOT) this commercial television spot is television spot? FOR EACH on the (was) shown on (READ THE SPOT television in television? ANSWERS) RECALLED. total? (READ PROBE: OPTIONS) (any others?) E. Gayane in the 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent Family Planning GO TO Q61 3. No →GO TO 2. 11-20 more than 2. Good Cabinet F 3. 21-30 necessary 3. Normal Gayane visits the 88. Don’t 4. 31-40 2. Spot is shown 4. Poor cabinet with her remember →GO 5. 41-50 less than necessary 5. Very poor husband. A TO F 6. More than 50 3. Spot is shown as 88. Don’t know doctor discusses 88. Don’t often as necessary FP issues with remember 88. Don’t know her and answer her questions about methods F. Gayane at 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent Sister’s House GO TO Q61 3. No→GO TO 2. 11-20 more than 2. Good Gayane visits G 3. 21-30 necessary 3. Normal her elder sister 88. Don’t 4. 31-40 2. Spot is shown 4. Poor in a village, tells remember→GO 5. 41-50 less than necessary 5. Very poor her about FP TO G 6. More than 50 3. Spot is shown as 88. Don’t know cabinets, and 88. Don’t often as necessary offers her a remember 88. Don’t know brochure. G. Abortions 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent are dangerous GO TO Q61 3. No→GO TO 2. 11-20 more than 2. Good A doctor H 3. 21-30 necessary 3. Normal explains that 88. Don’t 4. 31-40 2. Spot is shown 4. Poor abortions are remember→GO 5. 41-50 less than necessary 5. Very poor deleterious and TO H 6. More than 50 3. Spot is shown as 88. Don’t know advocates FP 88. Don’t often as necessary cabinets remember 88. Don’t know H. Happy 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent children/ happy GO TO Q61 3. No→GO TO 2. 11-20 more than 2. Good family J 3. 21-30 necessary 3. Normal Pictures of 88. Don’t 4. 31-40 2. Spot is shown 4. Poor playing children remember→GO 5. 41-50 less than necessary 5. Very poor and smiling TO J 6. More than 50 3. Spot is shown as 88. Don’t know mothers 88. Don’t often as necessary remember 88. Don’t know J. Your way of 1. Mentioned→ 2. Yes 1. 1-10 times 1. Spot is shown 1. Excellent happiness GO TO Q61 3. No→GO TO 2. 11-20 more than 2. Good Parents are Q64 3. 21-30 necessary 3. Normal playing with 88. Don’t 4. 31-40 2. Spot is shown 4. Poor their 2 children remember→GO 5. 41-50 less than necessary 5. Very poor and laughing TO Q64 6. More than 50 3. Spot is shown as 88. Don’t know 88. Don’t often as necessary remember 88. Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

64. How often do you listen to the radio?

1. None/hardly any 2. 1 hour or less per day 3. 1 to 2 hours per day 4. 2 to 4 hours per day 5. More than 4 hours per day 88. Don’t know/don’t remember

65. Since June 2000 have you heard anything on radio on any station about modern contraceptives/Family Planning?

1 Yes 2 No →GO TO Q70 88 Don’t know/don’t remember →GO TO Q70

66. What did you hear? (READ, CIRCLE YES OR NO FOR EACH OPTION)

Yes No DK 1. Advertisement of Family Planning cabinets 1 2 88 2. Advertisement of pharmacies 1 2 88 3. Health program 1 2 88 4. Other ______1 2 88

NI: IF OPTION 1OR/AND 2 IS YES, CONTINUE WITH Q 67, IF NOT – GO TO Q70

67. What were the main messages of the advertisements? (DON’T READ, CIRCLE ALL THAT APPLY) PROBE: any other?

AUA Center for Health Services Research Evaluation of the Green Path Campaign

68. What attitude toward the campaign and FP cabinets did the radio spots leave you with? (READ THE ANSWERS)

1. Positive 2. Negative 3. Neutral 88. Don’t know/don’t remember

69. What is your opinion about the quality of these radio ads? (READ THE ANSWERS)

1. Excellent 2. Good 3. Normal 4. Poor 5. Very poor 88. Don’t know

70. How often do you read a newspaper or magazine?

1. Daily 2. 3-4 times per week 3. 1-2 times per week 4. Rarely/never 88. Don’t know/don’t remember

71. Since June 2000 have you read anything in newspapers or magazines about family planning/ modern contraceptives?

1 Yes 2 No → GO TO Q75 88. Don’t know/don’t remember→ GO TO Q75

72. What did you read? (CIRCLE YES OR NO FOR EACH OPTION) Yes No DK 1. Advertisement 1 2 88 2. Health article 1 2 88 3. Article(s) about the “Green Path” program 1 2 88 4. Other ______1 2 88

NI: IF OPTION 3 IS YES, CONTINUE WITH Q73, IF NOT, SKIP TO THE Q75

AUA Center for Health Services Research Evaluation of the Green Path Campaign

73. Was this article(s) positive or negative about the “Green Path” campaign?

1. Positive 2. Negative 3. Neutral 4. Different 88. Don’t know/don’t remember

74. What attitude toward the campaign and FP cabinets did the article(s) leave you with? (READ THE ANSWERS)

1. Positive 2. Negative 3. Neutral 88. Don’t know/don’t remember

75. Since June 2000, have you seen any posters about contraceptive methods/family planning?

1. Yes 2. No → GO TO Q78 88. Don’t know/don’t remember → GO TO Q78

76. Have you seen this poster? (Show the poster to the respondent)

1. Yes 2. No → GO TO Q78 88. Don’t know/don’t remember → GO TO Q78

77. Where did you see it? (CIRCLE ALL THAT APPLY)

1. Woman’s consultation 2. FP Cabinet 3. Polyclinic 4. Pharmacy 5. Women’s Seminar 4. Other ______88. Don’t know/don’t remember

78. Since June 2000, have you seen any brochures about contraceptive methods/family planning?

1. Yes 2. No→ GO TO THE INSTRUCTIONS BEFORE Q84 88. Don’t know/don’t remember → GO TO THE INSTRUCTIONS BEFORE Q84

AUA Center for Health Services Research Evaluation of the Green Path Campaign

79. Where did you see it? (CIRCLE ALL THAT APPLY)

1. Woman’s consultation 2. FP Cabinet 3. Polyclinic 4. Pharmacy 5. Women’s Seminar 6. Other ______88. Don’t know/don’t remember

80. Which brochures have you seen? (Show the brochures to the respondent, CIRCLE ALL THAT APPLY)

1. The addresses of the FP cabinets 2. Oral Contraceptives 3. Modern Methods of Contraception 4. What is Family Planning 5. Other ______→ GO TO THE INSTRUCTIONS BEFORE Q84 88. Don’t know/don’t remember → GO TO THE INSTRUCTIONS BEFORE Q84

81. Have you read any of these brochures?

1. Yes 2. No →GO TO THE INSTRUCTIONS BEFORE Q84 88. Don’t remember→GO TO THE INSTRUCTIONS BEFORE Q84

82. On a scale from 1 to 5, please rate these brochure(s) with regard to its (their) usefulness (0 – haven’ t read, 1 - extremely unuseful, 5 – extremely useful)

1. The addresses of the FP cabinets 0 1 2 3 4 5 88=DK 2. Oral Contraceptives 0 1 2 3 4 5 88=DK 3. Modern Methods of Contraception 0 1 2 3 4 5 88=DK 4. What is Family Planning 0 1 2 3 4 5 88=DK

83. What attitude toward the campaign and FP cabinets did the brochures leave you with? (READ THE ANSWERS)

1. Positive 2. Negative 3. Neutral 88. Don’t know/don’t remember

AUA Center for Health Services Research Evaluation of the Green Path Campaign

NI: IF THE RESPONDENT IS FROM ARMAVIR/YEREVAN, GO TO Q88. IF SHE IS FROM LORI/VAYOTS DZOR, CONTINUE WITH Q84

84. Have you seen/participated in any local events related to “Green Path” campaign (events in your marz or city/village)?

1. Yes 2. No →GO TO Q88 88. Don’t know/don’t remember →GO TO Q88

85. Which activities have you seen/participated in? (CIRCLE ALL THAT APPLY)

1. Concert 2. Theatre Show 3. Sport events 4. Open House in FP clinic 5. Women’s Seminar 6. Other ______88. Don’t know/don’t remember

86. How many times have you participated in/seen these events?

1. 1 times 2. 2-5 times 3. 6-10 times 4. More than 10 times 88. Don’t know/don’t remember

87. What attitude toward the campaign e and FP cabinets did these events leave you with? (READ THE ANSWERS)

1. Positive 2. Negative 3. Neutral 88. Don’t know/don’t remember

88. Did you do anything as a result of the things you have seen or heard about contraceptive methods/family planning?

1. Yes 2. No→ GO TO Q90 3. Haven’t seen or heard anything→ GO TO Q90 88. Don’t know/don’t remember → GO TO Q90

AUA Center for Health Services Research Evaluation of the Green Path Campaign

89. What did you do? (READ OPTIONS) Yes No DK/DR A. Started using a contraceptive method 1 2 88 B. Got a refill of my contraceptive method 1 2 88 C. Stopped using my contraceptive method 1 2 88 D. Changed to a different method 1 2 88 E. Went to a family planning cabinet 1 2 88 F. Talked to my physician about modern contraceptives 1 2 88 G. Talked to my husband/partner about modern contraceptives 1 2 88 H. Talked to a friend about modern contraceptives 1 2 88 I. Looked for more information about modern contraceptives 1 2 88 J. Other______1 2 88

90. What is the source of information about family planning and contraceptives you trust the most? (DO NOT PROMPT OR READ – CIRCLE CODE FOR THE OPTION MENTIONED).

91. Do you think that family planning is necessary/beneficial in Armenia?

1. Yes 2. No 88. Don’t know

AUA Center for Health Services Research Evaluation of the Green Path Campaign

92. Please indicate whether the sponsorship/endorsement of the organization/ministry listed below increases, decreases, or has no effect on your assessment of a message’s credibility (SHOW THE LOGOS ON THE POSTER, CLARIFY WHICH ORGANIZATIONS THEY REPRESENT)

A. USAID logo

1. Increases credibility of the message 2. Decreases credibility of the message 3. Has no effect 88. Don’t know

B. JHU Logo

1. Increases credibility of the message 2. Decreases credibility of the message 3. Has no effect 88. Don’t know

C. MOH Logo

1. Increases credibility of the message 2. Decreases credibility of the message 3. Has no effect 88. Don’t know

CONTRACEPTIVE IMAGE

On a scale from 1 to 5, please rate each of the following contraceptive methods according to each of the characteristics I will mention:

93. First, rate each of the following with regard to safety and health effects? (1=extremely unsafe, 5=completely safe)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

AUA Center for Health Services Research Evaluation of the Green Path Campaign

94. How would you rate each of the following with regard to effectiveness at preventing pregnancy? (1=completely ineffective, 5=completely effective)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Withdrawal 1 2 3 4 5 88=DK

95. How would you rate each of the following with regard to cost? (1=very inexpensive, 5=very expensive)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

96. Overall, how much do you like each of the methods of preventing births? (1=dislike very much, 5=like very much)

A. Pills 1 2 3 4 5 88=DK B. IUD 1 2 3 4 5 88=DK C. Male Condoms 1 2 3 4 5 88=DK D. Spermicide/Cream/Jelly 1 2 3 4 5 88=DK E. Abortion 1 2 3 4 5 88=DK F. Withdrawal 1 2 3 4 5 88=DK

Thank the woman for her cooperation and provide her an incentive.

END OF INTERVIEW

TIME INTERVIEW ENDED __ __ : __ __

INTERVIEWED BY:______

QUESTIONNAIRE REVIEWED BY:______

DATA ENTRY OPERATOR # 1______

DATA ENTRY OPERATOR # 2______

AUA Center for Health Services Research Evaluation of the Green Path Campaign APPENDIX 3. JOURNAL FORMS

Appendix 3A. JOURNAL FORM FOR BASELINE

Date: ______City/Town/Village______Interviewer’s name ______

Cluster number: Starting address: Offset address: Shared cluster: Yes No Direction: Right Left

Visit 1234567891011121314 number # Of eligible respondents Result

Amount of shift to this attempt

Visit 15 16 17 18 19 20 21 22 23 24 25 26 27 28 number # Of eligible respondents Result

Amount of shift to this attempt

RESULT CODES 1. Completed interview 2. No eligible females 3. Nobody at home 4. Selected respondent (from baseline) not at home 5. Total refusal 6. Refusal by selected respondent 7. Unoccupied house 8. Respondent incompetent______9. Other ______10. Incomplete interview

AUA Center for Health Services Research Evaluation of the Green Path Campaign Appendix 3B. JOURNAL FORM FOR FOLLOW-UP Date: ______City/Town/Village______Interviewer’s name ______

Cluster number: Starting address: Last address: Shared cluster: Yes No

1. Baseline cluster Visit 123456 number Result

RESULT CODES 1. Completed interview 2. Respondent not at home 3. Nobody at home 4. Respondent changed address in the same city/village 5. Respondent moved to another city/village within Armenia 6. Respondent moved to another country 7. Total refusal 8. Refusal by selected respondent 9. Other ______10. Incomplete interview 2. Additional interviews Visit 1 2 3 4 5 6 7 8 9 10111213141516171819 number # Of eligible respondents Result

Amount of shift to this attempt RESULT CODES 1. Completed interview 2. No eligible females 3. Nobody at home 4. Selected respondent (from baseline) not at home 5. Total refusal 6. Refusal by selected respondent 7. Unoccupied house 8. Respondent incompetent______9. Other ______10. Incomplete interview

AUA Center for Health Services Research Evaluation of the Green Path Campaign

APPENDIX 4

TRAINING MANUALS

AUA Center for Health Services Research Evaluation of the Green Path Campaign

AMERICAN UNIVERSITY OF ARMENIA Center For Health Services Research (CHSR)

APPENDIX 4A TRAINING MANUAL FOR INTERVIEWERS

Armenian Women’s Reproductive Health Baseline Survey

Yerevan 2000

AUA Center for Health Services Research Evaluation of the Green Path Campaign

Project Overview

The Johns Hopkins University Population Communication Services has received funding from the United States Agency for International Development (USAID) to carry out a national mass media campaign to promote family health. This is in response to the high rate of abortions in Armenia as a form of birth control and the limited dissemination of information about family planning services in Armenia. This campaign proposes to promote family health through the use of family planning methods and to publicize the 77 UNFPA-funded family planning sites located throughout Armenia.

This is the second research component of this project to be carried out by the CHSR. The first was a qualitative project completed last year in conjunction with the Center for Policy Analysis. The results of that project informed the design of the media campaign and shaped the specific messages that were developed. The current phase of the research involves evaluating the program’s impact.

The main purpose of this phase of research is to gather baseline data (self-reported knowledge, attitudes, beliefs, and practices as well as key demographic and socio-cultural information) against which to measure the impact of the program. Listed below are the specific outcome measures, which will be addressed.

Program Outcome Measures

1. Changes in women’s awareness, usage, attitude and knowledge of different modern contraception methods 2. Changes in women’s knowledge of sources to obtain modern contraception methods 3. Changes in women’s attendance of Family Planning Cabinets 4. Changes in abortion practices, 5. Quality changes in contraceptive counseling delivered by Family Planning Cabinet Physicians 6. Changes in women’s satisfaction with Family Planning Services

AUA Center for Health Services Research Evaluation of the Green Path Campaign

7. Changes in women’s exposure to the information about modern contraceptives 8. Changes in partner’s awareness, usage, knowledge and attitude towards modern contraceptive methods 9. Changes in knowledge of women’s reproductive health aspects 10. Changes in knowledge regarding STD transmission and manifestation.

Concept of the Evaluation

The study is a pre-post panel design, with an estimated 1,000 women of reproductive age (18-35) to be surveyed. As elements of the program are national in scope, there will not be a natural control group, thus limiting study design selections. It is hoped that the sampling strategy can offset this limitation through ‘dose-response’ assessments of campaign exposure.

Program elements include

1. a national multi-media media campaign and 2. regional community organizing efforts in select areas (Lori, Vayots Dzor). In addition, similar efforts, not coordinated with this project will be implemented in other regions (e.g. MSF in Tavush).

Currently, it is expected that 500 women will be selected from Yerevan and 500 from the two community intervention regions. It is possible that another group of 200-300 may be selected from the remaining regions.

Project Time Period

The data collection for the baseline component of this project is expected to begin in early April and must conclude by May 20, 2000. It is expected that administering the survey by a team of 10 interviewers will require the equivalent of 17 full days. Each interview will last for about 40 minutes - 1 hour.

AUA Center for Health Services Research Evaluation of the Green Path Campaign

Project Travel Expectations

Interviewers/Research Analysts are expected to travel throughout Yerevan, Vayots Dzor and Lori to administer the survey. It is projected that each interviewer will complete 6 surveys per day. Transport will be provided/coordinated by AUA.

Payment

Survey interviewers will be paid according the completed interviews. Work hours of the interviewers will be flexible; still, the minimum amount of the interviews that should be completed per day will be set. The gross compensation for the contract period will be $2.70 per completed interview for Yerevan and $4.00 per completed interview from the regions. Payment will be based upon completed survey questionnaires submitted and approved by CHSR staff/CHSR associate director.

Supplies

Each interviewer will be provided with the stationery supplies necessary for conducting the interviews. These may include: papers for notes, pens, pencils and erasers. CHSR is responsible for providing interviewers with all the instruments necessary for work: questionnaire forms, consent forms, journal forms, “logo” forms, sampling and administration guides, etc.

Training

Interviewers and Research Analysts involved in the project must complete this training or will be ineligible to work on this project, thus voiding the employment contract.

AUA Center for Health Services Research Evaluation of the Green Path Campaign

Pre-test and Observations

A local pre-test of the instrument and interviewer is planned before the actual fielding of the survey. These pre-tests will be observed by a member of the CHSR staff or the JHU/PCS field office. The intent of this activity is to provide confidence to interviewers and to highlight any deficiencies of the training program, as well as to acquire the information about the flow and appropriateness of questions and the interview length.

After pre-tests are conducted and the appropriate revisions are made to the questionnaire, actual interviews will start.

Languages Used

All interviews are expected to be conducted in Armenian. However there can be exceptions for Russian-speaking women. Whenever Russian-speaking respondents are encountered, the interviewers should stress the importance of the interview conduction in Armenian and start Russian version only in case if a woman experiences real difficulties with Armenian, which can lead to the misunderstanding of the questions and answer options. For that case, the interviewers should use Russian translated questionnaire to make sure that the questions asked are uniform.

Project staff work expectations Interviewers will be expected to work individually. Interviewers are not expected to select an area/geographical location of a cluster, CHSR is responsible for that. However, interviewers are responsible for the recruitment of the respondents within a cluster, strictly adhering to the rules of random selection in cluster sampling, identified below, as well as for all the aspects related to conduct of the interview (recording).

Process guide For the selection of the respondents multistage cluster sampling will be used. This sampling method is used when the lists of people from which the selection should be done is not available.

AUA Center for Health Services Research Evaluation of the Green Path Campaign

For this method, “clusters” of the sampling elements are chosen first (for instance, policlinics) and then elements are chosen (women of appropriate age). Taking into consideration the specifics of the current project and the conditions of Armenian health facilities, the following sampling design was generated.

Sampling for Yerevan

• Identification of all the children policlinics in Yerevan. • Identification of the number of clusters that need to be taken from the population served by each policlinic (the population numbers are taken into consideration for this step). • Identification of the separate “policlinic districts” from where the clusters will be chosen. • Selection of the address of the household, which will be the starting point of the cluster from the lists of families, served by each district.

Sampling for Lory/Vaiots Dzor

• Identification of the cities/regional centers/villages within each of these marzes to be selected. • Identification of the number of the clusters that should be taken from each city/regional center/village, based on the # of population. • Identification of the number of policlinics/health centers within these areas from which the clusters will be taken. • Selection of the address of the household, which will be the starting point of the cluster from the lists of families, served by each policlinic/health center.

The interviewers will be involved mostly in the process of identification of the eligible respondents, from which the interviews should be obtained, within a cluster, explained below.

AUA Center for Health Services Research Evaluation of the Green Path Campaign

Sampling Instructions (Yerevan)

Starting: For each cluster the interviewers should have an address of the randomly selected starting point. This address should be found first. The interviewer should not contact this household, but the fifth apartment/private house to the right/up counting from the starting point [exclude business addresses in your counting]. Subsequent selection of households depends on whether a completed survey was obtained from the previous household

1. The direction of movement from the offset household throughout the rest of the cluster is determined by a coin toss: heads = right/up; tails = left/down. Note – the direction of movement is chosen only once for each cluster.

Basic concept ☛ if the prior household was a completed survey move 5 units; if incomplete or no response move 1 unit.

2. If an eligible respondent lives in the household: Start selection of the respondent within a household. If there are more than 1 respondent in the household, use the table “Selection of the individual respondent” to make a random choice. Interview the respondent. ✓ If you complete the interview, move 5 units. ✓ If the interview is incomplete or the selected respondent refuses to participate or is later determined to have been ineligible 1. Select another eligible respondent from the household (if any) 2. If no remaining eligible respondents in the household, consider the household as a non-respondent and move to the next (1 unit) household

• If there is no response or an eligible respondent does not reside there: Move (1 unit) to the next

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✹ Note: This technique of selection may be changed in regions; especially in small villages where only I cluster will be taken from. In such cases in order to make the selection process less time-consuming, the interviewers may work in teams, each of them conducting one interview in the cluster. After all interviews in a cluster are finished the group may move to another geographically close village and start interviewing there.

Survey Administration

Script of an interviewer’s introduction to the household.

Good morning/day, I am from the Public Health Department of the American University of Armenia. We are conducting a study regarding Armenian women’s knowledge/attitude/practice of Family Planning for the Johns Hopkins University and the Ministry of Health and would like to talk with you for a little.

✔ If a respondent opens the door/you enter, continue. If refuses – first try to answer specific objections; if unsuccessful, leave the household.

1. Sorry for troubling you. Our study focuses on married women 18-35 years old. Do you have female members of the household in this age group?

Possible answers: • Yes • No - Apologize and thank the person you are talking with. Leave the household. • Don’t know – Ask once again, if the answer is the same or “No”, apologize and thank the person you are talking with. Leave the household. 2. If yes, continue. Go ahead and fill the “Selection of respondent” page. After respondent is selected, continue.

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3. Is she at home?

Possible answers: • Yes • No - Select another respondent from the same household and continue. If there are no other eligible women in the household, apologize and thank the person you are talking with. Leave the household.

4. Can I talk to her/you?

Possible answers: • Yes • No – Try to find out the reasons for the refusal. Try to persuade a woman to participate, based on what you know about the survey – talk about the confidentiality issues, say that it will be interesting experience to a woman and that her answers will be really valuable for the study, etc. NOTE: Don’t be too persistent. If a woman still refuses, try to contact another woman, if there are no other eligible women - apologize and leave the household.

5. Present the introductory statement.

I would be very thankful if you participate in our survey and answer some questions that I am going to ask. Any personal information that you’ll provide will be anonymous and will not cause any harm to you. Your participation is very important and valuable for us and hopefully it will help to improve the health of Armenian women. The interview will not take more than 45 minutes. Thank you in advance.

6. Can we start? Possible answers: • Yes

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• No – Try to find out the reasons for the refusal. Try to persuade a woman to participate, based on what you know about the survey – talk about the confidentiality issues, say that it will be interesting experience to a woman and that her answers will be really valuable for the study, etc. NOTE: Don’t be too persistent. If a woman refuses- apologize and leave the household.

7. Make sure that you and respondent are alone in a room. If someone else is present/wants to be present, explain gracefully that the specifics of the interview requires the absence of the third person in a room to avoid interruptions and to allow the respondent to feel free and relaxed.

8. Now it is necessary to provide a woman with the consent form. Give her time to read and understand, if she has questions, answer them. After she signed the form, go ahead and start with question #100.

Interview tips

The interviewers should pay attention to their style of communication with the potential and actual respondents and to the style of the survey administration.

The interviewer should 1. Use the introductory statement as an opportunity to gain the rapport with a respondent. It is better to not read the statement, but say it in the conversational manner, to avoid tension and formal tone. 2. Not be intrusive/ too persistent in his/her attempt to recruit respondent. 3. Provide respect to person being interviewed/members of the household 4. Convey that respondent’s knowledge, experience and attitude is important 5. Listen and record without passing verbal/nonverbal judgment 6. Show no favor, discontent, shock, anger 7. Not be afraid to interrupt gracefully when the respondent starts talking too much and deviate from the topic/question.

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How to deal with interview “flows” • Question Refusal

It is possible that during the interview a respondent will refuse to answer certain questions or even refuse to continue the interview. In the first case, it is necessary to ask about the reasons for refusal, record it, and continue with the next question. In the second case, it is necessary to ask about the reasons for discontinuing and then try to convince the respondent to continue. NOTE: Have just one attempt, don’t be too persistent. If a respondent still refuses, apologize and quit the surveying. Try to interview another woman from the same household.

• Ineligible Respondent

If you discover during the interview that a respondent is ineligible though she reported /you considered her to be eligible, stop the interview. Go back and try to clarify this question once again. If you notice that the respondent misunderstands, go back to the question, which defines a woman’s eligibility for the survey, and ask the question again. If you notice that the respondent hides something, ask probing questions in conversational manner, till you make the question clear for yourself. If it becomes apparent that she is ineligible, quit the interview, explain gracefully that a respondent doesn’t fit our eligibility criteria and try to contact another eligible woman from the same household. If there is no any eligible woman, thank the respondent and leave the household.

• Incorrect Administration/Skipping

It is possible that you err in administering the survey and make wrong skip. In this case you should find out where the right flow of the questions was distorted – for that, go back from the current question and check the previous questions/answers. Find the point and proceed from this. Explain the respondent that you found a minor mistake and want to correct it, ask her to help you and, if necessary, to answer certain questions second time.

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• Cannot Find Start Address

If at the beginning of the survey you can’t find your starting point (address is not correct, no such address exists, etc.), you should define new starting point yourself. This starting point should be on the same street as the address not found. You should pick the address, which is geographically closest to the one that you were not able to find. Record why you were not able to find the address, the time spent on searching, and the new starting address. After the new address is defined, start the same process as identified above. NOTE: This is the last option. Always try to find the starting point chosen previously.

• What defines completed survey

Do not leave the household until the survey is completed. The survey can be considered completed if 1. All the questions are covered/are not omitted (do not consider selective refusals to certain questions as omissions). 2. The information on the respondents’ selection is recorded/completed. 3. The “Journal form” is filled correctly. 4. Identification/location information is recorded for the follow-up visit. 5. Time interview started/ended is recorded 6. Consent form is signed

Explanations on consent forms/uses of data/panel design

The study uses a “panel design”, which implies that the same sample of people is studied at different times. In the perspective of the current survey, the panel design is used in order to be able to describe how Armenian women ‘s knowledge, attitude and practice of Family Planning change as a result of JHU/PCS program. For these reasons, women from the sampled households will be interviewed now and once more after the Family Planning national mass media campaign (most likely in the fall).

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The data collected from women will be analyzed and on the basis of the analysis results the inferences will be made regarding the JHU/PCS program effectiveness in Armenia. The changes in women’s knowledge, attitude and practice of family planning will be measured and the corresponding conclusions will be made. The detailed analysis will enable researchers and program implementers to reveal the strong and weak sides of the project, what worked better and what didn’t work and where to put accent when planning and conducting similar programs in the future.

Asking people questions in the survey regarding their personal life (especially regarding their reproductive health /family planning knowledge, behavior and attitude) should involve a consideration of the ethical issues. It is necessary for the respondents to be fully informed about the study and voluntarily agree to participate. They have a right to remain anonymous and to be sure that the information they provide will be kept in confidentiality. For these reasons before the start of the interview, an interviewer should provide a respondent with informed consent form, which includes the general information about the logistics and the goals of the survey, the information concerning respondents’ rights and confidentiality issues and contact information. A respondent should read the consent form and sign it before the interview starts.

Summary/Conclusion

It is imperative for the success of any survey that the sampling strategies/respondent selection is performed in unbiased and systematic manner. It is necessary also that the questions in the survey are asked precisely and uniformly and the answers of respondents are registered accurately and correctly. Thus, the interviewer’s adherence to the survey rules and instructions and their ability to feel responsible for their performance is important, since they are the performers of the most essential part of the study information gathering

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Interviewer Checklist:

Before leaving for Interviews, check to see if you have the following and that they are functioning appropriately:

" Sampling Guide " Survey Administration Guide " Blank Surveys " ‘Logo Page’ " Selection of the respondent page " List with codes of family planning clinics " Consent Forms " Journal Forms " Note taking paper, pen " Incentives " Contact Information (CHSR phone number, etc)

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AMERICAN UNIVERSITY OF ARMENIA Center For Health Services Research (CHSR)

APPENDIX 4B GUIDE FOR INTERVIEWERS

Armenian Women’s Reproductive Health Follow-up Survey

Yerevan 2000

AUA Center for Health Services Research Evaluation of the Green Path Campaign 1. The purpose of the follow-up survey

Baseline assessments of knowledge, attitudes, and practices of women regarding family planning and reproductive health of Armenian women were assessed using survey instruments and methods developed in cooperation with the JHU/PCS (in April/May 2000). Approximately six months following the implementation of the “Green Path” campaign (in November 2000), the same women should be re-interviewed using an instrument similar to the one used for the baseline assessment. Specific constructs to be measured include gain knowledge, attitudes, and practices related to family planning and reproductive health. It is hoped that there will be changes in these constructs due to the exposure to the campaign.

A sufficient number of women were sampled for the baseline taking into consideration that there would be those lost to follow-up over the duration of the study. A representative panel of 1212 women was enrolled at baseline. During the follow-up, additional 236 women will be enrolled to assess for any reactive/instrumentation effects. There were 84 clusters (6 women in each cluster) in Lori/Vayots Dzor and 34 clusters in Armavir. Additional 1-2 women per each cluster will be enrolled at follow-up for testing questionnaire/survey administration effect. This translates to 84 women from Yerevan, 84 women from Lori/Vayots Dzor and 68 women from Armavir.

2. Process guide

The interviewers should proceed according to the following protocol. First, the interviewers should complete the cluster of 6 women, trying to find and interview women whose addresses are already known from the baseline. After these interviews are completed, the interviewers should go ahead and conduct 1 (in Yerevan and Lori/Vayots Dzor) or 2 (in Armavir) additional interviews. These respondents should be selected according to the method, used in the baseline survey, with slight modifications:

From the respondent address at the geographic end of the cluster, the interviewer should count off 5 houses/units in the direction used for this cluster in baseline survey and contact corresponding house.

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• If there is at least one eligible, willing respondent at the address, the interviewers start interviewing, or proceed with the “Selection of the Respondent “ page. • Once a survey is completed or if the household yields no respondents, the next household should be selected as follows:

Direction of movement: Direction of movement for the cluster is the same as in baseline Magnitude of Movement: Last household resulted in: • Completed survey: skipping 5 doors (for Armavir), or finishing surveying • Non-respondent/unwilling respondent: next household • After the second interview is conducted (for Armavir), the interviewer finishes surveying.

3. Interviewer’s introduction to the household

“Good morning/day, I am from the Center for Health Services Research of the American University of Armenia. We are conducting a study regarding Armenian women’s knowledge/ attitude/ practice of Family Planning for the Johns Hopkins University and the Ministry of Health and would like to talk with you for a little. As you may remember, we visited you once in the spring, and now we are conducting the second phase of our investigation. I would like to remind you that any personal information that you’ll provide will be anonymous and will not cause any harm to you. Your participation is very important and valuable for us and hopefully it will help to improve the health of Armenian women.”

For the ”additional” interviews, the interviewer should omit the last part of the script (underlined), proceed according to the “Training Manual” for baseline, and present Informed Consent form.

4. Possible obstacles

It is possible that interviewers cannot conduct interviews with all 6 women surveyed in the baseline because of the following reasons.

a) Some women may be not at home. The procedure will depend on whether the household members are at home or not.

If a respondent is not at home, but household members are at home.

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The interviewers should ask household members about when the interviewee will be at home and visit the house once again at the identified time, if it is possible. If household members have no information about when the woman will return, the interviewers should try to contact the woman during the day, when convenient, and/or at the end of the day, after finishing the rest of the cluster and “additional interviews”. If a respondent is again not at home at the end of the day, then the interviewer should try to negotiate with the household members or neighbors. First of all the interviewee should try to find out and record the respondent’s phone number to contact a respondent later. If there is no phone number, it is necessary to record phone numbers of neighbors, or relatives, or anyone, who may be helpful in making a woman aware of the time of a next visit. If there are no phone numbers, the interviewer should leave, having an information about whether a woman is in a city or moved, when usually she is at home, and when it will be more convenient to contact her later. The above-mentioned information should be thoroughly registered and provided to CHSR staff at the end of the day. Up to 2 additional attempts will be made to contact this respondent later on.

If a respondent is not at home, and household members/neighbors are not at home (don’t provide information). The interviewer should try to contact a woman during the day, when convenient, and/or at the end of the day/after finishing the rest of the cluster and “additional interviews”. If she is again not at home, and there is nobody to negotiate with, the interviewer should leave the household. Up to 2 additional attempts will be made to contact this respondent later on.

NOTE: For regions, later “follow-up” contacts will be performed for any marz at the end of the survey period in this marz (after the rest of the interviews in this region are completed). The contacts will be made after CHSR staff revise the addresses of “non-contacted” women and find a sufficient number of such women to arrange a car and interviewers to send to a remote region. But it is possible that in certain cases, the second/third contacts may be done earlier – as it will be convenient in terms of transportation (f.i, if the car is sent to the region close to the

AUA Center for Health Services Research Evaluation of the Green Path Campaign city/village of non-contacted respondent, then the interviewers may be assigned to finish incomplete clusters during that trip in addition to that day’s clusters). For Yerevan later contacts will be made at the end of the surveying in Yerevan. In certain cases, as in regions, the interviewers may be assigned to make a second contact earlier, if they are going to conduct the interviews in close districts. The interviewers working in Yerevan are welcomed to contact the respondent left for the second “follow-up” next day or in other convenient time. In this case the interview should be conducted in addition to the new cluster, assigned to an interviewer for a day, and no transportation will be provided for this.

b) Some women will not be at home/relocated. In this case the interviewers should find out new address and phone number of the respondent (either form her household members or from neighbors), and record it, for further attempts to contact the respondent. If the address is changed, but is in confines of the city/village where the interviews are conducted, the interviewer should try to find it and complete the interview, after all other addresses are found and “additional interviews” are completed. When the interviewer arrives to the new address, and the respondent is not at home, the interviewer should adhere to the instructions presented above in paragraph a. If a respondent moved to another proximate city/village in the confines of Armenia, attempts will be made to contact a woman later at the new address at the end of the surveying in regions, if a respondent is out of Armenia, she is considered “dropped” from the study, and no further attempts to contact her will be made.

c) Some women may refuse to participate. In this case the interviewers should first try to find out the reasons for the refusal. If a woman has no time/busy/is going to leave, the interviewer should try to assign another time during the same day. If it is not convenient for a woman, the interviewer should take the detailed contact information from the respondent (phone numbers, when she is usually at home, will she be in a city/village), and leave. These women will be conducted later, and treated as the 2 follow-ups (with the same differences in the technique for Yerevan/Regions, see paragraph a, NOTE). If the woman still does not want to be interviewed, or if there is another reason for refusal, the

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interviewers should try to persuade the woman explaining her the importance of her answers, since she participated in the baseline, and that the loss of any additional person with whom the interviews were already conducted, is very crucial for the survey results. If the woman still refuses, interviewers should not insist on her participation and should leave the household.

The interviewers are responsible to finish the “incomplete” clusters left at the end of the survey. The efficient and effective work of the interviewers will save their time and efforts.

5. Additional notes

At the end of the day each interviewer should return the list with the contact information on respondent(s), whom they were not able to contact, along with completed questionnaires and journal forms.

Each interviewer working in Yerevan is responsible for calling an interviewee (if phone number is available) a day or two before the interview to assign an appropriate time for visit and make sure that the respondents be at home when necessary, and thus to save time and efforts. For the interviewers working in regions such calls will be made by CHSR staff. It is expected that the part of the interviewers who participated in the baseline survey will be involved in follow-up, and it is planned that these interviewers will survey the women with whom they conducted the interview previously. This will facilitate the process of interviewing, since the women will be already acquainted to the surveyor, feel more relaxed during the administration of the questionnaire and hopefully answer more openly. Besides, the interviewers will spend less time trying to find the respondent, since they will be already familiar with the geographical location.

NOTE: THE COMPLETION OF THE FOLLOW-UP SAMPLE IS VERY CRUCIAL FOR THE SUCCESS OF THE SURVEY AND IS DETERMINED MOSTLY BY THE THOROUGH AND CONSCIENTIOUS PERFORMANCE OF THE INTERVIEWERS.

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In addition to completing a cluster of 7-8 interviews, interviewers should complete journal forms, where information should be logged on compliance with the sampling protocol and response patterns.

The interviewers will use journal forms for the ID number recording on the first page of the questionnaire for the control group (additional interviews). The codes for ID number are presented below.

ID NUMBER* ______

*The coding for ID number:

Digit 1 Respondent status (1 = panel, 2 = control) Digit 2 Region code (1 =Yerevan, 2 = Lori, 3 = Vayots Dzor, 4 = Armavir) Digit 3-4 Cluster number Digit 5-6-7 Visit number (number of attempted household/person in a cluster) Note: Use Journal form for writing this number

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JOURNAL FORM

Date: ______City/Town/Village______Interviewer’s name ______Cluster number: Starting address: Last address: Shared cluster: Yes No

1. Baseline cluster Visit 123456 number Result

RESULT CODES

1. Completed interview 2. Respondent not at home 3. Nobody at home 4. Respondent changed address in the same city/village 5. Respondent moved to another city/village within Armenia 6. Respondent moved to another country 7. Total refusal 8. Refusal by selected respondent 9. Other ______10. Incomplete interview

2. Additional interviews Visit 1 2 3 4 5 6 7 8 9 10111213141516171819 number # Of eligible respondents Result

Amount of shift to this attempt

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Training/pre-testing: Interviewer training (1 day) and pre-testing (2 days) will take place on November 18 and 20, with a final retraining of the revised instrument/protocol occurring on November 24. A total of 10 full-time interviewers, all women, will be utilized.

Data Collection: Data collection will start on November 25 and end in the middle of December. A senior member of the CHSR or JHU/PCS staff will observe each interviewer at least two times during the pre-testing phase and once during the implementation phase.

Payment: Survey interviewers will be paid according the completed interviews. Work hours of the interviewers will be flexible; still, the minimum amount of the interviews that should be completed per day will be set. Payment will be based upon completed survey questionnaires submitted and approved by CHSR staff/CHSR associate director.

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