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Digital Health Literacy Intervention to Support Maternal, Child and Family Health in Primary Healthcare Settings of Pakistan during the Age of Coronavirus: Study Protocol for a Randomized Controlled Trial
ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-045163
Article Type: Protocol
Date Submitted by the 25-Sep-2020 Author:
Complete List of Authors: Jafree, Sara; Forman Christian College, Department of Sociology Bukhari, Nadia; University College London, School of Pharmacy Muzamill, Anam; Forman Christian College, Department of Mass Communications Tasneem, Faiza; Forman Christian College, Department of Business Fischer, Florian; Charité Universitätsmedizin Berlin, Institute of Public Health; University of Applied Sciences Ravensburg-Weingarten, Doggenriedstraße
Maternal medicine < OBSTETRICS, Community child health < Keywords: PAEDIATRICS, COVID-19, PRIMARY CARE
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786 1 2 3 Digital Health Literacy Intervention to Support Maternal, Child and Family Health in 4 5 Primary Healthcare Settings of Pakistan during the Age of Coronavirus: Study Protocol 6 for a Randomized Controlled Trial 7 8 9 Sara Rizvi Jafree, Nadia Bukhari, Anam Muzammil, Faiza Tasneem, Florian Fischer 10 11 Dr. Sara Rizvi Jafree 12 13 Department of Sociology, Forman Christian College University, Lahore, Pakistan 14 [email protected] 15 16 For peer review only 17 Nadia Bukhari 18 School of Pharmacy, University College London, London, United Kingdom 19 [email protected] 20 21 22 Anam Muzammil 23 Department of Mass Communications, Forman Christian College University, Lahore, Pakistan 24 [email protected] 25 26 27 Faiza Tasneem 28 Department of Business, Forman Christian College University, Lahore, Pakistan 29 30 [email protected] 31 32 Dr. Florian Fischer 33 34 1) Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany 35 2) Institute of Gerontological Health Services and Nursing Research, Ravensburg- 36 Weingarten University of Applied Sciences, Weingarten, Germany 37 38 [email protected] 39 40 Corresponding author: 41 42 Dr. Florian Fischer 43 Charité – Universitätsmedizin Berlin 44 Institute of Public Health 45 46 Charitéplatz 1 47 10117 Berlin 48 E-Mail: [email protected] 49 50 51 52 Word count: 3,592 53 54 55 56 57 58 - 1 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 64 BMJ Open
786 1 2 3 1 Abstract 4 5 6 2 Introduction: There is a need to continue primary healthcare services through digital 7 8 3 communication for disadvantaged women living in underdeveloped areas of Pakistan, especially 9 10 4 in the age of the coronavirus pandemic, social distancing, and lockdown of communities. This 11 12 5 project will be the first of its kind in aiming to provide women with a smartphone and access for 13 14 15 6 a digital health literacy intervention through community healthcare workers. The majority of poor 16 For peer review only 17 7 women in Pakistan is dependent on primary health services, because 1) they suffer more from 18 19 8 health challenges compared to men due to multiple social and structural disadvantages, 2) they are 20 21 22 9 the dominant care-providers and nurturers in the home, and 3) they need support in understanding 23 24 10 public health messages during health crises due to low health literacy and awareness. 25 26 11 Methods and analysis: The digital health literacy intervention will be delivered in two target areas: 27 28 29 12 (i) hygiene and sanitation, and (ii) awareness and prevention related to the coronavirus. Women 30 31 13 will be sampled from disadvantaged areas across the four provinces of Pakistan (Baluchistan, 32 33 14 KPK, Punjab, and Sindh) and the autonomous territory Gilgit-Baltistan. A target of 1,000 women 34 35 15 will comprise the sample with 500 women each assigned randomly to the intervention and control 36 37 38 16 group. ANOVA will be used for analyzing the intervention’s effects compared to the control 39 40 17 group. 41 42 18 Dissemination: Results will be disseminated to the international scientific community and 43 44 45 19 stakeholders in Pakistan. 46 47 20 48 49 21 Keywords: digital health literacy, primary healthcare, community healthcare workers, maternal 50 51 52 22 and child health, COVID-19, RCT 53 54 23 Trial Registration: Registered at clinicaltrials.gov (NCT04603092) 55 56 57 58 - 2 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 64
786 1 2 3 24 Ethics Committee Approval: Internal Review Board of the Forman Christian College University; 4 5 6 25 Approval reference number: IRB-252/06-2020 7 8 26 9 10 27 Strengths and limitations of the study 11 12 13 28 This is the first randomized controlled trial investigating the effects of a digital health 14 15 29 literacy intervention in Pakistan. 16 For peer review only 17 30 Using a two-step approach of pre-testing, we aim to establish an intervention tailored to 18 19 20 31 the needs of study participants. 21 22 32 The study results are not only relevant for digital interventions in general, but particularly 23 24 33 in times of the coronavirus pandemic, where social distancing hinders the provision of 25 26 27 34 health interventions personally. 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 3 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 64 BMJ Open
786 1 2 3 35 Introduction 4 5 6 36 South Asia is home to 25% of the world population, the majority of them is poor and without 7 8 37 universal health coverage. Research has estimated that 1 in 10 South Asians face health challenges, 9 10 38 multimorbidity, and risk of infectious disease; with each additional morbidity carrying greater risk 11 12 39 of mortality [1, 2]. Pakistan’s healthcare sector is known to be under-resourced and inefficient, 13 14 15 40 with health budget allocation standing at less than 1.5% of gross domestic product [3]. Primary 16 For peer review only 17 41 healthcare services in Pakistan are not adequate or well planned, contributing to the infectious 18 19 42 disease burden in the country [4]. There is critical need for more integrated and innovative planning 20 21 22 43 for primary health services, where identification of diseases, treatment referrals and prevention is 23 24 44 possible. 25 26 45 According to its number of inhabitants, Pakistan is the sixth largest country worldwide [5], with 27 28 29 46 more than a 100 million women living there. Local research has confirmed that women in the 30 31 47 country are suffering from a quadruple disease burden of 1) communicable/infectious diseases, 2) 32 33 48 non-communicable diseases, 3) accidents, injuries, and violence, and 4) multimorbidity [6, 7]. 34 35 49 Additionally, women from lower- and middle-income countries (LMIC) may suffer from health 36 37 38 50 challenges and infection risk more than men [1]. It has also been estimated that women from 39 40 51 unfavorable socio-demographic backgrounds and living in deprived areas experience health 41 42 52 challenges and multimorbidity 15 years earlier than people from more affluent backgrounds [8]. 43 44 45 53 An additional and important consideration is that women from Pakistan suffer from regressive 46 47 54 cultural norms and community neglect. This is why most women in Pakistan are unemployed [9], 48 49 55 illiterate or semi-literate, crippled by poverty [6], and thus increasingly vulnerable to multiple 50 51 52 56 health burdens. Several socio-cultural burdens adversely influence the health of women in 53 54 57 Pakistan, including undernutrition, early marriage, reproductive burdens and lack of birth spacing, 55 56 57 58 - 4 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 64
786 1 2 3 58 and a culture that prevents health-seeking behavior. Though it is assumed that health challenges 4 5 6 59 affect people at more advanced years, pregnant women in LMICs are at an increased risk of health 7 8 60 burdens and infectious diseases [1, 2, 10]. Pregnant women are not merely at risk of mortality 9 10 61 themselves, but there is concern that their child is also at heightened risk [11]. 11 12 62 The greatest concern for LMIC and Pakistan is that women of reproductive years who are illiterate 13 14 15 63 and semi-literate are not able to manage health, or adopt protective behavior, due to lack of 16 For peer review only 17 64 awareness and education, and difficulty in understanding instructions by physicians or public 18 19 65 health experts. Research suggests that health services provided to women for maternal health in 20 21 22 66 Pakistan are insufficient at both primary and tertiary level [12]. In the age of coronavirus, they 23 24 67 have been further compromised due to enforced social distancing. It is critical that women are 25 26 68 provided urgent assistance for infection protection, symptom management, and health access 27 28 29 69 during the pandemic [13, 14]. Digital health literacy in Pakistan, during the corona pandemic, 30 31 70 would also contribute to improvements in patient safety, referral for other health and social needs 32 33 71 through community healthcare workers, and ultimately enhance the socio-economic potential of 34 35 72 the country. 36 37 38 73 Until now, research on digital interventions for health are non-existent in Pakistan. There is no 39 40 74 doubt that promoting digital health literacy must be the first step of intervention to support patients 41 42 75 in managing their health in times of social distancing [15]. Disadvantaged populations who have 43 44 45 76 received health literacy interventions showed greater adherence to medication and improved 46 47 77 adoption of health-seeking behavior compared to those with lower health literacy [16]. 48 49 78 Additionally, digital health literacy interventions that facilitate self-management have been 50 51 52 79 successful when the following efforts have been made: (i) development of easy reading material, 53 54 80 and (ii) coding through numbers, pictures, or colors [17, 18]. This protocol describes the methods 55 56 57 58 - 5 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 7 of 64 BMJ Open
786 1 2 3 81 for randomized controlled trial which aims at investigating the effects of a digital health literacy 4 5 6 82 intervention to support maternal, child and family health in primary healthcare settings of Pakistan. 7 8 83 9 10 84 Methods 11 12 85 Study design 13 14 15 86 A randomized controlled trial (RCT) will be conducted. The study follows three consecutive steps. 16 For peer review only 17 87 At the first step, baseline data (Appendix A) will be collected about the health challenges faced by 18 19 88 women living in disadvantaged communities. At the second step, a pre-test survey (Appendix B) 20 21 22 89 will be administered to both the control and intervention group assessing their health literacy. A 23 24 90 health literacy booklet will be provided to both the control and intervention group after the pre- 25 26 91 test. In addition, the intervention group receives an intervention using digital means through a 27 28 29 92 three-month period for promoting health literacy. The intervention will target improvement in 30 31 93 areas of (i) hygiene and sanitation, and (ii) coronavirus awareness and prevention. At third and 32 33 94 final step, both the control and intervention group will be delivered a post-test (Appendix B) to 34 35 95 assess the differences between intervention and non-intervention group. 36 37 38 96 The specific study hypothesis is: 39 40 97 H1: There is a positive impact of the digital health literacy intervention on the intervention 41 42 98 group (disadvantaged women of reproductive age in Pakistan) with regard to improvements 43 44 45 99 in (i) hygiene and sanitation, and (ii) coronavirus awareness and prevention. 46 47 100 This study protocol follows the “Standard Protocol Items: Recommendation for Interventional 48 49 101 Trials” (SPIRIT) checklist (Additional file 1). 50 51 52 102 53 54 55 56 57 58 - 6 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 8 of 64
786 1 2 3 103 Ethics of research 4 5 6 104 Ethics approval has been taken from the Internal Review Board of the Forman Christian College 7 8 105 University (IRB Approval reference IRB-252/06-2020). Informed consent will be taken from all 9 10 106 participants. A cover letter will be provided and read out to the participants. Contact information 11 12 107 of the principal investigator will be provided along with possibility of free counseling services in 13 14 15 108 case of any emotional disturbance caused by the discussion of health challenges. No personal 16 For peer review only 17 109 information will be taken and anonymity and confidentiality will be maintained. Only female 18 19 110 community healthcare workers will be responsible for collecting data from the women. Timing for 20 21 22 111 data collection and intervention delivery will be sought from participants in advance to ensure 23 24 112 privacy and comfort of women. All participants will be free to withdraw from the study at any 25 26 113 time. 27 28 29 114 30 31 115 Study population 32 33 116 The study population will comprise of disadvantaged women of reproductive age (15–45 years) 34 35 117 dependent on primary healthcare services who do not have access to digital tools (smartphone, 36 37 38 118 computer, laptop) or Wifi in their home. Given that there are 110 million women in Pakistan, using 39 40 119 the Taro Yamane’s formula [19], we need to sample an approximate 399 women each for the 41 42 120 control and intervention group. Considering the possibility of dropouts, we target to sample a total 43 44 45 121 of 1,000 women, 500 for the control and 500 for the intervention group (Table 1). We have chosen 46 47 122 the Taro sampling formulae as we anticipate difficulties in seeking permission for participation in 48 49 123 a digital health literacy intervention amongst poor disadvantaged women. This is because women 50 51 52 124 from disadvantaged communities belong to highly conservative and patriarchal families in 53 54 55 56 57 58 - 7 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 9 of 64 BMJ Open
786 1 2 3 125 Pakistan and are entirely dependent on their husband, in-laws, and family for permission with 4 5 6 126 regard to participation in research and access to digital technologies. 7 8 127 All four provinces of Pakistan (Baluchistan, KPK, Sindh, and Punjab) and the autonomous 9 10 128 territory Gilgit-Baltistan will be sampled according to their population weightage. Probability 11 12 129 sampling will be adopted in communities to allow equal chance of selection [20]. The intervention 13 14 15 130 will be delivered via community healthcare workers. A nation-wide database of community 16 For peer review only 17 131 healthcare workers from government sources will be used to randomly select participants from 18 19 132 primary healthcare settings according to provincial population weightage. Each community 20 21 22 133 healthcare worker will oversee 10 study participants (5 each from intervention and control group). 23 24 134 25 26 135 Table 1: Sampling strategy 27 28 Community healthcare workers Total 29 Intervention Control for data collection and Population sample** 30 intervention delivery 31 Province weightage* 32 Punjab 52.95% 550 275 275 55 33 Sindh 23.04% 250 125 125 25 34 Baluchistan 5.94% 100 50 50 10 35 KPK 14.69% 36 50 25 25 5 37 Gilgit-Baltistan 3,38% 50 25 25 5 38 1000 500 500 100 39 136 *Sample weightage of Gilgit-Baltistan has been over-quoted, because federally administered and tribal areas cannot be sampled in 40 137 our study due to permission issues. 41 138 **Absolute sample figures have been rounded off. 42 139 43 44 45 140 Baseline, pre-test and post-test surveys 46 47 141 The baseline survey will be used for data collection about the overall health status of sampled 48 49 142 women. It has been developed using a standardized and validated scale, which is the 50 51 143 ‘Multimorbidity Assessment Questionnaire for Primary Care’ [21]. The six domains covered in 52 53 54 144 this scale include: (i) Socio-demographic characteristics, (ii) health care utilization, (iii) chronic 55 56 145 diseases, (iv) depression, (v) disease severity, and (vi) health-related quality of life. 57 58 - 8 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 10 of 64
786 1 2 3 146 The pre- and post-test survey for the intervention has been developed using a standardized and 4 5 6 147 validated questionnaire, the ‘Health Education Impact Questionnaire’ [22]. The following five 7 8 148 domains of this scale will be used in our research: (i) Health-related behavior changes in lifestyle, 9 10 149 (ii) positive and active engagement in life, (iii) emotional well-being and satisfaction with life, (iv) 11 12 150 self-monitoring and insight to monitor health conditions and disease, and (v) social integration and 13 14 15 151 support. Both surveys will be adapted to make them appropriate for the regional context based on 16 For peer review only 17 152 findings from a pilot test. Furthermore, they will be translated in the provincial language by the 18 19 153 research team and data collectors in collaboration. The primary outcome for this study will be the 20 21 22 154 positive and active changes in health directed behavior, engagement with life, and self-monitoring 23 24 155 and insight to monitor health conditions. The secondary outcomes will be improvement in social 25 26 156 integration and support and emotional well-being and satisfaction with life. 27 28 29 157 30 31 158 Health literacy booklet 32 33 159 The control and intervention groups will both be provided a health literacy booklet after the pre- 34 35 160 test. The health literacy booklet will include images and content related to: (i) hygiene and 36 37 38 161 sanitation, and (ii) coronavirus awareness and prevention. The booklet will introduce and reinforce 39 40 162 concepts for hygiene, sanitation and coronavirus prevention to women that have already been 41 42 163 circulating on TV, radio, newspapers, and other social media sources. The attempt will be to 43 44 45 164 reintroduce and highlight health and infection control information to women. The hardcopy of the 46 47 165 booklet will encourage women to retain and adopt information by circulating within household 48 49 166 family members. The material is in line with international health communication standards. 50 51 52 167 Pictures will be taken from valid and reliable sources including Government of Pakistan, World 53 54 168 Health Organization, and United Nations. The booklet will be delivered at the doorstep of the 55 56 57 58 - 9 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 11 of 64 BMJ Open
786 1 2 3 169 female participants. Women will be asked to retrieve the material after five minutes of the delivery 4 5 6 170 to secure social distancing during the coronavirus pandemic. 7 8 171 9 10 172 Digital health literacy intervention 11 12 173 The health literacy intervention is guided by previous research and carefully considers the 13 14 15 174 following: (i) the literacy and semi-literacy of participants, (ii) the social context of female 16 For peer review only 17 175 participants related to their role and relationship with their family, husband, in-laws, and 18 19 176 community, and (iii) the socio-demographic characteristics of participants, such as their residence, 20 21 22 177 income, home responsibilities, working status, time and energy for intervention, ability and extent 23 24 178 to change their lifestyle. 25 26 179 In the intervention group, participants will be provided with equipment (smartphone and a 4G Wifi 27 28 29 180 gadget) including instructions for the intervention. The health literacy intervention will last three 30 31 181 months and includes a combination of the following four components: 32 33 182 1) Health literacy video tutorial: The health literacy video has been developed by the research 34 35 183 team based on literature review, previous research experience, and ground information of needs. 36 37 38 184 It will be divided into two different segments, (i) hygiene and sanitation, and (ii.) coronavirus 39 40 185 awareness and prevention. Derived from the diffusion of innovations theory [23], a screenplay 41 42 186 showing interaction between a change agent (community healthcare worker) and an early 43 44 45 187 adopter (disadvantaged woman in the community) will be used. The video will be 46 47 188 communicated and reinforced through monthly repetition over the intervention period. 48 49 189 Voiceover in the provincial language will be used, but the narrative will be evident through 50 51 52 190 images and symbols. Therefore, even without voiceover the audience will be able to understand 53 54 191 the messages being communicated. 55 56 57 58 - 10 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 12 of 64
786 1 2 3 192 2) Virtual one-on-one weekly meetings: These meetings will provide a forum for one-on-one 4 5 6 193 communication between the community healthcare worker and the female client. It will offer 7 8 194 opportunities for the community healthcare worker to discuss health generally, hygiene and 9 10 195 sanitation, and coronavirus prevention and awareness in theory and practice. It will also provide 11 12 196 the opportunity for women to share their challenges and to seek guidance on improvement, 13 14 15 197 adoption, and challenges related to health awareness and behavior. 16 For peer review only 17 198 3) Monthly virtual group meetings and WhatsApp group: Monthly virtual meetings via Zoom 18 19 199 will be an opportunity for community healthcare workers to collectively interact with their 20 21 22 200 respective five intervention participants and discuss the interpretation of the health literacy 23 24 201 video and individual meetings. The virtual group meeting and WhatsApp group will provide a 25 26 202 platform for participants to share their challenges and gains to provide collective support and 27 28 29 203 reinforcement, as well as the opportunity for information sharing. Group forums also have the 30 31 204 benefit of encouraging question and answers that individuals may not be able to address or 32 33 205 voice in one-on-one sessions. WhatsApp further has the advantage of providing participants the 34 35 206 assurance that there is consistent communication available. WhatsApp audios will also enable 36 37 38 207 women who cannot write/type to record their questions to community healthcare providers 39 40 208 when needed. 41 42 209 4) Provision and guidance of a self-management chart: A self-management chart will be tailor- 43 44 45 210 made for each participant based on the information from baseline survey and their current health 46 47 211 challenges and socio-demographic characteristics. It will be filled and updated weekly by the 48 49 212 participants during the intervention period to help them track improvement in health practices, 50 51 52 213 health behavior, and lifestyle change related to hygiene, sanitation, and preventive behavior 53 54 55 56 57 58 - 11 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 13 of 64 BMJ Open
786 1 2 3 214 related to the coronavirus. For women who cannot type or write, this self-management chart 4 5 6 215 will have the option of recording information through symbols. 7 8 216 9 10 217 Data collection 11 12 218 The data will be collected and intervention will be administered by community healthcare workers 13 14 15 219 who belong to the same community as the participants. Pakistan has a well-established Lady 16 For peer review only 17 220 Healthcare Worker Programme with over 110,000 functional women providing healthcare services 18 19 221 across communities in Pakistan for primary healthcare [24]. Services provided by community 20 21 22 222 healthcare workers are mainly related to maternal and child health, immunization and vaccination 23 24 223 [25]. Community healthcare workers are either directly employed by the government or managed 25 26 224 through out-sourcing or contracting of private sector [26]. 27 28 29 225 The intervention deliverers for this study will be previously trained community healthcare workers 30 31 226 with at least one year of working experience in delivering primary healthcare services in the 32 33 227 community. The target is for one community healthcare worker to manage overall 10 participants 34 35 228 (5 each in the control and intervention group), which would mean 100 community healthcare 36 37 38 229 workers will be recruited for this project. The recruitment process is assisted by both the 39 40 230 government and private sector. Over a two-week period, the community health workers will be 41 42 231 trained for this project and its research objectives via zoom meetings. Self-reported data are 43 44 45 232 assessed for baseline survey, pre-test survey, and post-test survey. Data collection employ an 46 47 233 online-based approach. The digital format for survey data collection and intervention delivery have 48 49 234 the advantage of enabling intervention deliverers and participants to answer/question/learn 50 51 52 235 conveniently at their own preferred time, within their homes, and at their own and family’s 53 54 236 convenience. 55 56 57 58 - 12 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 14 of 64
786 1 2 3 237 Intervention delivery will take place through WhatsApp and Zoom. All data and communication 4 5 6 238 between community healthcare workers and female study participants will be recorded on 7 8 239 electronic tabs of data collectors and afterwards transferred to the principal investigator for 9 10 240 permanent storage, record keeping, and data analysis. An electronic ‘Patient Progress Card’ will 11 12 241 be maintained by the intervention deliverers to track the progress of the digital intervention of each 13 14 15 242 participant (Appendix C). Participants will not be provided any incentive to participate in this 16 For peer review only 17 243 study. However, we believe the following elements will support retention of participants in the 18 19 244 study: (i) health benefits for participants and their family, (ii) familiarity, trust and cultural 20 21 22 245 sensitivity of female community healthcare providers delivering intervention, and (iii) frequency 23 24 246 of contact. 25 26 247 27 28 29 248 Development and piloting of the tools 30 31 249 The principal and co-investigators have developed the tools for this study, including the surveys 32 33 250 and the intervention. However, for strengthening validity they will conduct two more steps after 34 35 251 the recruitment of the community healthcare workers. At the first step, focus group discussions 36 37 38 252 with community healthcare workers in different provinces will be conducted to gain more 39 40 253 information about their experiences with regard to women in their community and their challenges 41 42 254 with regard to interaction, communication, and service delivery. Additionally, the surveys and the 43 44 45 255 intervention plans will be shared with the community healthcare workers in order to gain their 46 47 256 feedback and recommendations for additions or deletion. At the second step, after incorporation 48 49 257 of feedback from community healthcare workers, a pilot test with 15 female participants will be 50 51 52 258 conducted. We will share the surveys (baseline survey and pre-test survey questions) and the plans 53 54 259 for the intervention with them and ask to complete feedback questions, which they can orally 55 56 57 58 - 13 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 15 of 64 BMJ Open
786 1 2 3 260 answer online through a video call, with regard to their ease in understanding and the convenience 4 5 6 261 in participation. 7 8 262 9 10 263 Data analysis 11 12 264 Data will be collected electronically on smartphones of community healthcare workers. Analysis 13 14 15 265 will be conducted using SPSS after data cleaning prior to the analysis and analyzing non- 16 For peer review only 17 266 responders. As data collectors or women clients cannot be blinded, we will be ensuring that data 18 19 267 analysis and outcomes being measured are as objective as possible by blinding the first data 20 21 22 268 analyst. This will ensure that bias is avoided during the statistical analysis of the intervention 23 24 269 results. The data analysis will be completed once by the blinded data analyst and then repeated by 25 26 270 a second person to confirm validity. Furthermore, a third data analyst will be involved in checking 27 28 29 271 and ensuring data management and result interpretation. 30 31 272 Data regarding refusal and dropout will be reported according to CONSORT guidelines [27]. 32 33 273 Descriptive statistics will be used to report baseline survey data with regard to health status of 34 35 274 study participants. Associations between socio-demographic characteristics of women and broad 36 37 38 275 health challenges of infectious disease, chronic disease, multimorbidity, and mental health will be 39 40 276 presented using binomial multivariate regression models. With regard to pre-test and post-test 41 42 277 results for the intervention, chi square test, means, standard deviations, and ANOVA will be used 43 44 45 278 to present the differences between the intervention and control group and to compare outcomes 46 47 279 and change in health behavior. Levels of significance will be reported at p<0.05 and confidence 48 49 280 intervals will be described. 50 51 52 281 53 54 55 56 57 58 - 14 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 16 of 64
786 1 2 3 282 Data audit 4 5 6 283 Data analysis is conducted by the principal and co-investigator team. It will not involve the funders 7 8 284 of this project. The data will be audited by independent senior scholars comprising the Office of 9 10 285 Research, Innovation and Commercialization, at Forman Christian College University. A weekly 11 12 286 progress report will be provided to the auditors to help them monitor the project and provide 13 14 15 287 feedback. 16 For peer review only 17 288 18 19 289 Data storage and sharing 20 21 22 290 All data of the research project, the master file for survey data collection results, and intervention 23 24 291 results will be available in Excel files and SPSS. This data will be stored in the FCCU repository. 25 26 292 Hardcopies of all data collection (surveys and notes), unblended data, and contractual agreements 27 28 29 293 will be held securely by the principal investigator. 30 31 294 32 33 295 Patient and public involvement 34 35 296 This study includes the view of the people involved in the research (disadvantaged women of 36 37 38 297 reproductive age as well as community health workers) at an early stage in the pilot testing. This 39 40 298 offers the opportunity of rephrasing or including further questions in the questionnaire. 41 42 299 43 44 45 300 Dissemination 46 47 301 A website will be developed for sharing aggregated data, which will also be used for dissemination 48 49 302 of findings and communication with women in the communities. Women will be able to download 50 51 52 303 an app on their phone and share their problems and issues. This will be used to elaborate on further 53 54 304 research needs and recommendations for policy improvements via the website. 55 56 57 58 - 15 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 17 of 64 BMJ Open
786 1 2 3 305 Furthermore, we aim to disseminate the findings of our study via publication in an international 4 5 6 306 peer-reviewed journal and through conference proceedings. The plans for future research include: 7 8 307 (i) Repeat nation-wide cross-sectional data collection and longitudinal systematic data collection 9 10 308 for women’s health to a wider sample, (ii) strengthening of partnership with government for team- 11 12 309 building between female community healthcare workers and other health workers for primary 13 14 15 310 healthcare support of women, such as health social workers, and (iii) including further digital 16 For peer review only 17 311 health literacy interventions related to maternal and child health, nutrition and food security, and 18 19 312 mental health counseling and therapy. 20 21 22 313 23 24 314 Discussion 25 26 315 We have identified the need to support women in the primary healthcare setting for improvements 27 28 29 316 in health awareness, health literacy, infection awareness, and protective behavior against the 30 31 317 coronavirus. In the age of social distancing and infectious disease burden, the main strength of this 32 33 318 intervention is the adoption of digital means to communicate with disadvantaged women by 34 35 319 empowering them with digital tools and Wifi access for removing communication barriers with 36 37 38 320 community healthcare providers at primary care level. Low levels of preventive and health literacy 39 40 321 in disadvantaged, illiterate and semi-literate women have an negative impact on maternal health, 41 42 322 as well as child and family health. The intervention seeks to improve participants understanding 43 44 45 323 with respect to hygiene, sanitation and coronavirus prevention, and also to present comparative 46 47 324 results between a control and intervention group to highlight the impact of intervention delivery. 48 49 325 There have been few interventions involving female healthcare practitioners in Pakistan and there 50 51 52 326 is need for more [28]. In addition, there have been problems with regard to the assessment of RCTs 53 54 327 due to methods and research design, and measurement of outcomes in cities or provinces rather 55 56 57 58 - 16 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 18 of 64
786 1 2 3 328 than at national level [29-31]. This will be one of the randomized controlled trials attempted in 4 5 6 329 Pakistan with respect to empowering female clients and healthcare providers of the community. 7 8 330 We believe this study will change the landscape of primary healthcare delivery services by 9 10 331 digitalizing services and improving service delivery standards of community healthcare workers 11 12 332 who have been facing challenges related to movement in community and household visitation even 13 14 15 333 before the coronavirus pandemic [32]. Empowering disadvantaged women with health access 16 For peer review only 17 334 digitally will also open avenues for women in accessing future opportunities related to 18 19 335 communication, employment, and small business development. It is also hoped that this study and 20 21 22 336 further research can plan more comprehensive literacy and awareness interventions in primary 23 24 337 healthcare settings for disadvantaged women related to other maternal and child health areas, 25 26 338 nutrition and food security, chronic disease and multimorbidity management, and mental health 27 28 29 339 counseling. 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 17 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 19 of 64 BMJ Open
786 1 2 3 340 Acknowledgements 4 5 6 341 We would like to thank Dr. Asher Hasan and Dr. Kauser Malik for their support and guidance 7 8 342 during the development of this project. 9 10 343 We acknowledge support from the German Research Foundation (DFG) and the Open Access 11 12 344 Publication Fund of Charité – Universitätsmedizin Berlin. 13 14 15 345 16 For peer review only 17 346 Competing interests 18 19 347 The authors declare that no competing interests exist. 20 21 22 348 23 24 349 Funding 25 26 350 This project is funded by doctHERS, in partnership with University of Health Sciences (UHS), 27 28 29 351 Punjab Population Innovation Fund (PPIF), Women Chamber of Commerce and Industry (WCCI) 30 31 352 and Rural Support Programmes Network (RSPN); under their joint agreement to provide Maternal, 32 33 353 Child Health & Family Planning Services via telemedicine to underprivileged women of Pakistan. 34 35 354 The funds will be used for the following expenses: Digital assets (Smartphone, Wifi, and video 36 37 38 355 development), stipend for two research assistants, and stipend for community health workers who 39 40 356 will be collecting the data and delivering the intervention. The principal and co-investigators are 41 42 357 not receiving a salary for this project. The funding body will not be involved in study design, data 43 44 45 358 management, or interpretation of data. 46 47 359 48 49 360 Data availability and sharing 50 51 52 361 There is no data available, because it is a study protocol. All data relevant to the study are included 53 54 362 in the article or uploaded as supplementary information. 55 56 57 58 - 18 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 20 of 64
786 1 2 3 363 4 5 6 364 Ethical considerations 7 8 365 Ethics approval for this study has been gained from Forman Christian College University (IRB 9 10 366 Approval reference IRB-252/06-2020). 11 12 367 13 14 15 368 Author’s contributions 16 For peer review only 17 369 SRJ planned and developed the trial intervention. NB and FF provided expertise with the research 18 19 370 design. AM and FT have assisted in developing the digital health literacy video and health literacy 20 21 22 371 booklet, respectively. SRJ drafted the protocol; NB, AM, FT, and revised it critically for important 23 24 372 intellectual content. All authors approved the final version of this manuscript. 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 19 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 21 of 64 BMJ Open
786 1 2 3 373 References 4 5 374 1. MacMahon S, Calverley P, Chaturvedi N, et al. Multimorbidity: A priority for global health 6 7 375 research. London: The Academy of Medical Sciences 2018. 8 376 2. Singh K, Patel SA, Biswas S, et al. Multimorbidity in South Asian adults: prevalence, risk 9 10 377 factors and mortality. J Public Health 2018;41(1):80–9. 11 12 378 3. Nishtar S. Choked pipes: reforming Pakistan’s mixed health system. Oxford: Oxford 13 14 379 University Press 2010. 15 380 4. Pati S, Swain S, Hussain MA, et al. Prevalence and outcomes of multimorbidity in South 16 For peer review only 17 381 Asia: a systematic review. BMJ Open 2015;5(10):e007235. 18 19 382 5. International Monetary Fund. World Economic Outlook Database – October 2019. 20 21 383 Washington: International Monetary Fund 2019. 22 384 6. Mumtaz K. Gender and poverty in Pakistan. Development 2007;50(2):149–53. 23 24 385 7. Nasrullah M, Bhatti JA. Gender inequalities and poor health outcomes in Pakistan: a need 25 26 386 of priority for the national health research agenda. J Coll Physicians Surg Pak 27 387 2012;22(5):273–4. 28 29 388 8. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of 30 31 389 multimorbidity and implications for health care, research, and medical education: a cross- 32 33 390 sectional study. Lancet 2012;380(9836):37–43. 34 391 9. Begum Sadaquat M, Sheikh Q-t-a A. Employment situation of women in Pakistan. 35 36 392 International Journal of Social Economics 2011;38(2):98–113. 37 38 393 10. Beeson JG, Homer CS, Morgan C, Menendez C. Multiple morbidities in pregnancy: Time 39 40 394 for research, innovation, and action. PLoS Med 2018;15(9):e1002665. 41 395 11. Aubert CE, Fankhauser N, Vasques-Vidal P-M, Stirnemann J, Aujesky D, Limacher A, 42 43 396 Donzé J. Patterns of multimorbidity in internal medicine patients in Swiss university 44 45 397 hospitals: a multicentre cohort study. Swiss Med Wkly 2019;149:w20094. 46 398 12. Abdullah M, Mukhtar F, Wazir S, Gilani I, Gorar Z, Shaikh B. The health workforce crisis 47 48 399 in Pakistan: a critical review and the way forward. World Health Popul 2014;15(3):4–12. 49 50 400 13. Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet 51 52 401 2020;395(10226):760–2. 53 54 55 56 57 58 - 20 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 22 of 64
786 1 2 3 402 14. Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, 4 5 403 and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and 6 7 404 pregnancy outcomes. Arch Pathol Lab Med 2020;144(7):799–805. 8 405 15. Contant É, Loignon C, Bouhali T, Almirall J, Fortin M. A multidisciplinary self- 9 10 406 management intervention among patients with multimorbidity and the impact of 11 12 407 socioeconomic factors on results. BMC Fam Pract 2019;20:53. 13 14 408 16. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health 15 409 outcomes. J Gen Intern Med 2004;19(12):1228–39. 16 For peer review only 17 410 17. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J Gen 18 19 411 Intern Med 2006;21(8):888–90. 20 21 412 18. Tortajada S, Giménez-Campos MS, Villar-López J, et al. Case management for patients 22 413 with complex multimorbidity: development and validation of a coordinated intervention 23 24 414 between primary and hospital care. Int J Integr Care 2017;17(2):4. 25 26 415 19. Yamane T. Statistics: an introductory analysis. New York: Harper & Row 1973. 27 416 20. Cho C, Kim DI, Kim J, Kim MJ. Random number generator with random sampling. United 28 29 417 States Patent, Patent No.: US 7,904,494 B2; March 8, 2011. 30 31 418 21. Pati S, Hussain MA, Swain S, Salisbury C, Metsemakers JF, Knottnerus JA, van den Akker 32 33 419 M (2016). Development and validation of a questionnaire to assess multimorbidity in 34 420 primary care: An Indian experience. Biomed Res Int 2016;6582487. 35 36 421 22. Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire 37 38 422 (heiQ): an outcomes and evaluation measure for patient education and self-management 39 40 423 interventions for people with chronic conditions. Patient Educ Couns 2007;66(2):192–201. 41 424 23. Rogers EM. Diffusion of Innovations. New York: Free Press 2003. 42 43 425 24. Jalal S. The lady health worker program in Pakistan – a commentary. Eur J Public Health 44 45 426 2011;21(2):143–4. 46 427 25. Douthwaite M, Ward P. Increasing contraceptive use in rural Pakistan: an evaluation of the 47 48 428 Lady Health Worker Programme. Health Policy Plan 2005;20(2):117–23. 49 50 429 26. Khan IA. Public sector institutions, politics and outsourcing: Reforming the provision of 51 52 430 primary healthcare in Punjab, Pakistan. Journal of International Development 53 431 2010;22(4):424–40. 54 55 56 57 58 - 21 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 23 of 64 BMJ Open
786 1 2 3 432 27. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting 4 5 433 randomized trials: explanation and elaboration. Ann Intern Med 2001;134(8):663–94. 6 7 434 28. Bhutta ZA, Ali S, Cousens S, et al. Interventions to address maternal, newborn, and child 8 435 survival: what difference can integrated primary health care strategies make? Lancet 9 10 436 2008;372(9642):972–89. 11 12 437 29. Ahmed J, Shaikh B. The state of affairs at primary health care facilities in Pakistan: where 13 14 438 is the State’s stewardship? East Mediterr Health J 2011;17(7):619–23. 15 439 30. Loevinsohn B, Ul Haq I, Couffinhal A, Pande A. Contracting-in management to strengthen 16 For peer review only 17 440 publicly financed primary health services – the experience of Punjab, Pakistan. Health 18 19 441 Policy 2009;91(1):17–23. 20 21 442 31. Mumtaz Z, Levay A, Bhatti A, Salway S. Good on paper: the gap between programme 22 443 theory and real‐world context in Pakistan's Community Midwife programme. BJOG 2015; 23 24 444 122(2):249–58. 25 26 445 32. Sultan F, Khan A. Infectious diseases in Pakistan: a clear and present danger. Lancet 27 446 2013;381(9884):2138–40. 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 22 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 24 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 4 5 6 Contents 7 Informed Cover letter and Consent for Intervention- ...... 1 8 CONTROL GROUP ...... 1 9 Informed Cover letter and Consent for Intervention- ...... 3 10 EXPERIMENT GROUP ...... 3 11 12 Survey for Health Status of Women in the Age of Corona ...... 5 13 SECTION A: ...... 5 14 SOCIO-DEMOGRAPHIC CHARACHTERISTICS ...... 5 15 SECTION B: ...... 7 16 MULTIMORBIDITYFor ASSESSMENT peer QUESTIONAIREreview FORonly PRIMARY CARE (MAQ-PC) 17 ...... 7 18 SECTION C: ...... 12 19 20 WOMEN’S HEALTH CARE EXPERIENCES SURVEY ...... 12 21 SECTION D: ...... 18 22 BASELINE NUTRITION AND FOOD SECURITY SURVEY UNICEF ...... 18 23 SECTION E ...... 20 24 WHO MULTI-COUNTRY STUDY ON WOMEN’S HEALTH AND DOMESTIC 25 VIOLENCE AGAINST WOMEN ...... 20 26
27 28 29 30 31 Informed Cover letter and Consent for Intervention- 32 33 CONTROL GROUP 34 35 36 37 38 To be translated or read out/recorded on phone by Guddi Baji in provincial language 39 40 41 42 Thank you for your valuable time. 43 44 45 We request you to participate in a research project that will benefit you and your family with 46 47 regard to your health and wellbeing. As you know Coronavirus is preventing you from meeting 48 49 with or visiting your doctors physically. Thus, we would like to sk you uestions relted to your 50 helth on the phone or t the door step while observing physicl distancing nd enuring preventive 51 52 mesures (wering msk nd lkepeing 6 feet distance). 53 54 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 25 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 During this engagement you may be asked questions and your responses will be recorded, but 4 5 they will be entirely confidential. Your name is not required and all research analysis will be 6 7 undertaken with complete anonymity. We will also provide you a health literacy booklet. 8 9 10 If you have need for further questions and clarifications at any time, please contact us at any 11 12 time. Thank you for your time and we look forward to working together on this project to 13 14 improve your health and wellbeing. 15 16 For peer review only 17 Dr. Sara Rizvi Jafree, 18 19 Research Investigator 20 21 Assistant Professor, Forman Christian College\ University 22 E-mail: [email protected] 23 24 Cell: 0300 400 5740 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 26 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Digital Sign or Button/Tab for 4 Informed Cover letter and Consent for Intervention- 5 acceptance 6 7 EXPERIMENT GROUP 8 9 10 11 To be translated or read out/recorded on phone by Guddi Baji in provincial language 12 13 14 15 Thank you for your valuable time. 16 For peer review only 17 18 We request you to participate in a research project that will benefit you and your family with 19 20 regard to your health and wellbeing. As you know Coronavirus is preventing you from meeting 21 22 with or visiting your doctors physically. Thus, we are bringing your community healthworker/ 23 24 Guddi Baji to you through a mobile device. If you agree to participate in this study, you will be 25 provided a smartphone and an internet at your doorstep for your use. Instructions and assistance 26 27 will be provided on how to manage the phone and internet. 28 29 30 The research includes an intervention, which has been designed to support you in key areas for 31 32 your health, such as (i) understanding your current health challenges, and (ii) providing you with 33 34 health literacy and awareness with regard to hygiene, infection protection, and any other health- 35 36 related help you may need. 37 38 39 This intervention will involve a three month daily communication and engagement with your 40 41 Guddi Baji through a phone. During this engagement you may be asked questions and your 42 responses will be recorded, but they will be entirely confidential. Your name is not required and 43 44 all research analysis will be undertaken with complete anonymity. 45 46 47 48 You may opt to withdraw at any point during this intervention. If you have need for further 49 questions and clarifications at any time, please contact us at any time. 50 51 52 53 Thank you for your time and we look forward to working together on this project to improve 54 55 your health and wellbeing. 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 27 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 4 5 Dr. Sara Rizvi Jafree, 6 7 Research Investigator 8 9 Assistant Professor, Forman Christian College\ University 10 E-mail: [email protected] 11 12 Cell: 0300 400 5740 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 4 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 28 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Survey for Health Status of Women in the Age of Corona 4 5 6 7 The questionnaire will be read out on phone and completed by the Guddi Baji, on behalf of the 8 9 participants 10 11 12 Province/City: ______13 14 District: ______15 16 Guddi Baji Code: ______For peer review only 17 Participant Code: ______18 19 20 21 SECTION A: 22 23 SOCIO-DEMOGRAPHIC CHARACHTERISTICS 24 25 Coding 26 27 Q1. Age 28 Q2. Religion 1.Muslim 2.Christian 3.Hindu 4.Other 29 30 Q3. Marital status 1.Never 2.Currently 3.Seperated/divorced 4.Widow/widower 31 married married 32 33 Q4. Ethnicity 1.Schedule 2.Schedule 3.General 34 cast tribe 35 36 Q5. Present place of living 1.Urban 2.Semi- 3.Rural 37 urban 38 39 Q6. Highest education 1.Illiterate 2.Primary 3.High school or 3.Graduation and 40 Secondary above 41 42 Q7. Housing type 1.Kutcha 2.Pucca 3.Semi-pucca Other 43 (specify) 44 Q8. House Ownership Owned Rented Living with Other 45 46 Someone (specify) 47 Q9. Occupation 1.Unemployed 2.Employed 48 49 50 51 52 Q10. What is the nature of your 53 Employment 54 55 Q11. What is your monthly income 56 57 58 5 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 29 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 Q12. What is your monthly 4 5 household Income 6 Q13. Spouse literacy 1.Illiterate 2.Primary 3.High school or 4. Graduation or 7 8 secondary above 9 Q14. Spouse occupation 1.Unemployed 2.Employed 3.Type of 10 employment 11 12 Q15. How many children do you 13 have 14 15 Q16. What is the age of your last 16 child For peer review only 17 18 Q17. Number of people living in 19 house 20 21 22 23 24 Q18.Number of rooms in house 1. 1 2. 2-3 3. 4-5 4. >6 25 26 1.No 2.Yes If Yes, who: 27 Q19.Are you currently taking care of a 28 disabled/ dependent family member 29 30 31 Q20. Do you have the following in your 32 33 house: (tick all that apply) 34 TV 35
36 Radio 37 Landline 38
39 Electricity at least 8 hours in a day 40 Mobile phone with internet 41
42 Washing machine 43 Toile facility in house with flush If not, what do you use 44 45 Drinking water from tap If not, what do you use 46
47 48 Gutter drainage If not, what do you use 49 50 Stove for cooking with gas connection If not, what do you use 51 52 Garbage collectors come to dispose If not, what do you use 53
54 garbage 55 Q21. Are you taking any health insurance 56 57 58 6 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 30 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 (please describe scheme/ installment/ 4 5 coverage) 6 7 Q22. Do you have any savings? 8 9 (Approximately how much?) 10 11 12 Q23. Have you taken a loan? (From 13 where, what is the duration, what is the 14 15 amount, how much installment are you 16 paying?) For peer review only 17 18 19 Q28. During the past 12 months have you been admitted to 1.No 2.Yes 3. If yes, can you describe Coding 20 health problem 21 hospital for any diseases or health problem? 22 Q29. If yes, then how many nights have you stayed in the 23 24 hospital for the past 12 months? 25 Q30. Beside the hospitalization in past 12 months, how 26 many times you have visited a public hospital for 27 28 consultation? 29 Q31. How many times in a month do you visit or are visited 30 31 by your local LHW? 32 Q32. How many different types of medicine/drugs are you 33
34 taking at present? 35 36 37 38
39 40 41 42 43 44 SECTION B: 45 46 MULTIMORBIDITY ASSESSMENT QUESTIONAIRE FOR PRIMARY CARE (MAQ- 47 PC) 48 49 50 Q33. Please provide information about the following chronic diseases Yes No Coding 51 Arthritis A. Have you ever been diagnosed by a doctor with arthritis? 52 53 B. In the last 12 months have you experienced pain, itching, 54 stiffness or swelling in or around the joints (like arms, hands, 55 56 57 58 7 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 31 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 legs or feet) which were not related to an injury and lasted for 4 5 more than a month 6 Diabetes A, Have you ever been diagnosed with diabetes (high blood 7 8 sugars)? 9 B. Not applicable 10 11 Hypertension A, Have you ever been diagnosed with high blood pressure 12 (Hyper tension)? 13 B. Not applicable 14 15 Chronic lungs diseases A. Have you ever been diagnosed with chronic lungs diseases 16 (including Asthma) (includingFor asthma)? peer review only 17 18 B. Not applicable 19 Acid Peptic diseases A. Have you ever been diagnosed with Acid Peptic diseases? 20 21 B. Not applicable 22 Chronic back ache A. Have you ever been diagnosed with chronic back ache? 23 24 B. Not applicable 25 Heart disease A. Have you ever been diagnosed with angina/ heart attack/ 26 27 heart disease? 28 B. in the last 12 months have you felt any pain of discomfort in 29 30 your chest when you walk uphill or hurry or normal walking 31 Stroke A. Have you ever been told by a health professional that you 32 33 have had a stroke? 34 B. In the last 12 months have you suffered from sudden onset 35 of paralysis or weakness in your arms or legs on one side of 36 37 your body for more than 24 hours? 38 Blindness A. Have you been diagnosed with blindness? 39 40 B. Do you have difficulty with vision? (answer NO if you can 41 see OKM with the glasses) 42 43 Deafness A. In the last 12 months, have you been diagnosed with 44 deafness? 45 46 B. In the last 12 months, do you have deafness or difficulty in 47 hearing for more than 3 months? 48 49 Dementia A. Have you ever been diagnosed with dementia? 50 B. Do you have memory problems which hinders with the 51 activities of your daily life? 52 53 Alcohol disorder A. Have you visited any doctor because of alcohol habit? 54 B. Are you habituated to alcohol? 55 56 57 58 8 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 32 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Cancer A. Have you ever been diagnosed with any type of cancer? 4 5 B. Not applicable 6 Chronic kidney disease A. Have you ever been diagnosed with a long term kidney 7 8 problem? 9 B. Have you ever been on dialysis 10 11 Epilepsy A. Have you ever been told by a health professional that you 12 have epilepsy? 13 B. Have you ever suffered from a sudden onset of seizure 14 15 while at work or at rest? 16 Thyroid disease A.For Have you peerever been diagnosed review with thyroid disease? only 17 18 B. Not applicable 19 Tuberculosis A. Do you suffer from TB 20 21 B. Are you under any treatment for TB 22 Filariasis A. Do you have filaria 23 24 B. Not applicable 25 Corona Virus Questions 26 27 Q34. Are you aware of Yes No 28 the Corona Virus 29 30 symptoms? 31 Q35. Have you or any Acute respiratory distress syndrome ____ Identify the HH 32 33 of your family Cough ____ members 34 members experienced Conjunctivitis ____ 35 any of the following in Diarrhea ____ 36 37 the last 2 weeks? Fatigue____ 38 (please tick all that Fever ____ 39 40 apply) Chills ____ 41 Headache ____ 42 43 Nausea ____ 44 Pneumonia ____ 45 Sore throat____ 46 47 Vomiting ____ 48 Other symptoms…please specify? 49 50 51 Q36. What have you 52 53 done about the 54 symptoms above? 55 56 Q37. Have you 57 58 9 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 33 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 received messages 4 5 about Corona virus 6 prevention? 7 8 Q38. Where have you TV ____ 9 received these Radio____ 10 messages? (please tick Phone texts ____ 11 12 all that apply) Phone calls ____ 13 Neighborhood ____ 14 15 Friends ____ 16 FamilyFor ____ peer review only 17 18 Other (Please specify) 19 20 21 Questions related to Depression Coding 22 Over the past 2 weeks, how often have you been bothered by any of the following problems? 23 24 Always Very Sometimes Rarely Never 25 Often 26 27 Q39. Little interest and pleasure in doing things 28 Q40. Feeling down, depressed or hopeless 29 30 Q41. Trouble falling/staying asleep, sleeping too 31 much 32 Q42. Feeling tired or having little energy 33 34 Q43. Feeling bad about yourself – or that you are a 35 failure or have let yourself or your family down? 36 37 Q44. Trouble concentrating on things such as 38 reading newspaper or watching television 39 40 Q45. Moving or speaking so slowly that other 41 people could have noticed. Or the opposite – being 42 43 so fidgety or restless that you have been moving 44 around a lot more than usual 45 46 Q46. Thoughts that you would be better off dead 47 or of hurting yourself someway 48 Q47. Have you ever been to see a practitioner for 49 50 being sad or depressed? (Please indicate which 51 practitioner or healer/ date of last visit/ medicine 52 53 prescribed/ still continuing medicine/ if not, why 54 not?) 55 56 57 58 10 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 34 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 4 5 Questions related to Mobility Coding 6 This information will help keep track of how well you feel and how well you are able to do your usual activities? 7 8 Q40. In general, would you say your health is: Excellent Very Good Fair Poor 9 Good 10 11 The following questions are about activities you might do during a typical day. Does your health now limit you in 12 13 these activities? If so, how much? 14 Q41. Moderate activities, such as moving a table, All of the Most of the Some of the A little of None of 15 time time time the time the time 16 pushing a vacuum cleaner, cleaning house For peer review only 17 18 Q42. Climbing several flights of stairs All of the Most of the Some of the A little of None of 19 time time time the time the time 20 21 During the past 4 weeks, how much of the time have you had any of the following problems with your work or 22 23 other regular daily activities as a result of your physical health? 24 Q43. Accomplished less than you would like All of the Most of the Some of the A little of None of 25 time time time the time the time 26
27 28 Q44. Were limited in kind of work or other activities All of the Most of the Some of the A little of None of 29 time time time the time the time 30 31 During the past 4 weeks, how much of the time have you had any of the following problems with your work or regular daily 32 33 activities as a result of emotional problems (such as feeling depressed or anxious)? 34 Q45. Did work or activities less carefully than usual Not at all A little bit Moderately Quite a Extremely 35 bit 36 37 Q46. During the past 4 weeks, how much did pain Not at all A little bit Moderately Quite a Extremely 38 interfere with your normal work (including both work bit 39 40 outside the home and housework) 41 These questions are about how you feel and how things have been with you during the past 4 weeks. For each question please 42 43 choose one of the answers that comes closest to the way you have been feeling. 44 How much of the times during the past 4 weeks… 45 46 Q47. Have you felt calm and peaceful? All of the Most of Some of the A little of None of 47 time the time time the time the time 48 49 Q48. Did you have a lot of energy? All of the Most of Some of the A little of None of 50 time the time time the time the time 51
52 53 Q49. Have you felt downhearted and depressed? All of the Most of Some of the A little of None of 54 time the time time the time the time 55 56 57 58 11 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 35 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 Q50. During the past 4 weeks, how much of the time All of the Most of Some of the A little of None of 4 time the time time the time the time 5 has your physical health or emotional problems
6 interfered with your physical activities? 7 8 9 10 SECTION C: 11 WOMEN’S HEALTH CARE EXPERIENCES SURVEY 12 13 14 Q51.Compared to other women your age, how Excellent Very Good Good Fair Poor 15 would you rate your health 16 For peer review only 17 Apni hum umar auraton ki nisbat aap apni sehat ka kya 18 mayaar samjhtay hain? 19 Q52. Do you feel your health could be better Always Very Often Sometimes Rarely Never 20 21 than it is presently? 22 Kya apki sehat ke mayaar mai koi behtari lai ja sakti hai? 23 Q53. Does your husband/ male relative/in-laws Always Very Often Sometimes Rarely Never 24 25 decide/ give approval when you or your children 26 need consultation from a medical practitioner 27 28 Kya apka khawand/susral apko doctor pe janay ki ijazat deta 29 hai? Kya ye faisla bhi apka susral/khawand krta hai? 30 31 32 Please indicate if you have experienced any of the following health issues in the last 12 months? 33 Q54.Minor illness like the flu or an infection 1.Yes 2.No 34 35 Pichlay 12 mahinay mai apko nazla ya infection hua hai? 36 Q55. Had to go for a checkup or routine physical 1.Yes 2.No 37 exam 38 39 Jismani muaaenay ke liye gae hain? 40 Q56.Were you pregnant? 1.Yes 2.No 41 Kya app hamla theen? 42 1.Yes 2.No 43 Q57. Did you need family planning or 44 preconceptional services? 45 Kya apko munsoba bandi ki zaroorat thee? 46 1.Yes 2.No 47 Q58. Did you have an injury that you have not 48 already mentioned? 49 Kya apko koi chot lagi hai? 50 51 Q59. Did you need care for a chronic health 1.Yes 2.No 52 problem, (that is one that goes on for a long 53 54 time)? 55 Kya apko kisi taweel bemari ke liye hospital jana para hai? 56 57 58 12 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 36 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Q60.Did you need surgery for a condition not 1.Yes 2.No If yes, what? 4 5 already mentioned?
6 Kya apko operation keranay ki zaroorat parhi? 7 8 Q61.Were you feeling depressed, anxious, or 1.Yes 2.No Could you pinpoint why? 9 highly stressed? 10 Kya iski waja se apko kisi kisam ka zehni dabao ya bechaini 11 12 mehsoos hui hai? 13 Q62. Have you had one of the following medical tests in the last 12 months? 14 1.Yes 2.No 15 Cancer screening, (or check for blood in your 16 stool, sigmoidoscopy, or colonoscopyFor ) peer review only 17 Test for glaucoma or pressure in the eye 1.Yes 2.No 18 19 Blood cholesterol test 1.Yes 2.No 20 Check for high blood pressure 1.Yes 2.No 21 22 Test for diabetes 1.Yes 2.No 23 Breast or abdominal ultrasound 1.Yes 2.No 24 25 Mammogram 1.Yes 2.No 26 Pap test 1.Yes 2.No 27 28 Bone density test (for osteoporosis) 1.Yes 2.No 29 Genetic screening test 1.Yes 2.No 30 31 Screening for HIV/AIDS 1.Yes 2.No 32 Screening for sexually transmitted diseases 1.Yes 2.No 33 34 Dental exam 1.Yes 2.No 35 Shot for flu or pneumonia 1.Yes 2.No 36 37 Pregnancy test 1.Yes 2.No 38 Corona 1.Yes 2.No 39 40 Tests for infertility 1.Yes 2.No 41 Malaria 1.Yes 2.No 42 43 Another other test (please specify)? 44 45 46 Q63. In the past 12 months, did any of your health care providers/LHWs give you information about? 47 (pichlay 12 mahino mai kya apkay doctor/nurse ne aap se in chizon ke baray mai maloomat di hain?) 48 Smoking, second-hand smoke, or quitting 1.Yes 2.No 49 50 smoking 51 Tambako noshi, kisi aisay shaks k saath bethtna/rehna jo 52 tambako noshi mein mulawis ho, ya tambako noshi chorna 53 Nutrition or diet 1.Yes 2.No 54 55 (Khuraak) 56 57 58 13 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 37 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 Alcohol or drug use 1.Yes 2.No 4 5 Shraab ya adviyaat? 6 Physical fitness or exercise 1.Yes 2.No 7 Jismani sehat ya warzish? 8 Menopause or hormone replacement therapy 1.Yes 2.No 9 10 San – e - yaas ya hormone tabdeeli therapy? 11 Violence in the home or workplace 1.Yes 2.No 12 Kya ghar ya kaam pe kisi tashadud ka shikar hue hain? 13 14 Hygiene 1.Yes 2.No 15 Sanitation 1.Yes 2.No 16 For peer review only 17 How to protect against infectious diseases 1.Yes 2.No 18 Work or financial problems 1.Yes 2.No 19 Kaam ya muaashi mushkilaat ka samna hua hai? 20 21 Family or relationship problems 1.Yes 2.No 22 Ghar walon ya rishtadaron ke masa’il? 23 Importance of child health and nutrition 1.Yes 2.No 24 25 Bachon ki sehat or khuraak ki ehmiyat? 26 Stress management 1.Yes 2.No 27 Zehani dabao ko kum karna 28 29 Preventing unintended pregnancies & birth 1.Yes 2.No 30 spacing 31 Bachon ke darmiya wakfa? 32 33 Using alternative therapies, such as herbs or 1.Yes 2.No 34 acupuncture 35 36 Preventing osteoporosis 1.Yes 2.No 37 Hadion ke dard se bachao 38 Nutritional needs for you and family 1.Yes 2.No 39 40 Ways to avoid food shortages 1.Yes 2.No 41 Improve self-sufficiency for food security 1.Yes 2.No 42 43 Q64. Are there any dietary supplements that you have used in the last 12 months? 44 Vitamin C 1.Yes 2.No 45 46 Vitamin D 1.Yes 2.No 47 Vitamin E 1.Yes 2.No 48 49 B Complex 1.Yes 2.No 50 Calcium 1.Yes 2.No 51 1.Yes 2.No 52 Pregnancy Vitamin 53 Lactation Vitamin 1.Yes 2.No 54 1.Yes 2.No 55 General Multi-vitamin 56 57 58 14 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 38 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Q65. What is your personal preference for health services? 4 5 Tibbi saholiyat se mutalik apki zaati tarjihaat kya hain? 6 Family (e.g. mother/ mother-in-law/ aunt) 1.Yes 2.No 7 8 Ghar walay? 9 A women’s health center where you can get 1.Yes 2.No 10 most of your basic health care, including 11 12 gynecological care, in one place 13 Khawateen ki sehat markaz? 14 15 Trusted community member 1.Yes 2.No 16 Baradari? For peer review only 17 18 A nurse or LHW (Not a physician/ surgeon/ 1.Yes 2.No 19 medical consultant) 20 21 Public Hospital 1.Yes 2.No 22 Local female healer 1.Yes 2.No 23 24 Private Clinic 1.Yes 2.No 25 Q66. In general, how difficult have you found it All of the Most of the Some of A little of None of 26 to talk to LHW/CMW/Doctors about your time time the time the time the time 27 28 personal health concerns? 29 doctor/nurse se baat krna apko kitna mushkil 30 31 lagta hai? 32 Please rate the local doctor/ healthcare provider as you have experienced them in the past? 33 34 Q67. Listening to what you have to say All of the Most of the Some of the A little of None of 35 Kya apki baat ghor se suntay hain? time time time the time the time 36 37 Q68. Talking to you in a respectful and caring All of the Most of the Some of the A little of None of 38 time time time the time the time 39 manner
40 Kya ap se izzat se baat kartay hai? 41 42 Q69. Speaking to you in the language/ dialect All of the Most of the Some of the A little of None of 43 you understand better time time time the time the time 44 45 Kya apse apki madri zubaan mai baat krtay hai 46 Q70. Answering your questions clearly All of the Most of the Some of the A little of None of 47 Ap ke sawalon ka sahi se jawaab detay hai? time time time the time the time 48 49 All of the Most of the Some of the A little of None of 50 Q71. Giving you the opportunity to ask all of 51 your questions time time time the time the time 52 Apko sawaal puchnay ka wakt detay hai? 53 54 Q72. Helping you to feel comfortable talking All of the Most of the Some of the A little of None of 55 about your personal or sensitive health concerns time time time the time the time 56 57 58 15 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 39 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 Kya ap asaani se unhe apnay masaael ke baray 4 5 mai bata deti hain? 6 Q73. Giving you complete health information All of the Most of the Some of the A little of None of 7 Kya sehat se mutalik tamaam jankari detay hain? time time time the time the time 8 9 10 Q74. Discussing alternative therapies, diet and All of the Most of the Some of the A little of None of 11 lifestyle time time time the time the time 12 13 Kya ap se mutabadil therapy ya khuraq ya roz 14 mara ki zindagi guzarnay kay tareekay pe 15 tabadal e khayal kya hai? 16 For peer review only 17 Q75. Giving you complete information about All of the Most of the Some of the A little of None of 18 any tests or services time time time the time the time 19 20 Test ke baray mai mukamal jaankari detay hain? 21 Q76. Giving you the results of your tests All of the Most of the Some of the A little of None of 22 time time time the time the time 23 Test ke nataij batatay hain?
24 25 Q77. Giving you complete information about all All of the Most of the Some of the A little of None of 26 your options for treatments time time time the time the time 27 28 Kya ilaaj ke mutalik apko mukamal jaankari 29 detay hai? 30 Q78. Giving you the opportunity to make All of the Most of the Some of the A little of None of 31 32 important decisions about your health care time time time the time the time 33 Kya sehat se mutalik tamam faislay apko karnay 34 35 detay hai? 36 Q79. Giving you written, printed or digital All of the Most of the Some of the A little of None of 37 time time time the time the time 38 information when you need it
39 Malumaat likh kr dete hai? 40 41 Q80. Spending enough time with you during All of the Most of the Some of the A little of None of 42 your visits time time time the time the time 43 44 Apko tasali bakhsh wakt detay hai? 45 Q81. Treating you like a partner in your health All of the Most of the Some of the A little of None of 46 care time time time the time the time 47 48 Apka sathi bun kr apki sehat ka khayal rakhtay 49 hai? 50 51 Q82. Which are the primary/ most important sources you depend on for making health decisions? (Tick relevant options) 52 Sehat se mutalik faislon ke liye ap kis se mashwara leti hai? 53 54 Husband 55 Mother in law 56 57 58 16 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 40 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Other in-laws 4 5 Blood family (parents, siblings, children…) 6 Newspapers / magazines 7 8 Heath newsletter 9 TV 10 11 Radio 12 Internet 13
14 Mobile services 15 Family/ friends 16 For peer review only 17 Community 18 Medical Practitioner 19 Local Healer 20 21 Local Imam/ religious leader 22 Other (Please list) 23 24 Current Health Risks 25 Q83. Do you currently smoke? 1.Yes 2.No 26
27 Kya app tambako noshi mein mulawis hain? 28 Q84. How many in a day? 29 30 Din ke kitnay ? 31 Q85. Does anyone else smoke in the house when 1.Yes 2.No If yes, who is this: 32 33 you/ children are in same room? 34 Kya koi aur tambako noshi mein mulawis hain 35 Q86. Do you feel anxious, stressed, depressed, 1.Yes 2.No Indicate which: 36
37 suicidal?
38 Kya app kabhi bechain hotay hain ya zehni dabao ka shakar 39 ya khud kushi ka khayal aya hai? 40 If yes, which ones: 41 Q87. Do you take any drugs (to relieve 42 yourselves of stress or an ailment? 1.Yes 2.No
43 Kya app in ke liye koi dawa laitay hain? 44 45 Q88. In the past 5 years, has a doctor ever told you that you have any of the following conditions (Tick relevant options) 46 Kya pichlay paanch salon mai doctor ne aapko bataya ke apko ye bemari hai? 47 48 Hypertension/ BP 49 High blood pressure 50 Heart disease 51 Dil ki bemari 52 53 High cholesterol 54 Diabetes 55 56 (sugar) 57 58 17 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 41 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 Depression 4 5 Zehni dabao 6 Anxiety 7 Bechaini 8 Migraine headaches 9 10 (sar dard) 11 Arthritis 12 Joro ki dard 13 14 Osteoporosis 15 Obesity/ Over-weight problems 16 (mutapa) For peer review only 17 18 Urinary incontinence 19 (pishaap ki takleef) 20 Cancer 21 22 Eating disorder like bulimia/ anorexia 23 Khanay k hawaly se koi mushkil, jaisay bhook na lagna ya 24 kha k ulti kerna 25 26 Thyroid problems 27 Malaria/ Dengue 28 29 Are you facing any disability which? 30 Kya aap kisi mazoori ka shikaar hain? 31 Q89. Does your disability keeps you from All of the Most of the Some of A little of None of 32 time time the time the time the time 33 participating fully in your ability to take care of
34 your family 35 36 Jiski waja se ap apnay ghar walon ka khayal na rakh sakain 37 Q90. Does your disability keep you from All of the Most of the Some of A little of None of 38 participating fully in your ability to continue time time the time the time the time 39 40 with your life 41 Apnay karobaar mai sahi se kaam na kr sakain 42 43 44 SECTION D: 45 46 BASELINE NUTRITION AND FOOD SECURITY SURVEY UNICEF 47 48 Q91.In the past 6 months did you find it too All of the Most of the Some of A little of None of 49 time time the time the time the time 50 expensive to purchase the foods you needed to
51 feed your family? 52 Pichlay 6 maah mai kya apko khaandan ko palnay ke liye 53 54 khana lenay mai mushkilaat hoti hai? 55 Q92.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 56 57 58 18 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 42 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 fruit? time time the time the time the time 4 5 Kya phal khareedna bohat mehnga hai? 6 Q93.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 7 vegetables? time time the time the time the time 8 9 Kya sabzi khareedna bohat mehnga hai? 10 Q94.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 11 time time the time the time the time meat? 12 13 Kya gosht khareedna bohat mehnga hai? 14 Q95.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 15 eggs? time time the time the time the time 16 For peer review only 17 Kya anday khareedna bohat mehnga hai? 18 Q96.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 19 milk? time time the time the time the time 20 21 Kya doodh khareedna bohat mehnga hai? 22 Q97.Did you find it too expensive to purchase All of the Most of the Some of A little of None of 23 wheat, for roti? time time the time the time the time 24 25 Kya roti khareedna bohat mehnga hai? 26 Q98.In the last 3 months were you worried about All of the Most of the Some of A little of None of 27 time time the time the time the time 28 running out of food because of high costs?
29 Pichlay 3 maah mai mehngai ki waja se khana na khareed 30 panay ka dart ha? 31 Q99.In the last 3 months did you run out of food All of the Most of the Some of A little of None of 32 time time the time the time the time 33 because of expense?
34 Pichlay 3 maah mai kya mehngai ki waja se kabhi ghar mai 35 khana khatam ho gaya ho? 36 All of the Most of the Some of A little of None of 37 Q100.In the last 3 months did you or any other 38 adult in the house skip meals because there was time time the time the time the time 39 not enough food? 40 41 Pichlay 3 maah mai aap ya kisi or ghar walay se khana kum 42 honay ki waja se khana na khaya ho? 43 Q101.In the last 3 months did you ever think All of the Most of the Some of A little of None of 44 time time the time the time the time 45 your children are still hungry because of not
46 being fed enough food? 47 Pichlay 3 maah mai apko kabhi laga ke apkay bachay 48 49 bhookay hai kyunkay khana pura nai tha? 50 Q102. In the last 3 months did any of your All of the Most of the Some of A little of None of 51 time time the time the time the time children go to bed hungry? 52 53 Pichlay 3 maah mai kya apkay bachay kabhi bhookay soe 54 houn? 55 56 57 58 19 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 43 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 4 SECTION E 5 WHO MULTI-COUNTRY STUDY ON WOMEN’S HEALTH AND DOMESTIC VIOLENCE 6 AGAINST WOMEN 7 8 Psychological violence experienced at home 9 Please reply with reference to the last 4 weeks 10 Coding 11 12 Q102.Has someone in your home insulted you or Always Very Sometimes Rarely Never 13 Often made you feel bad about yourself? 14 15 16 Q103.Has someone in yourFor home belittled peer or Alwaysreview Very Sometimesonly Rarely Never 17 humiliated you in front of other people? Often 18 19 20 Q104.Has someone in your home done things to Always Very Sometimes Rarely Never 21 scare or intimidate you on purpose? Often 22 23 24 Q105.Has someone in your home threatened to Always Very Sometimes Rarely Never 25 Often 26 hurt you or someone you care about? 27 28 Physical violence experienced at home 29 30 Please reply with reference to the last 4 weeks 31 Q106. Has someone in your home slapped you or Always Very Sometimes Rarely Never 32 Often 33 thrown something at you that could hurt you? 34 35 Q107. Has someone in your home pushed or Always Very Sometimes Rarely Never 36 Often 37 shoved you? 38 39 Q108.Has someone in your home hit you with his Always Very Sometimes Rarely Never 40 Often 41 fist or with something else that could hurt you? 42 43 Q109.Has someone in your home kicked you, Always Very Sometimes Rarely Never 44 Often 45 dragged you or beaten you up? 46 47 Q110.Has someone in your home choked or burnt Always Very Sometimes Rarely Never 48 Often 49 you on purpose? 50 51 Q111.Has he threatened to use or actually used a Always Very Sometimes Rarely Never 52 Often 53 gun, knife or other weapon against you? 54 55
56 57 58 20 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 44 of 64
786Survey for Health Status of Women in the Age of Corona 1 2 3 Sexual violence experienced at home 4 5 Please reply with reference to the last 4 weeks 6 Q112.Has your husband physically forced you to Always Very Sometimes Rarely Never 7 Often 8 have sexual intercourse when you didn’t want to? 9 10 Q113.Did you ever have sexual intercourse when Always Very Sometimes Rarely Never 11 Often 12 you didn’t want because you were afraid of what 13 your husband might do? 14
15 16 Q114.Has your husband forcedFor you to dopeer Alwaysreview Very Sometimesonly Rarely Never 17 something sexual that you found degrading or Often 18 19 humiliating? 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 21 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 45 of 64 BMJ Open
786Survey for Health Status of Women in the Age of Corona 1 2 3 SUPPLEMENTRAY SHEETS- for each chronic disease 4 5 6 7 Disease name: 8 Arthritis Heart disease Cancer 9 Diabetes Stroke Chronic kidney disease 10 Hypertension Deafness Epilepsy 11 Chronic lung disease Blindness Thyroid 12 Acid peptic disease Dementia Tuberculosis 13 14 Chronic back ache Alcohol Filaria 15 16 C. Have you ever beenFor to private peer health center forreview this condition? Yes only Coding 17 18 (e.g. clinic/ hospital) No 19 D. Have you ever been to government hospital for such Yes 20 21 condition? No 22 If yes to C and D, ask E. If NO, move to G 23 24 E When did you last visit a physician about this disease? M 25 (enter number of months (M) or years (Y) or today (T) Y 26 27 T 28 F Where did you last visit for this condition? Public Health Center 29 30 Private Health Center 31 Alternative provider 32 G Have you ever been prescribed any medication/inhaler/hearing Yes 33 34 aid for this condition by a doctor? No 35 NA 36 37 If yes, continue to F. If NO, go to J 38 H If yes, are you still continuing it? Yes 39 40 No 41 NA 42 43 I If NO, what was the reason for stopping it? 44 J Are you taking any medication for this condition that was not Yes 45 46 prescribed by a doctor or a nurse? (e.g. you bought it at a No 47 pharmacy or was given to you by a relative) 48 K Have you ever consulted any other treatment for this condition? 49 50 1. Ayurveda 2. Traditional healer 3. Faith healer 4. Home remedy 5. Others specify 51
52 53 L How much is this condition limiting your activities? 54 1. Not at all 2. A little 3. Somewhat 4. Quite a bit 5. A lot 55 56 57 58 22 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 46 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 5 6 7 8 9 Contents 10 Informed Cover letter and Consent for Intervention- ...... 2 11 12 CONTROL GROUP ...... 2 13 Informed Cover letter and Consent for Intervention- ...... 3 14 15 EXPERIMENT GROUP...... 3 16 For peer review only 17 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact ...... 5 18 19 Section A: ...... 5 20 The Health Education Impact Questionnaire (heiQ) ...... 5 21 22 Section B: ...... 7 23 24 Survey on Hygiene Knowledge, Attitude and Practice ...... 7 25 SECTION C: ...... 8 26 27 HOMECARE OF COVID SURVEY ...... 8 28 29 SECTION D: ...... 8 30 Survey for mobile u-Health program by Ahn, Bae, and Kim ...... 8 31 32 SECTION E: ...... 10 33 34 WOMEN’S HEALTH CARE EXPERIENCES SURVEY ...... 10 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 47 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Informed Cover letter and Consent for Intervention- 5 Digital Sign or Button/Tab for 6 CONTROL GROUP acceptance 7 8 9 10 11 To be translated or read out/recorded on phone by Guddi Baji in provincial language 12 13 14 Thank you for your valuable time. 15 16 For peer review only 17 18 We request you to participate in a research project that will benefit you and your family with 19 20 regard to your health and wellbeing. As you know Coronavirus is preventing you from meeting 21 with or visiting your doctors physically. Thus, we would like to sk you uestions relted to your 22 23 helth on the phone or t the door step while observing physicl distancing nd enuring preventive 24 25 mesures (wering msk nd lkepeing 6 feet distance). 26 27 28 During this engagement you may be asked questions and your responses will be recorded, but 29 30 they will be entirely confidential. Your name is not required and all research analysis will be 31 32 undertaken with complete anonymity. We will also provide you a health literacy booklet. 33 34 35 If you have need for further questions and clarifications at any time, please contact us at any 36 37 time. Thank you for your time and we look forward to working together on this project to 38 improve your health and wellbeing. 39 40 41 42 Dr. Sara Rizvi Jafree, 43 44 Research Investigator 45 Assistant Professor, Forman Christian College\ University 46 47 E-mail: [email protected] 48 49 Cell: 0300 400 5740 50 51 52 53 54 55 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 48 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Digital Sign or Button/Tab for 5 Informed Cover letter and Consent for Intervention- acceptance 6 7 EXPERIMENT GROUP 8 9 10 11 12 To be translated or read out/recorded on phone by Guddi Baji in provincial language 13 14 15 Thank you for your valuable time. 16 For peer review only 17 18 19 We request you to participate in a research project that will benefit you and your family with 20 21 regard to your health and wellbeing. As you know Coronavirus is preventing you from meeting 22 with or visiting your doctors physically. Thus, we are bringing your community healthworker/ 23 24 Guddi Baji to you through a mobile device. If you agree to participate in this study, you will be 25 26 provided a smartphone and an internet at your doorstep for your use. Instructions and assistance 27 will be provided on how to manage the phone and internet. 28 29 30 31 The research includes an intervention, which has been designed to support you in key areas for 32 33 your health, such as (i) understanding your current health challenges, and (ii) providing you with 34 health literacy and awareness with regard to hygiene, infection protection, and any other health- 35 36 related help you may need. 37 38 39 This intervention will involve a three month daily communication and engagement with your 40 41 Guddi Baji through a phone. During this engagement you may be asked questions and your 42 43 responses will be recorded, but they will be entirely confidential. Your name is not required and 44 45 all research analysis will be undertaken with complete anonymity. 46 47 48 You may opt to withdraw at any point during this intervention. If you have need for further 49 50 questions and clarifications at any time, please contact us at any time. 51 52 53 Thank you for your time and we look forward to working together on this project to improve 54 55 your health and wellbeing. 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 49 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 5 6 Dr. Sara Rizvi Jafree, 7 Research Investigator 8 9 Assistant Professor, Forman Christian College\ University 10 11 E-mail: [email protected] 12 Cell: 0300 400 5740 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 4 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 50 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 5 6 7 The questionnaire will be read out on phone and completed by the Guddi Baji, on behalf of the 8 9 participants 10 11 12 13 Province/City: ______14 District: ______15 16 Guddi Baji Code: ______For peer review only 17 18 Participant Code: ______19 20 (Note: The participant code will link the socio-demographic data, already collected) 21 22 Section A: 23 24 The Health Education Impact Questionnaire (heiQ) 25 Please answer with respect to your health quality of life overall 26 Strongly Agree Neutral Disagree Strongly Coding 27 Agree Disagree 28 Q1. I feel that I have positive and active 29 engagement in life 30 Q2. I am doing interesting things in my life 31 Q3.Most days I am doing some of the things I 32 really enjoy 33 Q4. I try to make the most of my life 34 35 Q5. I have plans to do enjoyable things for 36 myself 37 Q6. I feel like I am actively involved in life 38 Please answer with respect to your health directed behavior 39 Q7.I walk for exercise for at least 15 minutes 40 per day, most days (or do some other form of 41 exercise for 15 minutes) 42 Q8.I do at least one type of physical activity 43 every day 44 Q9.Most of the week I do at least one activity 45 Q10.Most of the week I set aside the time for 46 healthy activities 47 Skill and technique acquisition 48 Q11.When I have symptoms, I have skills that 49 help me cope 50 Q12.I am very good at using health aids and 51 devices to make my life easier 52 Q13.I have effective skills that helps me handle 53 stress 54 Q14.I have a very good idea of how to manage 55 my health problems 56 Q15.I have a very good idea of how to protect 57 58 5 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 51 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 myself and my family from Corona virus 5 Q16.I have effective ways to prevent symptoms 6 of infection or other disease 7 Constructive attitudes and approaches 8 Q17.If others can cope with problems like 9 mine, I can too 10 Q18.I try not to let health problems stop me 11 from enjoying my life 12 Q19.I do not let health problems control my 13 life 14 Q20.My health problems do not ruin my life 15 Q21.I feel I have a very good life, even when I 16 have health problems For peer review only 17 Self-monitoring and insight 18 Q22.With my health/ infection risk/ nutrition in 19 mind, I have realistic expectations 20 Q23.As well as seeing my doctor/ meeting with 21 LHW, I do regularly monitor my changes 22 Q24.I know what things can trigger my health 23 problems 24 Q25.When I have health problems, I have clear 25 understanding 26 Q26.I have a very good understanding of when 27 and why 28 Q27.I carefully watch my health and do what is 29 necessary to keep 30 Q28.I know when my lifestyle is creating 31 health problems for me 32 Health services navigation 33 Q29.I communicate very confidently with my 34 doctor/ LHW 35 Q30.I have very positive relationships with my 36 healthcare 37 Q31.I confidently give healthcare professionals 38 the information they need 39 Q32.I get my needs met from available 40 healthcare resources 41 Q33.I work like a team with my doctors/ 42 LHWs/ other HCPs 43 Social integration and support 44 Q34.I have enough friends/ neighbors who help 45 me cope with my health 46 Q35.I have enough family/ relatives who help 47 me cope with my health 48 Q36.I get enough chances to talk about my 49 health 50 Q37.If I need help, I have plenty of people I 51 can rely on 52 Q38.Overall I feel well looked after by my 53 friends and family 54 Q39.When I feel ill, my family and Care- 55 providers really understand 56 Emotional well being 57 58 6 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 52 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Q40.If I think about my health/ infection risk/ 5 nutrition, I get depressed 6 Q41.I get upset when I think about my health/ 7 infection risk/ nutrition 8 Q42.I often feel angry when I think about my 9 health/ infection risk/ nutrition 10 Q43.My health/ infection risk/ nutrition problems make me very dissatisfied with life 11 Q44.I often worry about my health/ infection 12 risk/ nutrition 13 Q45.I feel hopeless because of my health/ 14 infection risk/ nutrition problems 15 16 For peer review only 17 18 Section B: 19 20 Survey on Hygiene Knowledge, Attitude and Practice 21 Please answer with relation to washing hands 22 Never Rarely Sometimes Very Always Coding 23 Often 24 Q46.I forget about it 25 Q47.I do not have time to do it 26 Q48.I have more important things to do 27 Q49.There is no water available 28 Q50.I do not understand why to wash my 29 hands 30 Q51.There is no soap available 31 Q52.Other Reason (please specify) 32
33
34 In what kind of situations do you consider washing hands as necessary? 35
36 Always Very Sometimes Rarely Never Often 37 Q53.Before meals or preparing a meal 38 39 Q54.After using a toilet 40 Q55.After contact with a sick person 41 Q56.After contact with any person, even 42 family member 43 Q57.After coming back home 44 Q58.After visiting public places 45 Q59.After contact with a pet/ animal 46 Q60.After waking up 47 Q61.After visiting public places (e.g. public 48 transport, supermarkets, restaurants…) 49 Q62.Do you always use soap to wash hands 50 Q63.Do you use hand sanitizer 51 Q64.How long do you wash your hands for? 52 53 54 55 56 57 58 7 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 53 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 SECTION C: 5 6 HOMECARE OF COVID SURVEY 7 In the past few weeks are you taking the following precautions 8 9 Always Very Sometimes Rarely Never Coding 10 Often 11 Q65.Avoiding physical contact (e.g. hugs, 12 hands shaking, etc.) with family members 13 Q66.Avoiding physical contact (e.g. hugs, 14 hands shaking, etc.) with relatives, neighbors, 15 known store keepers you meet daily 16 Q67.Avoiding as much Foras possible peershared review only 17 spaces and staying in a single, well-ventilated 18 room. 19 Q68.Wearing a face mask that covers the nose 20 and mouth as much as possible, especially 21 when in shared areas 22 Q69.Changing the face mask frequently; 23 especially when it becomes soiled or wet 24 Q70.Taking the mask off by touching only the 25 elastic bands or strings (not touching the front 26 and inside parts) 27 Q71.Sanitizing house with disinfectant (e.g. 28 Dettol, or other cleaner) 29 Q72.Washing hands immediately (and 30 thoroughly) after removing the face mask 31 Q73.When not wearing a face mask, covering 32 nose and mouth with paper tissue when sneezing or coughing 33 Q74.Keeping a number of paper tissues at hand 34 ready to be used 35 Q75.Disposing paper tissues after use and 36 washing hands after use of paper tissue 37 Q76.Cleaning hands frequently with alcohol- 38 based hand-rubbing solution or washing them 39 with soap and water and dry them with 40 disposable towels/ tissue 41 Q77.If disposable towels are not available, 42 keeping and using dedicated towels for self and 43 family. (Keeping them separate from the 44 towels used by the rest of the household) 45 Q78.Washing and changing towels regularly 46 Q79.Using dedicated eating utensils, cutlery, 47 and drinking glass/ mug 48 Q80.Cleaning eating, drinking and cooking 49 utensil with dish detergent after every use 50 51 52 53 SECTION D: 54 55 Survey for mobile u-Health program by Ahn, Bae, and Kim 56 57 58 8 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 54 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Please answer with respect to nutrition and eating habits: 5 Always Very Sometimes Rarely Never Coding 6 Often 7 Q81.I am interested in issues of health and 8 nutrition 9 Q82.I believe that foods that I eat influence my 10 health 11 Q83.I think the balance of the food I eat and 12 energy consumption is important 13 Q84. I am aware of the nutritional needs of the 14 body for everyday life 15 Q85. I will eat some foods that I dislike if it is 16 good for my health For peer review only 17 Q86.I want to change my incorrect eating habits 18 Q87. I have been provided nutritional 19 guidelines by experts 20 Q88. I count calories of the food I eat 21 22 Q89. Taste is important factor for my food choice 23 Q90. I keep on eating even if I am full if it the 24 taste is good 25 Q91. I eat according to what is convenient 26 cost-wise 27 Q92. I eat according to what is available in 28 community market 29 Q93. I want to exercise regularly 30 Q94. I eat at the same time everyday 31 32 Q95. I eat breakfast 33 Q96. I eat according to my age, height and 34 weight 35 Q97. I eat slowly 36 Q98. My meal is planned according to the 37 nutritional needs of body 38 Q99. I always follow meal plan according to a 39 plan, based on nutritional needs of body 40 Q100. I eat whole grains and/or rice with other 41 grains daily 42 Q101. I eat fruits daily 43 Q102. I eat vegetables daily 44 Q103. I consume dairy daily 45 Q104. I eat eggs daily 46 Q105. I take multivitamins to balance any 47 nutritional deficiency in diet 48 Q106. I have knowledge about growing some 49 of my own foods in my garden, small plot, 50 small space outside room, or in pots 51 Q107. I have money to grow some of my own 52 foods 53 Q108. I have time and energy to grow some of 54 my own foods 55 Q109. I make sure to buy and cook a balanced 56 meal for self and family 57 58 9 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 55 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Q110. I know where to get organic and pure 5 ingredients for meal preparation 6 Q111. I am careful to use organic and pure 7 ingredients for meal preparation 8 Q112. I usually cook/ serve unhealthy food to 9 family due to convenience / tradition (with oil, meat, Nans from outside) 10 Q113. I usually cook/ serve unhealthy food to 11 family due to cheaper cost (with oil, meat, 12 Nans from outside) 13 Q114. I eat at least two meals a day 14 15 Q115. I eat sweets/ some type of desert/ sugar based food daily 16 Q116. I eat salty foods For peer review only 17 18 Q117. I drink more than 2 glasses of filtered or 19 clean water daily 20 Q118. I smoke or consume some form of intoxicant (ghutka, pan, niswar) 21 Q119. I exercise more than 30 minutes each 22 time per day 23 24 25 26 SECTION E: 27 28 WOMEN’S HEALTH CARE EXPERIENCES SURVEY 29 30 31 Please rate the local doctor and healthcare provider services as you have experienced them in the past? 32 33 All of the Most of Some of A little None Coding 34 time the time the time of the of the 35 36 time time 37 38 39 Q120. Listening to what you have to say 40 Kya apki baat ghor se suntay hain? 41 Q121. Talking to you in a respectful and caring 42 43 manner 44 Kya ap se izzat se baat kartay hai? 45 46 Q122. Speaking to you in the language/ dialect 47 you understand better 48 49 Kya apse apki madri zubaan mai baat krtay hai 50 Q123. Answering your questions clearly 51 52 Ap ke sawalon ka sahi se jawaab detay hai? 53 Q124. Giving you the opportunity to ask all of 54 55 your questions 56 57 58 10 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 56 of 64
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Apko sawaal puchnay ka wakt detay hai? 5 Q125. Helping you to feel comfortable talking 6 7 about your personal or sensitive health concerns 8 Kya ap asaani se unhe apnay masaael ke baray 9 mai bata deti hain? 10 11 Q126. Giving you complete health information 12 Kya sehat se mutalik tamaam jankari detay hain? 13 14 Q127. Discussing alternative therapies, diet and 15 lifestyle 16 For peer review only 17 Kya ap se mutabadil therapy ya khuraq ya roz 18 mara ki zindagi guzarnay kay tareekay pe 19 20 tabadal e khayal kya hai? 21 Q128. Discussing hygiene and infection and 22 23 prevention 24 Q129. Discussing self-sufficiency for food 25 Q130. Discussing nutritional needs for you and 26 27 family 28 Q131. Giving you complete information about 29 30 any tests or services 31 Test ke baray mai mukamal jaankari detay hain? 32 33 Q132. Giving you the results of your tests 34 Test ke nataij batatay hain? 35 36 Q133. Giving you complete information about 37 all your options for treatments 38 39 Kya ilaaj ke mutalik apko mukamal jaankari 40 detay hai? 41 Q134. Giving you the opportunity to make 42 43 important decisions about your health care 44 Kya sehat se mutalik tamam faislay apko karnay 45 46 detay hai? 47 Q135. Giving you written, printed or digital 48 49 information when you need it 50 Malumaat likh kr dete hai? 51 52 Q136. Spending enough time with you during 53 your visits 54 Apko tasali bakhsh wakt detay hai? 55 56 57 58 11 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 57 of 64 BMJ Open
1 786 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Q137. Treating you like a partner in your health 5 care 6 7 Apka sathi bun kr apki sehat ka khayal rakhtay 8 hai? 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 12 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 58 of 64
1 2 3 4 Patient Progress Card (Experiment Group) 5 6 To be completed by Guddi Bajis 7 8 9 10 11 12 Participant District/ Area: 13 Code/ (name): 14 15 Age: Cell Number: 16 Enrollment: For peer review only 17 Informed Consent for intervention 18 Cross-sectional data survey 19 completed 20 21 22 23 24 25 26 Summary Medical Condition: 27 28 29 30 31 32 33 Intervention Date Notes Comments 34 Track 35 Smartphone & 36 37 Wifi 38 Pre-test Survey 39 Literacy Booklet To both control & 40 experiment group 41 Video 42 1 2 3 4 43 44 Virtual one on 45 one chat - 46 weekly follow- 47 up 48 Group virtual 49 meetings (group) 50 51 Availability of a 52 Whatsapp group 53 and constant 54 communication 55 Provision & - physical exercise 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 59 of 64 BMJ Open
1 2 3 guidance of a - nutrition 4 5 self-management - home garden 6 chart (oral + - medicine 7 written/ delivery - hygiene sanitation 8 of print) 9 Record of daily 10 calls/ text 11 12 Messages 13 Post-test survey 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 60 of 64
1 2 3 4 Patient Progress Card (Control Group) 5 6 To be completed by Guddi Bajis 7 8 9 10 Participant District/ Area: 11 Code/ (name): 12 Age: Cell Number: 13 14 Enrollment: 15 Informed Consent for booklet 16 delivery (at doorstep)For peer review only 17 Cross-sectional data survey 18 completed 19 20 21 22 23 Summary Medical Condition: 24 25 26 27 28 29 30 Intervention Date Notes Comments 31 Track 32 Pre-test Survey 33 Literacy Booklet To both control & 34 35 experiment group 36 Post-test Survey 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 61 of 64 BMJ Open
1 2 3 4 5 6 7 8 SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents* 9 10 Section/item Item Description Addressed on 11 No page number 12 For peer review only 13 14 Administrative information 15 16 Title 1 Descriptive title identifying the study design, population, interventions, and, if applicable, trial acronym 1 17 18 Trial registration 2a Trial identifier and registry name. If not yet registered, name of intended registry 2 19 20 2b All items from the World Health Organization Trial Registration Data Set 2 21 22 Protocol version 3 Date and version identifier 1 23 24 Funding 4 Sources and types of financial, material, and other support 18 25 26 Roles and 5a Names, affiliations, and roles of protocol contributors 1, 19 27 responsibilities 5b Name and contact information for the trial sponsor 18 28 29 5c Role of study sponsor and funders, if any, in study design; collection, management, analysis, and 18 30 31 interpretation of data; writing of the report; and the decision to submit the report for publication, including 32 whether they will have ultimate authority over any of these activities 33 34 5d Composition, roles, and responsibilities of the coordinating centre, steering committee, endpoint 15-19 35 adjudication committee, data management team, and other individuals or groups overseeing the trial, if 36 applicable (see Item 21a for data monitoring committee) 37 38 39 40 41 42 1 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 62 of 64
1 Introduction 2 3 Background and 6a Description of research question and justification for undertaking the trial, including summary of relevant 2-5 4 rationale studies (published and unpublished) examining benefits and harms for each intervention 5 6 6b Explanation for choice of comparator 6-7 7 8 Objectives 7 Specific objectives or hypotheses 4-5 9 10 Trial design 8 Description of trial design including type of trial (eg, parallel group, crossover, factorial, single group), 4-5 11 12 allocation ratio,For and framework peer (eg, superiority, review equivalence, noninferiority, only exploratory) 13 14 Methods: Participants, interventions, and outcomes 15 16 Study setting 9 Description of study settings (eg, community clinic, academic hospital) and list of countries where data will 4-6 17 18 be collected. Reference to where list of study sites can be obtained 19 Eligibility criteria 10 Inclusion and exclusion criteria for participants. If applicable, eligibility criteria for study centres and 7-8 20 21 individuals who will perform the interventions (eg, surgeons, psychotherapists) 22 23 Interventions 11a Interventions for each group with sufficient detail to allow replication, including how and when they will be 9-12 24 administered 25 26 11b Criteria for discontinuing or modifying allocated interventions for a given trial participant (eg, drug dose N/A 27 change in response to harms, participant request, or improving/worsening disease) 28 29 11c Strategies to improve adherence to intervention protocols, and any procedures for monitoring adherence 13 30 (eg, drug tablet return, laboratory tests) 31 32 11d Relevant concomitant care and interventions that are permitted or prohibited during the trial N/A 33 34 Outcomes 12 Primary, secondary, and other outcomes, including the specific measurement variable (eg, systolic blood 35 36 pressure), analysis metric (eg, change from baseline, final value, time to event), method of aggregation (eg, 6 37 median, proportion), and time point for each outcome. Explanation of the clinical relevance of chosen 38 efficacy and harm outcomes is strongly recommended 39 40 Participant timeline 13 Time schedule of enrolment, interventions (including any run-ins and washouts), assessments, and visits 6 41 for participants. A schematic diagram is highly recommended (see Figure) 42 2 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 63 of 64 BMJ Open
1 Sample size 14 Estimated number of participants needed to achieve study objectives and how it was determined, including 7-8 2 clinical and statistical assumptions supporting any sample size calculations 3 4 Recruitment 15 Strategies for achieving adequate participant enrolment to reach target sample size 7-8 5 6 7 Methods: Assignment of interventions (for controlled trials) 8 9 Allocation: 10 11 Sequence 16a Method of generating the allocation sequence (eg, computer-generated random numbers), and list of any 7 12 generation factors for stratification.For Topeer reduce predictability review of a random sequence, only details of any planned restriction 13 (eg, blocking) should be provided in a separate document that is unavailable to those who enrol participants 14 or assign interventions 15 16 Allocation 16b Mechanism of implementing the allocation sequence (eg, central telephone; sequentially numbered, 7 17 concealment opaque, sealed envelopes), describing any steps to conceal the sequence until interventions are assigned 18 19 mechanism 20 21 Implementation 16c Who will generate the allocation sequence, who will enrol participants, and who will assign participants to 7 22 interventions 23 24 Blinding (masking) 17a Who will be blinded after assignment to interventions (eg, trial participants, care providers, outcome 14 25 assessors, data analysts), and how 26 27 17b If blinded, circumstances under which unblinding is permissible, and procedure for revealing a participant’s 14 28 allocated intervention during the trial 29 30 31 Methods: Data collection, management, and analysis 32 33 Data collection 18a Plans for assessment and collection of outcome, baseline, and other trial data, including any related 12-13 34 methods processes to promote data quality (eg, duplicate measurements, training of assessors) and a description of 35 36 study instruments (eg, questionnaires, laboratory tests) along with their reliability and validity, if known. 37 Reference to where data collection forms can be found, if not in the protocol 38 39 18b Plans to promote participant retention and complete follow-up, including list of any outcome data to be 7-8 40 collected for participants who discontinue or deviate from intervention protocols 41 42 3 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 64 of 64
1 Data management 19 Plans for data entry, coding, security, and storage, including any related processes to promote data quality 14-15 2 (eg, double data entry; range checks for data values). Reference to where details of data management 3 procedures can be found, if not in the protocol 4 5 Statistical methods 20a Statistical methods for analysing primary and secondary outcomes. Reference to where other details of the 14 6 statistical analysis plan can be found, if not in the protocol 7 8 20b Methods for any additional analyses (eg, subgroup and adjusted analyses) 14 9 10 20c Definition of analysis population relating to protocol non-adherence (eg, as randomised analysis), and any 14 11 12 statistical methodsFor to handle peer missing data (eg,review multiple imputation) only 13 14 Methods: Monitoring 15 16 Data monitoring 21a Composition of data monitoring committee (DMC); summary of its role and reporting structure; statement of 15 17 whether it is independent from the sponsor and competing interests; and reference to where further details 18 19 about its charter can be found, if not in the protocol. Alternatively, an explanation of why a DMC is not 20 needed 21 22 21b Description of any interim analyses and stopping guidelines, including who will have access to these interim 14-15 23 results and make the final decision to terminate the trial 24 25 Harms 22 Plans for collecting, assessing, reporting, and managing solicited and spontaneously reported adverse N/A 26 events and other unintended effects of trial interventions or trial conduct 27 28 Auditing 23 Frequency and procedures for auditing trial conduct, if any, and whether the process will be independent 15 29 30 from investigators and the sponsor 31 32 Ethics and dissemination 33 34 Research ethics 24 Plans for seeking research ethics committee/institutional review board (REC/IRB) approval 7 35 approval 36 37 Protocol 25 Plans for communicating important protocol modifications (eg, changes to eligibility criteria, outcomes, 15 38 39 amendments analyses) to relevant parties (eg, investigators, REC/IRBs, trial participants, trial registries, journals, 40 regulators) 41 42 4 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 65 of 64 BMJ Open
1 Consent or assent 26a Who will obtain informed consent or assent from potential trial participants or authorised surrogates, and 7 2 how (see Item 32) 3 4 26b Additional consent provisions for collection and use of participant data and biological specimens in ancillary N/A 5 studies, if applicable 6 7 Confidentiality 27 How personal information about potential and enrolled participants will be collected, shared, and maintained 7-8, 15 8 in order to protect confidentiality before, during, and after the trial 9 10 Declaration of 28 Financial and other competing interests for principal investigators for the overall trial and each study site 18 11 12 interests For peer review only 13 14 Access to data 29 Statement of who will have access to the final trial dataset, and disclosure of contractual agreements that 15 15 limit such access for investigators 16 17 Ancillary and post- 30 Provisions, if any, for ancillary and post-trial care, and for compensation to those who suffer harm from trial N/A 18 trial care participation 19 20 Dissemination policy 31a Plans for investigators and sponsor to communicate trial results to participants, healthcare professionals, 15-16 21 the public, and other relevant groups (eg, via publication, reporting in results databases, or other data 22 sharing arrangements), including any publication restrictions 23 24 31b Authorship eligibility guidelines and any intended use of professional writers N/A 25 26 31c Plans, if any, for granting public access to the full protocol, participant-level dataset, and statistical code N/A 27 28 29 Appendices 30 31 Informed consent 32 Model consent form and other related documentation given to participants and authorised surrogates Appendix A & B 32 materials 33 34 Biological 33 Plans for collection, laboratory evaluation, and storage of biological specimens for genetic or molecular N/A 35 specimens analysis in the current trial and for future use in ancillary studies, if applicable 36 37 *It is strongly recommended that this checklist be read in conjunction with the SPIRIT 2013 Explanation & Elaboration for important clarification on the items. 38 39 Amendments to the protocol should be tracked and dated. The SPIRIT checklist is copyrighted by the SPIRIT Group under the Creative Commons 40 “Attribution-NonCommercial-NoDerivs 3.0 Unported” license. 41 42 5 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open
Digital Health Literacy Intervention to Support Maternal, Child and Family Health in Primary Healthcare Settings of Pakistan during the Age of Coronavirus: Study Protocol for a Randomized Controlled Trial
ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-045163.R1
Article Type: Protocol
Date Submitted by the 15-Feb-2021 Author:
Complete List of Authors: Jafree, Sara; Forman Christian College, Department of Sociology Bukhari, Nadia; University College London, School of Pharmacy Muzamill, Anam; Forman Christian College, Department of Mass Communications Tasneem, Faiza; Forman Christian College, Department of Business Fischer, Florian; Charité Universitätsmedizin Berlin, Institute of Public Health; University of Applied Sciences Ravensburg-Weingarten, Doggenriedstraße
Primary Subject Public health Heading:
Secondary Subject Heading: Global health, Epidemiology
Maternal medicine < OBSTETRICS, Community child health < Keywords: PAEDIATRICS, COVID-19, PRIMARY CARE
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786 1 2 3 Digital Health Literacy Intervention to Support Maternal, Child and Family Health in 4 5 Primary Healthcare Settings of Pakistan during the Age of Coronavirus: Study Protocol 6 for a Randomized Controlled Trial 7 8 9 Sara Rizvi Jafree, Nadia Bukhari, Anam Muzamill, Faiza Tasneem, Florian Fischer 10 11 Dr. Sara Rizvi Jafree 12 13 Department of Sociology, Forman Christian College University, Lahore, Pakistan 14 [email protected] 15 16 For peer review only 17 Nadia Bukhari 18 School of Pharmacy, University College London, London, United Kingdom 19 [email protected] 20 21 22 Anam Muzamill 23 Department of Mass Communications, Forman Christian College University, Lahore, Pakistan 24 [email protected] 25 26 27 Faiza Tasneem 28 Department of Business, Forman Christian College University, Lahore, Pakistan 29 30 [email protected] 31 32 Dr. Florian Fischer 33 34 1) Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany 35 2) Institute of Gerontological Health Services and Nursing Research, Ravensburg- 36 Weingarten University of Applied Sciences, Weingarten, Germany 37 38 [email protected] 39 40 Corresponding author: 41 42 Dr. Florian Fischer 43 Charité – Universitätsmedizin Berlin 44 Institute of Public Health 45 46 Charitéplatz 1 47 10117 Berlin 48 E-Mail: [email protected] 49 50 51 52 Word count: 6,853 53 54 55 56 57 58 - 1 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 95 BMJ Open
786 1 2 3 1 Abstract 4 5 6 2 Introduction: There is a need to continue primary healthcare services through digital 7 8 3 communication for disadvantaged women living in underdeveloped areas of Pakistan, especially 9 10 4 in the age of the coronavirus pandemic, social distancing, and lockdown of communities. This 11 12 5 project will be the first of its kind in aiming to implement a digital health literacy intervention, 13 14 15 6 using smartphone and internet, to disadvantaged women through female community healthcare 16 For peer review only 17 7 workers. Improved health literacy in women of reproductive years is known to promote maternal, 18 19 8 child and family health overall. 20 21 22 9 Methods and analysis: The study will include a baseline survey, a pre- and post-test survey, and 23 24 10 a three-month lasting intervention on (i) hygiene and prevention, and (ii) coronavirus awareness 25 26 11 and prevention. Women of reproductive years will be sampled from disadvantaged areas across 27 28 29 12 the four provinces of Pakistan (Baluchistan, KPK, Punjab, and Sindh), and the selection criterion 30 31 13 will be poor, semi-literate or illiterate, belonging to underdeveloped neighborhoods devoid of 32 33 14 universal healthcare coverage, and dependent on free primary health services. A target of 1,000 34 35 15 women will comprise the sample with 500 women each assigned randomly to the intervention and 36 37 38 16 control group. ANOVA and multivariate analysis will be used for analyzing the intervention’s 39 40 17 effects compared to the control group. 41 42 18 Ethics and Dissemination: Ethics approval for this study has been received from the Internal 43 44 45 19 Review Board of the Forman Christian College University, reference number: IRB-252/06-2020. 46 47 20 Results will be published in academic journals of repute and dissemination to the international 48 49 21 scientific community and stakeholders will also be planned through workshops. 50 51 52 22 53 54 23 Trial Registration: Registered at clinicaltrials.gov (NCT04603092) 55 56 57 58 - 2 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 95
786 1 2 3 24 Keywords: digital health literacy, primary healthcare, community healthcare workers, maternal 4 5 6 25 and child health, COVID-19, RCT 7 8 26 9 10 27 Strengths and limitations of the study 11 12 13 28 This is the first randomized controlled trial in Pakistan investigating the effects of a digital 14 15 29 health literacy intervention for hygiene and sanitation, and coronavirus awareness and 16 For peer review only 17 30 prevention, tailored to the needs of disadvantaged women of reproductive years. 18 19 20 31 We aim to use a two-step approach to pre-testing and then establishing an intervention; the 21 22 32 findings will be relevant for digital health literacy interventions in general, but particularly in 23 24 33 times of the coronavirus pandemic, where social distancing hinders the provision of health 25 26 34 services to women dependent on primary health services in their community. 27 28 29 35 The study will be an important contribution to the knowledge about efficacy of digital health 30 31 36 literacy interventions to support sustainable development goals for maternal and child health. 32 33 37 We anticipate cultural barriers in gaining permission for women’s participation in the study 34 35 36 38 and the engagement with smartphones and internet, especially in more conservative and 37 38 39 inaccessible regions. 39 40 40 There are limitations to generalizability due to potential bias from including women who gave 41 42 43 41 consent to participate in the study and also because outcomes will be measured based on 44 45 42 subjective perceptions of respondents. 46 47 48 49 50 51 52 53 54 55 56 57 58 - 3 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 95 BMJ Open
786 1 2 3 43 Introduction 4 5 6 44 South Asia is home to 25% of the world population, the majority of who are poor and without 7 8 45 universal health coverage. Research has estimated that 1 in 10 South Asians face health challenges, 9 10 46 multimorbidity, and risk of infectious disease; with each additional morbidity carrying greater risk 11 12 47 of mortality [1, 2]. Pakistan’s healthcare sector is known to be under-resourced and inefficient, 13 14 15 48 with health budget allocation standing at less than 1.5% of gross domestic product [3]. Primary 16 For peer review only 17 49 healthcare services in Pakistan are not adequate or well planned, contributing to the infectious 18 19 50 disease burden in the country and unfavorable indicators for maternal and child health [4]. There 20 21 22 51 is critical need for more integrated and innovative planning for primary health services, where 23 24 52 identification of diseases, treatment referrals and prevention is possible. According to its number 25 26 53 of inhabitants, Pakistan is the sixth largest country worldwide [5], with more than a 100 million 27 28 29 54 women living there. Local research has confirmed that women in the country are suffering from a 30 31 55 quadruple disease burden of 1) communicable/infectious diseases, 2) non-communicable diseases, 32 33 56 3) accidents, injuries, and violence, and 4) multimorbidity [6, 7]. Additionally, women from lower- 34 35 57 and middle-income countries (LMIC) may suffer from health challenges and infection risk more 36 37 38 58 than men [8]. It has also been estimated that women from unfavorable socio-demographic 39 40 59 backgrounds and living in deprived areas experience health challenges and multimorbidity 15 41 42 60 years earlier than people from more affluent backgrounds [9]. 43 44 45 61 An additional and important consideration is that women from Pakistan suffer from regressive 46 47 62 cultural norms and community neglect. This is why most women in Pakistan are unemployed [10], 48 49 63 illiterate or semi-literate, crippled by poverty [6], and thus increasingly vulnerable to multiple 50 51 52 64 health burdens. Several socio-cultural burdens adversely influence the health of women of 53 54 65 reproductive years in Pakistan, including low health literacy, undernutrition, early marriage, lack 55 56 57 58 - 4 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 95
786 1 2 3 66 of birth spacing, and a culture that prevents health-seeking behavior. Though it is assumed that 4 5 6 67 health challenges affect people at more advanced years, pregnant women in LMICs are at an 7 8 68 increased risk of health burdens and infectious diseases [2, 8, 11]. Pregnant women are not merely 9 10 69 at risk of mortality themselves, but there is concern that their child is also at heightened risk [12]. 11 12 70 The greatest concern for LMIC and Pakistan is that women of reproductive years who are illiterate 13 14 15 71 and semi-literate are not able to manage health, or adopt protective behavior, due to lack of 16 For peer review only 17 72 awareness and education, and difficulty in understanding instructions by physicians or public 18 19 73 health experts. Research suggests that health services provided to women of reproductive years in 20 21 22 74 the country are insufficient at both primary and tertiary level [13]. In the age of coronavirus, 23 24 75 services have been further compromised due to enforced social distancing. It is critical that women 25 26 76 are provided urgent assistance for infection protection, symptom management, and health access 27 28 29 77 during the pandemic [14, 15]. There is no doubt that promoting digital health literacy must be the 30 31 78 first step of intervention to support disadvantaged women of reproductive years in managing their 32 33 79 health in times of social distancing [16]. Disadvantaged women are defined within this study as 34 35 80 those who are (i) from the lower wealth strata, with low levels of literacy, and from underdeveloped 36 37 38 81 neighborhoods, (ii) unable to afford private healthcare and private health insurance, and (iii) 39 40 82 dependent on free primary healthcare services delivered within their community [17]. 41 42 83 43 44 45 84 Aim of Study 46 47 85 The study’s aim is to develop and implement a digital health literacy intervention to disadvantaged 48 49 86 women in the areas of (i) hygiene and sanitation and (ii) coronavirus awareness and prevention. 50 51 52 87 The study includes a baseline survey and a pre- and post-test survey. The three-month lasting 53 54 88 digital health literacy intervention, using a smartphone and internet, will include four components 55 56 57 58 - 5 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 7 of 95 BMJ Open
786 1 2 3 89 of (a) video tutorials, (b) one-on-one training for improving awareness and practices, (c) group 4 5 6 90 training, and (d) one-on-one training for a self-management chart. The data will be collected by 7 8 91 community healthcare workers and the participants of this study will be disadvantaged women, 9 10 92 defined as poor, semi-literate or illiterate, and belonging to underdeveloped neighborhoods devoid 11 12 93 of universal healthcare coverage and dependent on free primary health services. 13 14 15 94 16 For peer review only 17 95 Methods 18 19 96 Study design 20 21 22 97 A randomized controlled trial (RCT) will be conducted providing a digital health literacy 23 24 98 intervention for (i) hygiene and sanitation, and (ii) coronavirus awareness and prevention. A 25 26 99 summary of the proposed steps and the timeline is summarized in Table 1. We expect to conclude 27 28 29 100 the study within five months, with a cushion of 15 days. The study follows three consecutive steps. 30 31 101 At the first step, baseline data will be collected about the health challenges faced by women living 32 33 102 in disadvantaged communities. At the second step, a pre-test survey will be administered to both 34 35 103 the control and intervention group assessing their health literacy. A health literacy booklet will be 36 37 38 104 provided to both the control and intervention group after the pre-test. In addition, the intervention 39 40 105 group will receive an intervention using digital means, smartphone and internet, through a three- 41 42 106 month period for promoting health literacy related to: (i) hygiene and sanitation and (ii) 43 44 45 107 coronavirus awareness and prevention. At third and final step, both the control and intervention 46 47 108 group will be delivered a post-test to assess the differences between intervention and non- 48 49 109 intervention group. 50 51 52 110 The specific study hypotheses are that there is a positive impact of the digital health literacy 53 54 111 intervention on the intervention group (disadvantaged women of reproductive age in Pakistan) 55 56 57 58 - 6 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 8 of 95
786 1 2 3 112 with regard to improvements in: H1. Hygiene and sanitation, and H2. Coronavirus awareness and 4 5 6 113 prevention. This study protocol follows the “Standard Protocol Items: Recommendation for 7 8 114 Interventional Trials” (SPIRIT) checklist (Supplementary file 1). 9 10 115 11 12 116 Table 1: Data collection schedule 13 14 1. Baseline 2. Pre-test 3. Health 4. Intervention delivery 5. Post- 15 survey survey literacy test 16 booklet survey For peer reviewdistribution only 17 Video One-on-one Group One-on-one 18 tutorials training for training training for a 19 improving self- 20 awareness management 21 and practices chart 22 Date 7 days 7 days 7 days 90 days 7 days 23 January 2021 January 2021 January 2021 February 2021 to April 2021 May 24 2021 25 Control group (n=500) √ √ √ √ Experiment (n=500) √ √ √ √ √ √ √ √ 26 Weekly training/ √ √ 27 discussion 28 Monthly training/ √ √ √ 29 discussion Training covers hygiene √ √ √ √ 30 and sanitation 31 Training covers √ √ √ √ 32 coronavirus awareness and 33 prevention Possibility to consult with √ 34 healthcare specialist (lady 35 doctor, pharmacist) 36 117 37 38 118 Ethics of research 39 40 119 Ethics approval has been taken from the Internal Review Board of the Forman Christian College 41 42 43 120 University (IRB Approval reference IRB-252/06-2020). Informed consent will be taken from all 44 45 121 participants (Supplementary file 2). A cover letter will be provided and read out to the participants. 46 47 122 Contact information of the principal investigator will be provided along with possibility of free 48 49 50 123 counseling services in case of any emotional disturbance caused by the discussion of health 51 52 124 challenges. No personal information will be taken and anonymity and confidentiality will be 53 54 125 maintained. Only female community healthcare workers will be responsible for collecting data 55 56 57 58 - 7 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 9 of 95 BMJ Open
786 1 2 3 126 from the women. Timing for data collection and intervention delivery will be sought from 4 5 6 127 participants in advance to ensure privacy and comfort of women. All participants will be free to 7 8 128 withdraw from the study at any time. 9 10 129 11 12 130 Study population 13 14 15 131 The study population will comprise of all disadvantaged women of reproductive age (15–45 years). 16 For peer review only 17 132 Women not of reproductive age will be excluded from the sample. Given that there are 110 million 18 19 133 women in Pakistan, using the Taro Yamane’s formula [18], we need to sample an approximate 20 21 22 134 399 women each for the control and intervention group. Considering the possibility of dropouts, 23 24 135 we target to sample a total of 1,000 women, 500 for the control and 500 for the intervention group 25 26 136 (Table 2). We have chosen the Taro sampling formulae as we anticipate difficulties in seeking 27 28 29 137 permission for participation in a digital health literacy intervention amongst poor disadvantaged 30 31 138 women. This is because women from disadvantaged communities belong to highly conservative 32 33 139 and patriarchal families in Pakistan and are entirely dependent on their husband, in-laws, and 34 35 140 family for permission with regard to participation in research and access to digital technologies. 36 37 38 141 Probability sampling will be adopted in communities to allow equal chance of selection [19]. A 39 40 142 nation-wide database of from government sources will be used to randomly select participants 41 42 143 from underprivileged communities that depend on primary healthcare services according to 43 44 45 144 provincial population weightage. All four provinces of Pakistan (Baluchistan, KPK, Sindh, and 46 47 145 Punjab) will be sampled according to their population weightage. 48 49 146 50 51 52 147 Data collectors 53 54 55 56 57 58 - 8 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 10 of 95
786 1 2 3 148 Pakistan has a well-established Lady Healthcare Worker Programme with over 110,000 functional 4 5 6 149 women providing healthcare services across communities in Pakistan for primary healthcare [20]. 7 8 150 Services provided by community healthcare workers are mainly related to maternal and child 9 10 151 health, immunization and vaccination [21]. Community healthcare workers are either directly 11 12 152 employed by the government or managed through out-sourcing or contracting of private sector 13 14 15 153 [22]. For this study the data will be collected and intervention will be administered by hiring 16 For peer review only 17 154 existing community healthcare workers, assisted by both the government and private sector. They 18 19 155 will have a minimum one year of working experience in delivering primary healthcare services in 20 21 22 156 the community. Each community healthcare worker will oversee ten study participants (five each 23 24 157 from intervention and control group), which would mean one hundred community healthcare 25 26 158 workers will be recruited for this project. Over a two-week period, the community healthcare 27 28 29 159 workers will be trained for this project and its research objectives via zoom meetings. 30 31 160 The community healthcare workers will also be provided a three-day training on the use of digital 32 33 161 technology and related software, including an interactive practice session. In turn, the community 34 35 162 healthcare workers will be responsible for training the participants in three meetings, targeted to 36 37 38 163 be completed in one week. All community health workers will be provided weekly supply of masks 39 40 164 and hand sanitizers to cover expected daily needs. They will have the provision to contact their 41 42 165 respective field coordinator if they run low on supplies. Before the intervention the community 43 44 45 166 health workers will receive a one day group training on safety measures and protocols for COVID- 46 47 167 19, by a trained female doctor. A training venue within each district will be reserved for this 48 49 168 activity. We plan to sample 6 districts in this study, and each district will have approximately 15- 50 51 52 169 20 community health workers. 53 54 170 55 56 171 Table 2: Sampling strategy 57 58 - 9 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 11 of 95 BMJ Open
786 1 2 3 4 Population Total CHWs for data collection Province Intervention Control 5 weightage sample* and intervention delivery 6 7 Punjab 52.95% 550 275 275 55 8 Sindh 23.04% 250 125 125 25 9 Baluchistan 5.94% 100 50 50 10 10 KPK 14.69% 50 25 25 5 11 12 Total 1000 500 500 100 13 172 *Absolute sample figures have been rounded off. 14 173 15 16 174 Baseline, pre-test andFor post-test peer surveys review only 17 18 19 175 The baseline survey will be used for data collection about the overall health status of sampled 20 21 176 women (Appendix A). It has been developed using a standardized and validated scale, which is 22 23 177 the ‘Multimorbidity Assessment Questionnaire for Primary Care’ [23]. The six domains covered 24 25 26 178 in this scale include: (i) health care utilization, (ii) chronic diseases, (iv) depression, (v) disease 27 28 179 severity, and (vi) health-related quality of life. The pre- and post-test survey for the intervention 29 30 180 has been developed using select items from standardized questionnaires, including (i) ‘Health 31 32 33 181 Education Impact Questionnaire’ [24], (ii) ‘The National Sanitation and Hygiene Knowledge, 34 35 182 Attitudes, and Practices Survey’, and (iii) ‘The Community-Based Assessment of Knowledge, 36 37 183 Attitude, Practices and Risk Factors Regarding COVID-19’ [25] (Appendix B). Both surveys 38 39 184 measure the perceptions of respondents and record answers on a 5 point Likert scale. The primary 40 41 42 185 outcome for this study will be the positive and active changes in health directed behavior, 43 44 186 engagement with life, and self-monitoring and insight to monitor health conditions. The secondary 45 46 187 outcomes will be improvement in social integration and support and emotional well-being and 47 48 49 188 satisfaction with life. 50 51 189 52 53 54 55 56 57 58 - 10 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 12 of 95
786 1 2 3 190 Health literacy booklet 4 5 6 191 The control and intervention groups will both be provided a health literacy booklet after the pre- 7 8 192 test (Appendix C). The health literacy booklet will include images and content related to: (i) 9 10 193 hygiene and sanitation, and (ii) coronavirus awareness and prevention. The booklet will include 11 12 194 literacy about hygiene, sanitation and coronavirus prevention that have already been circulating 13 14 15 195 on TV, radio, newspapers, and other social media sources. The attempt will be to reinforce and 16 For peer review only 17 196 highlight health and infection control information to women. The hardcopy of the booklet will 18 19 197 encourage women to retain and adopt information by circulating within household family 20 21 22 198 members. The material is in line with international health communication standards. Pictures will 23 24 199 be taken from valid and reliable sources including Government of Pakistan, World Health 25 26 200 Organization, and United Nations and cited accordingly. The booklet will be delivered at the 27 28 29 201 doorstep of the female participants. Women will be asked to retrieve the material after five minutes 30 31 202 of the delivery to secure social distancing during the coronavirus pandemic. 32 33 203 34 35 204 Digital health literacy intervention 36 37 38 205 The health literacy intervention is guided by previous research and carefully considers the 39 40 206 following: (i) the literacy and semi-literacy of participants, (ii) the social context of female 41 42 207 participants related to their role and relationship with their family, husband, in-laws, and 43 44 45 208 community, and (iii) the socio-demographic characteristics of participants, such as their residence, 46 47 209 income, home responsibilities, working status, time and energy for intervention, and ability to 48 49 210 change their lifestyle. Participants in the intervention group will be delivered the intervention 50 51 52 211 through a smartphone and internet, managed by the community healthcare workers including 53 54 212 instructions for the intervention. During the intervention the community healthcare worker will be 55 56 57 58 - 11 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 13 of 95 BMJ Open
786 1 2 3 213 accessible to participants as she resides in their village within half a mile radius. Participants will 4 5 6 214 know the house of the community healthcare workers and also have her contact number in case 7 8 215 they need to communicate in-between weekly visits. 9 10 216 The health literacy intervention will last three months and includes a combination of the following 11 12 217 four components: 13 14 15 218 1) Video tutorials: The health literacy video has been developed by the research team based on 16 For peer review only 17 219 literature review, previous research experience, and ground information of needs (Appendix 18 19 220 D). It will be divided into two different segments, (i) hygiene and sanitation, and (ii.) 20 21 22 221 coronavirus awareness and prevention. Derived from the diffusion of innovations theory [26], 23 24 222 a screenplay showing interaction between a change agent (community healthcare worker) and 25 26 223 an early adopter (disadvantaged woman in the community) will be used. The video will be 27 28 29 224 communicated and reinforced through monthly repetition over the intervention period. 30 31 225 Voiceover in the provincial language will be used, but the narrative will be evident through 32 33 226 images and symbols. Therefore, even without voiceover the audience will be able to understand 34 35 227 the messages being communicated. 36 37 38 228 2) One-on-one training for improving awareness and practices: Weekly one-on-one meetings 39 40 229 will provide a forum for one-on-one communication between the community healthcare worker 41 42 230 and the female client. It will offer opportunities for the community healthcare worker to discuss 43 44 45 231 health generally, hygiene and sanitation, and coronavirus prevention and awareness in theory 46 47 232 and practice. It will also provide the opportunity for women to share their challenges and to 48 49 233 seek guidance on improvement, adoption, and challenges related to health awareness and 50 51 52 234 behavior. The women will also be able to consult with healthcare practitioners, including 53 54 235 women doctors and pharmacists via the smartphone. 55 56 57 58 - 12 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 14 of 95
786 1 2 3 236 3) Group training: Monthly group meetings will be an opportunity for community healthcare 4 5 6 237 workers to collectively interact with their respective five intervention participants and discuss 7 8 238 the interpretation of the health literacy video and individual meetings. The virtual group 9 10 239 meeting will provide a platform for participants to share their challenges and gains to provide 11 12 240 collective support and reinforcement, as well as the opportunity for information sharing. Group 13 14 15 241 forums also have the benefit of encouraging question and answers that individuals may not be 16 For peer review only 17 242 able to address or voice in one-on-one sessions. Training content guidelines for the community 18 19 243 healthcare workers for the one-on-one weekly and monthly group meetings for hygiene and 20 21 22 244 sanitation and coronavirus awareness and prevention can be found in Appendix E and Appendix 23 24 245 F, respectively. 25 26 246 4) One-on-one training for a self-management chart: Separate weekly meetings with each 27 28 29 247 participant will be held for training of a self-management chart (Appendix G). This chart will 30 31 248 be tailor-made for each participant based on the information from baseline survey and their 32 33 249 current health challenges and socio-demographic characteristics. It will be filled and updated 34 35 250 weekly by the participants during the intervention period to help them track improvement in 36 37 38 251 health practices, health behavior, and lifestyle change related to hygiene, sanitation, and 39 40 252 preventive behavior related to the coronavirus. For women who cannot type or write, this self- 41 42 253 management chart will have the option of recording information through symbols. 43 44 45 254 46 47 255 Development and piloting of the tools 48 49 256 The principal and co-investigators have developed the tools for this study, including the surveys 50 51 52 257 and the intervention. For strengthening validity and finalization of the tools, two stages will be 53 54 258 adopted after the recruitment of the community healthcare workers. At the first stage, focus group 55 56 57 58 - 13 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 15 of 95 BMJ Open
786 1 2 3 259 discussions with community healthcare workers in different provinces will be conducted to gain 4 5 6 260 more information about their experiences with regard to women in their community and their 7 8 261 challenges with regard to interaction, communication, and service delivery. Additionally, the 9 10 262 surveys and the intervention plans will be shared with the community healthcare workers in order 11 12 263 to gain their feedback and recommendations for additions or deletion. At the second stage, after 13 14 15 264 incorporation of feedback from community healthcare workers, a pilot test with 15 female 16 For peer review only 17 265 participants will be conducted over a two week period. Participants for the pilot will be recruiting 18 19 266 from the existing network of the community healthcare workers and will be chosen based on the 20 21 22 267 selection criterion of the study. We will share the surveys (baseline survey and pre-test survey 23 24 268 questions) and the plans for the intervention with participants of the pilot study and ask them to 25 26 269 provide feedback. The objective of the pilot will be to gain feedback about the ease of 27 28 29 270 understanding the surveys and refinement of intervention material. Pilot study participants will not 30 31 271 be included in the intervention later. 32 33 272 The surveys and intervention material have been developed in English and Urdu (the national 34 35 273 language) and we will also be translating them in the provincial languages. The translation from 36 37 38 274 Urdu to provincial languages (Baluchi for Baluchistan; Pashto for KPK; Punjabi for Punjab; and 39 40 275 Sindhi for Sindh) will be done by experts in each language accompanied by four community 41 42 276 healthcare workers from each province, fluent in Urdu and the respective provincial language. The 43 44 45 277 translation will be done using the forward backward method [27], and will be double checked by 46 47 278 other language experts solicited for assistance after the internal team members have completed 48 49 279 translations. 50 51 52 280 53 54 281 Data collection 55 56 57 58 - 14 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 16 of 95
786 1 2 3 282 This study will be collecting self-reported data for the baseline survey, pre-test survey, and post- 4 5 6 283 test survey. Data collection will employ an online-based approach. The digital format for survey 7 8 284 data collection and intervention delivery have the advantage of enabling intervention deliverers 9 10 285 and participants to answer/question/learn conveniently at their own preferred time, within their 11 12 286 homes, and at their own and family’s convenience. We will be using the licensed software 13 14 15 287 ClickMedix for recording and storage of our survey data, sharing of videos, intervention delivery, 16 For peer review only 17 288 and video calls with healthcare specialists. This is a recommended software for health services and 18 19 289 assures data security by keeping patient data confidential and secure [28]. Every user will have a 20 21 22 290 separate login and password, and no user will be able to access an alternative account other their 23 24 291 own. All data and communication between community healthcare workers and female study 25 26 292 participants will be recorded on ClickMedix and transferred to the principal investigator for 27 28 29 293 permanent storage, record keeping, and data analysis. Only the principal investigator will have 30 31 294 access to the complete data on ClickMedix. Additionally, we will be ensuring privacy for women 32 33 295 by ensuring that all meetings and trainings take place in either i. a private space in participant’s 34 35 296 home, ii. private space in community healthcare workers home, or iii. the veranda or house garden 36 37 38 297 of participant. Headphones will be used by community healthcare workers and participants when 39 40 298 speaking to a healthcare specialist. Participants will not be provided any incentive to participate in 41 42 299 this study. However, we believe the following elements will support retention of participants in 43 44 45 300 the study: (i) health benefits for participants and their family, (ii) familiarity, trust and cultural 46 47 301 sensitivity of female community healthcare providers delivering intervention, and (iii) frequency 48 49 302 of contact. 50 51 52 303 53 54 304 Data analysis 55 56 57 58 - 15 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 17 of 95 BMJ Open
786 1 2 3 305 Data will be collected electronically on smartphones of community healthcare workers. Analysis 4 5 6 306 will be conducted using SPSS after data cleaning prior to the analysis and analyzing non- 7 8 307 responders. As data collectors or women clients cannot be blinded, we will be ensuring that data 9 10 308 analysis and outcomes being measured are as objective as possible by blinding the first data 11 12 309 analyst. This will ensure that bias is avoided during the statistical analysis of the intervention 13 14 15 310 results. The data analysis will be completed once by the blinded data analyst and then repeated by 16 For peer review only 17 311 a second person to confirm validity. Furthermore, a third data analyst will be involved in checking 18 19 312 and ensuring data management and result interpretation. 20 21 22 313 Data regarding refusal and dropout will be reported according to CONSORT guidelines [29]. 23 24 314 Descriptive statistics will be used to report baseline survey data with regard to health status of 25 26 315 study participants. Associations between socio-demographic characteristics of women and broad 27 28 29 316 health challenges of infectious disease, chronic disease, multimorbidity, and mental health will be 30 31 317 presented using binomial multivariate regression models. With regard to pre-test and post-test 32 33 318 results for the intervention, chi square test, means, standard deviations, and ANOVA will be used 34 35 319 to present the differences between the intervention and control group and to compare outcomes 36 37 38 320 and change in health behavior. In addition, multivariate logistic regression will be used to present 39 40 321 odds ratios and 95% confidence intervals to show the impact of the intervention through reporting 41 42 322 higher likelihood of an improvement in health literacy between the intervention and control group. 43 44 45 323 Levels of significance will be reported at p<0.05. 46 47 324 48 49 325 Data audit 50 51 52 326 Data analysis will be conducted by the principal and co-investigator team. It will not involve the 53 54 327 funders of this project. The data will be audited by independent senior scholars comprising the 55 56 57 58 - 16 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 18 of 95
786 1 2 3 328 Office of Research, Innovation and Commercialization, at Forman Christian College University. 4 5 6 329 A weekly progress report will be provided to the auditors to help them monitor the project and 7 8 330 provide feedback. 9 10 331 11 12 332 Data storage and sharing 13 14 15 333 All data of the research project, the master file for survey data collection results, and intervention 16 For peer review only 17 334 results will be available in Excel files and SPSS. This data will be stored in the FCCU repository. 18 19 335 Hardcopies of all data collection (surveys and notes), unblended data, and contractual agreements 20 21 22 336 will be held securely by the principal investigator. 23 24 337 25 26 338 Patient and public involvement 27 28 29 339 This study includes the view of the people involved in the research (disadvantaged women of 30 31 340 reproductive age as well as community healthcare workers) at an early stage in the pilot testing. 32 33 341 This offers the opportunity of rephrasing or including further questions in the questionnaire. 34 35 342 36 37 38 343 Dissemination 39 40 344 A website will be developed for sharing aggregated data and sharing findings. Workshops will be 41 42 345 held with health sector and stakeholders to share recommendations for policy improvements. 43 44 45 346 Furthermore, we aim to disseminate the findings of our study via publication in an international 46 47 347 peer-reviewed journal and through conference proceedings. The plans for future research include: 48 49 348 (i) Repeat nation-wide cross-sectional data collection and longitudinal systematic data collection 50 51 52 349 for women’s health to a wider sample, (ii) strengthening of partnership with government for team- 53 54 350 building between female community healthcare workers and other health workers for primary 55 56 57 58 - 17 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 19 of 95 BMJ Open
786 1 2 3 351 healthcare support of women, such as health social workers, and (iii) including further digital 4 5 6 352 health literacy interventions related to maternal and child health, nutrition and food security, and 7 8 353 mental health counseling and therapy. 9 10 354 11 12 355 Discussion 13 14 15 356 Health literacy of women is a major problem in Pakistan and other LMIC due to low literacy 16 For peer review only 17 357 generally, lack of inclusion in the general education curriculum, and greater seclusion in the home 18 19 358 [30]. Ironically, it is the women who are responsible for their own and their families health overall 20 21 22 359 and preventive behavior for infection control. Luckily, health literacy for women from LMIC is 23 24 360 gaining attention as it empowers poor and semi-literate women for informed decision making and 25 26 361 improved health behavior [31]. Non-digital health literacy interventions in LMIC have been 27 28 29 362 successful in providing women of reproductive years support for family planning [32], menstrual 30 31 363 health [33], child health [34], and mental health [35]. Improved health literacy in disadvantaged 32 33 364 populations has been linked to improved health status, greater adherence to medication, better 34 35 365 health recovery, and decrease in hospitalization [34]. At the macro-level, health literacy 36 37 38 366 interventions can improve maternal and child health indicators and decrease the health burden for 39 40 367 LMIC nations, which are already resource-short and facing greater infectious disease burden [36]. 41 42 368 The digitization of health services has been identified by the World Health Organization as a 43 44 45 369 contemporary global strategy to improve health [37]. With the onslaught of the pandemic and the 46 47 370 need for physical distancing, access to health information and health services through mobiles and 48 49 371 internet assumes greater significance. The additional need of the hour in LMICs is to provide 50 51 52 372 digital health literacy interventions related to hygiene and coronavirus management to women of 53 54 373 reproductive years to secure maternal, child and family health. Technology-based health literacy 55 56 57 58 - 18 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 20 of 95
786 1 2 3 374 interventions, using digital devices and the internet, have been successful in LMIC [38], especially 4 5 6 375 when efforts have been made to develop easy reading material and use of numbers, pictures, and 7 8 376 color [39, 40]. However, there have been difficulties with regard to the overall assessment of RCT 9 10 377 impact due to differences in methods and research design, and measurement of outcomes in cities 11 12 378 or provinces rather than at national level [41-43]. 13 14 15 379 In Pakistan digital health interventions have so far focused on SMS messages for heart patients 16 For peer review only 17 380 [44], mobile services for diabetes patients [45], and provision of a mobile app to access online 18 19 381 consultancy from a doctor [46]. Other interventions have targeted to empower healthcare providers 20 21 22 382 and record and manage patient information [47, 48]. So far interventions have been targeting 23 24 383 populations that already own and use a mobile phone or smartphone and have knowledge about 25 26 384 downloading health related apps [49]. Another limitation is that interventions so far in the country 27 28 29 385 have targeted general health and non-communicable diseases, and there have been no efforts to 30 31 386 improve literacy for hygiene, sanitation, and coronavirus management in disadvantaged women 32 33 387 [50]. There have also been few interventions involving community-based intervention and female 34 35 388 community healthcare workers in Pakistan [51]. Difficulties in conducting digital interventions in 36 37 38 389 LMIC include: (i) high costs and shortage of national and international funding for such projects, 39 40 390 (ii) problems related to internet access in remote areas, (iii) barriers in communicating with 41 42 391 semiliterate populations, and (iv) lack of cultural acceptability with regard to the use of technology, 43 44 45 392 especially for women [52]. 46 47 393 This protocol describes the methods for a RCT which aims at investigating the effects of a digital 48 49 394 health literacy intervention to empower women clients and healthcare providers of the community. 50 51 52 395 This study will make an important contribution by improving participants understanding with 53 54 396 respect to hygiene, sanitation and coronavirus prevention, and will also present comparative results 55 56 57 58 - 19 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 21 of 95 BMJ Open
786 1 2 3 397 between a control and intervention group to highlight the impact of the intervention delivery. We 4 5 6 398 believe this study will change the landscape of primary healthcare delivery services by digitalizing 7 8 399 services and improving service delivery standards of community healthcare workers [53]. 9 10 400 Empowering disadvantaged women with health access digitally will also open avenues for women 11 12 401 in accessing future opportunities related to communication, employment, and small business 13 14 15 402 development. Digital health literacy in Pakistan, during the coronavirus pandemic, would also 16 For peer review only 17 403 contribute to improvements in patient safety, referral for other health and social needs through 18 19 404 community healthcare workers, and ultimately enhance the socio-economic potential of the 20 21 22 405 country. It is hoped that this study and further research can plan more comprehensive literacy and 23 24 406 awareness interventions in primary healthcare settings for disadvantaged women related to other 25 26 407 maternal and child health areas, nutrition and food security, chronic disease and multimorbidity 27 28 29 408 management, and mental health counseling. 30 31 409 32 33 410 Acknowledgements 34 35 411 We would like to thank Professors Dr. Sikandar Hayat and Dr. Kauser Malik for their support and 36 37 38 412 guidance during the development of this project. Sincerest thanks is also due to Professor Syeda 39 40 413 Khadija Burhan and Dr. Amna Khawar for assistance in review of the content developed for the 41 42 414 health literacy intervention. 43 44 45 415 We acknowledge support from the German Research Foundation (DFG) and the Open Access 46 47 416 Publication Fund of Charité – Universitätsmedizin Berlin. 48 49 417 50 51 52 418 Competing interests 53 54 419 The authors declare that no competing interests exist. 55 56 57 58 - 20 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 22 of 95
786 1 2 3 420 4 5 6 421 Funding 7 8 422 This project is funded by doctHERS, in partnership with University of Health Sciences (UHS), 9 10 423 Punjab Population Innovation Fund (PPIF), Women Chamber of Commerce and Industry (WCCI) 11 12 424 and Rural Support Programmes Network (RSPN); under their joint agreement to provide Maternal, 13 14 15 425 Child Health & Family Planning Services via telemedicine to underprivileged women of Pakistan. 16 For peer review only 17 426 The contact point for doctHERS is: [email protected]. 18 19 427 The funds will be used for the following expenses: Digital assets (Smartphone, Wifi, and video 20 21 22 428 development), stipend for two research assistants, and stipend for community healthcare workers 23 24 429 who will be collecting the data and delivering the intervention. The principal and co-investigators 25 26 430 are not receiving a salary for this project. The funding body will not be involved in study design, 27 28 29 431 data management, or interpretation of data. 30 31 432 32 33 433 Data availability and sharing 34 35 434 There is no data available, because it is a study protocol. All data relevant to the study are included 36 37 38 435 in the article or uploaded as supplementary information. Change of information related to Protocol 39 40 436 will be shared with relevant parties, including trial registry and publisher. 41 42 437 43 44 45 438 Ethical considerations 46 47 439 Ethics approval for this study has been gained from Forman Christian College University (IRB 48 49 440 Approval reference IRB-252/06-2020). 50 51 52 441 53 54 442 Author’s contributions 55 56 57 58 - 21 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 23 of 95 BMJ Open
786 1 2 3 443 SRJ planned and developed the trial intervention. FF and AM provided expertise with the research 4 5 6 444 design. NB helped to gain funds for the project. SRJ, AM and FT have developed the material for 7 8 445 data collection and health literacy intervention. SRJ drafted the protocol; FF and AM revised it 9 10 446 critically for important intellectual content. All authors approved the final version of this 11 12 447 manuscript. 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 22 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 24 of 95
786 1 2 3 448 References 4 5 449 1. MacMahon, S., Multimorbidity: A priority for global health research. The Academy of 6 7 450 Medical Sciences: London, UK, 2018. 8 451 2. Singh, K., et al., Multimorbidity in South Asian adults: prevalence, risk factors and 9 10 452 mortality. Journal of Public Health, 2018. 41(1): p. 80-89. 11 12 453 3. Nishtar, S., Choked pipes: reforming Pakistan's mixed health system. 2010: Oxford 13 14 454 University Press Karachi. 15 455 4. Pati, S., et al., Prevalence and outcomes of multimorbidity in South Asia: a systematic 16 For peer review only 17 456 review. BMJ open, 2015. 5(10): p. e007235. 18 19 457 5. Fund., I.M., World Economic Outlook Database – October 2019. Washington: 20 21 458 International Monetary Fund 2019. 22 459 6. Mumtaz, K., Gender and poverty in Pakistan. Development, 2007. 50(2): p. 149-153. 23 24 460 7. Nasrullah, M. and J.A. Bhatti, Gender inequalities and poor health outcomes in Pakistan: 25 26 461 a need of priority for the national health research agenda. J J Coll Physicians Surg Pak, 27 462 2012. 22(5): p. 273-274. 28 29 463 8. MacMahon, S., et al., Multimorbidity: A priority for global health research. J The 30 31 464 Academy of Medical Sciences: London, UK, 2018. 32 33 465 9. Barnett, K., et al., Epidemiology of multimorbidity and implications for health care, 34 466 research, and medical education: a cross-sectional study. The Lancet, 2012. 380(9836): 35 36 467 p. 37-43. 37 38 468 10. Begum Sadaquat, M. and Q.-t.-a.A. Sheikh, Employment situation of women in Pakistan. 39 40 469 International journal of social economics, 2011. 38(2): p. 98-113. 41 470 11. Beeson, J.G., et al., Multiple morbidities in pregnancy: Time for research, innovation, 42 43 471 and action. 2018, Public Library of Science San Francisco, CA USA. 44 45 472 12. Aubert, C.E., et al., Patterns of multimorbidity in internal medicine patients in Swiss 46 473 university hospitals: a multicentre cohort study. J Swiss medical weekly, 2019. 47 48 474 149(2526). 49 50 475 13. Abdullah, M., et al., The health workforce crisis in Pakistan: a critical review and the 51 52 476 way forward. J World Health Popul, 2014. 15(3): p. 4-12. 53 477 14. Qiao, J., What are the risks of COVID-19 infection in pregnant women? J The Lancet, 54 55 478 2020. 395(10226): p. 760-762. 56 57 58 - 23 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 25 of 95 BMJ Open
786 1 2 3 479 15. Schwartz, D.A., An analysis of 38 pregnant women with COVID-19, their newborn 4 5 480 infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections 6 7 481 and pregnancy outcomes. J Archives of pathology laboratory medicine, 2020. 144(7): p. 8 482 799-805. 9 10 483 16. Contant, É., et al., A multidisciplinary self-management intervention among patients with 11 12 484 multimorbidity and the impact of socioeconomic factors on results. BMC family practice, 13 14 485 2019. 20(1): p. 53. 15 486 17. Hunt, A. and E. Samman, Women’s economic empowerment: Navigating enablers and 16 For peer review only 17 487 constraints. J UN High Level Panel on Women‟ s Economic Empowerment background 18 19 488 paper. London: Overseas Development Institute, 2016. 20 21 489 18. Yamane, T., Taro Yamane’s formula. 1973. 22 490 19. Cho, C., et al., Random number generator with random sampling. 2011, Google Patents. 23 24 491 20. Jalal, S., The lady health worker program in Pakistan—a commentary. J European 25 26 492 journal of public health, 2011. 21(2): p. 143-144. 27 493 21. Douthwaite, M. and P. Ward, Increasing contraceptive use in rural Pakistan: an 28 29 494 evaluation of the Lady Health Worker Programme. J Health policy planning, 2005. 20(2): 30 31 495 p. 117-123. 32 33 496 22. Khan, I.A., Public sector institutions, politics and outsourcing: Reforming the provision 34 497 of primary healthcare in Punjab, Pakistan. J Journal of International Development: The 35 36 498 Journal of the Development Studies Association, 2010. 22(4): p. 424-440. 37 38 499 23. Pati, S., et al., Development and validation of a questionnaire to assess multimorbidity in 39 40 500 primary care: An Indian experience. BioMed research international, 2016. 2016. 41 501 24. Osborne, R.H., G.R. Elsworth, and K. Whitfield, The Health Education Impact 42 43 502 Questionnaire (heiQ): an outcomes and evaluation measure for patient education and 44 45 503 self-management interventions for people with chronic conditions. Patient education and 46 504 counseling, 2007. 66(2): p. 192-201. 47 48 505 25. Afzal, M.S., et al., Community-based assessment of knowledge, attitude, practices and 49 50 506 risk factors regarding COVID-19 among Pakistanis residents during a recent outbreak: a 51 52 507 cross-sectional survey. J Journal of Community Health, 2020: p. 1-11. 53 508 26. Rogers, E.M., Diffusion of innovations. 2010: Simon and Schuster. 54 55 56 57 58 - 24 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 26 of 95
786 1 2 3 509 27. Maneesriwongul, W. and J.K. Dixon, Instrument translation process: a methods review. J 4 5 510 Journal of advanced nursing, 2004. 48(2): p. 175-186. 6 7 511 28. Ho, B., M. Lee, and A.W. Armstrong, Evaluation criteria for mobile teledermatology 8 512 applications and comparison of major mobile teledermatology applications. J 9 10 513 Telemedicine e-Health, 2013. 19(9): p. 678-682. 11 12 514 29. Altman, D.G., et al., The revised CONSORT statement for reporting randomized trials: 13 14 515 explanation and elaboration. J Annals of internal medicine, 2001. 134(8): p. 663-694. 15 516 30. Das, S., et al., Health literacy in a community with low levels of education: findings from 16 For peer review only 17 517 Chakaria, a rural area of Bangladesh. J BMC Public Health, 2017. 17(1): p. 1-10. 18 19 518 31. Vaz, N.F.M., Mobile health literacy to improve health outcomes in low-middle income 20 21 519 countries, in health care delivery and clinical science: concepts, methodologies, tools, 22 520 and applications. 2018, IGI Global. p. 1398-1411. 23 24 521 32. Kilfoyle, K.A., et al., Health literacy and Women's reproductive health: a systematic 25 26 522 review. J Journal of Women's Health, 2016. 25(12): p. 1237-1255. 27 523 33. Kansiime, C., et al., Menstrual health intervention and school attendance in Uganda 28 29 524 (MENISCUS-2): a pilot intervention study. J BMJ open, 2020. 10(2). 30 31 525 34. DeWalt, D.A. and A. Hink, Health literacy and child health outcomes: a systematic 32 33 526 review of the literature. J Pediatrics, 2009. 124(Supplement 3): p. S265-S274. 34 527 35. Jorm, A.F., Mental health literacy: empowering the community to take action for better 35 36 528 mental health. J American psychologist, 2012. 67(3): p. 231. 37 38 529 36. Peters, D.H., et al., Poverty and access to health care in developing countries. J Annals 39 40 530 of the New York Academy of Sciences, 2008. 1136(1): p. 161-171. 41 531 37. Holeman, I., T.P. Cookson, and C. Pagliari, Digital technology for health sector 42 43 532 governance in low and middle income countries: a scoping review. J Journal of global 44 45 533 health, 2016. 6(2). 46 534 38. Meherali, S., N.S. Punjani, and A. Mevawala, Health Literacy Interventions to Improve 47 48 535 Health Outcomes in Low-and Middle-Income Countries. J HLRP: Health Literacy 49 50 536 Researc Practice, 2020. 4(4): p. e251-e266. 51 52 537 39. Kripalani, S. and B.D. Weiss, Teaching about health literacy and clear communication. 53 538 Journal of general internal medicine, 2006. 21(8): p. 888-890. 54 55 56 57 58 - 25 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 27 of 95 BMJ Open
786 1 2 3 539 40. Tortajada, S., et al., Case management for patients with complex multimorbidity: 4 5 540 development and validation of a coordinated intervention between primary and hospital 6 7 541 care. International journal of integrated care, 2017. 17(2). 8 542 41. Ahmed, J. and B. Shaikh, The state of affairs at primary health care facilities in 9 10 543 Pakistan: where is the State's stewardship? J Eastern Mediterranean Health Journ, 2011. 11 12 544 17(7). 13 14 545 42. Loevinsohn, B., et al., Contracting-in management to strengthen publicly financed 15 546 primary health services—the experience of Punjab, Pakistan. J Health policy, 2009. 16 For peer review only 17 547 91(1): p. 17-23. 18 19 548 43. Mumtaz, Z., et al., Good on paper: the gap between programme theory and real‐world 20 21 549 context in Pakistan's Community Midwife programme. J BJOG: An International Journal 22 550 of Obstetrics Gynaecology, 2015. 122(2): p. 249-258. 23 24 551 44. Kamal, A.K., et al., A randomized controlled behavioral intervention trial to improve 25 26 552 medication adherence in adult stroke patients with prescription tailored Short Messaging 27 553 Service (SMS)-SMS4Stroke study. J BMC neurology, 2015. 15(1): p. 1-11. 28 29 554 45. Hashmi, N.R. and S.A. Khan, Interventional study to improve diabetic guidelines 30 31 555 adherence using mobile health (m-Health) technology in Lahore, Pakistan. J BMJ open, 32 33 556 2018. 8(5). 34 557 46. Ullah, N., et al., A telemedicine network model for health applications in Pakistan: 35 36 558 Current status and future prospects. J International Journal of Digital Content 37 38 559 Technology its Applications, 2009. 3(3): p. 149-155. 39 40 560 47. Hall, C.S., et al., Assessing the impact of mHealth interventions in low-and middle- 41 561 income countries–what has been shown to work? J Global health action, 2014. 7(1): p. 42 43 562 25606. 44 45 563 48. Zaidi, S., et al., Operability, acceptability, and usefulness of a mobile app to track routine 46 564 immunization performance in rural Pakistan: interview study among vaccinators and key 47 48 565 informants. J JMIR mHealth uHealth, 2020. 8(2): p. e16081. 49 50 566 49. Jacobs, R.J., et al., A systematic review of eHealth interventions to improve health 51 52 567 literacy. J Health informatics journal, 2016. 22(2): p. 81-98. 53 568 50. Kazi, A.M., et al., Current Challenges of Digital Health Interventions in Pakistan: Mixed 54 55 569 Methods Analysis. J Journal of medical Internet research, 2020. 22(9): p. e21691. 56 57 58 - 26 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 28 of 95
786 1 2 3 570 51. Bhutta, Z.A., et al., Interventions to address maternal, newborn, and child survival: what 4 5 571 difference can integrated primary health care strategies make? J The Lancet, 2008. 6 7 572 372(9642): p. 972-989. 8 573 52. Mbuagbaw, L., et al., The challenges and opportunities of conducting a clinical trial in a 9 10 574 low resource setting: the case of the Cameroon mobile phone SMS (CAMPS) trial, an 11 12 575 investigator initiated trial. J Trials, 2011. 12(1): p. 1-7. 13 14 576 53. Sultan, F. and A.J.T.L. Khan, Infectious diseases in Pakistan: a clear and present 15 577 danger. 2013. 381(9884): p. 2138-2140. 16 For peer review only 17 18 578 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - 27 - 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 29 of 95 BMJ Open
1 2 3 4 5 6 7 8 SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents* 9 10 Section/item Item Description Addressed on 11 No page number 12 For peer review only 13 14 Administrative information 15 16 Title 1 Descriptive title identifying the study design, population, interventions, and, if applicable, trial acronym 1 17 18 Trial registration 2a Trial identifier and registry name. If not yet registered, name of intended registry 2 19 20 2b All items from the World Health Organization Trial Registration Data Set 2 21 22 Protocol version 3 Date and version identifier 1 23 24 Funding 4 Sources and types of financial, material, and other support 21 25 26 Roles and 5a Names, affiliations, and roles of protocol contributors 1 & 22 27 responsibilities 28 5b Name and contact information for the trial sponsor 21 29 30 5c Role of study sponsor and funders, if any, in study design; collection, management, analysis, and 21 31 interpretation of data; writing of the report; and the decision to submit the report for publication, including 32 whether they will have ultimate authority over any of these activities 33 34 5d Composition, roles, and responsibilities of the coordinating centre, steering committee, endpoint 21-22 35 adjudication committee, data management team, and other individuals or groups overseeing the trial, if 36 applicable (see Item 21a for data monitoring committee) 37 38 39 40 41 42 1 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 30 of 95
1 Introduction 2 3 Background and 6a Description of research question and justification for undertaking the trial, including summary of relevant 3-6 4 5 rationale studies (published and unpublished) examining benefits and harms for each intervention 6 7 6b Explanation for choice of comparator 6 8 Objectives 7 Specific objectives or hypotheses 7 9 10 Trial design 8 Description of trial design including type of trial (eg, parallel group, crossover, factorial, single group), 6-7 11 12 allocation ratio,For and framework peer (eg, superiority, review equivalence, noninferiority, only exploratory) 13 14 15 Methods: Participants, interventions, and outcomes 16 Study setting 9 Description of study settings (eg, community clinic, academic hospital) and list of countries where data will 6-7 17 18 be collected. Reference to where list of study sites can be obtained 19 20 Eligibility criteria 10 Inclusion and exclusion criteria for participants. If applicable, eligibility criteria for study centres and 6-7 21 individuals who will perform the interventions (eg, surgeons, psychotherapists) 22 23 Interventions 11a Interventions for each group with sufficient detail to allow replication, including how and when they will be 7-11 24 administered 25 26 11b Criteria for discontinuing or modifying allocated interventions for a given trial participant (eg, drug dose 6 27 change in response to harms, participant request, or improving/worsening disease) 28 29 11c Strategies to improve adherence to intervention protocols, and any procedures for monitoring adherence 12 30 (eg, drug tablet return, laboratory tests) 31 32 11d Relevant concomitant care and interventions that are permitted or prohibited during the trial N/A 33 34 Outcomes 12 Primary, secondary, and other outcomes, including the specific measurement variable (eg, systolic blood 35 36 pressure), analysis metric (eg, change from baseline, final value, time to event), method of aggregation 9 37 (eg, median, proportion), and time point for each outcome. Explanation of the clinical relevance of chosen 38 efficacy and harm outcomes is strongly recommended 39 40 Participant timeline 13 Time schedule of enrolment, interventions (including any run-ins and washouts), assessments, and visits 9-11 41 for participants. A schematic diagram is highly recommended (see Figure) 42 2 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 31 of 95 BMJ Open
1 Sample size 14 Estimated number of participants needed to achieve study objectives and how it was determined, including 6-7 2 clinical and statistical assumptions supporting any sample size calculations 3 4 Recruitment 15 Strategies for achieving adequate participant enrolment to reach target sample size 6-7 5 6 7 Methods: Assignment of interventions (for controlled trials) 8 9 Allocation: 10 11 Sequence 16a Method of generating the allocation sequence (eg, computer-generated random numbers), and list of any 6-7 12 generation factors for stratification.For Topeer reduce predictability review of a random sequence, only details of any planned restriction 13 (eg, blocking) should be provided in a separate document that is unavailable to those who enrol 14 participants or assign interventions 15 16 Allocation 16b Mechanism of implementing the allocation sequence (eg, central telephone; sequentially numbered, 6-7 17 18 concealment opaque, sealed envelopes), describing any steps to conceal the sequence until interventions are assigned 19 mechanism 20 21 Implementation 16c Who will generate the allocation sequence, who will enrol participants, and who will assign participants to 6-7 22 interventions 23 24 Blinding (masking) 17a Who will be blinded after assignment to interventions (eg, trial participants, care providers, outcome 16 25 assessors, data analysts), and how 26 27 17b If blinded, circumstances under which unblinding is permissible, and procedure for revealing a participant’s 16 28 allocated intervention during the trial 29 30
31 Methods: Data collection, management, and analysis 32 33 Data collection 18a Plans for assessment and collection of outcome, baseline, and other trial data, including any related 15-16 34 methods processes to promote data quality (eg, duplicate measurements, training of assessors) and a description of 35 36 study instruments (eg, questionnaires, laboratory tests) along with their reliability and validity, if known. 37 Reference to where data collection forms can be found, if not in the protocol 38 39 18b Plans to promote participant retention and complete follow-up, including list of any outcome data to be 14-16 40 collected for participants who discontinue or deviate from intervention protocols 41 42 3 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 32 of 95
1 Data management 19 Plans for data entry, coding, security, and storage, including any related processes to promote data quality 16-17 2 (eg, double data entry; range checks for data values). Reference to where details of data management 3 procedures can be found, if not in the protocol 4 5 Statistical methods 20a Statistical methods for analysing primary and secondary outcomes. Reference to where other details of the 16-17 6 7 statistical analysis plan can be found, if not in the protocol 8 20b Methods for any additional analyses (eg, subgroup and adjusted analyses) 16-17 9 10 20c Definition of analysis population relating to protocol non-adherence (eg, as randomised analysis), and any 16-17 11 12 statistical methodsFor to handle peer missing data review(eg, multiple imputation) only 13 14 Methods: Monitoring 15 16 Data monitoring 21a Composition of data monitoring committee (DMC); summary of its role and reporting structure; statement of 16-17 17 18 whether it is independent from the sponsor and competing interests; and reference to where further details 19 about its charter can be found, if not in the protocol. Alternatively, an explanation of why a DMC is not 20 needed 21 22 21b Description of any interim analyses and stopping guidelines, including who will have access to these 15-17 23 interim results and make the final decision to terminate the trial 24 25 Harms 22 Plans for collecting, assessing, reporting, and managing solicited and spontaneously reported adverse N/A 26 27 events and other unintended effects of trial interventions or trial conduct 28 Auditing 23 Frequency and procedures for auditing trial conduct, if any, and whether the process will be independent 17 & 21 29 30 from investigators and the sponsor 31 32 Ethics and dissemination 33 34 Research ethics 24 Plans for seeking research ethics committee/institutional review board (REC/IRB) approval 7,8 35 approval 36 37 Protocol 25 Plans for communicating important protocol modifications (eg, changes to eligibility criteria, outcomes, 22 38 39 amendments analyses) to relevant parties (eg, investigators, REC/IRBs, trial participants, trial registries, journals, 40 regulators) 41 42 4 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 33 of 95 BMJ Open
1 Consent or assent 26a Who will obtain informed consent or assent from potential trial participants or authorised surrogates, and 7,8 2 how (see Item 32) 3 4 26b Additional consent provisions for collection and use of participant data and biological specimens in ancillary N/A 5 studies, if applicable 6 7 Confidentiality 27 How personal information about potential and enrolled participants will be collected, shared, and 15-16 8 maintained in order to protect confidentiality before, during, and after the trial 9 10 Declaration of 28 Financial and other competing interests for principal investigators for the overall trial and each study site 21 11 12 interests For peer review only 13 14 Access to data 29 Statement of who will have access to the final trial dataset, and disclosure of contractual agreements that 15 15 limit such access for investigators 16 17 Ancillary and post- 30 Provisions, if any, for ancillary and post-trial care, and for compensation to those who suffer harm from trial N/A 18 trial care participation 19 20 Dissemination policy 31a Plans for investigators and sponsor to communicate trial results to participants, healthcare professionals, 17-18 21 the public, and other relevant groups (eg, via publication, reporting in results databases, or other data 22 23 sharing arrangements), including any publication restrictions 24 25 31b Authorship eligibility guidelines and any intended use of professional writers N/A 26 31c Plans, if any, for granting public access to the full protocol, participant-level dataset, and statistical code 17-18 27 28
29 Appendices 30 31 Informed consent 32 Model consent form and other related documentation given to participants and authorised surrogates Supplementary 32 materials File 2 33 34 Biological 33 Plans for collection, laboratory evaluation, and storage of biological specimens for genetic or molecular N/A 35 specimens analysis in the current trial and for future use in ancillary studies, if applicable 36 37 38 *It is strongly recommended that this checklist be read in conjunction with the SPIRIT 2013 Explanation & Elaboration for important clarification on the items. 39 Amendments to the protocol should be tracked and dated. The SPIRIT checklist is copyrighted by the SPIRIT Group under the Creative Commons 40 “Attribution-NonCommercial-NoDerivs 3.0 Unported” license. 41 42 5 43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open Page 34 of 95
1 2 3 4 Informed Cover letter and Consent for Intervention 5 6 7 CONTROL GROUP 8 Thank you for your valuable time. 9 10 11 We request you to participate in a research project that will benefit you and your family with regard to your health 12 and wellbeing. As you know Coronavirus is preventing you from meeting with your LHW. Thus, we are bringing 13 14 community healthcare workers to you with a mobile device and internet to provide you with health services. 15 16 For peer review only 17 This study will require you to complete a baseline survey and a pre and post-test survey. We will also provide you 18 with a health literacy booklet. A suitable time will be taken from you for meeting and no information you share with 19 20 us will be communicated or disseminated. All anonymity and confidentiality will be maintained. 21 Digital Sign or Button/Tab for 22 CONSENT 23 24 25 26 27 Sara Rizvi Jafree, PhD 28 Principal Research Investigator 29 30 Assistant Professor, Forman Christian College\ University 31 E-mail: [email protected] 32 33 Cell: 0300 400 5740 34 35
36 37 Experiment GROUP 38 Thank you for your valuable time. 39 40 41 We request you to participate in a research project that will benefit you and your family with regard to your health 42 43 and wellbeing. As you know Coronavirus is preventing you from meeting with your LHW. Thus, we are bringing 44 community healthcare workers to you with a mobile device and internet to provide you with health services. 45
46 47 This study will require you to complete a baseline survey and a pre and post-test survey. We will also provide you 48 with a health literacy booklet. A suitable time will be taken from you for meeting and no information you share with 49 50 us will be communicated or disseminated. All anonymity and confidentiality will be maintained. 51 52 53 In addition, the research includes a three month intervention, which has been designed to support you in key areas 54 for your health: (i)hygiene and sanitation and (ii) coronavirus awareness and prevention. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 35 of 95 BMJ Open
1 2 3 There will be weekly one-one engagement with your community healthcare worker, and also a monthly group 4 5 engagement with your community women. You may opt to withdraw at any point during this intervention. If you 6 have need for further questions and clarifications at any time, please contact us at any time. 7
8 9 Thank you for your time and we look forward to working together on this project to improve your health and 10 wellbeing. 11 12 13 14 Digital Sign or Button/Tab for 15 CONSENT 16 For peer review only 17 18 19 Sara Rizvi Jafree, PhD 20 Principal Research Investigator 21 22 Assistant Professor, Forman Christian College\ University 23 E-mail: [email protected] 24 25 Cell: 0300 400 5740 26 27 28 29 30 ﮐﻨﺘﺮول ﮔﺮوپ 31 آپ ﮐﮯ ﻗﯿﻤﺘﯽ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ 32 33 ﮨم آپ ﺳﮯ ﮏﯾا ﺗﺣﻘ ﯽﻘﯾ ﻣﻧﺻوﺑﮯ ﻣ ںﯾ ﺷرﮐت ﮐرﻧﮯ ﮐﯽ درﺧواﺳت ﮐرﺗﮯ ﮨ ںﯾ ﺟو آپ اور آپ ﮐﮯ ﺧﺎﻧدان ﮐﯽ ﺻﺣت اور ﺧوﺷﺣﺎﻟﯽ 34 ﮐﮯ ﺳﻠﺳﻠﮯ ﻣ ںﯾ ﻓﺎﺋده ﻣﻧد ﯽﮔ ۔ ﺟﯾﺳﺎ ﮐہ آپ ﺟﺎﻧﺗﯽ ﮨﯾں ﮐہ ﮐروﻧﺎ ﮐﯽ وﺟہ ﺳﮯ آپ اﭘﻧﯽ ﮨﯾﻠﺗﮭ ورﮐر ﺳﮯ ﻣل ﻧﮩﯾں ﺳﮑﺗﯾں ﮨم آپ ﮐو 35 ﺻﺣت ﮐﯽ ﺧدﻣﺎت ﻓراﮨم ﮐرﻧﮯ ﮐﮯ ﻟﺋﮯ ﮐﻣﯾوﻧﮢﯽ ﮐﺎرﮐﻧوں ﮐو ﻻ رﮨﮯ ﮨ ںﯾ ان ﮐﮯ ﭘﺎس ﻣوﺑﺎﺋل اور اﻧﮢرﻧ ٹﯾ ﮐﯽ ﺻﮩوﻟت ﮨﮯ۔ اس 36 ﻣطﺎﻟﻌہ ﮐﮯ دوران آپ ﮐو ا ﮏﯾ سﯾﺑ ﺳروے اور ﭘری اور ﭘوﺳٹ ﮢﯾﺳٹ ﺳروے ﮐو ﻣﮑﻣل ﮐرﻧﮯ ﮐﯽ ﺿرورت ﮨوﮔﯽ . ﮨم آپ ﮐو 37 ﺻﺣت ﺧواﻧدﮔﯽ ﮐﺗﺎﺑﭼہ ﺑﮭﯽ ںﯾﻓراﮨم ﮐر ﮔﮯ ۔ اس ﺳﻠﺳﻠہ ﻣﯾں آپ ﺳﮯ ﮨوﻧﮯ واﻟﯽ ﻣﻼﻗﺎت اور اس ﺳﮯ ﺣﺎﺻل ﮨوﻧﮯ واﻟﯽ ﻣﻌﻠوﻣﺎت 38 39 ﮐو ﺻﯾﻐﺎﺋﮯ راز ﻣﯾں رﮐﮭﺎ ﺟﺎﺋﮯ ﮔﺎ۔ 40 41 دﺳﺘﺨﻂ ﯾﺎ ﺑﮣﻦ دﺑﺎ ﮐﺮرﺿﺎ ﻣﻨﺪی ﮐﺎ اﺿﮩﺎر 42 43 44 45 ﺳﺎره رﺿﻮی ﺟﻌﻔﺮی 46 ﺑﻨﯿﺎدی ﻣﺤﻘﻖ 47 اﺳﮣﻨﭧ ﭘﺮوﻓﯿﺴﺮ ؑﻓﻮرﻣﻦ ﮐﺮﺳﭽﯿﻦ ﮐﺎﻟﺞ و ﯾﻮﻧﯿﻮرﺳﮣﯽ 48 [email protected] : ای ﻣﯿﻞ 49 50 5740 400 0300 :ﻣﻮﺑﺎﺋﯿﻞ 51 ﺗﺠﺮﺑﺎﺗﯽ ﮔﺮوپ 52 53 آپ ﮐﮯ ﻗﯿﻤﺘﯽ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 36 of 95
1 2 ﮨم آپ ﺳﮯ ﮏﯾا ﺗﺣﻘ ﯽﻘﯾ ﻣﻧﺻوﺑﮯ ﻣ ںﯾ ﺷرﮐت ﮐرﻧﮯ ﮐﯽ درﺧواﺳت ﮐرﺗﮯ ﮨ ںﯾ ﺟو آپ اور آپ ﮐﮯ ﺧﺎﻧدان ﮐﯽ ﺻﺣت اور ﺧوﺷﺣﺎﻟﯽ 3 4 ﮐﮯ ﺳﻠﺳﻠﮯ ﻣ ںﯾ ﻓﺎﺋده ﻣﻧد ﯽﮔ ۔ ﺟﯾﺳﺎ ﮐہ آپ ﺟﺎﻧﺗﯽ ﮨﯾں ﮐہ ﮐروﻧﺎ ﮐﯽ وﺟہ ﺳﮯ آپ اﭘﻧﯽ ﮨﯾﻠﺗﮭ ورﮐر ﺳﮯ ﻣل ﻧﮩﯾں ﺳﮑﺗﯾں ﮨم آپ ﮐو 5 ﺻﺣت ﮐﯽ ﺧدﻣﺎت ﻓراﮨم ﮐرﻧﮯ ﮐﮯ ﻟﺋﮯ ﮐﻣﯾوﻧﮢﯽ ﮐﺎرﮐﻧوں ﮐو ﻻ رﮨﮯ ﮨ ںﯾ ان ﮐﮯ ﭘﺎس ﻣوﺑﺎﺋل اور اﻧﮢرﻧ ٹﯾ ﮐﯽ ﺻﮩوﻟت ﮨﮯ۔ اس 6 ﻣطﺎﻟﻌہ ﮐﮯ دوران آپ ﮐو ا ﮏﯾ سﯾﺑ ﺳروے اور ﭘری اور ﭘوﺳٹ ﮢﯾﺳٹ ﺳروے ﮐو ﻣﮑﻣل ﮐرﻧﮯ ﮐﯽ ﺿرورت ﮨوﮔﯽ . ﮨم آپ ﮐو 7 ﺻﺣت ﺧواﻧدﮔﯽ ﮐﺗﺎﺑﭼہ ﺑﮭﯽ ںﯾﻓراﮨم ﮐر ﮔﮯ ۔ اس ﺳﻠﺳﻠہ ﻣﯾں آپ ﺳﮯ ﮨوﻧﮯ واﻟﯽ ﻣﻼﻗﺎت اور اس ﺳﮯ ﺣﺎﺻل ﮨوﻧﮯ واﻟﯽ ﻣﻌﻠوﻣﺎت 8 ﮐو ﺻﯾﻐﺎﺋﮯ راز ﻣﯾں رﮐﮭﺎ ﺟﺎﺋﮯ ﮔﺎ۔ 9 10 اس ﮐﮯ ﻋﻼوه, ﺗﺣﻘ ﻖﯾ ںﯾﻣ ﮏﯾا نﯾﺗ ﻣﺎه ﮐﯽ ﯽﻣداﺧﻠت ﺑﮭ ﺷﺎﻣل ﮨﮯ ﺟس ﮐو آپ ﮐﯽ ﺻﺣت ﮐﮯ اﮨم ﻣﻌﺎﻣﻼت ںﯾﻣ آپ ﮐﯽ ﻣدد ﮐرﻧﮯ 11 12 ﯾﮐﮯ ﻟﺋﮯ ڈ زاﺋن ﺎﯾﮐ ﺎﯾﮔ ﮨﮯ ﺟﯾﺳﮯ (1) ﺣﻔظﺎن ﺻﺣت و ﺻﻔﺎﺋﯽ (2) ﮐروﻧﺎ واﺋرس ﺳﮯ ﺑﭼﺎؤ اور ﺣﻔﺎظت وﻏﯾره۔ 13 14 اس ﺳﻠﺳﻠﮯ ﻣﯾں آپ ﮐﯽ اﭘﻧﯽ ﮐﻣﯾوﻧﮢﯽ ﮨﯾﻠﺗﮭ ورﮐر ﺳﮯ ﮨﻔﺗہ وار اﻧﻔرادی ﻣﻼﻗﺎت ﮨو ﮔﯽ ﻋﻼوه ازﯾں ﻋﻼﻗہ ﮐﯽ اور ﺧواﺗﯾن ﮐﮯ ﺳﺎﺗﮭ 15 ﻣﺎﮨﺎﻧہ اﺟﺗﻣﺎﻋﯽ ﻣﻼﻗﺎت ﺑﮭﯽ ﮨوﮔﯽ۔ آپ اس onlyﻣداﺧﻠت ﮐﮯ دوران ﮐﺳﯽ ﺑﮭﯽ review وﻗت ﺷرﮐت ﺳﮯ peer اﻧﮑﺎر ﮐر Forﺳﮑﺗﯽ ﮨﯾں۔ اور اﮔر آپ ﮐوﺋﯽ 16 ﺳوال ﭘوﭼﮭﻧﺎ ﭼﺎﮨﯾں ﺗو ﮨم ﺳﮯ ﮐﺳﯽ ﺑﮭﯽ وﻗت ﭘوﭼﮭ ﺳﮑﺗﯽ ﮨﯾں۔ 17 18 .ﮨم آپ ﮐﯽ ﺻﺣت اور ﺧوﺷﺣﺎﻟﯽ ﮐو ﺑﮩﺗر ﺑﻧﺎﻧﮯ ﮐﮯ ﻟﺋﮯ اس ﻣﻧﺻوﺑﮯ ﭘر ﻣل ﮐر ﮐﺎم ﮐرﻧﮯ ﮐﮯ ﻟﯾﮯ ﭘر ﺟوش ںﯾﮨ ۔ ﺷﮑرﯾہ 19 20 21 دﺳﺘﺨﻂ ﯾﺎ ﺑﮣﻦ دﺑﺎ ﮐﺮرﺿﺎ ﻣﻨﺪی ﮐﺎ اﺿﮩﺎر 22 23 24 25 ﺳﺎره رﺿﻮی ﺟﻌﻔﺮی 26 ﺑﻨﯿﺎدی ﻣﺤﻘﻖ 27 اﺳﮣﻨﭧ ﭘﺮوﻓﯿﺴﺮ ؑﻓﻮرﻣﻦ ﮐﺮﺳﭽﯿﻦ ﮐﺎﻟﺞ و ﯾﻮﻧﯿﻮرﺳﮣﯽ 28 [email protected] :ای ﻣﯿﻞ 29 30 5740 400 0300 :ﻣﻮﺑﺎﺋﯿﻞ 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 37 of 95 BMJ Open
1 2 3 4 Appendix A 5 6 Baseline Survey 7 8 9 The questionnaire will be read out on phone and completed by the Guddi Bajis, on behalf of the participants 10 11 12 Province/City: ______13 District: ______14 15 Guddi Bajis Code: ______16 Participant Code: ______For peer review only 17 18 SECTION A: 19 SOCIO-DEMOGRAPHIC CHARACHTERISTICS 20
21 22 Coding 23 Q1. Age 24 25 Q2. Religion 1.Muslim 2.Christian 3.Hindu 4.Other 26 Q3. Marital status 1.Never 2.Currently 3.Seperated/divorced 4.Widow/widower 27 28 married married 29 Q4. Present place of living 1.Urban 2.Semi- 3.Rural 30 31 urban 32 Q5. Highest education 1.Illiterate 2.Primary 3.High school or 3.Graduation and 33 34 Secondary above 35 Q6. Housing type 1.Kutcha 2.Pucca 3.Semi-pucca Other 36 (specify) 37 38 Q7. House Ownership Owned Rented Living with Other 39 Someone (specify) 40 41 Q8. Occupation 1.Unemployed 2.Employed 42 43 44 45 Q9. What is your monthly income 46 47 Q10. Spouse literacy 1.Illiterate 2.Primary 3.High school or 4. Graduation or 48 secondary above 49 50 Q11. Spouse occupation 1.Unemployed 2.Employed 3.Type of 51 employment 52 53 Q12. How many children do you 54 have 55 Q13. What is the age of your last 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 38 of 95
1 2 3 child 4 5 Q14. Number of people living in 6 house 7 8 9 10 11 Q15.Number of rooms in house 12 13 Q16.Are you currently taking 1.No 2.Yes If Yes, who: 14 15 care of a disabled/ dependent 16 family member For peer review only 17 18 19 Q17. Do you have the following 20 21 in your house: (tick all that 22 apply) 23 24 TV 25 Radio 26 27 Landline 28 Electricity at least 8 hours in a 29 day 30 31 Mobile phone with internet 32 Washing machine 33 34 Toile facility in house with flush If not, what do you use 35
36 37 Drinking water from tap If not, what do you use 38 39 40 Gutter drainage If not, what do you use 41 42 43 Stove for cooking with gas If not, what do you use 44 connection 45 46 Garbage collectors come to If not, what do you use 47 dispose garbage 48 Q18. Are you taking any health 49 50 insurance (please describe 51 scheme/ installment/ coverage)? 52 53 54 Q19. Do you have any savings? 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 39 of 95 BMJ Open
1 2 3 (Approximately how much?) 4 5 6 Q20. Have you taken a loan? 7 8 (From where, what is the 9 duration, what is the amount, 10 how much installment are you 11 12 paying?) 13
14 15 Q21. During the past 12 months have you been admitted to 1.No 2.Yes 3. If yes, can you Coding 16 hospital for any diseases orFor health problem? peer review onlydescribe health 17 18 problem 19 Q22. Beside the hospitalization in past 12 months, how 20 21 many times you have visited a public hospital for 22 consultation? 23 24 Q23. How many times in a month do you visit or are visited 25 by your community healthcare provider? 26 Q24. How many different types of medicine/drugs are you 27 28 taking at present? 29
30 31 32 33 34 35 36 37 SECTION B: 38 MULTIMORBIDITY ASSESSMENT QUESTIONAIRE FOR PRIMARY CARE (MAQ-PC) 39
40 41 Q25. Please provide information about the following chronic diseases Yes No Coding 42 Arthritis 43 44 45 Diabetes 46 47 48 Hypertension 49 50 51 Chronic lungs diseases 52 53 (including Asthma) 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 40 of 95
1 2 3 Acid Peptic diseases 4 5 6 Chronic back ache 7 8 9 Heart disease 10 11 12 Stroke 13 14 15 Blindness 16 For peer review only 17 18 Deafness 19 20 21 Dementia 22 23 24 Alcohol disorder 25 26 27 Cancer 28 29 30 Chronic kidney disease 31 32 33 Epilepsy 34 35 36 Thyroid disease 37 38 39 Tuberculosis 40 41 42 Filariasis 43 44 45 Corona Virus Questions 46 Q26. Are you aware of Yes No 47 48 the Corona Virus 49 symptoms? 50 Q27. Have you or any Acute respiratory distress syndrome ____ Identify the HH 51 52 of your family Cough ____ members 53 members experienced Conjunctivitis ____ 54 55 any of the following in Diarrhea ____ 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 41 of 95 BMJ Open
1 2 3 the past 8 months? Fatigue____ 4 5 (please tick all that Fever ____ 6 apply) Chills ____ 7 8 Headache ____ 9 Nausea ____ 10 Pneumonia ____ 11 12 Sore throat____ 13 Vomiting ____ 14 15 Other symptoms…please specify? 16 For peer review only 17 18 Q28. Would you like 19 to tell anything else 20 21 about these symtoms? 22 Q29. Have you 23 received messages 24 25 about Corona virus 26 prevention? 27 28 Q30. Where have you TV ____ 29 received these Radio____ 30 31 messages? (please tick Phone texts ____ 32 all that apply) Phone calls ____ 33 34 Neighborhood ____ 35 Friends ____ 36 Family ____ 37 38 Other (Please specify) 39 40 41 Questions related to Depression Coding 42 Over the past 2 weeks, how often have you been bothered by any of the following problems? 43 44 Always Very Sometim Rarely Never 45 Often es 46 47 Q31. Little interest and pleasure in doing things 48 Q32. Feeling down, depressed or hopeless 49 50 Q33. Trouble falling/staying asleep, sleeping too 51 much 52 53 Q34. Feeling tired or having little energy 54 Q35. Feeling bad about yourself – or that you are a 55 failure or have let yourself or your family down? 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 42 of 95
1 2 3 Q36. Trouble concentrating on things such as 4 5 reading newspaper or watching television 6 Q37. Moving or speaking so slowly that other 7 8 people could have noticed. Or the opposite – being 9 so fidgety or restless that you have been moving 10 around a lot more than usual 11 12 Q38. Thoughts that you would be better off dead 13 or of hurting yourself someway 14 15 Q39. Have you ever been to see a practitioner for 16 being sad or depressed? (PleaseFor indicate peer which review only 17 18 practitioner or healer/ date of last visit/ medicine 19 prescribed/ still continuing medicine/ if not, why 20 21 not?) 22 23 24 Questions related to Mobility Coding 25 This information will help keep track of how well you feel and how well you are able to do your usual activities? 26 Q40. In general, would you say your health is: Excellent Very Good Fair Poor 27 28 Good 29
30 31 The following questions are about activities you might do during a typical day. Does your health now limit you in 32 these activities? If so, how much? 33 34 Q41. Moderate activities, such as moving a table, All of Most of Some of A little None of 35 pushing a vacuum cleaner, cleaning house the time the time the time of the the time 36 37 time 38 Q42. Climbing several flights of stairs All of Most of Some of A little None of 39 40 the time the time the time of the the time 41 time 42 During the past 4 weeks, how much of the time have you had any of the following problems with your work or 43 44 other regular daily activities as a result of your physical health? 45 Q43. Accomplished less than you would like All of Most of Some of A little None of 46 47 the time the time the time of the the time 48 time 49 50 Q44. Were limited in kind of work or other activities All of Most of Some of A little None of 51 the time the time the time of the the time 52 53 time 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 43 of 95 BMJ Open
1 2 3 SECTION C: 4 5 WOMEN’S HEALTH CARE EXPERIENCES SURVEY 6 7 8 Q45.Compared to other women your age, how Excellent Very Good Fair Poor 9 would you rate your health Good 10 Apni hum umar auraton ki nisbat aap apni sehat 11 12 ka kya mayaar samjhtay hain? 13 Q46. Do you feel your health could be better Always Very Sometimes Rarely Never 14 15 than it is presently? Often 16 Kya apki sehat ke mayaar maiFor koi behtari peer lai ja review only 17 18 sakti hai? 19 Q47. Does your husband/ male relative/in-laws Always Very Sometimes Rarely Never 20 21 decide/ give approval when you or your Often 22 children need consultation from a medical 23 practitioner 24 25 Kya apka khawand/susral apko doctor pe janay 26 ki ijazat deta hai? Kya ye faisla bhi apka 27 28 susral/khawand krta hai? 29 30 31 Please indicate if you have experienced any of the following health issues in the last 12 months? 32 Q48.Minor illness like the flu or an infection 1.Yes 2.No 33 34 Pichlay 12 mahinay mai apko nazla ya infection 35 hua hai? 36 Q49. Had to go for a checkup or routine 1.Yes 2.No 37 38 physical exam 39 Jismani muaaenay ke liye gae hain? 40 41 Q50.Were you pregnant? 1.Yes 2.No 42 Kya app hamla theen? 43 44 Q51. Did you need family planning or 1.Yes 2.No 45 preconceptional services? 46 47 Kya apko munsoba bandi ki zaroorat thee? 48 Q52. Did you have an injury that you have not 1.Yes 2.No 49 50 already mentioned? 51 Kya apko koi chot lagi hai? 52 Q53. Did you need care for a chronic health 1.Yes 2.No 53 54 problem, (that is one that goes on for a long 55 time)? 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 44 of 95
1 2 3 Kya apko kisi taweel bemari ke liye hospital 4 5 jana para hai? 6 Q54.Did you need surgery for a condition not 1.Yes 2.No If yes, what? 7 8 already mentioned? 9 Kya apko operation keranay ki zaroorat parhi? 10
11 12 Q55.Were you feeling depressed, anxious, or 1.Yes 2.No Could you pinpoint why? 13 highly stressed? 14 15 Kya iski waja se apko kisi kisam ka zehni dabao 16 ya bechaini mehsoos hui hai?For peer review only 17 18 Q56. Have you had one of the following medical tests in the last 12 months? 19 Cancer screening, (or check for blood in your 1.Yes 2.No 20 21 stool, sigmoidoscopy, or colonoscopy) 22 Test for glaucoma or pressure in the eye 1.Yes 2.No 23 24 Blood cholesterol test 1.Yes 2.No 25 Check for high blood pressure 1.Yes 2.No 26 27 Test for diabetes 1.Yes 2.No 28 Breast or abdominal ultrasound 1.Yes 2.No 29 30 Mammogram 1.Yes 2.No 31 Pap test 1.Yes 2.No 32 Bone density test (for osteoporosis) 1.Yes 2.No 33 34 Genetic screening test 1.Yes 2.No 35 Screening for HIV/AIDS 1.Yes 2.No 36 37 Screening for sexually transmitted diseases 1.Yes 2.No 38 Dental exam 1.Yes 2.No 39 40 Shot for flu or pneumonia 1.Yes 2.No 41 Pregnancy test 1.Yes 2.No 42 43 Corona 1.Yes 2.No 44 Tests for infertility 1.Yes 2.No 45 46 Malaria 1.Yes 2.No 47 Another other test (please specify)? 48 49 50 Q57. In the past 12 months, did any of your health care providers give you information about? 51 52 (pichlay 12 mahino mai kya apkay doctor/nurse ne aap se in chizon ke baray mai maloomat di hain?) 53 Smoking, second-hand smoke, or quitting 1.Yes 2.No 54 55 smoking 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 45 of 95 BMJ Open
1 2 3 Tambako noshi, kisi aisay shaks k saath 4 5 bethtna/rehna jo tambako noshi mein mulawis 6 ho, ya tambako noshi chorna 7 8 Nutrition or diet 1.Yes 2.No 9 (Khuraak) 10 Alcohol or drug use 1.Yes 2.No 11 12 Shraab ya adviyaat? 13 Physical fitness or exercise 1.Yes 2.No 14 15 Jismani sehat ya warzish? 16 Menopause or hormone replacementFor therapy peer 1.Yes review 2.No only 17 18 San – e - yaas ya hormone tabdeeli therapy? 19 Hygiene 1.Yes 2.No 20 21 Sanitation 1.Yes 2.No 22 How to protect against infectious diseases 1.Yes 2.No 23 24 Work or financial problems 1.Yes 2.No 25 Kaam ya muaashi mushkilaat ka samna hua hai? 26 27 Family or relationship problems 1.Yes 2.No 28 Ghar walon ya rishtadaron ke masa’il? 29 30 Importance of child health and nutrition 1.Yes 2.No 31 Bachon ki sehat or khuraak ki ehmiyat? 32 Stress management 1.Yes 2.No 33 34 Zehani dabao ko kum karna 35 Preventing unintended pregnancies & birth 1.Yes 2.No 36 37 spacing 38 Bachon ke darmiya wakfa? 39 40 Using alternative therapies, such as herbs or 1.Yes 2.No 41 acupuncture 42 43 Preventing osteoporosis 1.Yes 2.No 44 Hadion ke dard se bachao 45 46 Nutritional needs for you and family 1.Yes 2.No 47 Ways to avoid food shortages 1.Yes 2.No 48 Improve self-sufficiency for food security 1.Yes 2.No 49 50 Q58. Are there any dietary supplements that you have used in the last 12 months? 51 Vitamin C 1.Yes 2.No 52 53 Vitamin D 1.Yes 2.No 54 Vitamin E 1.Yes 2.No 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 46 of 95
1 2 3 B Complex 1.Yes 2.No 4 5 Calcium 1.Yes 2.No 6 Pregnancy Vitamin 1.Yes 2.No 7 8 Lactation Vitamin 1.Yes 2.No 9 General Multi-vitamin 1.Yes 2.No 10 11 Q59. What is your personal preference for health services? 12 Tibbi saholiyat se mutalik apki zaati tarjihaat kya hain? 13 14 Family (e.g. mother/ mother-in-law/ aunt) 1.Yes 2.No If Yes, 15 Ghar walay? describe 16 For peer review only who: 17 18 19 A women’s health center where you can get 1.Yes 2.No 20 21 most of your basic health care, including 22 gynecological care, in one place 23 24 Khawateen ki sehat markaz? 25 Trusted community member 1.Yes 2.No 26 27 Baradari? 28 A nurse or community healthcare provider (Not 1.Yes 2.No 29 a physician/ surgeon/ medical consultant) 30 31 Public Hospital 1.Yes 2.No 32 Local female healer 1.Yes 2.No 33 34 Private Clinic 1.Yes 2.No 35 Q60. In general, how difficult have you found it All of the Most of Some of A little None of 36 37 to talk to community healthcare provider about time the time the time of the the time 38 your personal health concerns? time 39 40 doctor/nurse se baat krna apko kitna mushkil 41 lagta hai? 42 43 Please rate the community healthcare provider services as you have experienced them in the past? 44 Q61. Listening to what you have to say All of the Most of Some of A little None of 45 46 Kya apki baat ghor se suntay hain? time the time the time of the the time 47 time 48 Q62. Talking to you in a respectful and caring All of the Most of Some of A little None of 49 50 manner time the time the time of the the time 51 Kya ap se izzat se baat kartay hai? time 52 53 Q63. Speaking to you in the language/ dialect All of the Most of Some of A little None of 54 you understand better time the time the time of the the time 55 56 Kya apse apki madri zubaan mai baat krtay hai time 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 47 of 95 BMJ Open
1 2 3 Q64. Answering your questions clearly All of the Most of Some of A little None of 4 5 Ap ke sawalon ka sahi se jawaab detay hai? time the time the time of the the time 6 time 7 8 Q65. Giving you the opportunity to ask all of All of the Most of Some of A little None of 9 your questions time the time the time of the the time 10 Apko sawaal puchnay ka wakt detay hai? time 11 12 Q66. Helping you to feel comfortable talking All of the Most of Some of A little None of 13 about your personal or sensitive health concerns time the time the time of the the time 14 15 Kya ap asaani se unhe apnay masaael ke baray time 16 mai bata deti hain? For peer review only 17 18 Q67. Giving you complete health information All of the Most of Some of A little None of 19 Kya sehat se mutalik tamaam jankari detay time the time the time of the the time 20 21 hain? time 22 Q68. Discussing alternative therapies, diet and All of the Most of Some of A little None of 23 24 lifestyle time the time the time of the the time 25 Kya ap se mutabadil therapy ya khuraq ya roz time 26 mara ki zindagi guzarnay kay tareekay pe 27 28 tabadal e khayal kya hai? 29 Q69. Giving you complete information about All of the Most of Some of A little None of 30 31 any tests or services time the time the time of the the time 32 Test ke baray mai mukamal jaankari detay hain? time 33 34 Q70. Giving you the results of your tests All of the Most of Some of A little None of 35 Test ke nataij batatay hain? time the time the time of the the time 36 37 time 38 Q71. Giving you complete information about all All of the Most of Some of A little None of 39 your options for treatments time the time the time of the the time 40 41 Kya ilaaj ke mutalik apko mukamal jaankari time 42 detay hai? 43 44 Q72. Giving you the opportunity to make All of the Most of Some of A little None of 45 important decisions about your health care time the time the time of the the time 46 47 Kya sehat se mutalik tamam faislay apko karnay time 48 detay hai? 49 50 Q73. Giving you written, printed or digital All of the Most of Some of A little None of 51 information when you need it time the time the time of the the time 52 Malumaat likh kr dete hai? time 53 54 Q74. Spending enough time with you during All of the Most of Some of A little None of 55 your visits time the time the time of the the time 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 48 of 95
1 2 3 Apko tasali bakhsh wakt detay hai? time 4 5 Q75. Treating you like a partner in your health All of the Most of Some of A little None of 6 care time the time the time of the the time 7 8 Apka sathi bun kr apki sehat ka khayal rakhtay time 9 hai? 10 Q76. Which are the primary/ most important sources you depend on for making health decisions? (Tick relevant options) 11 12 Sehat se mutalik faislon ke liye ap kis se mashwara leti hai? 13 Husband 14 15 Mother in law 16 Other in-laws For peer review only 17 18 Blood family (parents, siblings, children…) 19 Newspapers / magazines 20 21 Heath newsletter 22 TV 23 24 Radio 25 Internet 26 27 Mobile services 28 Family/ friends 29 30 Community 31 Medical Practitioner 32 33 Local Healer 34 Local Imam/ religious leader 35 36 Other (Please list) 37 38 39 Current Health Risks 40 Q77. Do you currently smoke? 1.Yes 2.No 41 Kya app tambako noshi mein mulawis hain? 42 43 Q78. Does anyone else smoke in the house 1.Yes 2.No If yes, who is this: 44 when you/ children are in same room? 45 46 Kya koi aur tambako noshi mein mulawis hain 47 Q79. Do you feel anxious, stressed, depressed, 1.Yes 2.No Indicate which: 48 49 suicidal? 50 Kya app kabhi bechain hotay hain ya zehni 51 52 dabao ka shakar ya khud kushi ka khayal aya 53 hai? 54 Q80. Do you take any drugs (to relieve If yes, which ones: 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 49 of 95 BMJ Open
1 2 3 yourselves of stress or an ailment? 1.Yes 2.No 4 5 Kya app in ke liye koi dawa laitay hain? 6 Are you facing any disability which? 7 8 Kya aap kisi mazoori ka shikaar hain? 9 Q81. Does your disability keeps you from All of the Most of Some of A little None of 10 participating fully in your ability to take care of time the time the time of the the time 11 12 your family time 13 Jiski waja se ap apnay ghar walon ka khayal na 14 15 rakh sakain 16 Q82. Does your disability Forkeep you from peer All reviewof the Most of Someonly of A little None of 17 18 participating fully in your ability to continue time the time the time of the the time 19 with your life time 20 21 Apnay karobaar mai sahi se kaam na kr sakain 22 23 24 SECTION D: 25 BASELINE NUTRITION AND FOOD SECURITY SURVEY UNICEF 26
27 28 Q83. In the past 6 months did you find it too All of the Most of Some of A little None of 29 expensive to purchase the foods you needed to time the time the time of the the time 30 31 feed your family? time 32 Pichlay 6 maah mai kya apko khaandan ko 33 34 palnay ke liye khana lenay mai mushkilaat hoti 35 hai? 36 37 Q84.Did you find it too expensive to purchase All of the Most of Some of A little None of 38 fruit? time the time the time of the the time 39 Kya phal khareedna bohat mehnga hai? time 40 41 Q85.Did you find it too expensive to purchase All of the Most of Some of A little None of 42 vegetables? time the time the time of the the time 43 44 Kya sabzi khareedna bohat mehnga hai? time 45 Q86.Did you find it too expensive to purchase All of the Most of Some of A little None of 46 47 meat? time the time the time of the the time 48 Kya gosht khareedna bohat mehnga hai? time 49 50 Q87.Did you find it too expensive to purchase All of the Most of Some of A little None of 51 eggs? time the time the time of the the time 52 Kya anday khareedna bohat mehnga hai? time 53 54 Q88.Did you find it too expensive to purchase All of the Most of Some of A little None of 55 milk? time the time the time of the the time 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 50 of 95
1 2 3 Kya doodh khareedna bohat mehnga hai? time 4 5 Q89.Did you find it too expensive to purchase All of the Most of Some of A little None of 6 wheat, for roti? time the time the time of the the time 7 8 Kya roti khareedna bohat mehnga hai? time 9 Q90.In the last 3 months were you worried All of the Most of Some of A little None of 10 about running out of food because of high time the time the time of the the time 11 12 costs? time 13 Pichlay 3 maah mai mehngai ki waja se khana 14 15 na khareed panay ka dart ha? 16 Q91.In the last 3 months didFor you run outpeer of food All reviewof the Most of Someonly of A little None of 17 18 because of expense? time the time the time of the the time 19 Pichlay 3 maah mai kya mehngai ki waja se time 20 21 kabhi ghar mai khana khatam ho gaya ho? 22 Q92.In the last 3 months did you or any other All of the Most of Some of A little None of 23 24 adult in the house skip meals because there was time the time the time of the the time 25 not enough food? time 26 Pichlay 3 maah mai aap ya kisi or ghar walay se 27 28 khana kum honay ki waja se khana na khaya 29 ho? 30 31 Q93.In the last 3 months did you ever think All of the Most of Some of A little None of 32 your children are still hungry because of not time the time the time of the the time 33 34 being fed enough food? time 35 Pichlay 3 maah mai apko kabhi laga ke apkay 36 bachay bhookay hai kyunkay khana pura nai 37 38 tha? 39 Q94. In the last 3 months did any of your All of the Most of Some of A little None of 40 41 children go to bed hungry? time the time the time of the the time 42 Pichlay 3 maah mai kya apkay bachay kabhi time 43 44 bhookay soe houn? 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 51 of 95 BMJ Open
1 2 3 ڈﯾﺟﯾﮢل ﺳﺎﺋن ﯾﺎ ﺑﮢن / ﮢﯾب ﻗﺑوﻟﯾت ﮐﮯ 4 ﻟﺋﮯ 5 ﺗﺤﻘﯿﻖ ﮐﮯ ﺣﺼہ ﻟﯿﻨﮯ واﻟﮯ ﮐﮯ ﻟﺌﮯ رﺿﺎﻣﻨﺪی ﮐﺎ ﺧﻂ 6 7
8 ﮔﮉی ﺑﺎﺟﯿﻮں ﮐﮯ ذرﯾﻌہ ﺻﻮﺑﺎﺋﯽ زﺑﺎن ﻣﯿﮟ ﻓﻮن ﭘﺮ ﺗﺮﺟﻤہ ﭘﮍھﻨﺎ / رﯾﮑﺎرڈ ﮐﺮﻧﺎ 9 10 11 آپ ﮐﮯ ﻗﯿﻤﺘﯽ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ۔ 12 13
14 ﮨﻢ آپ ﺳﮯ درﺧﻮاﺳﺖ ﮐﺮﺗﮯ ﮨﯿﮟ ﮐہ اس ﺗﺤﻘﯿﻘﯽ ﻣﻨﺼﻮﺑﮯ ﻣﯿﮟ ﺣﺼہ ﻟﯿﮟ اس ﺳﮯ آپ اور آپ ﮐﮯ اﮨﻞ ﺧﺎﻧہ ﮐﻮ ﺻﺤﺖ اور ﺗﻨﺪرﺳﺘﯽ ﮐﮯ ﺣﻮاﻟﮯ 15 16 ﺳﮯ ﻓﺎﺋﺪه ﮨﻮ۔ ﺟﯿﺴﺎ ﮐہ آپ ﺟﺎﻧﺘﮯ ﮨﯿﮟ ﮐہ ﮐﻮروﻧﺎ onlyواﺋﺮس آپ ﮐﻮ اﭘﻨﮯ اﯾﻞ اﯾﭻ ڈﺑﻠﯿﻮreview ﺳﮯ ﻣﻠﻨﮯ ﺳﮯ peerروک رﮨﺎ ﮨﮯ اس Forﻟﺌﮯ ﮨﻢ ﮔﮉی ﺑﺎﺟﯿﻮں ﮐﻮ ﻣﻮﺑﺎﺋﻞ 17 ڈﯾﻮاﺋﺲ ﮐﮯ ذرﯾﻌہ آپ ﮐﮯ ﭘﺎس ﻻ رﮨﮯ ﮨﯿﮟ ﺻﺤﺖ ﮐﯽ ﺧﺪﻣﺎت ﮐﮯ ﺳﺎﺗﮭ. اﮔﺮ آپ اس ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺣﺼہ ﻟﯿﻨﮯ ﭘﺮ راﺿﯽ ﮨﯿﮟ ﺗﻮ ، آپ ﮐﻮ اﯾﮏ 18 اﺳﻤﺎرٹ ﻓﻮن اور اﻧﮣﺮﻧﯿﭧ ﻓﺮاﮨﻢ ﮐﯿﺎ ﺟﺎﺋﮯ ﮔﺎآپ ﮐﯽ دﮨﻠﯿﺰ ﭘﺮ۔ 19 20 ﺗﺤﻘﯿﻖ ﻣﯿﮟ اﯾﮏ ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﺑﮭﯽ ﺷﺎﻣﻞ ﮨﮯ ، ﺟﻮ آپ ﮐﯽ ﺻﺤﺖ ﮐﮯ ﻟﺌﮯ ﮐﻠﯿﺪی ﺷﻌﺒﻮں ﻣﯿﮟ آپ ﮐﯽ ﻣﺪد ﮐﮯ ﻟﺌﮯ ﺗﯿﺎر ﮐﯿﺎ ﮔﯿﺎ ﮨﮯ۔ ﻣﺜﺎل ﮐﮯ 21 طﻮر ﭘﺮ ، آپ ﮐﯽ ﺻﺤﺖ ﮐﯽ ﻣﻮﺟﻮده ﻣﺸﮑﻼت ﮐﻮ ﺳﻤﺠﮭﻨﺎ۔ﺣﻔﻈﺎن ﺻﺤﺖ ، اﻧﻔﯿﮑﺸﻦ ﺳﮯ ﻣﺘﻌﻠﻖ ﺗﺤﻔﻆ ﮐﮯ ﺳﻠﺴﻠﮯ ﻣﯿﮟ آپ ﮐﻮ ﺻﺤﺖ ﺧﻮاﻧﺪﮔﯽ اور 22 23 آﮔﺎﮨﯽ ﻓﺮاﮨﻢ ﮐﺮﻧﺎ، اور ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﮐﻮﺋﯽ اور ﻣﺪد آپ ﮐﯽ ﺿﺮورت ﮨﻮﺳﮑﺘﯽ ﮨﮯ ، اور آپ ﮐﻮ اور آپ ﮐﮯ اﮨﻞ ﺧﺎﻧہ ﮐﯽ ﻏﺬاﺋﯽ ﺿﺮورﯾﺎت ﮐﻮ 24 ﭘﮩﭽﺎﻧﻨﮯ اور ﮐﮭﺎﻧﮯ ﮐﯽ ﺣﻔﺎظﺖ ﻣﯿﮟ ﺑﮩﺘﺮی ﻻﻧﮯ ﻣﯿﮟ آپ ﮐﯽ ﻣﺪد ﮐﺮﯾﮟ۔ 25 26 اس ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﻣﯿﮟ اﯾﮏ ﻓﻮن ﮐﮯ ذرﯾﻌہ آپ ﮐﯽ ﮔﮉی ﺑﺎﺟﯿﻮں ﮐﮯ ﺳﺎﺗﮭ ﺗﯿﻦ ﻣﺎه ﮐﯽ روزاﻧہ ﮐﯽ ﻣﻮاﺻﻼت اور ﻣﺸﻐﻮﻟﯿﺖ ﺷﺎﻣﻞ ﮨﻮﮔﯽ۔. اس 27 ﻣﺼﺮوﻓﯿﺖ ﮐﮯ دوران ، آپ ﺳﮯ ﺳﻮاﻻت ﭘﻮﭼﮭﮯ ﺟﺎ ﺳﮑﺘﮯ ﮨﯿﮟ اور آپ ﮐﮯ ﺟﻮاﺑﺎت رﯾﮑﺎرڈ ﮐﯿﮯ ﺟﺎﺋﯿﮟ ﮔﮯ ، ﻟﯿﮑﻦ وه ﻣﮑﻤﻞ طﻮر ﭘﺮ ﺧﻔﯿہ ﮨﻮں 28 ﮔﮯ۔ آپ ﮐﮯ ﻧﺎم ﮐﯽ ﺿﺮورت ﻧﮩﯿﮟ ﮨﮯ اور ﺗﻤﺎم ﺗﺤﻘﯿﻘﯽ ﺗﺠﺰﯾﮯ ﻣﮑﻤﻞ ﮔﻤﻨﺎﻣﯽ ﮐﮯ ﺳﺎﺗﮭ ﮐﯿﮯ ﺟﺎﺋﯿﮟ ﮔﮯ۔ آپ ﮐﮯ ﻧﺎم ﮐﯽ ﺿﺮورت ﻧﮩﯿﮟ ﮨﮯ اور 29 30 ﺗﻤﺎم ﺗﺤﻘﯿﻘﯽ ﺗﺠﺰﯾﮯ ﻣﮑﻤﻞ ﮔﻤﻨﺎﻣﯽ ﮐﮯ ﺳﺎﺗﮭ ﮐﯿﮯ ﺟﺎﺋﯿﮟ ﮔﮯ۔ 31 آپ اس ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﮐﮯ دوران ﮐﺴﯽ ﺑﮭﯽ ﻣﻮﻗﻊ ﭘﺮ دﺳﺘﺒﺮداری ﮐﺎ اﻧﺘﺨﺎب ﮐﺮﺳﮑﺘﮯ ﮨﯿﮟ۔ اﮔﺮ آپ ﮐﻮ ﮐﺴﯽ ﺑﮭﯽ وﻗﺖ ﻣﺰﯾﺪ ﺳﻮاﻻت اور وﺿﺎﺣﺖ 32 33 ﮐﯽ ﺿﺮورت ﮨﻮ ﺗﻮ ، ﮐﺴﯽ ﺑﮭﯽ وﻗﺖ ﮨﻢ ﺳﮯ راﺑﻄہ ﮐﺮﯾﮟ۔ 34 آپ ﮐﮯ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ اور ﮨﻢ اس ﻣﻨﺼﻮﺑﮯ ﭘﺮ ﻣﻞ ﮐﺮ ﮐﺎم ﮐﺮﻧﮯ ﮐﮯ ﻣﻨﺘﻈﺮ ﮨﯿﮟ آپ ﮐﯽ ﺻﺤﺖ اور ﺗﻨﺪرﺳﺘﯽ ﮐﻮ ﺑﮩﺘﺮ ﺑﻨﺎﻧﮯ ﮐﮯ ﻟﺌﮯ۔ 35 36 ڈاﮐﮣﺮ ﺳﺎره رﺿﻮی ﺟﻌﻔﺮی ، 37 ﺗﺤﻘﯿﻘﺎﺗﯽ ﺗﻔﺘﯿﺶ ﮐﺎر 38 39 اﺳﺴﮣﻨﭧ ﭘﺮوﻓﯿﺴﺮ ، ﻓﻮرﻣﺎن ﮐﺮﺳﭽﻦ ﮐﺎﻟﺞ \ ﯾﻮﻧﯿﻮرﺳﮣﯽ 40 41 [email protected] 42 0300 400 5740 43 44 45 46 47 48 49
50 51 52 53 54 55 56 57 58 59
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1 2 3 Survey for Health Status of Women in the Age of Corona-Translation 4 5 ﺷﺮﮐﺎء ﮐﯽ ﺟﺎﻧﺐ ﺳﮯ ﺳﻮاﻟﻨﺎﻣہ ﻓﻮن ﭘﺮ ﭘﮍھ ﮐﺮ ﮔﺎڈی ﺑﺠﯿﺰ ﮐﮯ ذرﯾﻌہ ﻣﮑﻤﻞ ﮐﯿﺎ ﺟﺎﺋﮯ ﮔﺎ 6 7 ______:ﺻﻮﺑہ / ﺷﮩﺮ 8 ______:ﺿﻠﻊ 9 10 ______: یﮔﮉ ﺰﯿﺑﺠ ﮐﻮڈ 11 ______:ﺷﺮﮐﺎء ﮐﺎ ﮐﻮڈ 12 : ﯿﺳ ﮑﺸﻦ اے 13 14 ﻣﻌﺎﺷرﺗﯽ و آﺑﺎدﯾﺎﺗﯽ ﺧﺎل:ﺳﯾﮑﺷن اے 15 16 For peer review only Coding 17 ﻋﻤﺮ 18 19 Q1 20 دﯾﮕر .4 ﮨﻧدو.3 ﻣﺴﯿﺤﯽ2 ﻣﺳﻠﻣﺎن.1 ﻣﺬﮨﺐ 21 22 Q2 23 24 ﺑﯾوه.4 ﻋﻠﺣﯾﯾد ﮔﯽ/طﻼق ﺷده.3 ازدواﺟﯽ ﺣﯿﺜﯿﺖ ﺷﺎدی .2 ﻏﯾر ﺷﺎدی .1 25 ﺷده ﺷده Q3 26 27 28 رﮨﺎﺋﺶ ﮐﺎ ﻣﻮﺟﻮده ﻣﻘﺎم دﯾﮩﺎﺗﯽ.3 ﻧﯾم .2 ﺷﮩری.1 29 ﺷﮩری Q4 30 31 32 33 ﺳﯿﮑﻨﮉری 4. ﮔﺮﯾﺠﻮﯾﺸﻦ ﮨﺎﺋﯽ اﺳﮑﻮل ﯾﺎ .3 ﭘﺮاﺋﻤﺮی.2 ﻧﺎ ﺧﻮاﻧﺪﮔﯽ.1 ﺗﻌﻠﯿﻢ 34 35 ﺎﯾ اس ﺳﮯ اوﭘﺮ Q5 ﺳﯿﮑﻨﮉری 36
37 دﯾﮕﺮ ﻧﯾم ﭘﮑﺎ.3 ﭘﮑﺎ.2 ﮐﭼﺎ.1 رﮨﺎﺋﺶ ﮐﯽ ﻗﺴﻢ 38 39 (وﺿﺎﺣﺖ) Q6 40
41 .4دﯾﮕﺮ .3ﮐﺴﯽ ﮐﮯ ﺳﺎﺗﮭ رﮨﻨﺎ .2ﮐﺮاﺋﮯ ﭘﺮ ﻟﯿﺎ ذاﺗﯽ طﻮر ﭘﺮ .1 ﻣﮑﺎن ﮐﯽ ﻣﻠﮑﯿﺖ 42 43 (وﺿﺎﺣﺖ) ﻣﻠﮑ ﺖﯿ Q7 44 3. ﻣﻼزﻣﺖ ﮐﯽ ﻗﺴﻢ 2. ﻣﻼزﻣﺖ 1. ﺑﮯ روزﮔﺎر ﭘﯿﺸہ 45 ﭘﯿﺸہ 46 47 Q8 48 49 50 51 آپ ﮐﯽ ﻣﺎﮨﺎﻧہ آﻣﺪﻧﯽ ﮐﺘﻨﯽ ﮨﮯ؟ 52 53 Q9 54 ﺳﯿﮑﻨﮉری 4. ﮔﺮﯾﺠﻮﯾﺸﻦ ﻧﺎ ﺧﻮاﻧﺪﮔﯽ.1 ﺷﺮﯾﮏ ﺣﯿﺎت ﮐﯽ ﺧﻮاﻧﺪﮔﯽ ﮨﺎﺋﯽ اﺳﮑﻮل ﯾﺎ .3 ﭘﺮاﺋﻤﺮی.2 55 56 57 58 59
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1 2 ﯾﺎ اس ﺳﮯ اوﭘﺮ ﺳﯿﮑﻨﮉری Q10 3 4 5 3. ﻣﻼزﻣﺖ ﮐﯽ ﻗﺴﻢ 2. ﻣﻼزﻣﺖ 1. ﺑﮯ روزﮔﺎر ﺷﺮﯾﮏ ﺣﯿﺎت ﮐﺎ ﭘﯿﺸہ 6 ﭘﯿﺸہ Q11 7 8 9 10 11 12 آپ ﮐﮯ ﮐﺘﻨﮯ ﺑﭽﮯ ﮨﯿﮟ؟ 13 14 Q12 15 آپ ﮐﮯ آﺧﺮی ﺑﭽﮯ ﮐﯽ ﻋﻤﺮ ﮐﺘﻨﯽ ﮨﮯ؟ 16 For peer review only 17 Q13 ﮔﮭﺮ ﻣﯿﮟ رﮨﻨﮯ واﻟﮯ اﻓﺮاد ﮐﯽ ﺗﻌﺪاد 18 19 20 Q14 21 22 ﮔﮭﺮ ﻣﯿﮟ ﮐﻤﺮوں ﮐﯽ ﺗﻌﺪاد 23 24 Q15 25 :اﮔﺮ ﮨﺎں ، ﺗﻮ ﮐﻮن ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﻓﯽ اﻟﺤﺎل ﮐﺴﯽ ﻣﻌﺬور / ﻣﻨﺤﺼﺮ 26 ﺧﺎﻧﺪاﻧﯽ ﻣﻤﺒﺮ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮ رﮨﮯ 27 28 ﮨﯿﮟ؟ 29 30 Q16 31
32 ﮐﯿﺎ آپ ﮐﮯ ﮔﮭﺮ ﻣﯿﮟ ﻣﻨﺪرﺟہ ذﯾﻞ ﭼﯿﺰﯾﮟ 33 ﮟﯿﮨ : (ﻻﮔﻮ ﺗﻤﺎم ﭼﯿﺰوں ﭘﺮ ﻧﺸﺎن ﻟﮕﺎﺋ ﮟﯿ ) 34 35 36 Q17 ﮢﯽ وی 37 38 رﯾڈﯾو 39 40 41 ﻟﯾﻧڈ ﻻﺋن 42 43
اﯾﮏ دن ﻣﯾں ﮐم از ﮐم 8 ﮔﮭﻧﮢﮯ ﺑﺟﻠﯽ 44 45 اﻧﮢرﻧﯾٹ ﮐﮯ ﺳﺎﺗﮭ ﻣوﺑﺎﺋل ﻓون 46 47 واﺷﻧﮓ ﻣﺷﯾن 48 49 اﮔﺮ ﻧﮩﯿﮟ ﺗﻮ ، آپ ﮐﯿﺎ اﺳﺘﻌﻤﺎل ﮐﺮﺗﮯ ﮨﯿﮟ؟ ﻓﻠش ﮐﮯ ﺳﺎﺗﮭ ﮔﮭر ﻣﯾں ﮢواﻟﯾٹ ﮐﯽ 50 ﺳﮩوﻟت 51 52 اﮔﺮ ﻧﮩﯿﮟ ﺗﻮ ، آپ ﮐﯿﺎ اﺳﺘﻌﻤﺎل ﮐﺮﺗﮯ ﮨﯿﮟ؟ ﻧل ﺳﮯ ﭘﺎﻧﯽ ﭘﯾﻧﺎ 53 54
55 56 57 58 59
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1 2 اﮔﺮ ﻧﮩﯿﮟ ﺗﻮ ، آپ ﮐﯿﺎ اﺳﺘﻌﻤﺎل ﮐﺮﺗﮯ ﮨﯿﮟ؟ ﮔﮢر ﻧﮑﺎﺳﯽ آب 3 4 5 اﮔﺮ ﻧﮩﯿﮟ ﺗﻮ ، آپ ﮐﯿﺎ اﺳﺘﻌﻤﺎل ﮐﺮﺗﮯ ﮨﯿﮟ؟ ﮔﯾس ﮐﻧﮑﺷن ﮐﮯ ﺳﺎﺗﮭ ﮐﮭﺎﻧﺎ ﭘﮑﺎﻧﮯ 6 7 ﮐﮯ ﻟﺋﮯ ﭼوﻟﮩﺎ 8 9 اﮔﺮ ﻧﮩﯿﮟ ﺗﻮ ، آپ ﮐﯿﺎ اﺳﺘﻌﻤﺎل ﮐﺮﺗﮯ ﮨﯿﮟ؟ ﮐﭼرا اﮢﮭﺎﻧﮯ واﻟﮯ ﮐوڑے ﮐو 10 ﮢﮭﮑﺎﻧﮯ ﻟﮕﺎﻧﮯ آﺗﮯ ﮨﯾں 11 12 ﮐﯿﺎ آپ ﮐﻮﺋﯽ ﺻﺤﺖ اﻧﺸﻮرﻧﺲ ﻟﮯ رﮨﮯ 13 ﮟﯿﮨ (ﺑﺮاه ﮐﺮم اﺳﮑ ﻢﯿ / ﻗﺴﻂ / ﮐﻮر ﺞﯾ ﯽﮐ 14 15 For peer review only وﺿﺎﺣﺖ ﮐﺮ ﮟﯾ )؟ 16 17 Q18 18 ﮐﯿﺎ آپ ﮐﯽ ﮐﻮﺋﯽ ﺑﭽﺖ ﮨﮯ؟ (ﺗﻘﺮﯾﺒﺎ ﮐﺘﻨﺎ؟) 19 20 Q19 21 ﮐﯿﺎ آپ ﻧﮯ ﻗﺮض ﻟﯿﺎ ﮨﮯ؟ (ﮐﮩﺎں ﺳﮯ ، 22 ﻣﺪت ﮐﺘﻨﯽ ﮨﮯ ، رﻗﻢ ﮐﺘﻨﯽ ﮨﮯ ، ﮐﺘﻨﯽ 23 24 ﻗﺴﻂ ادا ﮐﺮ رﮨﮯ ﮨﻮ؟) 25 26 Q20 27 28 Coding اﮔﺮ ﮨﺎں ، ﺗﻮ ﮐﯿﺎ آپ ﺻﺤﺖ ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﮐﮯ دوران آپ ﮐﻮ ﮐﺴﯽ ﺑﯿﻤﺎری ﯾﺎ ﺻﺤﺖ ﮐﯽ ﭘﺮﯾﺸﺎﻧﯽ 29 ﮐﮯ ﻣﺴﺌﻠﮯ ﮐﯽ وﺿﺎﺣﺖ ﮐﮯ ﺳﺒﺐ اﺳﭙﺘﺎل ﻣﯿﮟ داﺧﻞ ﮐﯿﺎ ﮔﯿﺎ ﮨﮯ؟ 30 31 ﮐﺮﺳﮑﺘﮯ ﮨﯿﮟ؟ Q21 32 ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﻣﯿﮟ اﺳﭙﺘﺎل ﻣﯿﮟ داﺧﻞ ﮨﻮﻧﮯ ﮐﮯ ﻋﻼوه ، ﻣﺸﻮرے ﮐﮯ 33 34 ﻟﺌﮯ آپ ﻧﮯ ﮐﺘﻨﯽ ﺑﺎر ﺳﺮﮐﺎری اﺳﭙﺘﺎل ﮐﺎ دوره ﮐﯿﺎ؟ 35 36 Q22 37 آپ اﭘﻨﮯ ﻣﻌﺎﺷﺮﺗﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﻓﺮاﮨﻢ ﮐﺮﻧﮯ واﻟﮯ ﮐﮯ ذرﯾﻌہ اﯾﮏ 38 ﻣﮩﯿﻨﮯ ﮟﯿﻣ ﮐﺘﻨﯽ ﺑﺎر ﺗﺸﺮ ﻒﯾ ﯿﻟ ﺘﮯ ﮟﯿﮨ ﺎﯾ ان ﮐﺎ دوره ﮐﺮﺗﮯ ﮨﯿﮟ؟ 39 40 Q23 41 آپ ﻓﯽ اﻟﺤﺎل ﮐﺘﻨﯽ ﻣﺨﺘﻠﻒ ﻗﺴﻢ ﮐﯽ دواﺋﯿﻮں / ادوﯾﺎت ﻟﮯ رﮨﮯ ﮨﯿﮟ؟ 42 43 Q24 44 45 46 47 48 49 50
51 : ﯿﺳ ﮑﺸﻦ ﯽﺑ 52 53 (MAQ-PC) اﺑﺘﺪاﺋﯽ ﻧﮕﮩﺪاﺷﺖ ﮐﮯ ﻟﺌﮯ ﻣﺘﻌﺪد اﺛﺎﺛﻮں ﺳﮯ ﻣﺘﻌﻠﻖ ﺳﻮال 54 55 56 57 58 59
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1 2 Codi ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﺮاﺋﮯ ﮐﺮم درج ذﯾﻞ داﺋﻤﯽ ﺑﯿﻤﺎرﯾﻮں ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﺮﯾﮟ 3 4 5 Q25 ng ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮔﮢﮭﯾﺎ 6 7 8 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ذﯾﺎﺑﯾطس 9 10 11 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮨﺎﺋﯽ ﺑﻠڈ ﭘرﯾﺷر 12 13 14 15 ﻧﮩﯿﮟ.2 ﮨﺎں.For peer review only 1 اﯾﺳڈ ﭘﯾﭘﮢﮏ اﻣراض 16 17 18 19 20 ﻧﮩﯿﮟ.2 ﮨﺎں.1 داﺋﻣﯽ ﮐﻣر ﻣﯾں درد 21 22 23 24 ﻧﮩﯿﮟ.2 ﮨﺎں.1 دل ﮐﯽ ﺑﯾﻣﺎری 25 26 27 28 ﻧﮩﯿﮟ.2 ﮨﺎں.1 اﺳﮢروک 29 30 31 32 ﻧﮩﯿﮟ.2 ﮨﺎں.1 اﻧدھﺎ ﭘن 33 34 35 36 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﮩرا ﭘن 37 38 39 40 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ڈﯾﻣﻧﺷﯾﺎ 41 42 43 44 ﻧﮩﯿﮟ.2 ﮨﺎں.1 اﻟﮑﺣل ﮐﯽ ﺧراﺑﯽ 45 46 47 48 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯾﻧﺳر 49 50 51
52 53 54 55 56 57 58 59
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1 2 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮔردے ﮐﯽ داﺋﻣﯽ ﺑﯾﻣﺎری 3 4 5 6 7 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣرﮔﯽ 8 9 10 11 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺗﺎﺋرواڈ ﮐﯽ ﺑﯾﻣﺎری 12 13 14 15 ﻧﮩﯿﮟ.2 ﮨﺎں.For peer review only 1 ﺗپ دق 16 17 18 19 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻓﯾﻼرﯾﺎﺳس 20 21 22 ﮐﻮروﻧﺎ واﺋﺮس ﺳﮯ ﻣﺘﻌﻠﻖ ﺳﻮاﻻت 23 24 25 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮروﻧﺎ واﺋﺮس ﮐﮯ 26 ﻋﻼﻣﺎت ﺳﮯ واﻗﻒ ﮨﯿﮟ؟ 27 28 29 Q26 اﯾﭻ اﯾﭻ ﻣﻤﺒﺮوں ﮐﯽ ﮐﯿﻮٹ رﯾﺴﭙﯿﺮﯾﮣﺮی ڈﺳﮣﺮﯾﺲ ﺳﻨﮉروم ____ ﮐﯿﺎ آپ ﻧﮯ ﯾﺎ آپ ﮐﮯ ﺧﺎﻧﺪان 30 31 ﺷﻨﺎﺧﺖ ﮐﺮ ﮟﯾ ﮐﮭﺎﻧﺴﯽ ____ ﮐﮯ ﮐﺴﯽ ﻓﺮد ﻧﮯ ﭘﭽﮭﻠﮯ 8 8 32 آﺷﻮب ﭼﺸﻢ ____ ﻣﮩﯿﻨﻮں ﻣﯿﮟ درج ذﯾﻞ ﻣﯿﮟ 33 اﺳﮩﺎل ____ ﺳﮯ ﮐﻮﺋﯽ ﺗﺠﺮﺑہ ﮐﯿﺎ ﮨﮯ؟ 34 35 ﺗﮭﮑﺎوٹ (ﺑﺮاه ﮐﺮم ﮨﺮ اﯾﮏ ﭘﺮ ﻧﺸﺎن 36 ﺑﺨﺎر ____ ﻟﮕﺎﺋﯿﮟ) 37 38 ﺳﺮدی ﻟﮓ رﮨﯽ ﮨﮯ ____ Q27 39 ﺳﺮ درد ____ 40 41 ﻣﺘﻠﯽ ____ 42 ﻧﻤﻮﻧﯿہ ____ 43 44 ﮔﻠﮯ ﮐﯽ ﺳﻮزش____ 45 اﻟﮣﯽ ____ 46 دﯾﮕﺮ ﻋﻼﻣﺎت… ﺑﺮاه ﮐﺮم ﺑﺘﺎﺋﯿﮟ؟ 47 48 49 ﮐﯿﺎ آپ ان ﻋﻼﻣﺖ ﮐﮯ ﺑﺎرے 50 51 ﮟﯿﻣ ﮐﭽﮭ اور ﺑﺘﺎﻧﺎ ﭘﺴﻨﺪ ﮐﺮ ﮟﯾ 52 ﮔﮯ؟ 53 54 Q28 55 56 57 58 59
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1 2 ﮐﯿﺎ آپ ﮐﻮ ﮐﻮروﻧﺎ واﺋﺮس 3 4 ﺳﮯ ﺑﭽﺎؤ ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ 5 ﯿﭘ ﻐﺎﻣﺎت ﻣﻮﺻﻮل ﮨﻮﺋﮯ ﮨﯿﮟ؟ 6 7 8 Q29 ﮢﯽ وی ____ آپ ﮐﻮ ﯾہ ﭘﯿﻐﺎﻣﺎت ﮐﮩﺎں ﺳﮯ 9 10 رﯾﮉﯾﻮ ____ ﻣﻠﮯ ﮨﯿﮟ؟ (ﺑﺮاه ﮐﺮم ﮨﺮ ا ﮏﯾ 11 ﻓﻮن ﭘﯿﻐﺎﻣﺎت ____ ﭘﺮ ﻧﺸﺎن ﻟﮕﺎﺋ ﮟﯿ ) 12 13 ﻓﻮن ﮐﺎﻟﺰ ____ Q30 14 ﭘﮍوس ____ 15 peer review only دوﺳﺖ For____ 16 17 ﮐﻨﺒہ ____ 18 دﯾﮕﺮ (وﺿﺎﺣﺖ ﺑﺮاه ﻣﮩﺮﺑﺎﻧﯽ) 19 20 21 Coding اﻓﺴﺮدﮔﯽ ﺳﮯ ﻣﺘﻌﻠﻖ ﺳﻮاﻻت 22 23 ﭘﭽﮭﻠﮯ 2 ﮨﻔﺘﻮں ﮐﮯ دوران ، آپ درج ذ ﻞﯾ ﮐﺴﯽ ﺑﮭﯽ ﭘﺮﯾﺸﺎﻧﯽ ﺳﮯ ﮐﺘﻨﯽ ﺑﺎر ﭘﺮﯾﺸﺎن ﮨﻮ ﭼﮑﮯ ﮨﯿﮟ؟ 24 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﺗﮭﮑﺎوٹ ﯾﺎ ﺗواﻧﺎﺋﯽ ﻣﯾں 25 26 ﮐﻣﯽ ﻣﺣﺳوس رﮐ ﻧﺎ 27 28 Q31 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ اﻓﺳرده ﯾﺎ ﻣﺎﯾوس ﻣﺣﺳوس 29 30 رﮐ ﻧﺎ 31 32 Q32 33 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﺳوﺗﮯ رﮨﻧﮯ ﻣﯾں ﭘرﯾﺷﺎﻧﯽ ، ﺑﮩت زﯾﺎده ﺳو ﺟﺎﻧﺎ 34 35 Q33 36 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﺗﮭﮑﺎوٹ ﯾﺎ ﺗواﻧﺎﺋﯽ ﻣﯾں 37 ﮐﻣﯽ ﻣﺣﺳوس رﮐ ﻧﺎ 38 39 Q34 40 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ اﭘﻧﮯ ﯾﺎ اﭘﻧﮯ ﮔﮭر واﻟوں 41 42 ﮐﮯ ﺑﺎرے ﻣﯾں ﻧﺎﮐﺎﻣﯽ ﯾﺎ 43 ﻣﺎﯾوﺳﯽ وﮐ ﻣﺣﺳوس رﮐ ﻧﺎ 44 45 Q35 46 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ اﺧﺑﺎر ﭘڑھﻧﮯ ﯾﺎ ﮢﯾﻠﯽ وﯾژن 47 دﯾﮑﮭﻧﺎ ﺟﯾﺳﮯ ﭼﯾزوں رﭘ هﺟوﺗ 48 49 دﯾﻧﮯ ﻣﯾں ﺷد واری 50 51 Q36 52 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ اﺗﻧﺎ آﮨﺳﺗه ﭼﻠﻧﺎ ﯾﺎ ﺑوﻟﻧﺎ ﮐه 53 دوﺳرے ﻟوگ ﻣﺗ هﺟو ﮨوں اس 54 55 ﮐﮯ رﺑ ﻋﮑس اﺗﻧﺎ ﮔﺑﮭراﻧﺎ ﯾﺎ ﺑﮯ 56 57 58 59
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1 2 آرام ﮨوﻧﺎ ﮐه آپ ﻣﻌﻣول ﺳﮯ 3 4 زﯾﺎده تﮐرﺣ رﮐ ﻧﮯ ﻟﮕﯾں 5 6 Q37 7 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﯾه ﺧﯾﺎﻻت ﮐه آپ ﻣرﺟﺎﺋﯾں 8 وﺗ ﺑﮩﺗر ﮨﮯ ﯾﺎ ﮐﺳﯽ طﺮح ودﺧ 9 10 وﮐ ﺗﮑﻠﯾف ﭘﮩﻧﭼﺎﺋﯾں 11 12 Q38 13 ﮐﯾﺎ آﭘﻧﮯ ﮐﺑﮭﯽ اﻓﺳرده ﯾﺎ 14 اداس وﮨ ﻧﮯ رﭘ ﮐﺳﯽ ﻣﻌﺎﻟﺞ ﺳﮯ 15 16 For peer review only ﺟر وع ﮐﯾﺎ ﮨﮯ؟ 17 18 Q39 19
20 Coding ﻣﻮﺑﻠﮣﯽ ﺳﮯ ﻣﺘﻌﻠﻖ ﺳﻮاﻻت 21 22 اس ﻣﻌﻠﻮﻣﺎت ﺳﮯ آپ ﮐﻮ ﯾہ ﻣﻌﻠﻮم رﮐﮭﻨﮯ ﻣﯿﮟ ﻣﺪد ﻣﻠﮯ ﮔﯽ ﮐہ آپ ﮐﻮ ﮐﺘﻨﺎ اﭼﮭﺎ ﻟﮕﺘﺎ ﮨﮯ اور آپ اﭘﻨﯽ ﻣﻌﻤﻮل ﮐﯽ ﺳﺮﮔﺮﻣﯿﺎں ﮐﺲ ﺣﺪ ﺗﮏ ﺑﮩﺘﺮ 23 طﺮﯾﻘﮯ ﺳﮯ اﻧﺠﺎم دے ﺳﮑﺘﮯ ﮨﯿﮟ؟ 24 ﻧﺎﻗص ﺑﮩﺗر اﭼﮭﯽ ﺑﮩت اﭼﮭﯽ ﻋﻤﺪه :ﻋﺎم طﻮر ﭘﺮ ، ﮐﯿﺎ آپ ﮐﮩﯿﮟ ﮔﮯ ﮐہ آپ ﮐﯽ ﺻﺤﺖ ﯾہ ﮨﮯ 25 26 27 Q40 درج ذﯾﻞ ﺳﻮاﻻت ان ﺳﺮﮔﺮﻣﯿﻮں ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﮨﯿﮟ ﺟﻮ آپ اﯾﮏ ﻋﺎم دن ﮐﮯ دوران ﮐﺮﺳﮑﺘﮯ ﮨﯿﮟ۔ ﮐﯿﺎ اب آپ ﮐﯽ ﺻﺤﺖ آپ ﮐﻮ ان ﺳﺮﮔﺮﻣﯿﻮں 28 29 ﮟﯿﻣ ﯽﻣﺤﺪود ﮐﺮﺗ ﮨﮯ؟ اﮔﺮ ﮨﮯ ﺗﻮ ، ﮐﺘﻨﺎ؟ 30 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ اﻋﺘﺪال ﭘﺴﻨﺪ ﺳﺮﮔﺮﻣﯿﺎں ، ﺟﯿﺴﮯ ﮢﯿﺒﻞ ﮐﻮ ﺣﺮﮐﺖ دﯾﻨﺎ ، وﯾﮑﯿﻮم ﮐﻠﯿﻨﺮ ﮐﻮ 31 32 تﻗو ﻧﮩﯿﮟ وﻗﺖ آﮔﮯ ﺑﮍھﺎﻧﺎ ، ﮔﮭﺮ ﮐﯽ ﺻﻔﺎﺋﯽ ﮐﺮﻧﺎ 33 34 Q41 35 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﺳﯿﮍھﯿﻮں ﮐﯽ ﮐﺌﯽ ﭘﺮوازﯾﮟ ﭼﮍھﻨﺎ 36 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q42 37 38
39 ﭘﭽﮭﻠﮯ 4 ﮨﻔﺘﻮں ﮐﮯ دوران ، آپ ﮐﯽ ﺟﺴﻤﺎﻧﯽ ﺻﺤﺖ ﮐﮯ ﻧﺘﯿﺠﮯ ﻣﯿﮟ آپ ﮐﻮ اﭘﻨﮯ ﮐﺎم ﯾﺎ دﯾﮕﺮ ﻣﻌﻤﻮل ﮐﯽ روزاﻧہ ﮐﯽ ﺳﺮﮔﺮﻣﯿﻮں ﻣﯿﮟ ﮐﺘﻨﺎ وﻗﺖ 40 درﭘ ﺶﯿ ﮨﮯ؟ 41 42 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ اﭘﻨﯽ ﭘﺴﻨﺪ ﺳﮯ ﮐﻢ ﮐﺎم ﮐﯿﺎ 43 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q43 44 45 46 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﺴﯽ ﻗﺴﻢ ﮐﮯ ﮐﺎم ﯾﺎ دﯾﮕﺮ ﺳﺮﮔﺮﻣﯿﻮں ﻣﯿﮟ ﻣﺤﺪود ﺗﮭﮯ 47 48 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q44 49 50 51 ﺳﯿﮑﺸﻦ ﺳﯽ 52 ﺧﻮاﺗ ﻦﯿ ﯽﮐ ﺻﺤﺖ ﮐﯽ ﯾد ﮑﮭ ﺑﮭﺎل ﮐﮯ ﺳﺮوے 53 54 ﻧﺎﻗص ﺑﮩﺗر اﭼﮭﯽ ﺑﮩت اﭼﮭﯽ ﻋﻤﺪه اﭘﻨﯽ ﻋﻤﺮ ﮐﯽ دوﺳﺮی ﺧﻮاﺗﯿﻦ ﮐﮯ ﻟﺌﮯ ﺗﯿﺎر ﮐﺮده ، آپ 55 56 57 58 59
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1 2 اﭘﻨﯽ ﺻﺤﺖ ﮐﯽ درﺟہ ﺑﻨﺪی ﮐﯿﺴﮯ ﮐﺮﯾﮟ ﮔﮯ 3 4 5 Q45 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﮐﯿﺎ آپ ﮐﻮ ﻟﮕﺘﺎ ﮨﮯ ﮐہ آپ ﮐﯽ ﺻﺤﺖ اس وﻗﺖ ﮐﯽ ﻧﺴﺒﺖ ﺑﮩﺘﺮ 6 7 ﮨﻮ ﺳﮑﺘﯽ ﮨﮯ؟ 8 9 Q46 10 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﯽ اﮐﺜﺮ ﮨﻤﯿﺸہ ﮐﯿﺎ آپ ﮐﮯ ﺷﻮﮨﺮ / ﻣﺮد رﺷﺘﮯ دار / ﺳﺴﺮال واﻟﮯ ﺟﺐ آپ ﯾﺎ 11 آپ ﮐﮯ ﺑﭽﻮں ﮐﻮ ﮐﺴﯽ طﺒﯽ ﯿﭘ ﺸہ ور ﺳﮯ ﻣﺸﻮرے ﮐﯽ 12 13 ﺿﺮورت ﮐﺮﺗﮯ ﮨ ﮟﯿ ﺗﻮ وه ﻣﻨﻈﻮری ﯾد ﺘﮯ ﮟﯿﮨ ﯾ/ د ﺘﮯ ﮟﯿﮨ 14 15 Q47 16 ﺑﺮاه ﮐﺮم اس ﺑﺎت ﮐﯽ ﻧﺸﺎﻧﺪﮨﯽ ﮐﺮﯾﮟ ﮐہ ﮐﯿﺎ آپ onlyﻧﮯ ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﻣﯿﮟ review ﻣﻨﺪرﺟہ ذﯾﻞ ﻣﯿﮟ ﺳﮯpeer ﮐﺴﯽ ﺻﺤﺖ Forﺳﮯ ﻣﺘﻌﻠﻖ ﻣﺴﺌﻠہ ﮐﺎ ﺗﺠﺮﺑہ ﮐﯿﺎ ﮨﮯ؟ 17 18 19 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﻌﻤﻮﻟﯽ ﺑﯿﻤﺎری ﺟﯿﺴﮯ ﻓﻠﻮ ﯾﺎ اﻧﻔﯿﮑﺸﻦ 20 21 Q48 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﭼﯿﮏ اپ ﯾﺎ ﻣﻌﻤﻮل ﮐﮯ ﺟﺴﻤﺎﻧﯽ اﻣﺘﺤﺎن ﮐﮯ ﻟﺌﮯ ﺟﺎﻧﺎ ﭘﮍا؟ 22 23 24 Q49 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﺣﺎﻣﻠہ ﺗﮭﯿﮟ؟ 25 26 27 Q50 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮ ﺧﺎﻧﺪاﻧﯽ ﻣﻨﺼﻮﺑہ ﺑﻨﺪی ﮐﯽ ﺧﺪﻣﺎت ﮐﯽ ﺿﺮورت 28 29 ﮨﮯ؟ 30 31 Q51 32 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮ ﮐﻮﺋﯽ ﭼﻮٹ ﮨﮯ ﺟﺲ ﮐﺎ آپ ﻧﮯ ﭘﮩﻠﮯ ﮨﯽ ذﮐﺮ ﻧﮩﯿﮟ 33 ﺎﯿﮐ ﮨﮯ؟ 34 35 Q52 36 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮ ﺻﺤﺖ ﮐﯽ داﺋﻤﯽ ﭘﺮﯾﺸﺎﻧﯽ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﯽ 37 ﺿﺮورت ﮨﮯ ، ( ہﯾ وه ﮨﮯ ﺟﻮ طﻮ ﻞﯾ ﻋﺮﺻﮯ ﺗﮏ ﭼﻠﺘﺎ رﮨﺘﺎ 38 39 ﮨﮯ)؟ 40 41 Q53 42 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮ ﮐﺴﯽ اﯾﺴﯽ ﺣﺎﻟﺖ ﮐﮯ ﻟﺌﮯ ﺳﺮﺟﺮی ﮐﯽ ﺿﺮورت 43 ﮨﮯ ﺟﺲ ﮐﺎ ﭘﮩﻠﮯ ﮨﯽ ذﮐﺮ ﻧﮩﯿﮟ ﮐﯿﺎ ﮔﯿﺎ ﮨﮯ؟ 44 45 Q54 46 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ اﻓﺴﺮده ، ﭘﺮﯾﺸﺎن ، ﯾﺎ اﻧﺘﮩﺎﺋﯽ ﺗﻨﺎؤ ﮐﺎ ﺷﮑﺎر ﮨﯿﮟ؟ 47 48 Q55 49 ﮐﯿﺎ آپ ﻧﮯ ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ﻣﻨﺪرﺟہ ذﯾﻞ ﻣﯿﮟ ﺳﮯ اﯾﮏ طﺒﯽ ﻣﻌﺎﺋﻨہ ﮐﯿﺎ ﮨﮯ؟ 50 51 Q56 52 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯾﻧﺳر ﮐﯽ اﺳﮑرﯾﻧﻧﮓ ، (ﯾﺎ اﭘﻧﮯ ﭘﺎﺧﺎﻧہ ، 53 54 ﺳﮕﻣﺎﺋﯾڈوﺳﮑوﭘﯽ ، ﯾﺎ ﮐﺎﻟوﻧوﺳﮑوﭘﯽ ﻣﯾں ﺧون ﮐﯽ ﺟﺎﻧﭻ 55 56 57 58 59
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1 2 ﮐرﯾں) 3 4 ﻧﮩﯿﮟ.2 ﮨﺎں.1 آﻧﮑﮭ ﻣﯾں ﮔﻠوﮐوﻣﺎ ﯾﺎ دﺑﺎؤ ﮐﮯ ﻟﺋﮯ ﮢﯾﺳٹ 5 6 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﻠڈ ﮐوﻟﯾﺳﮢرول ﮢﯾﺳٹ 7 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮨﺎﺋﯽ ﺑﻠڈ ﭘرﯾﺷر ﮐﯽ ﺟﺎﻧﭻ ﮐرﯾں 8 9 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ذﯾﺎﺑﯾطس ﮐﺎ ﮢﯾﺳٹ 10 11 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﭼﮭﺎﺗﯽ ﯾﺎ ﭘﯾٹ ﮐﺎ اﻟﮢراﺳﺎؤﻧڈ 12 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﯾﻣوﮔرام 13 14 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﭘﯾپ ﮢﯾﺳٹ 15 only ﻧﮩﯿﮟ.review 2ﮨﺎں .peer1 ﮨڈی ﮐﺛﺎﻓت Forﮢﯾﺳٹ (آﺳﮢﯾوﭘوروﺳس ﮐﮯ ﻟﺋﮯ) 16 17 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺟﯾﻧﯾﺎﺗﯽ اﺳﮑرﯾﻧﻧﮓ ﮢﯾﺳٹ 18 19 ﻧﮩﯿﮟ.2 ﮨﺎں.1 اﯾﭻ آﺋﯽ وی / اﯾڈز ﮐﯽ اﺳﮑرﯾﻧﻧﮓ 20 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺟﻧﺳﯽ ﺑﯾﻣﺎرﯾوں ﮐﯽ اﺳﮑرﯾﻧﻧﮓ 21 22 ﻧﮩﯿﮟ.2 ﮨﺎں.1 داﻧﺗوں ﮐﺎ اﻣﺗﺣﺎن 23 24 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻓﻠو ﯾﺎ ﻧﻣوﻧﯾﺎ ﮐﮯ ﻟﺋﮯ ﮔوﻟﯽ ﻣﺎر دی ﮔﺋﯽ 25 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺣﻣل ﮐﺎ ﮢﯾﺳٹ 26 27 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐوروﻧﺎ 28 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﺎﻧﺟﮭ ﭘن ﮐﮯ ﮢﯾﺳٹ 29 30 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﻠﯾرﯾﺎ 31 32 ﮐﻮﺋﯽ اور ﻣﯿﮉﯾﮑﻞ ﮢﯿﺴﭧ (ﺑﺮاه ﮐﺮم ﺑﺘﺎﺋﯿﮟ)؟ 33 34 35 ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ، ﮐﯿﺎ آپ ﮐﮯ ﮐﺴﯽ ﺑﮭﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﮯ ﻧﮯ آپ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﯿﮟ؟ 36 37 Q57 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺳﮕﺮﯾﭧ ﻧﻮﺷﯽ ، دوﺳﺮے ﮨﺎﺗﮭ ﮐﺎ دھﻮاں ، ﯾﺎ ﺗﻤﺒﺎﮐﻮ ﻧﻮﺷﯽ 38 39 ﭼﮭﻮڑﻧﺎ 40 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺧﻮراک 41 42 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺷﺮاب ﯾﺎ ﻣﻨﺸﯿﺎت ﮐﺎ اﺳﺘﻌﻤﺎل 43 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺟﺴﻤﺎﻧﯽ ﺗﻨﺪرﺳﺘﯽ ﯾﺎ ورزش 44 45 46 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺳﺎن - ﯾﺲ 47 48 ﯾﺎ ﮨﺎرﻣﻮن ﮐﯽ ﺗﺒﺪﯾﻠﯽ ﮐﯽ ﺗﮭﺮاﭘﯽ 49 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺣﻔﻈﺎن ﺻﺤﺖ 50 51 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺻﻔﺎﺋﯽ 52 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﺘﻌﺪی ﺑﯿﻤﺎرﯾﻮں ﺳﮯ ﮐﯿﺴﮯ ﺑﭽﺎﯾﺎ ﺟﺎﺋﮯ 53 54 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﺎم ﯾﺎ ﻣﺎﻟﯽ ﭘﺮﯾﺸﺎﻧﯽ 55 56 57 58 59
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1 2 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺧﺎﻧﺪاﻧﯽ ﯾﺎ رﺷﺘﮯ ﮐﮯ ﻣﺴﺎﺋﻞ 3 4 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﭽﻮں ﮐﯽ ﺻﺤﺖ اور ﺗﻐﺬﯾہ ﮐﯽ اﮨﻤﯿﺖ 5 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺗﻨﺎؤ ﮐﺎ اﻧﺘﻈﺎم 6 7 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻏﯿﺮﺟﺎﻧﺒﺪار ﺣﻤﻞ اور ﭘﯿﺪاﺋﺶ ﮐﮯ ﻓﺎﺻﻠﻮں ﮐﻮ روﮐﻨﺎ 8 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﺘﺒﺎدل ﻋﻼج ﺟﯿﺴﮯ ﺟﮍی ﺑﻮﮢﯿﺎں ﯾﺎ اﯾﮑﯿﻮﭘﻨﮑﭽﺮ اﺳﺘﻌﻤﺎل ﮐﺮﻧﺎ 9 10 ﻧﮩﯿﮟ.2 ﮨﺎں.1 آﺳﮣﯿﻮﭘﻮروﺳﺲ ﮐﯽ روک ﺗﮭﺎم 11 ﻧﮩﯿﮟ.2 ﮨﺎں.1 آپ اور ﮐﻨﺒﮯ ﮐﮯ ﻟﺌﮯ ﻏﺬاﺋﯽ ﺿﺮورﯾﺎت 12 13 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺧﻮراک ﮐﯽ ﮐﻤﯽ ﺳﮯ ﺑﭽﻨﮯ ﮐﮯ طﺮﯾﻘﮯ 14 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻏذاﺋﯽ ﺗﺣﻔظ ﮐﮯ ﻟﯾﮯﺧود ﮐﻔﯾل 15 16 For peer review only وﮨ ﻧﮯ وﮐ ﺑﮩﺗر رﮐ ﻧﺎ 17 ﮐﯿﺎ آپ ﮐﮯ ﭘﺎس ﻏﺬاﺋﯽ اﺟﺰاء ﮨﯿﮟ ﺟﻮ آپ ﻧﮯ ﭘﭽﮭﻠﮯ 12 ﻣﮩﯿﻨﻮں ﻣﯿﮟ اﺳﺘﻌﻤﺎل ﮐﯿﮯ ﮨﯿﮟ؟ 18 19 Q58 20 ﻧﮩﯿﮟ.2 ﮨﺎں.1 وﮢﺎﻣن ﺳﯽ 21 22 ﻧﮩﯿﮟ.2 ﮨﺎں.1 وﮢﺎﻣن ڈی 23 ﻧﮩﯿﮟ.2 ﮨﺎں.1 وﮢﺎﻣن ای 24 25 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺑﯽ ﮐﻣﭘﻠﯾﮑس 26 27 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯾﻠﺷﯾم 28 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺣﻣل واﻟﯽ وﮢﺎﻣن 29 30 ﻧﮩﯿﮟ.2 ﮨﺎں.1 دودھ ﭘﻼﻧﮯ واﻟﯽ وﮢﺎﻣن 31 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺟﻧرل ﻣﻠﮢﯽ وﮢﺎﻣن 32 33 ﺻﺣت ﮐﯽ ﺧدﻣﺎت ﮐﮯ ﻟﯾﮯ ان ﻣﯾں ﺳﮯ آﭘﮑﯽ ﺗرﺟﯾﺢ ﮐون ﮨﯾں؟ 34 35 36 Q59 اﮔﺮ ﮨﺎں ، ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﻨﺒہ (ﺟﯿﺴﮯ ﻣﺎں / ﺳﺎس / ﺧﺎﻟہ) 37 38 ﺗﻮ ﺑﯿﺎن 39 ﮐﺮ ﮟﯾ ﮐہ 40 41 :ﮐﻮن 42 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺧﻮاﺗﯿﻦ ﮐﺎ ﺻﺤﺖ ﻣﺮﮐﺰ ﺟﮩﺎں آپ اﭘﻨﯽ ﺑﻨﯿﺎدی ﺻﺤﺖ ﮐﯽ 43 44 دﯾﮑﮭ ﺑﮭﺎل ﺣﺎﺻﻞ ﮐﺮﺳﮑﺘﮯ ﮨﯿﮟ ، ﺑﺸﻤﻮل اﻣﺮاض ﺻﺤﺖ ﮐﯽ 45 دﯾﮑﮭ ﺑﮭﺎل ، اﯾﮏ ﺟﮕہ ﭘﺮ 46 47 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻗﺎﺑﻞ اﻋﺘﻤﺎد ﺑﺮادری ﮐﺎ ﻣﻤﺒﺮ 48 49 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻧﺮس ﯾﺎ ﻣﻌﺎﺷﺮﺗﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﯽ 50 51 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻧﺮس ﯾﺎ ﻣﻌﺎﺷﺮﺗﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﯽ 52 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻣﻘﺎﻣﯽ ﺧﻮاﺗﯿﻦ 53 54 ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﻧﺠﯽ ﮐﻠﯿﻨﮏ 55 56 57 58 59
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1 2 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﻋﺎم طﻮر ﭘﺮ ، آپ ﮐﻮ ﻣﻌﺎﺷﺮﺗﯽ ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ اﭘﻨﯽ 3 4 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﭘﺮﯾﺸﺎﻧﯿﻮں ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﻣﻌﺎﺷﺮﺗﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل 5 ﮐﺮﻧﮯ واﻟﮯ ﺳﮯ ﺑﺎت ﮐﺮﻧﺎ ﮐﺘﻨﺎ ﻣﺸﮑﻞ ﮨﮯ؟ 6 7 8 Q60 ﺑﺮاه ﮐﺮم ﮐﻤﯿﻮﻧﮣﯽ ﮐﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﻓﺮاﮨﻢ ﮐﺮﻧﮯ واﻟﯽ ﺧﺪﻣﺎت ﮐﯽ درﺟہ ﺑﻨﺪی ﮐﺮﯾﮟ ﺟﯿﺴﺎ ﮐہ آپ ﻧﮯ ﻣﺎﺿﯽ ﻣﯿﮟ ﺗﺠﺮﺑہ ﮐﯿﺎ ﮨﮯ۔ 9 10 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯾﺎ آﭘﮑﯽ ﺑﺎت ﻏور ﺳﮯ 11 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﺳﻧﯽ ﺟﺎﺗﯽ ﮨﮯ؟ 12 13 Q61 14 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﺳﮯ اﺣﺘﺮام اور ﺧﯿﺎل رﮐﮭﻨﮯ واﻟﮯ اﻧﺪاز ﻣﯿﮟ ﮔﻔﺘﮕﻮ ﮐﺮﻧﺎ 15 تﻗو ﻧﮩﯿﮟ وﻗﺖQ62 For peer review only 16 17 18 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ اﯾﺳﯽ زﺑﺎن ﯾﺎ ﺑوﻟﯽ ﻣﯾں آپ ﺳﮯ ﺑﺎت ﮐرﻧﺎ ﺟو آﭘﮑو اﭼﮭﯽ 19 20 تﻗو ﻧﮩﯿﮟ وﻗﺖ طﺮح ﺳﻣﺟﮭ ﻣﯾں آﺗﯽ ﮨو 21 22 Q63 23 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﮯ ﺳﻮاﻟﻮں ﮐﺎ واﺿﺢ ﺟﻮاب دﯾﻨﺎ 24 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q64 25 26
27 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﻮ اﭘﻨﮯ ﺳﺐ ﺳﻮاﻻت ﭘﻮﭼﮭﻨﮯ ﮐﺎ ﻣﻮﻗﻊ ﻓﺮاﮨﻢ ﮐﺮﻧﺎ 28 29 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q65 30 31 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﻮ اﭘﻨﯽ ذاﺗﯽ ﯾﺎ ﺣﺴﺎس ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﭘﺮﯾﺸﺎﻧﯿﻮں ﮐﮯ 32 33 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﺑﺎرے ﻣﯿﮟ ﺑﺎت ﮐﺮﻧﮯ ﻣﯿﮟ آﺳﺎﻧﯽ ﻣﺤﺴﻮس ﮐﺮﻧﮯ ﻣﯿﮟ ﻣﺪد 34 دﯾﻨﺎ 35 36 37 Q66 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﻮ ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻣﮑﻤﻞ ﻣﻌﻠﻮﻣﺎت دﯾﻨﺎ 38 39 تﻗو ﻧﮩﯿﮟ وﻗﺖ 40 Q67 41 42 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﻣﺘﺒﺎدل ﻋﻼج ، ﻏﺬا اور طﺮز زﻧﺪﮔﯽ ﭘﺮ ﺗﺒﺎدﻟہ ﺧﯿﺎل ﮐﺮﻧﺎ 43 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q68 44 45 46 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﺴﯽ ﺑﮭﯽ ﮢﯿﺴﭧ ﯾﺎ ﺧﺪﻣﺎت ﮐﮯ ﺑﺎرے ﻣﯿﮟ آپ ﮐﻮ ﻣﮑﻤﻞ 47 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﻣﻌﻠﻮﻣﺎت دﯾﻨﺎ 48 49 50 Q69 51 52 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﻮ اﭘﻨﮯ ﮢﯿﺴﭧ ﮐﮯ ﻧﺘﺎﺋﺞ دﯾﻨﺎ 53 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q70 54 55
56 57 58 59
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1 2 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ ﻋﻼج ﮐﮯ اﻣﻮر آپ ﮐﻮ ﻣﮑﻤﻞ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﺮﺗﮯ ﮨﯿﮟ؟ 3 4 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q71 5 6 7 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ آپ ﮐﻮ اﭘﻨﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﮯ ﺑﺎرے ﻣﯿﮟ اﮨﻢ ﻓﯿﺼﻠﮯ 8 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮐﺮﻧﮯ ﮐﺎ ﻣﻮﻗﻊ ﻓﺮاﮨﻢ ﮐﺮﻧﺎ 9 10 Q72 11 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﺟﺐ آپ ﮐﻮ ﺿﺮورت ﮨﻮ ﺗﻮ آپ ﮐﻮ ﺗﺤﺮﯾﺮی ، طﺒﺎﻋﺖ ﯾﺎ 12 13 تﻗو ﻧﮩﯿﮟ وﻗﺖ ڈﯾﺠﯿﮣﻞ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﺮﻧﺎ۔ 14 15 Q73 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ onlyوﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ review وﻗﺖ ﭘﻨﮯ peer دوروں ﮐﮯ Forدوران آپ ﮐﮯ ﺳﺎﺗﮭ ﮐﺎﻓﯽ وﻗﺖ ﮔﺰارﻧﺎ 16 17 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q74 18 19 20 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ اﭘﻨﯽ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﮯ ﺳﺎﺗﮭﯽ ﮐﯽ طﺮح ﺳﻠﻮک ﮐﺮﻧﺎ 21 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q75 22 23 24 ﺻﺤﺖ ﮐﮯ ﻓﯿﺼﻠﮯ ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ آپ ﮐﺲ ﭘﺮ اﻧﺤﺼﺎر ﮐﺮﺗﮯ ﮨﯿﮟ وه ﺑﻨﯿﺎدی / اﮨﻢ وﺳﺎﺋﻞ ﮐﻮن ﺳﮯ ﮨﯿﮟ؟ (ﻣﺘﻌﻠﻘہ اﺧﺘﯿﺎرات ﭘﺮ ﻧﺸﺎن ﻟﮕﺎﺋﯿﮟ) 25 26 Q76 27 ﺷﻮﮨﺮ 28 29 ﺳﺎس 30 دوﺳﺮے ﺳﺴﺮال واﻟﮯ 31 32 ﮐﻨﺒہ (واﻟﺪﯾﻦ ، ﺑﮩﻦ ﺑﮭﺎﺋﯽ ، ﺑﭽﮯ…) 33 اﺧﺒﺎرات / رﺳﺎﻟﮯ 34 ﺻﺤﺖ ﻧﯿﻮز ﻟﯿﮣﺮ 35 36 ﮢﯽ وی 37 رﯾﮉﯾﻮ 38 39 اﻧﮣﺮﻧﯿﭧ 40 ﻣﻮﺑﺎﺋﻞ ﺧﺪﻣﺎت 41 42 ﺧﺎﻧﺪاﻧﯽ دوﺳﺖ 43 ﺑﺮادری 44 45 ﻣﯿﮉﯾﮑﻞ ﭘﺮﯾﮑﮣﯿﺸﻨﺮ 46 ﻣﻘﺎﻣﯽ ﻋﻼج 47 48 ﻣﻘﺎﻣﯽ اﻣﺎم / ﻣﺬﮨﺒﯽ رﮨﻨﻤﺎ 49 دﯾﮕﺮ (ﺑﺮاﺋﮯ ﻣﮩﺮﺑﺎﻧﯽ ﻓﮩﺮﺳﺖ دﯾﮟ) 50 51 52 ﺻﺤﺖ ﮐﮯ ﻣﻮﺟﻮده ﺧﻄﺮات 53 54 ﻧﮩﯿﮟ ﮨﺎں ﺗﻢ ﻓﯽ اﻟﺤﺎل ﺗﻤﺒﺎﮐﻮ ﻧﻮﺷﯽ ﮐﺮﺗﮯ ﮨﮯ؟ 55 1. 2. 56 57 58 59
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1 2 3 Q77 4 اﮔﺮ ﮨﺎں ، ﺗﻮ ﯾہ ﮐﻮن ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﺟﺐ آپ / ﺑﭽﮯ اﯾﮏ ﮨﯽ ﮐﻤﺮے ﻣﯿﮟ ﮨﻮﺗﮯ ﮨﯿﮟ ﺗﻮ ﮐﯿﺎ ﮐﻮﺋﯽ 5 :ﮨﮯ اور ﮔﮭﺮ ﻣﯿﮟ ﺗﻤﺒﺎﮐﻮ ﻧﻮﺷﯽ ﮐﺮﺗﺎ ﮨﮯ؟ 6 7 8 Q78 اﮔﺮ ﮨﺎں ، ﺗﻮ ﮐﻮن ﺳﯽ: ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﭘﺮﯾﺸﺎن ، دﺑﺎؤ ، اﻓﺴﺮده ، ﺧﻮدﮐﺸﯽ ﻣﺤﺴﻮس ﮐﺮﺗﮯ 9 10 ﮨﯿﮟ؟ 11 12 Q79 13 اﮔﺮ ﮨﺎں ، ﺗﻮ ﮐﻮن ﺳﯽ: ﻧﮩﯿﮟ.2 ﮨﺎں.1 ﮐﯿﺎ آپ ﮐﻮﺋﯽ ﺑﮭﯽ دواﺋﯽ ﻟﯿﺘﮯ ﮨﯿﮟ (اﭘﻨﮯ آپ ﮐﻮ ﺗﻨﺎؤ ﯾﺎ 14 ﺑﯿﻤﺎری ﺳﮯ ﻧﺠﺎت ﮐﮯ ﻟﺌﮯ؟ 15 16 Q80 For peer review only 17 18 ﮐﯿﺎ آپ ﮐﻮ ﮐﺴﯽ ﺑﮭﯽ ﻣﻌﺬوری ﮐﺎ ﺳﺎﻣﻨﺎ ﮨﮯ؟ 19 20 21 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯾﺎ آﭘﮑﯽ ﻣﻌذوری آﭘﮑو 22 23 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮐﻧﺑﮯ ﮐﯽ ﻣﮑﻣل د ﯾﮑﮭ ﺑﮭﺎل ﺳﮯ 24 روﮐﺗﯽ ﮨﮯ؟ 25 26 Q81 27 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯾﺎ آﭘﮑﯽ ﻣﻌذوری آﭘﮑو ذﻧدﮔﯽ ﻣﮑﻣل طﻮر ﭘر ﺟﺎری 28 29 تﻗو ﻧﮩﯿﮟ وﻗﺖ رﮐﮭﻧﮯ ﺳﮯ روﮐﺗﯽ ﮨﮯ؟ 30 31 Q82 32 33 ﺳﯿﮑﺸﻦ ڈی: 34 ﺑﯿﺲ ﻻﺋﻦ-ﻏﺬاﺋﯿﺖ اور ﺧﻮراک ﮐﯽ ﺣﻔﺎظﺖ ﮐﺎ ﺳﺮوﯾﺲ ﯾﻮﻧﯿﺴﻒ 35 36 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﭘﭽﮭﻠﮯ 6 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ، آپ ﮐﻮ اﭘﻨﮯ ﮐﻨﺒﮯ ﮐﻮ ﮐﮭﺎﻧﺎ ﮐﮭﻼﻧﺎ 37 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ درﮐﺎر ﮐﮭﺎﻧﮯ ﮐﯽ ﺧﺮﯾﺪاری ﮐﺮﻧﺎ اﺗﻨﺎ ﻣﮩﻨﮕﺎ 38 39 ﻟﮕﺎ؟ 40 41 Q83 42 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ ﭘﮭﻞ ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 43 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q84 44 45 46 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ ﺳﺒﺰی ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 47 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q85 48 49 50 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ ﮔﻮﺷﺖ ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 51 52 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q86 53 54 55 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ اﻧﮉے ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 56 57 58 59
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1 2 وﻗت ﻧﮩﯿﮟ وﻗﺖ Q87 3 4 5 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ دودھ ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 6 7 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q88 8 9 10 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﻮ روﮢﯽ ﺧﺮﯾﺪﻧﺎ ﺑﮩﺖ ﻣﮩﻨﮕﺎ ﻟﮕﺎ؟ 11 تﻗو ﻧﮩﯿﮟ وﻗﺖ Q89 12 13
14 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ ﭘﭽﮭﻠﮯ 3 ﻣﮩﯿﻨﮯ ﻣﮩﻨﮕﺎﺋﯽ ﮐﯽ وﺟہ ﺳﮯ ﮐﮭﺎﻧﺎ ﻧہ ﺧﺮﯾﺪﻧﮯ 15 تﻗو ﻧﮩﯿﮟ وﻗﺖFor peer review only ﮐﺎ ﺧﺪﺷہ ﭘﯿﺪا ﮨﻮا ؟ 16 17 18 Q90 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﭼﮭﻠﮯ 3 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ، ﻣﮩﻨﮕﺎﺋﯽ ﮐﯽ وﺟہ ﺳﮯ ﮐﺒﮭﯽ ﮔﮭﺮ ﭘﺮ 19 20 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮐﮭﺎﻧﺎ ﺧﺘﻢ ﮨﻮا؟ 21 22 Q91 23 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﭘﭽﮭﻠﮯ 3 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ، ﮐﯿﺎ آپ ﯾﺎ ﮐﺴﯽ اور ﻧﮯ ﺧﻮراک ﮐﯽ 24 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮐﻤﯽ ﮐﯽ وﺟہ ﺳﮯ ﻧﮩﯿﮟ ﮐﮭﺎﯾﺎ؟ 25 26 Q92 27 28 29 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﭘﭽﮭﻠﮯ 3 ﻣﮩﯿﻨﻮں ﻣﯿﮟ ، ﮐﯿﺎ آپ ﻧﮯ ﮐﺒﮭﯽ اﯾﺴﺎ ﻣﺤﺴﻮس ﮐﯿﺎ 30 تﻗو ﻧﮩﯿﮟ وﻗﺖ ﮨﮯ ﮐہ آپ ﮐﮯ ﺑﭽﮯ ﺑﮭﻮﮐﮯ ﮨﯿﮟ ﮐﯿﻮﻧﮑہ ﮐﮭﺎﻧﺎ ﮐﺎﻓﯽ ﻧﮩﯿﮟ ﺗﮭﺎ؟ 31 32 Q93 33 ﮐﺳﯽ ﺑﮭﯽ ﺗﮭﻮڑا ﮐﭽﮭ وﻗﺖ ﺑﯿﺸﺘﺮ وﻗﺖ ﮨﺮ وﻗﺖ ﮐﯿﺎ آپ ﮐﮯ ﺑﭽﮯ 3 ﻣﺎه ﺑﮭﻮﮐﮯ ﺳﻮﺋﮯ 34 تﻗو ﻧﮩﯿﮟ وﻗﺖ ؟ 35 36 37 Q94 38 39
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
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1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 5 Appendix B 6 7 8 Pre- and Post-test Survey 9 10 11 12 Province/City: ______13 14 District: ______15 Guddi Baji Code: ______16 For peer review only 17 Participant Code: ______18 (Note: The socio-demographic data has to be linked from the participant code from base-line survey) 19 20 Section A: 21 22 The Health Education Impact Questionnaire (heiQ) 23 24 Strongly Agree Neutral Disagree Strongly Coding Agree Disagree 25 Please answer with respect to your health quality of life overall 26 27 Q1. I have positive and active engagement in 28 life 29 Q2. I am doing some of the things I really 30 enjoy 31 Q3. I try to make the most of my life 32 Q4. I have plans to do enjoyable things for 33 myself 34 Q5. I feel like I am actively involved in life 35 Please answer with respect to your health directed behavior 36 Q6.I walk for exercise for at least 15 minutes 37 per day, most days 38 Q7.I do at least one type of physical activity 39 every day 40 Q8.Most of the week I do at least one activity 41 Q9.Most of the week I set aside the time for 42 healthy activities 43 Skill and technique acquisition 44 Please answer with respect to your confidence in having skills for? 45 Q10. Managing symptoms of illness 46 Q11.Handling the medication and nutrients I 47 need 48 Q12.Managing my health problems 49 Q13.Protecting myself and my family from 50 Coronavirus 51 Q14. Preventing symptoms of infection or 52 other disease 53 Self-monitoring and insight 54 55 Q15.As well as seeing my healthcare provider, I do regularly monitor my changes 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 67 of 95 BMJ Open
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Q16.I know what things can trigger my health 5 problems 6 Q17.When I have health problems, I have clear 7 understanding 8 Q18.I have a very good understanding of when 9 I need to visit the doctor 10 Q19.I carefully watch my health and do what is necessary to keep 11 Q20.I know when my lifestyle is creating 12 health problems for me 13 Health services navigation 14 15 Q21.I communicate very confidently with 16 healthcare providers For peer review only 17 Q22.I have very positive relationships with my 18 healthcare providers 19 Q23.I confidently give healthcare professionals 20 the information they need 21 Q24.I get my needs met from available 22 healthcare resources 23 Q25.I work like a team with my healthcare 24 providers 25 Social integration and support 26 Q26.I have enough people who help me cope 27 with my health 28 Q27.I get enough chances to talk about my 29 health 30 Q28.If I need help, I have plenty of people I 31 can rely on 32 Q29.Overall I feel well looked after by my 33 friends and family 34 Q30.When I feel ill, my family and careproviders really help me 35 Emotional well being 36 37 Q31.If I think about my health/ infection risk/ 38 nutrition, I get depressed 39 Q32.I often feel angry when I think about my 40 health/ infection risk/ nutrition 41 Q33.My health/ infection risk/ nutrition problems make me very dissatisfied with life 42 Q34.I often worry about my health/ infection 43 risk/ nutrition 44 Q35.I feel hopeless because of my health/ 45 infection risk/ nutrition problems 46
47 48 Section B: 49 50 National Sanitation and Hygiene Knowledge, Attitudes, and Practices (KAP) Survey & 51 52 Survey on Hygiene Knowledge, Attitude and Practice 53 Please answer with relation to your confidence levels for knowledge regarding: 54 Strongly Agree Neutral Disagree Strongly Coding 55 Agree Disagree 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 68 of 95
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Q36. Sanitation & hygiene 5 Q37. Hand hygiene and cleanliness 6 Q38. Clean and safe water given to my 7 family 8 Q39.Clean and hygienic food given to my 9 family 10 Q40. Personal hygiene 11 Q41. General hygiene 12 Q42.Safe disposal of faeces 13 Q43.Cleaning the house, kitchen and latrine 14 Q44.Safe disposal of solid and liquid waste 15 In what kind of situations do you consider washing hands necessary? 16 For peerAlways review Very Sometimes only Rarely Never 17 Often 18 Q45.Before meals or preparing a meal 19 Q46.After using a toilet 20 21 Q47.After contact with a sick person 22 Q48.After contact with any person, even 23 family member 24 Q49.After coming back home 25 Q50.After visiting public places 26 Q51.After contact with a pet/ animal 27 Q52.After waking up 28 Q53.After visiting public places (e.g. public 29 transport, supermarkets, restaurants…) 30 Q54.Do you always use soap to wash hands 31 Q55.How long do you wash your hands for? 32 33 34 35 SECTION C: 36 37 HOMECARE OF COVID SURVEY 38 In the past few weeks are you taking the following precautions 39 Strongly Agree Neutral Disagree Strongly Coding 40 Agree Disagree 41 Q56.Avoiding physical contact (e.g. hugs, 42 hands shaking, etc.) with people 43 Q57.Wearing a face mask that covers the nose 44 and mouth as much as possible, especially 45 when in shared areas 46 Q58.Changing the face mask frequently; 47 especially when it becomes soiled or wet 48 Q59.Taking the mask off by touching only the 49 elastic bands or strings (not touching the front 50 and inside parts) 51 Q60.Sanitizing house with disinfectant (e.g. 52 Dettol, or other cleaner) 53 Q61.Washing hands immediately (and 54 thoroughly) after removing the face mask 55 Q62.Washing and changing towels regularly 56 Q63.Using dedicated eating utensils, cutlery, 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 69 of 95 BMJ Open
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 and drinking glass/ mug 5 Q64.Cleaning eating, drinking and cooking 6 utensil with dish detergent after every use 7 8 9 10 11 12 ﺳﺮورق اور رﺿﺎﻣﻨﺪی 13 14 15 Digital Sign or Button/Tab for For peer review only acceptance ﮐﻨﮣﺮول ﮔﺮوپ 16 17 18 19 آپ ﮐﮯ ﻗﯿﻤﺘﯽ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ۔ 20 21
22 ﮨﻢ آپ ﺳﮯ درﺧﻮاﺳﺖ ﮐﺮﺗﮯ ﮨﯿﮟ ﮐہ اس ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺣﺼہ ﻟﯿﮟ اس ﺳﮯ آپ اور آپ ﮐﮯ اﮨﻞ ﺧﺎﻧہ ﮐﯽ ﺻﺤﺖ ﮐﻮ ﻓﺎﺋﺪه ﮨﻮﮔﺎ 23 ۔ ﮨﻢ آپ ﮐﻮ ﺻﺤﺖ ﮐﯽ ﺧﻮاﻧﺪﮔﯽ ﮐﺎ اﯾﮏ ﮐﺘﺎﺑﭽہ ﻓﺮاﮨﻢ ﮐﺮﯾﮟ ﮔﮯ اور ﮐﺘﺎﺑﭽﮯ ﮐﯽ ﺗﻘﺴﯿﻢ ﺳﮯ ﭘﮩﻠﮯ اور ﺗﯿﻦ ﻣﺎه ﺑﻌﺪ ﺳﺮوے ﻣﮑﻤﻞ ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ 24 ﺳﻮاﻻت ﭘﻮﭼﮭﯿﮟ ﮔﮯ۔ 25 26
27 Digital Sign or Button/Tab for
28 acceptance ﺳﺮورق اور رﺿﺎﻣﻨﺪی 29 30 ﺗﺠﺮﺑﺎﺗﯽ ﮔﺮوپ 31 32 33 آپ ﮐﮯ ﻗﯿﻤﺘﯽ وﻗﺖ ﮐﺎ ﺷﮑﺮﯾہ۔ 34 35
36 ﮨﻢ آپ ﺳﮯ درﺧﻮاﺳﺖ ﮐﺮﺗﮯ ﮨﯿﮟ ﮐہ اس ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺣﺼہ ﻟﯿﮟ اس ﺳﮯ آپ اور آپ ﮐﮯ اﮨﻞ ﺧﺎﻧہ ﮐﯽ ﺻﺤﺖ ﮐﻮ ﻓﺎﺋﺪه ﮨﻮﮔﺎ 37 38 ۔ ﮨﻢ آپ ﮐﻮ ﺻﺤﺖ ﮐﯽ ﺧﻮاﻧﺪﮔﯽ ﮐﺎ اﯾﮏ ﮐﺘﺎﺑﭽہ ﻓﺮاﮨﻢ ﮐﺮﯾﮟ ﮔﮯ اور ﮐﺘﺎﺑﭽﮯ ﮐﯽ ﺗﻘﺴﯿﻢ ﺳﮯ ﭘﮩﻠﮯ اور ﺗﯿﻦ ﻣﺎه ﺑﻌﺪ ﺳﺮوے ﻣﮑﻤﻞ ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ 39 ﺳﻮاﻻت ﭘﻮﭼﮭﯿﮟ ﮔﮯ۔ 40 41 42 43 44 45 46 47 48
49 50 51
52 53 54 55 56 57 58 4 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 70 of 95
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 5 6 7 8 9 10 11 Pre and Post-Test Health Literacy Questionnaire to Measure Intervention Impact-Translation 12
13 ﺻﻮﺑہ / ﺷﮩﺮ: ______14 ﺿﻠﻊ: ______15 16 For peer review only ﮔﮉی ﺑﺎﺟﯽ ﮐﻮڈ: ______17 ﺷﺮﮐﺎء ﮐﺎ ﮐﻮڈ: ______18 19 20 (Note: The socio-demographic data has to be linked from the participant code from base-line survey) 21 22 Section A: 23 24 The Health Education Impact Questionnaire (heiQ) ﺑﺮاه ﮐﺮم ﻣﺠﻤﻮﻋﯽ طﻮر ﭘﺮ اﭘﻨﯽ ﺻﺤﺖ ﮐﮯ ﻣﻌﯿﺎر زﻧﺪﮔﯽ ﮐﮯ ﺣﻮاﻟﮯ ﺳﮯ ﺟﻮاب دﯾﮟ 25 26 Coding ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q1 27 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ زﻧﺪﮔﯽ ﻣﯿﮟ ﻣﺜﺒﺖ اور ﻓﻌﺎل ﻣﺼﺮوﻓﯿﺖ رﮐﮭﺘﯽ 28 ﮨﻮں 29 30 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q2 31 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﮐﭽﮭ ﭼﯿﺰﯾﮟ ﮐﺮ رﮨﯽ ﮨﻮں ﺟﺲ ﺳﮯ ﻣﺠﮭﮯ واﻗﻌﯽ ﻟﻄﻒ 32 آﺗﺎ ﮨﮯ 33 34 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q3 35 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﭘﻨﯽ زﻧﺪﮔﯽ ﮐﺎ زﯾﺎده ﺳﮯ زﯾﺎده ﻓﺎﺋﺪه اﮢﮭﺎﻧﮯ ﮐﯽ 36 ﮐﻮﺷﺶ ﮐﺮﺗﯽ ﮨﻮں 37 38 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q4 39 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮے ﭘﺎس اﭘﻨﮯ ﻟﺌﮯ ﺧﻮﺷﮕﻮار ﭼﯿﺰﯾﮟ ﮐﺮﻧﮯ ﮐﺎ اراده ﮨﮯ 40 41 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q5 42 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﺠﮭﮯ اﯾﺴﺎ ﻟﮕﺘﺎ ﮨﮯ ﺟﯿﺴﮯ ﻣﯿﮟ زﻧﺪﮔﯽ ﻣﯿﮟ ﺳﺮﮔﺮم ﻋﻤﻞ 43 ﮨﻮں 44
45 ﺑﺮاه ﮐﺮم اﭘﻨﮯ ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ طﺮز ﻋﻤﻞ ﮐﮯ ﺣﻮاﻟﮯ ﺳﮯ ﺟﻮاب دﯾﮟ 46
47 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q6 48 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ زﯾﺎده ﺗﺮ دن ﻣﯿﮟ ﮐﻢ ﺳﮯ ﮐﻢ 15 ﻣﻨﭧ ورزش ﮐﮯ ﻟﺌﮯ 49 ﭼﻠﺘﯽ ﮨﻮں 50 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q7 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﮨﺮ روز ﮐﻢ ﺳﮯ ﮐﻢ اﯾﮏ ﻗﺴﻢ ﮐﯽ ﺟﺴﻤﺎﻧﯽ ﺳﺮﮔﺮﻣﯽ 51 ﮐﺮﺗﯽ ﮨﻮں 52 53 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q8 54 ﻧﮩﯿﮟ ﻣﺘﻔﻖ زﯾﺎده ﺗﺮ ﮨﻔﺘﮯ ﻣﯿﮟ اﯾﮏ ﺳﺮﮔﺮﻣﯽ ﮐﺮﺗﯽ ﮨﻮں 55 56 57 58 5 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 71 of 95 BMJ Open
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q9 4 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ زﯾﺎده ﺗﺮ ﮨﻔﺘﮯ ﺻﺤﺘﻤﻨﺪ ﺳﺮﮔﺮﻣﯿﻮں ﮐﮯ ﻟﺌﮯ وﻗﺖ 5 ﻣﺨﺘﺺ ﮐﺮﺗﯽ ﮨﻮں 6 7 ﻣﮩﺎرت اور ﺗﮑﻨﯿﮏ ﮐﮯ ﺣﺼﻮل 8 ﺑﺮاه ﮐﺮم درج ذﯾﻞ ﺻﻼﺣﯿﺘﻮں ﭘﺮ اﭘﻨﮯ اﻋﺘﻤﺎد ﮐﮯ ﺣﻮاﻟﮯ ﺳﮯ ﺟﻮاب دﯾﮟ 9 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q10 10 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺑﯿﻤﺎری ﮐﯽ ﻋﻼﻣﺎت ﮐﺎ اﻧﺘﻈﺎم ﮐﺮﻧﺎ 11 12 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q11 13 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮی ﺿﺮورت دواؤں اور ﻏﺬاﺋﯽ اﺟﺰا ﺳﮯ ﻧﻤﮣﻨﺎ 14 15 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ onlyﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ reviewزﯾﺎده .For peerQ12 16 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮی ﺻﺤﺖ ﮐﯽ ﭘﺮﯾﺸﺎﻧﯿﻮں ﮐﺎ اﻧﺘﻈﺎم ﮐﺮﻧﺎ 17 18 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q13 19 ﻧﮩﯿﮟ ﻣﺘﻔﻖ اﭘﻨﯽ اور اﭘﻨﮯ ﮐﻨﺒﮯ ﮐﻮ ﮐﻮروﻧﺎ واﺋﺮس ﺳﮯ ﺑﭽﺎﻧﺎ 20
21 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q14 22 ﻧﮩﯿﮟ ﻣﺘﻔﻖ اﻧﻔﯿﮑﺸﻦ ﯾﺎ دﯾﮕﺮ ﺑﯿﻤﺎری ﮐﯽ ﻋﻼﻣﺎت ﮐﯽ روک ﺗﮭﺎم 23
ﺧﻮد ﻧﮕﺮاﻧﯽ اور ﺑﺼﯿﺮت 24 25 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q15 26 ﻧﮩﯿﮟ ﻣﺘﻔﻖ اﭘﻨﯿﺼﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻓﺮاﮨﻢ ﮐﻨﻨﺪه ﮐﻮ دﯾﮑﮭﻨﮯ ﮐﮯ ﺳﺎﺗﮭ ، 27 ﻣﯿﮟ ﺑﺎﻗﺎﻋﺪﮔﯽ ﺳﮯ اﭘﻨﯽ ﺗﺒﺪﯾﻠﯿﻮں ﮐﯽ ﻧﮕﺮاﻧﯽ ﮐﺮﺗﯽ ﮨﻮں 28 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q16 29 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﺟﺎﻧﺘﯽ ﮨﻮں ﮐہ ﮐﻮن ﺳﯽ ﭼﯿﺰﯾﮟ ﻣﯿﺮی ﺻﺤﺖ ﮐﯽ 30 ﭘﺮﯾﺸﺎﻧﯽ ﮐﻮ ﺟﻨﻢ دے ﺳﮑﺘﯽ ﮨﯿﮟ 31 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q17 32 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺟﺐ ﻣﺠﮭﮯ ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﭘﺮﯾﺸﺎﻧﯽ ﮨﻮﺗﯽ ﮨﮯ ﺗﻮ ، 33 ﻣﺠﮭﮯ اﯾﮏ واﺿﺢ ﺗﻔﮩﯿﻢ ﮨﻮﺗﯽ ﮨﮯ 34 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q18 35 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﯾہ اﭼﮭﯽ طﺮح ﺟﺎﻧﺘﯽ ﮨﻮں ﮐہ ﻣﺠﮭﮯ ﮐﺐ ڈاﮐﮣﺮ ﺳﮯ 36 ﻣﻠﻨﺎ ﭼﺎﮨﺌﮯ 37 38 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q19 39 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﭘﻨﯽ ﺻﺤﺖ ﮐﺎ ﺧﯿﺎل رﮐﮭﺘﯽ ﮨﻮں اور وﮨﯽ ﮐﺮﺗﯽ 40 ﮨﻮں ﺟﻮ ﻣﯿﺮی ﺻﺤﺖ ﮐﮯ ﻟﺌﮯ ﺿﺮوری ﮨﮯ 41 42 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q20 43 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﺟﺎﻧﺘﯽ ﮨﻮں ﮐہ ﺟﺐ ﻣﯿﺮی طﺮز زﻧﺪﮔﯽ ﻣﯿﺮے ﻟﺌﮯ 44 ﺻﺤﺖ ﮐﮯ ﻣﺴﺎﺋﻞ ﭘﯿﺪا ﮐﺮرﮨﺎ ﮨﮯ 45 ﺻﺤﺖ ﮐﯽ ﺧﺪﻣﺎت ﮐﺎ ﻧﯿﻮﯾﮕﯿﺸﻦ 46 47 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q21 48 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﻮں ﮐﮯ ﺳﺎﺗﮭ ﺑﮩﺖ 49 اﻋﺘﻤﺎد ﮐﮯ ﺳﺎﺗﮭ ﺑﺎت ﭼﯿﺖ ﮐﺮﺗﯽ ﮨﻮں 50 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q22 51 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮی اﭘﻨﮯ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﻮں ﮐﮯ ﺳﺎﺗﮭ 52 ﺑﮩﺖ ﻣﺜﺒﺖ ﺗﻌﻠﻘﺎت ﮨﯿﮟ 53 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q23 54 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﻋﺘﻤﺎد ﮐﮯ ﺳﺎﺗﮭ ﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮﻧﮯ واﻟﮯ 55 ﭘﯿﺸہ ور اﻓﺮاد ﮐﻮ اﭘﻨﯽ ﺿﺮورت ﮐﯽ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﺮﺗﯽ 56 57 58 6 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 72 of 95
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 ﮨﻮں 4 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q24 5 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﭘﻨﯽ ﺿﺮورﯾﺎت ﮐﻮ ﺻﺤﺖ ﮐﮯ دﺳﺘﯿﺎب وﺳﺎﺋﻞ ﺳﮯ 6 ﭘﻮرا ﮐﺮﺗﯽ ﮨﻮں 7 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q25 8 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﭘﻨﮯ ﮨﯿﻠﺘﮭ ﮐﯿﺌﺮ ﻓﺮاﮨﻢ ﮐﺮﻧﮯ واﻟﻮں ﮐﮯ ﺳﺎﺗﮭ ﺑﻄﻮر 9 ﺳﺎﺗﮭﯽ ﮐﺎم ﮐﺮﺗﯽ ﮨﻮں 10 11 ﺳﻤﺎﺟﯽ اﺗﺤﺎد اور اﻋﺎﻧﺖ 12 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q26 13 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﯾﺮے ﭘﺎس ﮐﺎﻓﯽ ﻟﻮگ ﮨﯿﮟ ﺟﻮ ﻣﯿﺮی ﺻﺤﺖ ﺳﮯ ﻧﻤﮣﻨﮯ ﻣﯿﮟ 14 ﻣﯿﺮی ﻣﺪد ﮐﺮﺗﮯ ﮨﯿﮟ 15 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ onlyﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ reviewزﯾﺎده .For peerQ27 16 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﺠﮭﮯ اﭘﻨﯽ ﺻﺤﺖ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﺑﺎت ﮐﺮﻧﮯ ﮐﮯ ﮐﺎﻓﯽ 17 ﻣﻮاﻗﻊ ﻣﻠﺘﮯ ﮨﯿﮟ 18 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q28 19 ﻧﮩﯿﮟ ﻣﺘﻔﻖ اﮔﺮ ﻣﺠﮭﮯ ﻣﺪد ﮐﯽ ﺿﺮورت ﮨﮯ ﺗﻮ ، ﻣﯿﺮے ﭘﺎس ﺑﮩﺖ 20 ﺳﺎرے ﻟﻮگ ﮨﯿﮟ ﺟﻦ ﭘﺮ ﺑﮭﺮوﺳہ ﮐﺮﺗﯽ ﮨﯿﮟ 21 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q29 22 ﻧﮩﯿﮟ ﻣﺘﻔﻖ واﻟﻮں ﮐﯽ ﻣﺠﻤﻮﻋﯽ طﻮر ﭘﺮ ﻣﯿﮟ اﭘﻨﮯ دوﺳﺘﻮں اور ﮐﻨﺒہ 23 دﯾﮑﮭ ﺑﮭﺎل ﮐﻮ اﭼﮭﯽ طﺮح ﺳﮯ دﯾﮑﮭ رﮨﯽ ﮨﻮں 24 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q30 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺟﺐ ﻣﯿﮟ ﺑﯿﻤﺎر ﮨﻮ ﺗﻮ ﻣﯿﺮا ﮐﻨﺒہ اورﺻﺤﺖ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل 25 ﮐﺮﻧﮯ واﻟﮯ ﻣﯿﺮا ﺧﯿﺎل رﮐﮭﺘﮯ ﮨﯿﮟ 26 27 28 29 ﺟﺬﺑﺎﺗﯽ ﺧﯿﺮﯾﺖ 30 31 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q31 ﻧﮩﯿﮟ ﻣﺘﻔﻖ اﮔﺮ ﻣﯿﮟ اﭘﻨﯽ ﺻﺤﺖ / اﻧﻔﯿﮑﺸﻦ ﮐﮯ ﺧﻄﺮے/ ﻏﺬاﺋﯿﺖ 32 ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﺳﻮﭼﺘﯽ ﮨﻮں ﺗﻮ ، ﻣﯿﮟ اﻓﺴﺮده ﮨﻮﺟﺎﺗﯽ ﮨﻮں 33 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q32 34 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺟﺐ ﻣﯿﮟ اﭘﻨﯽ ﺻﺤﺖ / اﻧﻔﯿﮑﺸﻦ ﮐﮯ ﺧﻄﺮے / ﻏﺬاﺋﯿﺖ ﮐﮯ 35 ﺑﺎرے ﻣﯿﮟ ﺳﻮﭼﺘﯽ ﮨﻮں ﺗﻮ ﻣﺠﮭﮯ اﮐﺜﺮ ﻏﺼہ آﺗﺎ ﮨﮯ 36 37 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q33 38 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮی ﺻﺤﺖ / اﻧﻔﯿﮑﺸﻦ ﮐﮯ ﺧﻄﺮے/ ﻏﺬاﺋﯿﺖ ﮐﮯ ﻣﺴﺎﺋﻞ 39 ﻧﮯ ﻣﺠﮭﮯ زﻧﺪﮔﯽ ﺳﮯ ﻏﯿﺮ ﻣﻄﻤﺌﻦ ﮐﺮدﯾﺎ ﮨﮯ 40 41 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q34 42 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﮐﺜﺮ اﭘﻨﯽ ﺻﺤﺖ / اﻧﻔﯿﮑﺸﻦ ﮐﮯ ﺧﻄﺮه / ﻏﺬاﺋﯿﺖ ﮐﯽ 43 ﺿﺮورﯾﺎت ﺑﺎرے ﻣﯿﮟ ﻓﮑﺮ ﻣﻨﺪ رﮨﺘﯽ ﮨﻮں 44 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q35 45 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﮟ اﭘﻨﯽ ﺻﺤﺖ / اﻧﻔﯿﮑﺸﻦ ﮐﮯ ﺧﻄﺮے / ﻏﺬاﺋﯿﺖ ﮐﯽ 46 دﺷﻮارﯾﻮں ﮐﯽ وﺟہ ﺳﮯ ﻣﺎﯾﻮس ﮨﻮں 47 48 49 50 51 52 53 54 55 56 57 58 7 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 73 of 95 BMJ Open
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 4 Section B: 5 6 National Sanitation and Hygiene Knowledge, Attitudes, and Practices (KAP) Survey & 7 8 Survey on Hygiene Knowledge, Attitude and Practice ﺑﺮاه ﮐﺮم ﺟﻮاب دﯾﮟ ﮐہ آپ ﻣﻨﺪرﺟہ ذﯾﻞ آﺋﮣﻤﺰ ﮐﮯ ﻋﻠﻢ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﮐﺘﻨﮯ ﭘﺮاﻋﺘﻤﺎد ﮨﯿﮟ 9 Coding ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q36 10 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺣﻔﻈﺎن ﺻﺤﺖ 11 12 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q37 13 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﮨﺎﺗﮭ ﮐﯽ ﺻﻔﺎﺋﯽ ﺳﺘﮭﺮاﺋﯽ 14 15 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ only ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ review زﯾﺎده .For peerQ38 16 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻣﯿﺮے اﮨﻞ ﺧﺎﻧہ ﮐﮯ ﻟﺌﮯ ﺻﺎف اور ﻣﺤﻔﻮظ ﭘﺎﻧﯽ 17 18 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q39 19 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﮐﻨﺒﮯ ﮐﮯ ﻟﺌﮯ ﺻﺎف ﺳﺘﮭﺮا ﮐﮭﺎﻧﺎ 20
21 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q40 22 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ذاﺗﯽ ﺣﻔﻈﺎن ﺻﺤﺖ 23
24 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q41 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻋﻤﻮﻣﯽ/ﻋﺎم ﺣﻔﻈﺎن ﺻﺤﺖ 25 26 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q42 27 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﭘﺎﺧﺎﻧہ ﮐﺎ ﻣﺤﻔﻮظ ﺗﻠﻒ ﮨﻮﻧﺎ 28 29 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q43 30 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﮔﮭﺮ ، ﮐﭽﻦ اور ﻟﯿﮣﺮﯾﻦ ﮐﯽ ﺻﻔﺎﺋﯽ 31 32 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q44 33 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ھﻮس اور ﻣﺎﺋﻊ ﻓﻀﻠہ ﮐﻮ ﻣﺤﻔﻮظ طﺮﯾﻘﮯ ﺳﮯ ﺿﺎﺋﻊ ﮐﺮﻧﺎ 34 35 آپ ﮐﺲ ﻗﺴﻢ ﮐﮯ ﺣﺎﻻت ﻣﯿﮟ ﮨﺎﺗﮭ دھﻮﻧﮯ ﮐﻮ ﺿﺮوری ﺳﻤﺠﮭﺘﮯ ﮨﯿﮟ؟ 36 Coding ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ 37 38 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q45 39 ﮐﮭﺎﻧﮯ ﺳﮯ ﭘﮩﻠﮯ ﯾﺎ ﮐﮭﺎﻧﺎ ﺗﯿﺎر ﮐﺮﻧﮯ ﺳﮯ ﭘﮩﻠﮯ 40 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q46 41 ﮢﻮاﺋﻠﭧ اﺳﺘﻌﻤﺎل ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ 42 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q47 43 ﮐﺴﯽ ﺑﯿﻤﺎر ﺷﺨﺺ ﺳﮯ راﺑﻄﮯ ﮐﮯ ﺑﻌﺪ 44 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q48 45 ﮐﺴﯽ ﺑﮭﯽ ﻓﺮد ، ﯾﮩﺎں ﺗﮏ ﮐہ ﮐﻨﺒہ ﮐﮯ ﺷﺨﺺ 46 ﺳﮯ راﺑﻄﮯ ﮐﮯ ﺑﻌﺪ 47 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q49 48 ﮔﮭﺮ واﭘﺲ آﻧﮯ ﮐﮯ ﺑﻌﺪ 49 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q50 50 ﻋﻮاﻣﯽ ﻣﻘﺎﻣﺎت ﮐﺎ دوره ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ 51 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q51 52 ﮐﺴﯽ ﭘﺎﻟﺘﻮ ﺟﺎﻧﻮر / ﺟﺎﻧﻮر ﺳﮯ راﺑﻄہ ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ 53 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q52 54 ﺟﺎﮔﻨﮯ ﮐﮯ ﺑﻌﺪ 55 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q53 56 57 58 8 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 74 of 95
1 786 Pre- and Post-Test Health Literacy Questionnaire to Measure Intervention Impact 2 3 ﻋﻮاﻣﯽ ﻣﻘﺎﻣﺎت (ﺟﯿﺴﮯ ﭘﺒﻠﮏ ﮢﺮاﻧﺴﭙﻮرٹ ، ﺳﭙﺮ 4 ﻣﺎرﮐﯿﮣﻮں ، رﯾﺴﺘﻮراں…) ﮐﺎ دوره ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ 5 ﮐﺒﮭﯽ ﻧﮩﯿﮟ ﺷﺎذ و ﻧﺎدر ﮐﺒﮭﯽ ﮐﺒﮭﺎر اﮐﺜﺮ ﮨﻤﯿﺸہ .Q54 6 ﮐﯿﺎ آپ ﮨﻤﯿﺸہ ﮨﺎﺗﮭ دھﻮﻧﮯ ﮐﮯ ﻟﺌﮯ ﺻﺎﺑﻦ ﮐﺎ اﺳﺘﻌﻤﺎل 7 ﮐﺮﺗﯽ ﮨﯿﮟ؟ 8 9 Q55. ﮐﺘﻨﯽ دﯾﺮ ﺗﮏ آپ اﭘﻨﮯ ﮨﺎﺗﮭ دھﻮﺗﯽ ﮨﯿﮟ؟ 10
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12 13 SECTION C: 14 15 HOMECARE OF COVID SURVEY 16 ﭘﭽﮭﻠﮯ ﮐﭽﮭ ﮨﻔﺘﻮں ﻣﯿﮟ ﮐﯿﺎ آپ درج ذﯾﻞ اﺣﺘﯿﺎطﯽ ﺗﺪاﺑﯿﺮonly اﺧﺘﯿﺎر ﮐﺮ رﮨﯽ ﮨﯿﮟ؟For peer review 17
18 Strongly Agree Neutral Disagree Strongly Coding 19 Disagree ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ Agree 20 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده ﻧﮩﯿﮟ ﻣﺘﻔﻖ 21 22 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q56 23 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﻟﻮﮔﻮں ﺳﮯ ﺟﺴﻤﺎﻧﯽ راﺑﻄﮯ (ﺟﯿﺴﮯ ﮔﻠﮯ ﻣﻠﻨﺎ ، ﻣﺼﺎﻓﺤہ 24 ﮐﺮﻧﺎ وﻏﯿﺮه) ﺳﮯ ﮔﺮﯾﺰ ﮐﺮﻧﺎ 25 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q57 26 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﭼﮩﺮے ﮐﺎ ﻣﺎﺳﮏ ﭘﮩﻨﻨﺎ ﺟﻮ ﻧﺎک اور ﻣﻨہ ﮐﻮ زﯾﺎده ﺳﮯ 27 زﯾﺎده ڈھﺎﻧﭗ رﮨﺎﮨﻮ ، ﺧﺎص ﮐﺮ ﺑﮭﯿﮍ واﻟﮯ ﻋﻼﻗﻮں 28 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q58 29 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﭼﮩﺮے ﮐﮯ ﻣﺎﺳﮏ ﮐﻮ ﺑﺎر ﺑﺎر ﺗﺒﺪﯾﻞ ﮐﺮﻧﺎ؛ ﺧﺎص طﻮر ﭘﺮ 30 ﺟﺐ ﯾہ ﮔﻨﺪا ﯾﺎ ﮔﯿﻠﮯ ﮨﻮ ﺟﺎﺋﮯ 31 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q59 32 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺻﺮف ﻟﭽﮑﺪار ﺑﯿﻨﮉ ﯾﺎ ﺗﺎر ﮐﻮ ﭼﮭﻮ ﮐﺮ ﻣﺎﺳﮏ ﮐﻮ ﮨﮣﺎﻧﺎ 33 (ﺳﺎﻣﻨﮯ اور اﻧﺪر ﮐﮯ ﺣﺼﮯ ﮐﻮ ﻧﮩﯿﮟ ﭼﮭﻮﻧﺎ) 34 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q60 35 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﮔﮭﺮ ﮐﻮ ﺻﺎف ﮐﺮﻧﮯ ﮐﯿﻠﺌﮯ ﺟﺮاﺛﯿﻢ ﮐﺶ دواﺋﯿﮟ اﺳﺘﻌﻤﺎل 36 ﮐﺮﻧﺎ (ﺟﯿﺴﮯ ڈﯾﮣﻮل ، ﯾﺎ دوﺳﺮے ﮐﻠﯿﻨﺮز) 37 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q61 38 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﭼﮩﺮے ﮐﺎ ﻣﺎﺳﮏ اﺗﺎرﻧﮯ ﮐﮯ ﻓﻮرا. ﺑﻌﺪ اﭼﮭﯽ طﺮح ﮨﺎﺗﮭ 39 دھﻮﻧﺎ 40 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q62 41 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺗﻮﻟﯿﻮں ﮐﻮ ﺑﺎﻗﺎﻋﺪﮔﯽ ﺳﮯ دھﻮﻧﺎ اور ﺗﺒﺪﯾﻞ ﮐﺮﻧﺎ 42 43 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q63 44 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﮐﮭﺎﻧﮯ ﮐﮯ ﻟﺌﮯﺧﺼﻮﺻﯽ ﺑﺮﺗﻦ ، ﮐﮣﻠﺮی ، اور ﭘﯿﻨﮯ ﮐﮯ 45 ﮔﻼس / ﭘﯿﺎﻻ ﮐﺎ اﺳﺘﻌﻤﺎل ﮐﺮﻧﺎ 46 47 ﺑﺎﻟﮑﻞ ﻣﺘﻔﻖ ﻏﯿﺮ ﻣﺘﻔﻖ ﻏﯿﺮﺟﺎﻧﺒﺪار ﻣﺘﻔﻖ ﺑﮩﺖ زﯾﺎده .Q64 48 ﻧﮩﯿﮟ ﻣﺘﻔﻖ ﺑﺮﺗﻦ ﮐﻮﮐﮭﺎﻧﮯ ، ﭘﯿﻨﮯاور ﮐﮭﺎﻧﺎ ﭘﮑﺎﻧﮯ ﮐﮯ ﺑﻌﺪ ڈش 49 ڈﮢﺮﺟﻨﭧ ﺳﮯ ﺻﺎف ﮐﺮﻧﺎ 50
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1 2 3 4 Appendix C 5 6 Digital Health Literacy Intervention-Booklet Translation 7 8 9 10 Note- all sections will be supplemented by pictorial representation 11 12 13 -Cover Page- 14 15 16 For peer review only 17 -Page 1- -Page 2- -Page 3- -Page 4- 18 Washing hands is the most Hygiene and Sanitation It is very important to take Wash the utensil with a 19 necessary element Campaign shower dish detergent 20 21 22 23 24 25 26 27 28 29 30
31 32 -Page 5- -Page 6- -Page 7- -Page 8- 33 Clean house is important Coronavirus-Awareness and Precautions related to How to stop the 34 Prevention Coronavirus spread of Coronavirus 35 Precaution is better than at Office and place of 36 treatment work? 37 -Wash your hand for 20 -Keep your essentials 38 seconds at least or use a like desk, telephone and 39 sanitizer computer clean at office 40 -Use tissue paper while -Wash your hands with 41 sneezing or coughing and water and soap for 20 42 discard the tissue paper in the seconds and avoid 43 trashcan after use touching your eyes, 44 -Avoid touching eyes, nose nose and mouth 45 and mouth -Avoid shaking hands 46 -Avoid shaking hands and with people, nod your 47 visiting crowded places head to greet 48 - Do not go out of the house -Display the posters unnecessarily encouraging practice of 49 washing hands in the 50 office 51 - Advise your 52 colleagues to wash 53 hands regularly and 54 follow hygiene and 55 sanitation guidelines 56 -Keep the hand washing 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 76 of 95
1 2 3 area clean and make 4 soap, soap dispenser 5 and sanitizer available 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 -Page 9- -Page 10- 21 Novel Coronavirus- COVID-19 Save your loved ones and yourself from falling sick 22 Use of Mask Wash your hands properly 23 Following people should wear mask -After coughing and sneezing 24 -Those who are infected by Coronavirus infection -Before, between and after preparing the meals 25 -Those who are taking care of Coronavirus patients (for -After cleaning and taking care of pets 26 example health workers) -Whenever your hands are dirty 27 -Those who have usual flu, cough and cold -After using the toilet 28 -Before and after eating meal 29 N-95 is a special mask and should be worn by only those -When you are taking care of a patient 30 who are taking care of infected patients 31 32 33 34 35 36 37 38 39 -Back Page- 40 41 42 43 44
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19 20 21 22 23 24 25 Digital Health Literacy Intervention-Booklet Translation 26 27 -Cover Page- 28 29 -Page 1- -Page 2- -Page 3- -Page 4- ﺑﺮﺗﻦ ﮐﻮ ﺻﺎﺑﻦ ﺳﮯ دھﻮﺋﯿﮟ ﻧﮩﺎﻧﺎ ﺑﮩﺖ ﺿﺮوری ﮨﮯ ﺣﻔﻈﺎن ﺻﺤﺖ اور ﺻﻔﺎﺋﯽ ﻣﮩﻢ ﮨﺎﺗﮭ دھﻮﻧﺎ ﺳﺐ ﺳﮯ ﺿﺮوری ﻋﻤﻞ 30 ﮨﮯ 31 32 33 34 35 36 37 38 39 -Page 5- -Page 6- -Page 7- -Page 8- دﻓﺘﺮ اور ﮐﺎم ﮐﯽ ﺟﮕہ ﭘﺮ ﮐﻮروﻧﺎ ﮐﻮروﻧﺎ واﺋﺮس ﺳﮯ ﻣﺘﻌﻠﻖ اﺣﺘﯿﺎطﯽ ﮐﻮروﻧﺎ واﺋﺮس ﺳﮯ آﮔﺎﮨﯽ اور روک اﯾﮏ ﺻﺎف ﮔﮭﺮ ﺿﺮوری ﮨﮯ 40 واﺋﺮس ﮐﮯ ﭘﮭﯿﻼؤ ﮐﻮ ﮐﯿﺴﮯ ﺗﺪاﺑﯿﺮ ﺗﮭﺎم 41 روﮐﺎ ﺟﺎﺋﮯ؟ اﺣﺘﯿﺎط ﻋﻼج ﺳﮯ ﺑﮩﺘﺮ ﮨﮯ 42 اﭘﻨﮯ ﺿﺮوری ﺳﺎﻣﺎن ﺟﯿﺴﮯ 43 ڈﯾﺴﮏ ، ﮢﯿﻠﯿﻔﻮن اور ﮐﻤﭙﯿﻮﮢﺮ ﮐﻮ ﮐﻢ از ﮐﻢ 20 ﺳﯿﮑﻨﮉ ﺗﮏ اﭘﻨﮯ 44 ﺻﺎف رﮐﮭﯿﮟ ﮨﺎﺗﮭ دھﻮﺋﯿﮟ ﯾﺎ ﺳﯿﻨﯿﮣﺎﺋﺰر اﺳﺘﻌﻤﺎل 45 ﮐﺮﯾﮟ 46 -20 ﺳﯿﮑﻨﮉ ﺗﮏ اﭘﻨﮯ ﮨﺎﺗﮭﻮں ﮐﻮ 47 ﭘﺎﻧﯽ اور ﺻﺎﺑﻦ ﺳﮯ دھﻮﺋﯿﮟ اور ﭼﮭﯿﻨﮑﻨﮯ ﯾﺎ ﮐﮭﺎﻧﺴﯽ ﮐﮯ دوران ﮢﺸﻮ 48 اﭘﻨﯽ آﻧﮑﮭﻮں ، ﻧﺎک اور ﻣﻨہ ﮐﻮ ﭘﯿﭙﺮ ﮐﺎ اﺳﺘﻌﻤﺎل ﮐﺮﯾﮟ اور اﺳﺘﻌﻤﺎل 49 ﭼﮭﻮﻧﮯ ﺳﮯ ﮔﺮﯾﺰ ﮐﺮﯾﮟ ﮐﮯ ﺑﻌﺪ ﮢﺸﻮ ﭘﯿﭙﺮ ﮐﻮ ﺿﺎﺋﻊ ﮐﺮدﯾﮟ 50 51 ﮨﺎﺗﮭ ﻣﻼﻧﮯ ﺳﮯ ﮔﺮﯾﺰ ﮐﺮﯾﮟ ﺳﻼم آﻧﮑﮭﻮں ، ﻧﺎک اور ﻣﻨہ ﮐﻮ ﻣﺖ 52 ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ اﭘﻨﺎ ﺳﺮ ﯾﺎ ﮨﺎﺗﮭ ﭼﮭﻮﺋﯿﮟ 53 ﮨﻼﺋﯿﮟ 54 ﮨﺎﺗﮭ ﻣﻼﻧﮯ اور ﺑﮭﯿﮍ واﻟﯽ ﺟﮕﮩﻮں ﭘﺮ دﻓﺘﺮ ﻣﯿﮟ ﮨﺎﺗﮭ دھﻮﻧﮯ ﮐﯽ ﺣﻮﺻﻠہ ﺟﺎﻧﮯ ﺳﮯ ﮔﺮﯾﺰ ﮐﺮﯾﮟ 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 78 of 95
1 2 اﻓﺰاﺋﯽ ﮐﺮﻧﮯ واﻟﮯ ﭘﻮﺳﮣﺮ ﻟﮕﺎﺋﯿﮟ 3 ﻏﯿﺮ ﺿﺮوری طﻮر ﭘﺮ ﮔﮭﺮ ﺳﮯ ﺑﺎﮨﺮ 4 اﭘﻨﮯ ﺳﺎﺗﮭﯿﻮں ﺳﮯ ﺑﺎﻗﺎﻋﺪﮔﯽ ﺳﮯ ﻣﺖ ﺟﺎﺋﯿﮟ 5 ﮨﺎﺗﮭ دھﻮﻧﮯ اور ﺣﻔﻈﺎن ﺻﺤﺖ 6 ﺳﮯ ﻣﺘﻌﻠﻖ ﮨﺪاﯾﺎت ﭘﺮ ﻋﻤﻞ ﮐﺮﻧﮯ 7 ﮐﻮ ﮐﮩﯿﮟ 8 9 ﮨﺎﺗﮭ دھﻮﻧﮯواﻟﮯ 10 اﯾﺮﯾﺎ ﮐﻮ ﺻﺎف رﮐﮭﯿﮟ اور ﺻﺎﺑﻦ 11 ، ﺻﺎﺑﻦ ڈﺳﭙﻨﺴﺮ ، اور ﺳﯿﻨﯿﮣﺎﺋﺰر 12 ﮐﯽ دﺳﺘﯿﺎﺑﯽ ﮐﻮ ﯾﻘﯿﻨﯽ ﺑﻨﺎﺋﯿﮟ 13 14 15 16 For peer review only 17 18 19 20 21 22 -Page 9- -Page 10- اﭘﻨﮯ ﭘﯿﺎروں اور اﭘﻨﮯ آپ ﮐﻮ ﺑﯿﻤﺎر ﮨﻮﻧﮯ ﺳﮯ ﺑﭽﺎﺋﯿﮟ COVID-19 ﻧﺎول ﮐﻮروﻧﺎ واﺋﺮس 23 اﭘﻨﮯ ﮨﺎﺗﮭﻮں ﮐﻮ اﭼﮭﯽ طﺮح ﺳﮯ دھﻮﺋﮯ ﻣﺎﺳﮏ ﮐﺎ اﺳﺘﻌﻤﺎل 24 ﻣﻨﺪرﺟہ ذﯾﻞ ﻟﻮﮔﻮں ﮐﻮ ﻣﺎﺳﮏ ﭘﮩﻨﻨﺎ ﭼﺎﮨﺌﮯ 25 ﮐﮭﺎﻧﺴﯽ اور ﭼﮭﯿﻨﮏ آﻧﮯ ﮐﮯ ﺑﻌﺪ وه ﻟﻮگ ﺟﻮ ﮐﻮروﻧﺎ واﺋﺮس ﮐﮯ اﻧﻔﯿﮑﺸﻦ ﺳﮯ ﻣﺘﺎﺛﺮ ﮨﯿﮟ 26 ﮐﮭﺎﻧﺎ ﺗﯿﺎر ﮐﺮﻧﮯ ﺳﮯ ﭘﮩﻠﮯ ، ﮐﮯ درﻣﯿﺎن اور ﺑﻌﺪ ﻣﯿﮟ وه ﻟﻮگ ﺟﻮ ﮐﻮروﻧﺎ واﺋﺮس ﮐﮯ ﻣﺮﯾﻀﻮں ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮ رﮨﮯ ﮨﯿﮟ (ﻣﺜﺎل ﮐﮯ 27 ﭘﺎﻟﺘﻮ ﺟﺎﻧﻮروں ﮐﯽ ﺻﻔﺎﺋﯽ اور دﯾﮑﮭ ﺑﮭﺎل ﮐﮯ ﺑﻌﺪ طﻮر ﭘﺮ ﮨﯿﻠﺘﮭ ورﮐﺮز) 28 ﺟﺐ ﺑﮭﯽ آپ ﮐﮯ ﮨﺎﺗﮭ ﮔﻨﺪے ﮨﻮں وه ﻟﻮگ ﺟﻨﮑﻮﻓﻠﻮ ، ﮐﮭﺎﻧﺴﯽ اور ﻧﺰﻟہ زﮐﺎم ﮨﻮ 29 ﮢﻮاﺋﻠﭧ اﺳﺘﻌﻤﺎل ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ 30 ﮐﮭﺎﻧﺎ ﮐﮭﺎﻧﮯ ﺳﮯ ﭘﮩﻠﮯ اور ﺑﻌﺪ ﻣﯿﮟ 31 ﺟﺐ آپ ﮐﺴﯽ ﻣﺮﯾﺾ ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮ رﮨﮯ ﮨﻮ 32 اﯾﻦ 95 اﯾﮏ ﺧﺎص ﻣﺎﺳﮏ ﮨﮯ اور اﺳﮯ ﺻﺮف وﮨﯽ ﭘﮩﻨﻨﺎ ﭼﺎﮨﺌﮯ ﺟﻮ ﻣﺘﺎﺛﺮه 33 ﻣﺮﯾﻀﻮں ﮐﯽ دﯾﮑﮭ ﺑﮭﺎل ﮐﺮرﮨﮯ ﮨﯿﮟ 34
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1 2 3 4 Appendix D 5 6 Digital Health Literacy Intervention-Video Script 7 8 9 10 Characters: 11 12 Bushra Baji: Health Worker, shares information about causes and prevention of Corona Virus with her family 13 Shamsa: (Homemaker, receives information and pledges to fight against Corona Virus) 14 Shamsa’s Children: Ali and Sana 15 16 Shamsa’ Mother in Law:For Khurshid peerBibi review only 17 Aslam: Shamsa’s Husband 18 19 20 Spoke Copy Corresponding Visuals/animation BGM (Background Duration 21 22 Music/Score) 23 Establishing Visual: Shamsa (homemaker) along with her two children and mother in law are watching television. 24 25 Meanwhile, Bushra Baji enters the house takes off her mask, disposes it and reaches out to a bucket to wash her hands. She 26 keeps a shopping bag of fruits on the table, Sana tries to reach out eat an apple from the fruits bag and immediately interrupted 27 by Bushra Baji. 28 29 Sanitation and Hygiene 30 Bushra Baji: Sana, we should first wash Both Bushra Baji and Sana are in NO BGM required. 31 32 fruits and vegetables that we bring from frame. 33 the market to avoid contact with germs. If Sana looks at Bushra Baji and nods Add NAT (Natural 34 35 we eat them without washing, we might to her instruction. Sound) 36 get sick. 37 38 Sana: Aunty, do we only find germs in Sana is in frame. NO BGM required. 39 the stuff we bring from market? 40 Add NAT 41 42 Bushra Baji: No Sana, we can have (Sana’s mother Shamsa join in the BGM Reference 1: (A 43 germs in our house also, if we don’t clean conversation and Shamsa and Sana pacing sound that helps 44 45 house and ourselves we can fall sick even nods to the precautions told by create an effect of 46 inside our house, we should always Bushra baji). instructions on the 47 48 dispose the waste properly in a trashcan family). 49 and should keep washrooms and kitchen Insert MONTAGE: Visuals of 50 51 clean. We must pay attention to personal sanitation violation. Each of these BGM Reference 2: NAT 52 hygiene and must wash our hands before visuals will have a red cross sign to of flies buzzing, water 53 eating, keep our body clean, trim our nails signify the violation: spilling from bucket and. 54 55 and keep them clean as well. Trash is kept in a corner of the 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 80 of 95
1 2 3 house and flies are buzzing on the 4 5 trash 6 A bucket with water and rags are 7 8 kept carelessly. 9 Toilet’s door is open. 10 11 Food is kept uncovered in kitchen. 12 13 14 Shamsa: Sister Bushra, we will do all the All characters are in the frame, 15 necessary things as explained by you so visibly calm and content. 16 we can keep us and everyone Foraround us peer review only 17 18 safe. 19 Transition Shot: A broadcast on television is explaining the situation in country due to Corona virus. During transition the 20 21 BGM of TV broadcast will increase. 22 23 24 Shamsa: Sister, what are they explaining Shamsa is in frame TV broadcast runs in the 25 on TV about Corona and do you think all background. 26 27 of this is true? 28 Bushra Baji: Yes, this is right. Corona is Bushra Baji in frame, frame locks at TV broadcast runs in the 29 a pandemic and it is affecting all the Bushra baji while explanation. background, slowly 30 31 countries including ours. It is not Frame cuts to Shamsa and her fades out in the 32 restricted to one province; city or town it children who are looking worried. background. 33 34 is a matter of concern for the entire 35 country. Insert graphic/Montage: A view of 36 37 world hospitals and health workers 38 taking care of corona virus patients. 39 40 Shamsa: Do you think it can affect as all Shamsa and her children are in 41 and is it life threatening? frame. 42 Bushra Baji: If we don’t take the Bushra baji is in frame. BGM signifies worry 43 44 necessary precautions it can affect anyone 45 and can be life threatening. Children and Frame will open (wide shot) 46 47 elderly are amongst the most vulnerable. covering Ali, Sana and Khurshid 48 But we must not panic but should fight bibi in background while Bushra 49 50 against it. Baji explains that children and 51 elderly are most vulnerable. 52 53 Prevention 54 Khurshid Bibi: Then what precautions Khurshid Bibi is in frame. 55 we must take? 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 81 of 95 BMJ Open
1 2 3 Bushra Baji:. Government and concerned Bushra baji in frame, explaining the BGM will change, while 4 5 health departments have explained all the prevention. The background scene explaining the 6 necessary precautions about this. will change when she will start prevention. A 7 8 Awareness messages against Corona explaining the prevention. background music that 9 Virus are sent to the public by TV and Placement of the frame will be such compliments 10 Radio. For example, messages regarding that all character could be viewed instructions/solution 11 12 common symptoms include cough, sore on screen. Bushra Baji has to be should be used. 13 throat, fever, headache, flu and difficulty kept at an angle where she could be 14 15 in breathing. visible appears a person who in 16 For peercharge of instructionreview and rest of theonly 17 18 family is gathering to listen to her. 19 Bushra Baji: We must remember the Bushra Baji is in Frame, with BGM for instruction 20 21 following precautions so we can keep sanitation supplies in the continues 22 ourselves and everyone around us safe. background. 23 -We must follow social distancing and 24 25 should not go out of the house 26 unnecessarily Insert Graphic: A person wearing 27 28 -If we have to get out of the house we mask while stepping outside of 29 must wear mask all the time. house. 30 31 -Main a 6 feet distance and avoid shaking 32 hands and hugging people Insert Graphic: Social distancing 33 -Avoid touching mouth, nose and eyes as (people moving backwards and a 34 35 virus can enter the body through these dotted line between them will 36 areas signify the distance). 37 38 39 Insert Graphic: Extreme close up of 40 41 nose, eyes and mouth. 42 43 44 Shamsa: How this virus is transferred Zoom to Shamsa. 45 from one person to the other? 46 Bushra Baji: Shamsa, corona virus can Family in frame receiving BGM for instruction 47 48 speard through tiny droplets of an infected instruction cut to: continues 49 person when he/she sneezes or coughs that Insert Graphic: Droplets are flying 50 51 is why we should avoid close contact and in the air and reaching others. 52 should not go to the crowded places. . 53 54 And a very important precaution to note: Insert Graphic: Close op of hand BGM for instruction 55 we must wash our hands frequently with being washed according to WHO continues and concludes. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 82 of 95
1 2 3 20 seconds at least and prescribed standards. A clock 4 5 If you or anybody at your home has animation to signify the 20 sec 6 Corona Virus symptoms, then one must prescription. 7 8 self-isolate so everyone else at home stays 9 safe. For information related to testing and Shamsa and children join in to wash 10 treatment one can contact designated hands. 11 12 health and medical facilities by 13 government. 14 15 Reinforcement/Post Climax 16 Insert B-Roll: Shamsa is shownFor handing outpeer mask to Aslam review when he goes out, cleaningonly house and washing hands and 17 18 practicing social distancing while talking to the vegetable vendor outside house. 19 Add celebratory BGM on B-Roll. 20 21 22 End Credits. 23 FCC Research Team 24 25 ------26 ُ◌ ﺑﺸﺮه ﺑﺎﺟﯽ: ﺛﻨﺎء ﮨﻤﯿﻨﺒﺎزار ﺳﮯ آﻧﮯ واﻟﯽ ﭘﮭﻞ اور ﺳﺒﺰﯾﺎﻧﮑﻮدھﻮ ﮐﮯ ﮐﮭﺎﻧﺎﭼﺎﮨﯿﮯ،ﮐﯿﻮں ﮐﮯ ان ﻣﯿﻨﺠﺮاﺛﯿﻢ ﮨﻮﺗﮯ ﮨﮯ۔ﺑﻐﯿﺮدھﻮے اﻧﮑﮯ اﺳﺘﻌﻤﺎل 27 ﮐﺮﻧﮯ ﺳﮯ ﮨﻢ ﺑﯿﻤﺎر ﭘﮍ ﺳﮑﺘﮯ ﮨﯿﮟ۔ 28 ُ◌ ُ◌ﺛﻨﺎء: ﭘﮭﻮﭘﮭﻮ،ﮐﯿﺎ ﺻﺮف ﺟﺮاﺛﯿﻢ ﺑﺎزار ﻣﯿﮟ ﮨﻮﺗﮯ ﮨﯿﮟ؟ 29 30 ﺑﺸﺮه ﺑﺎﺟﯽ: ﻧﮩﯿﻨﺜﻨﺎء،ﺟﺮاﺛﯿﻢ ﮔﮭﺮ ﻣﯿﮟ ﺑﮭﯽ ﮨﻮ ﺳﮑﺘﮯ ﮨﯿﮟ،ﮔﮭﺮ ﮐﯽ اور اﭘﻨﯽ ﺻﻔﺎﺋﯽ ﮐﺎ ﺧﯿﺎل ﻧﮩﯿﻨﺮﮐﮭﻨﮯ ﺳﮯ ﯾہ ﮨﻤﯿﮟ ﮔﮭﺮ ﮐﮯ ﺑﮭﯽ ﺑﯿﻤﺎر ﮐﺮ ﺳﮑﺘﮯ 31 ﮨﯿﮟ۔اس ﻟﯿﮯ ﮨﻤﯿﮟ اﭘﻨﮯ ﮔﮭﺮ ﮐﻮ ﺻﺎف رﮐﮭﻨﺎ ﭼﺎﮨﯿﮯ، ﮐﭽﺮے ﮐﻮ ﮐﻮڑے دان ﻣﯿﮟ ﭘﮭﯿﻨﮑﻨﺎ ﭼﺎﮨﯿﮯ، ﮔﮭﺮ ﮐﮯ ﺑﺎورﭼﯽ ﺧﺎﻧﮯ اور ﻏﺼﻞ ﺧﺎﻧﮯ ﮐﯽ 32 ﺻﻔﺎﺋﯽ ﮐﺎ ﺧﺎص دھﯿﺎن رﮐﮭﻨﺎ ﭼﺎﮨﯿﮯ۔اس ﮐﮯ ﺳﺎﺗﮭ ﺳﺎﺗﮭ اﭘﻨﯽ ﺻﻔﺎﺋﯽ ﮐﺎ ﺑﮭﯽ دھﯿﺎن رﮐﮭﻨﺎ ﭼﺎﮨﯿﮯ۔ﮐﮭﺎﻧﮯ ﺳﮯ ﭘﮩﻠﮯ ﮨﺎﺗﮭ دﮨﻮﻧﺎ،اﭘﻨﮯ ﺟﺴﻢ ﮐﻮ ﺻﺎف 33 رﮐﮭﻨﺎ،ﻧﺎﺧﻨﻮﻧﮑﻮ ﺗﺮاﺷﻨﺎﺑﮩﺖ ﺿﺮوری ﮨﮯ۔ 34 35 ﺷﻤﺴﺎ: ﺑﺸﺮه ﺑﺎﺟﯽ ، آﭘﮑﯽ ﺳﺎری ﺑﺘﺎﺋﯽ ﮨﻮﺋﯽ ﺗﺪاﺑﯿﺮﭘﮯ ﻋﻤﻞ ﮐﺮﯾﮟ ﮔﮯ ﺗﺎﮐہ ﮨﻢ اور آس ﭘﺎس ﮐﮯ ﻟﻮگ ﻣﺤﻔﻮظ رﮨﯿﮟ۔ 36 ﺷﻤﺴﺎ:ﺑﺎﺟﯽ ﯾہ ﮢﯽ وی ﭘﮯ ﮐﯿﺎ ﺑﺎت ﮨﻮ رﮨﯽ ﮨﮯ ﮐﺮوﻧﺎ ﮐﮯ ﺑﺎرے ﻣﯿﮟ؟ﮐﯿﺎ ﯾہ ﺳﭻ ﮨﮯ؟ 37 38 ُ ﺑﺸﺮه ﺑﺎﺟﯽ: ﮨﺎں ﺑﻠﮑﻞ ﺳﮩﯽ ﺑﺘﺎ رﮨﮯ ﮨﯿﮟ۔ﮐﺮوﻧﺎ واﺋﺮس اﯾﮏ وﺑﺎ ﮨﮯ اور ﭘﻮری دﻧﯿﺎ ﮐﮯ ﺳﺎﺗﮭ ﺳﺎﺗﮭ ﮨﻤﺎرے ﻣﻠﮏ ﻣﯿﮟ ﺑﮭﯽ ﭘﮭﯿﻞ رﮨﯽ ﮨﮯ۔ﯾہ ﮐﺴﯽ اﯾﮏ 39 ﺻﻮﺑﮯ ، ﺷﮩﺮﯾﺎ ﻣﮩﻠﮯ ﻧﮩﯿﮟ ﺑﻠﮑﮯ ﺳﺎرے ﻣﻠﮏ ﻣﯿﮟ ﭘﮭﯿﻞ رﮨﯽ ﮨﮯ۔ 40 41 ﺷﻤﺴﺎ:ﺗﻮ ﮐﯿﺎ ﯾہ ﮨﻢ ﺳﺐ ﮐﻮ ﺑﯿﻤﺎر ﮐﺮے ﮔﯽ اور ﮐﯿﺎ ﯾہ وﺑﺎ ﺟﺎن ﻟﯿﻮا ﮨﮯ؟ 42 43 ُ ﺑﺸﺮه ﺑﺎﺟﯽ: اﮔﺮ ﮨﻢ اﺣﺘﯿﺎط ﻧﮩﯿﮟ ﮐﺮے ﮔﮯ ﺗﻮ ﯾہ وﺑﺎ ﮐﺴﯽ ﮐﻮ ﺑﮭﯽ ﻟﮓ ﺳﮑﺘﯽ ﮨﮯ اور ﺟﺎن ﻟﯿﻮا ٰﺛﺎﺑﺖ ﮨﻮ ﺳﮑﺘﯽ ﮨﮯ۔ اس ﺳﮯ ﺑﭽﮯ اور ﺑﻮڑھﮯ 44 زﯾﺎده ﻣﺘﺎﺛﺮ ﮨﻮ ﺳﮑﺘﮯ ﮨﯿﮟ۔ﻟﯿﮑﻦ ﮨﻤﯿﮟ اس ﺳﮯ ﮔﮭﺒﺮاﻧﺎ ﻧﮩﯿﮟ ﮨﮯ ،اﺳﮑﺎ ﻣﻘﺎﺑﻠہ ﮐﺮﻧﺎ ﮨﮯ۔ 45 ﺧﺮﺷﯿﺪ ﺑﯽ ﺑﯽ:ﺗﻮ ﮨﻤﯿﮟ ﮐﯿﺴﮯ اﺣﺘﯿﺎط ﮐﺮﻧﯽ ﮨﻮﮔﯽ؟ 46 47 48 49 50 ُ ﺑﺸﺮه ﺑﺎﺟﯽ:اس ﮐﮯ ﻟﯿﮯ ﺣﮑﻮﻣﺖ اور ﻣﺘﻌﻠﻘہ اداروﻧﻨﮯ ﺗﻤﺎم ﺗﺪاﺑﯿﺮﺑﺘﺎﺋﯽ ﮨﮯ۔اس وﺑﺎ ﺳﮯ ﺑﭽﺎوﮐﮯ ﺑﺎرے ﻣﯿﻨﺘﻤﺎم ﺗﺮ ﻣﻌﻠﻮﻣﺎت ﮢﯽ وی اور رﯾﮉﯾﻮ ﮐﮯ 51 ذرﯾﺌﮯ ﻟﻮﮔﻮں ﺗﮏ ﭘﮩﻨﭽﺎﺋﯽ ﺟﺎ رﮨﯽ ﮨﮯ۔ﺟﯿﺴﮯ اس ﮐﮯ ﻋﻼﻣﺎت ﻣﯿﮟ ﮐﮭﺎﻧﺴﯽ ،ﺑﺨﺎر،ﺳﺮ درد،ﺳﺎﻧﺲ ﻟﯿﻨﮯ ﻣﯿﮟ ﻣﺸﮑﻞ ﭘﯿﺶ آﻧﺎ ﺷﺎﻣﻞ ﮨﮯ۔ 52 53 ﺑﺸﺮه ﺑﺎﺟﯽ:ﺳﺐ ﮐﻮ اﺣﺘﯿﺎطﯽ ﺗﺪاﺑﯿﺮ ﯾﺎد رﮐﮭﻨﯽ ﮨﮯ ﺗﺎﮐہ ﻧﺎ ﺻﺮف ﮨﻢ اﭘﻨﯽ ﺑﻠﮑہ آس ﭘﺎس رﮨﻨﮯ واﻟﻮں ﮐﯽ ﺑﮭﯽ ﺣﻔﺎطﺖ ﮐﺮ ﺳﮑﮯ۔ 54 55 ّ◌ -ﺳﺐ ﺳﮯ ﭘﮩﻠﮯ ﮨﻤﯿﮟ ــ"ﺳﻤﺎﺟﯽ ﻓﺎﺻﻠﮯ"ﮐﮯ اﺻﻮل ﭘہ ﻋﻤﻞ ﮐﺮﻧﺎ ﮨﮯ۔ﮔﮭﺮ ﺳﮯ ﻏﯿﺮﺿﺮوری ﺑﺎﮨﺮ ﻧﮩﯿﮟ ﻧﮑﻠﻨﺎﮨﮯ۔ 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 83 of 95 BMJ Open
1 2 اﮔﺮ ﮨﻤﯿﮟ ﮐﺴﯽ ﺑﮩﺖ ﺿﺮوری ﮐﺎم ﮐﮯ ﻟﯿﮯ ﮔﮭﺮ ﺳﮯ ﺑﺎﮨﺮ ﺟﺎﻧﺎ ﺑﮭﯽ ﭘﮍے ﺗﻮ ﻣﺎﺳﮏ ﮐﺎ اﺳﺘﻌﻤﺎل ﻻزﻣﯽ ﮨﮯ۔ - 3 4 ﻟﻮﮔﻮں ﺳﮯ ﺑﺎت ﮐﺮﺗﮯ وﻗﺖ ﮐﻢ از ﮐﻢ 6ﻓﭧ ﮐﺎ ﻓﺎﺻﻠہ رﮐﮭﯿﮟ اور ﮨﺎﺗﮭ ﻣﻼﻧﮯ اور ﮔﻠﮯ ﻣﻠﻨﮯ ﺳﮯ ﮔﺮﯾﺰ ﮐﺮﯾﮟ۔ - 5 6 آﭘﻨﯽ آﻧﮑﮭﻮں ، ﻧﺎک اور ﻣﻨہ ﮐﻮ ﮨﺎﺗﮭ ﻧہ ﻟﮕﺎﯾﮯ ﮐﯿﻮﻧﮑہ اس ﺳﮯ واﺋﺮس آﭘﮑﮯ ﺟﺴﻢ ﻣﯿﮟ ﻣﻨﺘﻘﻞ ﮨﻮﻧﮯ ﮐﺎ ﺧﺪﺷہ ﮨﮯ۔- 7 ﺷﻤﺴﺎ: ﯾہ وا ﺋﺮس اﯾﮏ ﺳﮯ دوﺳﺮے ﺷﺨﺺ ﻣﯿﮟ ﮐﯿﺴﮯ ﻣﻨﺘﻘﻞ ﮨﻮﺗﺎ ﮨﮯ؟ 8 9 ﺑﺸﺮه ﺑﺎﺟﯽ: ﺷﻤﺴﺎ دراﺻﻞ ﮐﺮوﻧﺎ واﺋﺮس ﮐﺴﯽ اﯾﺴﮯ ﻓﺮد ﺟﺲ ﻣﯿﮟ واﺋﺮس ﻣﻮﺟﻮد ﮨﻮ، ﮐہ ﭼﮭﯿﻨﮑﻨﮯ ﯾﺎ ﮐﮭﺎﻧﺴﻨﮯ ﺳﮯ ﭘﯿﺪا ﮨﻮﻧﮯ واﻟﮯ ﭘﺎﻧﯽ ﻧﻤہ ﻗﻄﺮه 10 ﺳﮯ ﭘﮭﯿﻠﺘﺎ ﮨﮯ۔اﺳﯿﻠﮯ ﮨﻤﯿﮟ ﻟﻮﮔﻮں ﮐﮯ ذﯾﺎده ﻗﺮﯾﺐ اور اﯾﺴﯽ ﺟﮕﮩﻮں ﭘہ ﺟﮩﺎں ﻟﻮﮔﻮں ﮐﺎ ﺣﺠﻮم ﮨﻮ ﻧﮩﯿﮟ ﺟﺎ ﻧﺎ ﭼﺎﮨﯿﮯ۔اور اﯾﮏ اﻧﺘﮩﺎﺋﯽ ﺿﺮوری اﺣﺘﯿﺎط 11 ، ﮔﮭﺮ آ ﮐﺮ ﺳﺐ ﺳﮯ ﭘﮩﻠﮯ اﭘﻨﮯ ﮨﺎﺗﮭﻮں ﮐﻮ ﺻﺎﺑﻦ ﺳﮯ 20ﺳﯿﮑﻨﮉ ﺗﮏ ﻻزﻣﯽ اﭼﮭﯽ طﺮح ﺳﮯ دھﻮﺋﯿﮟ۔ 12 13 اﮔﺮ آﭘﮑﻮ ﯾﺎ ﮔﮭﺮ ﻣﯿﮟ ﮐﺴﯽ اور ﮐﻮ اس وﺑﺎ ﮐﮯ ﻋﻼﻣﺎت ظﺎﮨﺮ ﮨﻮ ﺗﻮ ا ٓﭘﻨﮯ آپ ﮐﻮ ﺳﺐ ﺳﮯ ﻋﻠﯿﺪه ﮐﺮ ﻟﮯ، ﺧﺎص طﻮر ﭘﺮ ﺑﭽﻮں اور ذﯾﺎده ﻋﻤﺮ ﮐﮯ - 14 اﻓﺮاد ﺳﮯ دور رﮨﯿﮟ، ﺗﺎﮐہ ﺑﯿﻤﺎری آپ ﺳﮯ دوﺳﺮوں ﺗﮏ ﻧہ ﭘﮩﻨﭽﮯ۔ﺑﯿﻤﺎری ﮐﯽ ﺻﻮرت ﻣﯿﮟ ﺣﮑﻮﻣﺖ ﮐﮯ ﺑﺘﺎﺋﮯ ﮨﻮﺋﮯ ﺳﻨﮣﺮز ﺳﮯ راﺑﻄہ ﮐﯿﺎ ﺟﺎ 15 ﺳﮑﺘﺎ ﮨﮯ۔ For peer review only 16 17 18 19 20
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44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 84 of 95
1 2 3 4 Appendix E 5 6 Content guide for community health workers for health literacy training for 7 hygiene and sanitation 8 9 10 11 Guide for weekly & Monthly meetings 12 13 14 Tips to keep house clean 15 16 • Clean and mopFor the house dapeerily review only 17 • Add Dettol or any disinfectant in water while mopping the house 18 • Clean washroom/Toilet with disinfectant everyday 19 • Do away with the trash and impurities 20 • 21 Cover up the trash carefully or dispense it with the garbage collector. 22 • Check your bedsheet before spreading it on the bed. 23 • Put out your comforters, bedspread and quilts out in the sunlight from time to time 24 • Wash your hands with soap after doing chores. 25 26 Tips to keep kitchen area clean 27 • Clean your utensils and pots every time you use them 28 • Keep your washed pots covered 29 • Wash the cloth you use to clean the kitchen 30 • 31 Secure the peels from vegetables and other trash 32 • Keep kitchen dry 33 • Please keep your wok and the seat clean at all times. 34 • Use sprays to keep the kitchen clear of mosquitoes and insects 35 • Tips to observe food hygiene 36 • Use different set of cups, plates and spoons for family members 37 • Boil the water before using it 38 • Eat freshly prepared food every day. 39 • Keep water and food covered 40 • Heat up the food before eating 41 • Avoid street food 42 • ۔Wash vegetables and fruits before eating 43 44 • Do not consume left over food. 45 • Keep edible food away from the trash can. 46 • Secure the leftovers properly and store an airy place 47 48 Tips for Personal hygiene 49 • Take shower daily and use soap 50 • Wash your hands before and after eating with soap 51 • 52 Wash your hands before touching anything, e.g: before and after ironing, preparing food, entering the 53 house, meeting someone upon your return to the house etc. 54 • Wash your clothes upon your return to home. 55 • Use washed towel and wash towels in disinfectants 56 • Put out the towel in sunlight to dry 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 85 of 95 BMJ Open
1 2 3 • Keep a separate towel for every family member 4 • Keep a separate bed, quilt and pillow for every member of the family 5 • Do not use clothes without washing 6 • 7 Wash your bed linen with disinfectants 8 • Brush your teeth daily or use “Miskak” 9 • Clip your nails weekly and keep them clean 10 • Take shower daily and keep your hair clean 11 12 Tips for illness and its treatment 13 • Consult doctor before using medicine 14 • Keep medicine in a dry and cold place 15 • Do not take food on empty stomach 16 • For peer review only 17 Keep medicines away from the reach of children 18 • Avoid unnecessary gaps in taking medicine 19 • Rest properly and eat well. 20 • Before taking medicine check its expiry date 21 22 ﮔﮉی ﺑﺎﺟﯿﻮں ﮐﮯ ﻟﺌﮯ ﺣﻔﻈﺎن ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻣﻮاد 23 24 25 26 (ﮨﻔﺘہ وار اﻧﻔﺮادی اور ﻣﺎﮨﺎﻧہ ﮔﺮوپ ﻣﻼﻗﺎت ﮐﮯ ﻟﺌﮯ) 27 28 ﮔﮭﺮ ﮐﯽ ﺻﻔﺎﺋﯽ 29 30 روزاﻧہ ﮔﮭﺮ ﻣﯿﮟ ﺟﮭﺎڑو ﭘﻮﭼﺎ ﮐﺮﯾﮟ ۔ 31 32 ﭘﻮﭼﺎ ﻟﮕﺎﺗﮯ وﻗﺖ ﭘﺎﻧﯽ ﻣﯿﮟ ﯾڈ ﮣﻮل ﯾﺎ ﺟﺮاﺛﯿﻢ ﮐﺶ دوا ﺷﺎﻣﻞ ﮐﺮﯾﮟ۔ 33 34 ﺖﯿﺑﺎﺗﮭ روم اور ﺑ ﻢﯿاﻟﺨﻼ ﮐﻮ ﺟﺮاﺛ ُﮐﺶ دوا ﺳﮯ ﺻﺎف ﮐﺮﻧﺎ 35 36 ﮐﭽﺮے ﮐﻮ ﮢﮭﮑﺎﻧﮯ ﻟﮕﺎﯾﮟ اور ﻣﮑﺎن ﮐﮯ ﻓﻀﻠہ ﮐﺎ اﻧﺘﻈﺎم ﮐﺮﯾﮟ 37 38 ﮐﭽﺮے ﮐﻮ ڈھﺎﻧﭗ ﮐﺮ ﮐﭽﺮا ﺟﻤﻊ ﮐﺮﻧﮯ ﮐﮯ ﻣﻘﺎم ﭘﺮ رﮐﮭﯿﮟ ﯾﺎ ﮐﭽﺮا ﺟﻤﻊ ﮐﺮﻧﮯ واﻟﮯ ﮐﻮ دﯾﮟ 39 40 ﭼﺎدرﯾﮟ ﺟﮭﺎڑ ﮐﺮ ﺑﭽﮭﺎﺋﯿﮟ۔ 41 42 ﮔﺪے ﮐﻤﺒﻞ اور رﺿﺎﺋﯿﻮں ﮐﻮ دھﻮپ ﻟﮕﻮاﺋﯿﮟ 43 اس ﮐﺎم ﮐﻮ ﻣﮑﻤﻞ ﮐﺮ ﮐﮯ ﺻﺎﺑﻦ ﮐﮯ ﺳﺎﺗﮭ اﭼﮭﯽ طﺮح ﮨﺎﺗﮭ ﻣﻨہ دھﻮﺋﯿﮟ۔ 44 45 ﮐﭽﻦ ﮐﯽ ﺻﻔﺎﺋﯽ 46 47 ﮐﮭﺎﻧﮯ اور ﭘﯿﻨﮯ ﮐﮯ ﺑﺮﺗﻦ اور ﭼﻤﭽﻮں ﮐﻮ ﮨﺮ ﺑﺎر اﺳﺘﻌﻤﺎل ﮐﮯ ﺑﻌﺪ ﺻﺎﺑﻦ ﺳﮯ دھﻮﺋﯿﮟ۔ 48 49 دھﻮﻧﮯ ﮐﮯ ﺑﻌﺪ ﺑﺮﺗﻮں ﮐﻮ ڈھﺎﻧﭗ ﮐﺮ رﮐﮭﯿﮟ۔ 50 51 ﮐﭽﻦ ﻣﯿﮟ اﺳﺘﻌﻤﺎل ﮨﻮﻧﮯ واﻟﮯ ﮐﭙﮍوں ﮐﻮ روزاﻧہ دھﻮﺋﯿﮟ اور دھﻮپ ﻣﯿﮟ ﺳﮑﮭﺎﺋﯿﮟ۔ 52 53 ﺳﺒﺰی ﮐﮯ ﭼﮭﻠﮑﻮں اور دﯾﮕﺮ ﮐﻮڑے ﮐﻮ ڈھﺎﻧﭗ ﮐﺮ رﮐﮭﯿﮟ اور ﺟﻠﺪ از ﺟﻠﺪ ﮢﮭﮑﺎﻧﮯ ﻟﮕﺎﺋﯿﮟ۔ 54 55 ﮐﭽﻦ ﻣﯿﮟ ﭘﺎﻧﯽ ﮐﮭﮍا ﻧہ ﮨﻮﻧﮯ دﯾﮟ۔ 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 86 of 95
1 2 ﭼﻮﻟہ اور اس ﮐﯽ ﭼﻮﮐﯽ ﺻﺎف رﮐﮭﯿﮟ۔ 3 4 ﺑﺎورﭼﯽ ﺧﺎﻧﮯ ﮐﻮ ﻣﮑﮭﯽ ﻣﭽﮭﺮ اور دﯾﮕﺮ ﮐﯿﮍے ﻣﮑﻮڑوں ﺳﮯ ﭘﺎک رﮐﮭﯿﮟ۔ 5 6 ﺧﻮراک ﮐﯽ ﺻﻔﺎﺋﯽ 7 8 ﮔﮭﺮﯾﻠﻮ اﻓﺮاد ﮐﮯ ﻟﺌﮯ ﭘﯿﻨﮯ ﮐﮯ ﮐﭗ ، ﭘﻠﯿﭧ اور ﭼﻤﭻ ﮐﻮ اﻟﮓ ﮐﺮﯾﮟ۔ 9 10 ﭘﯿﻨﮯ ﺳﮯ ﭘﮩﻠﮯ ﭘﺎﻧﯽ ﮐﺎ اﺑﺎﻟﯿﮟ۔ 11 12 روزاﻧہ ﺗﺎزه ﮐﮭﺎﻧﺎ ﺗﯿﺎر ﮐﺮﯾﮟ۔ 13 14 ﮐﮭﺎﻧﮯ اور ﭘﺎﻧﯽ ﮐﻮ ڈھﺎﻧﭗ ﮐﺮ رﮐﮭﯿﮟ۔ 15 16 For peer review only ﮐﮭﺎﻧﺎ ﮔﺮم ﮐﺮ ﮐﮯ ﮐﮭﺎﺋﯿﮟ۔ 17 18 ﺑﺎزار ﮐﮯ ﮐﮭﺎﻧﮯ ﺳﮯ ﭘﺮﮨﯿﺰ ﮐﺮﯾﮟ۔ 19 20 ﭘﮭﻞ اور ﺳﺒﺰﯾﺎں دھﻮ ﮐﺮ اﺳﺘﻌﻤﺎل ﮐﺮﯾﮟ۔ 21 ﺧﻮراک ﮐﻮ ﮐﭽﺮے ﮐﮯ ڈﺑﮯ ﺳﮯ دور رﮐﮭﯿﮟ۔ 22 23 اﮔﺮ ﮐﮭﺎﻧﺎ ﺑﭻ ﺟﺎﺋﮯ ﺗﻮ ڈھﺎﻧﭗ ﮐﺮ ﮨﻮادار ﺟﮕہ ﭘﺮ رﮐﮭﯿﮟ۔ 24 25 اﯾﮏ دوﺳﺮے ﮐﺎ ﺟﻮﮢﮭﺎ ﮐﮭﺎﻧﺎ ﻧہ ﮐﮭﺎﺋﯿﮟ۔ 26 27 زاﺗﯽ ﺻﻔﺎﺋﯽ 28 29 ﺻﺎﺑﻦ ﺳﮯ روزاﻧہ ﻧﮩﺎﻧﺎ 30 31 ﮐﮭﺎﻧﮯ ﺳﮯ ﭘﮩﻠﮯ اور ﺑﻌﺪ ﻣﯿﮟ ﮨﺎﺗﮭ دھﻮﯾﮟ 32 33 ﮐﺴﯽ ﺑﮭﯽ ﭼﯿﺰ ﮐﻮ ﭼﮭﻮﻧﮯ ﺳﮯ ﭘﮩﻠﮯ اورﺑﻌﺪ ﻣﯿﮟ ﮨﺎﺗﮭ دھﻮﻧﺎ ﺟﯿﺴﮯ ﮐﭙﮍے اﺳﺘﺮی ﮐﺮﻧﺎ ، ﮐﮭﺎﻧﺎ ﺗﯿﺎر ﮐﺮﻧﮯ ﺳﮯ ﭘﮩﻠﮯ ، 34 ﮔﮭﺮ ﻟﻮﮢﻨﮯ ﮐﮯ ﺑﻌﺪ ، ﮨﺎﺗﮭ ﭼﮭﻮﻧﮯ / ﻣﻼﻧﮯ ﮐﮯ ﺑﻌﺪ وﻏﯿﺮه 35 36 ﮐﭙﮍے دھﻮﺋﯿﮟ اور ﺟﺮاﺛﯿﻢ ﮐﺸﯽ ﮐﺮﺋﯿﮟ ﺧﺎص طﻮر ﭘﺮ ﺟﺐ ﮐﭙﮍے ﺑﺎﮨﺮ ﭘﮩﻨﮯ ﮨﻮں۔ 37 38 ﺗﻮﻟ ﮯﯿ دھﻮﻧﺎ اور ﺟﺮاﺛ ﻢﯿ ُﮐﺶ دوا ﺳﮯ ﺻﺎف ﮐﺮﯾﮟ۔ 39 40 اﺳﺘﻌﻤﺎل ﮐﮯ ﺑﻌﺪ ﭘﻮﻟﯿﮯ ﮐﻮ دھﻮپ ﻣﯿﮟ ﺳﮑﮭﺎﺋﯿﮟ۔ 41 42 ﺧﺎﻧﺪان ﮐﮯ ﮨﺮ ﻓﺮد ﮐﮯ ﻟﺌﮯ ﺗﻮﻟ ﮯﯿ اﻟﮓ ﮐﺮﯾﮟ۔ 43 44 ﮔﮭﺮ ﮐﮯ ﮨﺮ ﻓﺮد ﮐﮯ ﻟﯿﮯ ﺑﺴﺘﺮ، ﭼﺎدر، ﮐﻤﺒﻞ، اور ﺗﮑﯿہ اﻟﮓ ﻣﻘﺮر ﮐﺮﯾﮟ۔ 45 46 ﺑﻨﺎ دھﻮﺋﮯ اﯾﮏ دوﺳﺮے ﮐﮯ ﮐﭙﮍے اﺳﺘﻌﻤﺎل ﻧہ ﮐﺮﯾﮟ۔ 47 48 ﺑﺳﺗر ﮐﯽ ںﯾﭼﺎدر دھوﻧﺎ، ﺟراﺛﯾم ﺳﮯ ﭘﺎک ﮐﺮﯾﮟ۔ 49 50 داﻧﺘﻮں ﮐﻮ ﺑﺮش ﯾﺎ ﻣﺴﻮاک ﮐﺮﻧﺎ اور ﻣﻨہ ﮐﯽ ﺻﻔﺎﺋﯽ ﮐﺮﯾﮟ۔ 51 52 ﻧﺎﺧﻦ ﺻﺎف ﮐﺮﻧﺎ اورﮨﻔﺘہ وار ﺗﺮاﺷﯿﮟ۔ 53 ﺑﺎﻗﺎﺋﺪﮔﯽ ﺳﮯ ﻧﮩﺎﺋﯿﮟ اور ﺳﺮ ﮐﻮ ﺻﺎف رﮐﮭﯿﮟ۔ 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 87 of 95 BMJ Open
1 2 ﺑﯿﻤﺎری اور دوا ﮐﺎ اﺳﺘﻌﻤﺎل 3 4 دوا ڈاﮐﮣﺮ ﮐﮯ ﻣﺸﻮرے ﺳﮯ اﺳﺘﻌﻤﺎل ﮐﺮﯾﮟ۔ 5 دوا ﮢﮭﻨﮉی اور ﺧﺸﮏ ﺟﮕہ ﭘﺮ رﮐﮭﯿﮟ۔ 6 دوا ﺧﺎﻟﯽ ﭘﯿﭧ اﺳﺘﻌﻤﺎل ﻧہ ﮐﺮﯾﮟ۔ 7 دوا ﺑﭽﻮں ﮐﯽ ﭘﮩﻨﭻ ﺳﮯ دور رﮐﮭﯿﮟ۔ 8 9 دوا ﻣﯿﮟ ﻧﺎﻏہ ﻧہ ﮐﺮﯾﮟ۔ 10 آرام اور ﺧﻮراک ﮐﺎ ﺧﯿﺎل رﮐﮭﯿﮟ۔ 11 ﮔﮭﺮ ﻣﯿﮟ ﭘﮍی دوا ﮐﻮ اس ﮐﯽ ﻣﻌﯿﺎد ﺟﺎﻧﮯ ﺑﻐﯿﺮ اﺳﺘﻌﻤﺎل ﻧہ ﮐﺮﯾﮟ۔ 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 88 of 95
1 2 3 4 Appendix F 5 6 Content for CHW – Coronavirus awareness and prevention 7
8 • 9 Corona Virus: Corona Virus is a disease that affects breathing severely, some of the symptoms are cough, 10 fever and flu. It is a viral infection that can affect anyone regardless of their age. 11 • How does Corona virus spread: The virus is transmitted through direct contact with respiratory droplets 12 of an infected person (generated through coughing and sneezing. Individuals can also be infected from and 13 touching surfaces contaminated with the virus and touching their face (e.g., eyes, nose, mouth). Close 14 contact with e infected person 15 • Symptoms: It can take up to 14 days to for the symptoms in an infected person to show. Cough, Difficulty 16 in breathing, fever,For sour throat peer review only 17 • People who are more likely to be infected easily: Cancer patient, heart patient, diabetic, Aged people- (50 18 and above), With lung disease, People with hyper tension 19 • Preventive measures against Corona: Avoid crowded places, Wear a Mask, Cover your face while 20 sneezing or coughing, Avoid visiting unwell people, Wash your hands for 20 seconds, Reach out to a 21 doctor if you are feeling unwell, Avoid contacting animals, Avoid hugging people or shaking hands 22 • Misconceptions about Corona Virus: Corona virus does not spread due to mosquito, Antibiotics can not 23 help with this virus, taking shower with hot water cannot save you from virus, Research still has not proved 24 that garlic can help save people from this virus 25 • Instructions 26 Guddi bajis will visit the areas allocated them on daily basis 27 o Please wear masks and gloves when you leave the house. 28 o 29 o While visiting people house, you will have discussion on general health issues and corona virus as 30 well. 31 o Please maintain 6 feet distance while mingling with people 32 o While visiting places, you are given instructions regarding croronavirus, please follow them to 33 keep your self safe from the infection. 34 • Instructions on how to give out information on health 35 o Group gatherings: 36 o Wear masks and gloves 37 o 6 feet distance markers must be placed in the place of gathering 38 o Please ask women to sit in the place marked for them and make sure 6 feet distance between them 39 o While holding discussion on general women health, please also spread awareness about Corona 40 Virus and its preventive measures 41 o Care during visits to Homes to impart health related information 42 o Wear masks and gloves 43 o Avoid hugging or hand shaking with the client 44 o Put 6 feet marker if a gathering is required 45 o Please ask women to sit in the place marked for them and make sure 6 feet distance between them 46 o While holding discussion on general women health, please also spread awareness about Corona 47 Virus and its preventive measures 48 instructions for visits to homes to impart health related information: 49 o o Wear masks and gloves 50 Avoid hugging or hand shaking with the client 51 o Put 6 feet marker if a gathering is required 52 o Before entering a house please ensure: 53 o No one in the house has COVID-19 or one or more symptoms 54 o If anyone has symptoms, please maintain 6 feet distance, cover up your face with something 55 o 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 89 of 95 BMJ Open
1 2 3 o Please share with them information regarding Corona & ask them to Quarantine ( information 4 regarding quarantine has been shared on your tablet) 5 o If no symptoms, then: 6 Stay 6 feet away while holding discussions 7 o While holding discussion on general health issues, please also spread awareness about Corona 8 o Virus and its preventive measure 9 • Instructions for video consultations 10 If there are Corona related Symptoms, please observe: 11 o 12 o If anyone has symptoms, please maintain 6 feet distance, cover up your face with something 13 o Register them on clickmedix 14 o While talking to the doctor, please tell them about the situation of the patient yourself, and pass on 15 to the patients the instructions doctors provide. 16 o In caseFor doctors wants peer to talk to patientsreview please observe theonly following: 17 o If you have gloves, please share it with them 18 o Once the consultation sessions, please clean the tablet with the alcohol wipes given to you 19 o Please discard your gloves carefully 20 o Wash your hands and wear gloves 21 o Help patient understand how to quarantine 22 o If there are no corona virus symptoms: 23 o Maintain 6 feet distance while holding discussions 24 o Ask people to cover up their face and nose. 25 o Please register them with clickmedix 26 o While talking to the doctor, please tell them about the situation of the patient yourself, and pass on 27 to the patients the instructions doctors provide. 28 o In case doctors wants to talk to patients please observe the following: 29 o If you have gloves, please share it with them 30 o Once the consultation sessions, please clean the tablet with the alcohol wipes given to you 31 o Please discard your gloves carefully 32 Wash your hands and wear gloves 33 o o Help patient understand how to quarantine 34 Instructions for video consultations from home 35 o 36 37 38 39 ﮐﺮوﻧﺎ واﺋﺮس : اﯾﮏ اﯾﺴﯽ ﺑﯿﻤﺎری ﮨﮯ ﺟﻮ ﺳﺎﻧﺲ ﮐﻮ ﺷﺪﯾﺪ طﻮر ﭘﺮ ﻣﺘﺎﺛﺮ ﮐﺮﺗﯽ ﮨﮯ اس ﮐﯽ ﮐﭽﮭ ﻋﻼﻣﺎت ﮐﮭﺎﻧﺴﯽ ، ﺑﺨﺎر اور ﻓﻠﻮ ﮨ ﮟﯿ ۔ ہﯾ ﮏﯾا واﺋﺮل 40 اﻧﻔﯿﮑﺸﻦ ﮨﮯ ﺟﻮ ﻋﻤﺮ ﺳﮯ ﻗﻄﻊ ﻧﻈﺮ ﮐﺴﯽ ﺑﮭﯽﮐﻮ ﻣﺘﺎﺛﺮ ﮐﺮ ﺳﮑﺘﯽ ﮨﮯ ۔ 41 واﺋﺮس ﮐﯿﺴﮯ ﭘﮭ ﺘﻠﯿ ﺎ ﮨﮯ : واﺋﺮس ا ﮏﯾ ﻣﺘﺎﺛﺮه ﺷﺨﺺ ﮐﯽ ﮐﮭﺎﻧﺴﯽ ﯿاور ﭼﮭ ﻨﮏ ﮐﮯ ذرﯾﻌﮯ ﯿﭘ ﺪا ﮨﻮﻧﮯ واﻟﮯ ﻗﻄﺮه ﮐﮯ ﺳﺎﺗﮭ ﺑﺮاه راﺳﺖ راﺑﻄﮯ ﮐﮯ 42 ذرﯾﻌﮯ ﻣﻨﺘﻘﻞ ﮨﻮ ﺟﺎﺗﺎ ﮨﮯ۔ اﮔﺮ وارس ﺳﮯ آﻟﻮده ﺳﻄﺢ ﮐﻮ ﻣﺲ ﮐﺮﻧﮯ ﮐﮯ ﺑﻌﺪ ﭼﮩﺮے، ﻣﻨہ اور آﻧﮑﮭ ﮐﻮ ﮨﺎﺗﮭ ﻟﮕﺎﯾﺎ ﺟﺎﺋﮯ ﺗﻮ ﯾﻮں ﺑﮭﯽ وارس ﻣﻨﺘﻘﻞ ﮨﻮ 43 ﺳﮑﺘﺎ ﮨﮯ۔ ﻣﺘﺎﺛﺮه ﺷﺨﺺ ﮐﮯ ﺳﺎﺗﮭ ﻗﺮ ﯽﺒﯾ راﺑﻄﮯﺳﮯ ﺑﮭﯽ ۔ 44 45 ﻋﻼﻣﺎت :ﻣﺘﺎﺛﺮه ﺷﺨﺺ ﻣﯿﮟ ﻋﻼﻣﺎت ظﺎﮨﺮ ﮨﻮﻧﮯ ﮐﮯ ﻟﺌﮯ 14 دن ﺗﮏ ﻟﮓ ﺳﮑﺘﮯ ﮨ ﮟﯿ ۔ﯾہ ﮐﮭﺎﻧﺴﯽ ، ﺳﺎﻧﺲ ﻟﯿﻨﮯ ﮟﯿﻣ دﺷﻮاری ، ﺑﺨﺎر ، ﮔﻠﮯ ﻣﯿﮟ درد 46 ﮨﻮ ﺳﮑﺘﯽ ﮨﯿﮟ۔ 47 48 وه ﻟﻮگ ﺟﻮ آﺳﺎﻧﯽ ﺳﮯ ﻣﺘﺎﺛﺮ ﮨﻮ ﺘﮑﺳ ﮯ ﮨ ﮟﯿ : ﯿﮐ ﻨﺴﺮ ﻣﺮ ﺾﯾ ، دل ﮐﮯ ﻣﺮ ﺾﯾ ﯾ، ذ ﺎﺑﯿﻄﺲ ﮐﮯ ﻣﺮﯾﺾ ﺑﮍی، ﻋﻤﺮ ﮐﮯ ﻟﻮﮔﻮں (- 50 اور اس ﺳﮯ 49 اوﭘﺮ) ، ﭘﮭﯿﭙﮭﮍوں ﯽﮐ ﯿﺑ ﻤﺎری ﮐﺎ ﺷﮑﺎر ، اور ﺑﻠﮉ ﭘﺮﯾﺸﺮ ﮐﮯ ﻣﺮﯾﺾ۔ 50 51 ﮐﺮوﻧﺎ ﮐﮯ ﺧﻼف ﺣﻔﺎظﺘﯽ اﻗﺪاﻣﺎت: ﺑﮭ ﮍﯿ ﯽﮐ ﺟﮕﮩﻮں ﺳﮯ ﺑﭽ ﮟﯿ ، ﻣﺎﺳﮏ ﭘﮩﻨ ﮟﯿ ، اﭘﻨﮯ ﭼﮩﺮے ﮐﻮ ﭼﮭﯿﻨﮏ ﺎﯾ ﮐﮭﺎﻧﺴﯽ ﮐﮯ دوران ڈھﺎﻧﭗ ﻟ ﮟﯿ ، ﺑﯿﻤﺎر 52 ﻟﻮﮔﻮں ﮐﻮ ﻣﻠﻨﮯ ﺳﮯ ﺑﭽﯿﮟ ، اﭘﻨﮯ ﮨﺎﺗﮭﻮں ﮐﻮ 20 ﯿﺳ ﮑﻨﮉ ﺗﮏ دھﻮﺋﯿﮟ ، اﮔﺮ آپ ﺑﯿﻤﺎری ﻣﺤﺴﻮس ﮐﺮ رﮨﮯ ﮨ ﮟﯿ ﺗﻮ ڈاﮐﮣﺮ ﺳﮯ راﺑﻄہ ﮐﺮ ﮟﯾ ، اس ﺳﮯ 53 ﺑﭽﻨﮯ ﮐﮯ ﻟﮱ ، ﻟﻮﮔﻮں ﺳﮯ ﮨﺎﺗﮭ ﻣﻼ ﮯﻧ اور ﻣﻠﻨﮯﮔﻠﮯ ﺳﮯ ﺑﭽ ۔ﮟﯿ 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 90 of 95
1 2 ﮐﺮوﻧﺎ ﮐﮯ ﺣﻮاﻟﮯ ﺳﮯ ﻣﺘﻌﻠﻖ َﺷﺒﮩﺎت : واﺋﺮس ﮐﻮ ﻣﭽﮭﺮ ﮐﯽ وﺟہ ﺳﮯ ﻧﮩ ﮟﯿ ﭘﮭ ﻠﯿ ﺘﺎ ، اﯾﻨﮣﯽ ﺑﺎﺋﯿﻮﮢﮏ اس واﺋﺮس ﮐﮯ ﺧﻼف ﻣﺪد ﮔﺎر ﻧﮩ ﮟﯿ ، ﮔﺮم ﭘﺎﻧﯽ 3 ﮐﮯ ﺳﺎﺗﮭ ﺷﺎور ﻟﯿﻨﮯ ﺳﮯ آپ واﺋﺮس ﺳﮯ ﺑﭻ ﻧﮩ ﮟﯿ ﺳﮑﺘﮯ ، ﺗﺤﻘ ﻖﯿ ﺳﮯ اﺑﮭﯽ ﺗﮏ ہﯾ ﺛﺎﺑﺖ ﻧﮩ ﮟﯿ ﮨﻮﺗﺎ ﮐہ ﻟﮩﺴﻦ ﻟﻮﮔﻮں ﮐﻮ اس واﺋﺮس ﺳﮯ ﺑﭽﺎﻧﮯ ﻣ ﮟﯿ 4 ﯽﻣﺪد ﻣﻞ ﺳﮑﺘ ﮨﮯ۔ 5 6 ﮨﺪاﯾﺎت: 7 8 ﮔﻮڈی ﺑﺎﺟﯽ ﻣﺨﺘﺺ ﮐﺮده ﻋﻼﻗﻮں ﻣﯿﮟ روزاﻧہ ﮐﯽ ﺑﻨ ﺎدﯿ ﭘﺮ ﺟﺎﺋﯿﮟ ﮔﯽ۔ 9 10 ﺟﺐ آپ ﮔﮭﺮ ﺳﮯ ﺑﺎﮨﺮ ﺟﺎﺋﯿﮟ ﺗﻮ ﺑﺮاه ﻣﮩﺮﺑﺎﻧﯽ ﻣﺎﺳﮏ اور دﺳﺘﺎﻧﮯ ﭘﮩﻨ ۔ﮟﯿ 11 ﻟﻮﮔﻮں ﮐﮯ ﮔﮭﺮ ﮐﺎ دوره ﮐﺮﺗﮯ ﮨﻮﺋﮯ ، آپ ﮐﻮ ﻋﺎم ﺻﺤﺖ ﮐﮯ ﻣﺴﺎﺋﻞ اور ﮐﺮوﻧﺎ واﺋﺮس ﭘﺮ ﺑﮭﯽ ﺑﺎت ﭼﯿﺖ ﮐﺮﻧﺎ ﮨﻮﮔ ۔ﯽ 12 13 ﻟﻮﮔﻮں ﮐﮯ ﺳﺎﺗﮭ ﻣﯿﻞ ﻣﻼﻗﺎت ﮐﺮﺗﮯ ﮨﻮﺋﮯ 6 ﻓﻮٹ ﮐﺎ ﻓﺎﺻﻠہ ﺑﺮﻗﺮار رﮐﮭ ۔ﮟﯿ 14 15 واﺋﺮس ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ ﺟﻮ ﯾﮨﺪا ﺎت ید ﺟﺎﺗﯽ ﮟﯿﮨ ، ﺑﺮاه ﮐﺮم ان ﮐﯽ ﯿﭘ ﺮوی ﮐﺮ ﮟﯾ ﺗﺎﮐہ دوره ﮐﺮﺗﮯ ﮨﻮﺋﮯ آپ ﺧﻮد ﮐﻮ اﻧﻔﯿﮑﺸﻦ ﺳﮯ ﻣﺤﻔﻮظ رﮐﮭ ۔ﮟﯿ 16 For peer review only ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻣﻌﻠﻮﻣﺎت دﯾﻨﮯ ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ ﮨﺪاﯾﺎت 17 18 ﮔﺮوپ ﮐﮯ اﺟﺘﻤﺎﻋﺎت 19 20 ﻣﺎﺳﮏ اور دﺳﺘﺎﻧﮯ ﭘﮩﻨ ۔ﮟﯿ 21 اﺟﺘﻤﺎع ﮐﯽ ﺟﮕہ 6 ﻓﭧ ﻓﺎﺻﻠہ رﮐﮭﻨﮯ ﮐﮯ ﻟﯿﮯ ﻧﺸﺎن دﮨﯽ ﮐﺮﻧﺎ ﺿﺮوری ﮨﮯ۔ 22 23 ﺑﺮاه ﮐﺮم ﺧﻮاﺗ ﻦﯿ ﺳﮯ ﮐﮩﯿﮟ ﮐہ ان ﮐﮯ ﻟﺌﮯ ﻧﺸﺎن ﻟﮕﺎ د ﺎﯾ ﺎﯿﮔ ﮨﮯ اور وه اس ﺟﮕہ ﭘﺮ ﺑﯿﮣﮭﯿﮟ اس ﺑﺎت ﮐﺎ ﻦﯿﻘﯾ ﮐﺮﯾﮟ ان ﮐﮯ درﻣﯿﺎن 6 ﻓﭧ ﮐﺎ ﻓﺎﺻﻠہ 24 ﮨﮯ۔ 25 26 ﺧﻮاﺗ ﻦﯿ ﯽﮐ ﻋﺎم ﺻﺤﺖ ﭘﺮ ﺑﺤﺚ ﮐﺮﺗﮯ ﮨﻮﺋﮯ ، ﺑﺮاه ﮐﺮم ﮐﺮوﻧﺎ واﺋﺮس اور اس ﮐﮯ ﺣﻔﺎظﺘﯽ اﻗﺪاﻣﺎت ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ آﮔﺎﮨﯽ ﺑﮭﯽ ﭘﮭ ﻼﯿ ﺋﯽ ﺟﺎﺋﮯ ۔ 27 28 ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻣﻌﻠﻮﻣﺎت ﻓﺮاﮨﻢ ﮐﺮﻧﮯ ﮐﮯ ﻟﺌﮯ ﮔﮭﺮوں ﮐﮯ دوروں ﮐﮯ دوران دﯾﮑﮭ ﺑﮭﺎل اور ﺧﯿﺎل۔ 29 ﮐﻼﺋﻨﭧ ﮐﮯ ﺳﺎﺗﮭ ﮔﻠﮯﻣﻠﻨﮯ ﺎﯾ ﮨﺎﺗﮭ ﻣﻼﻧﮯ ﺳﮯ ﺑﭽ ۔ﮟﯿ 30 31 اﮔﺮ ا ﮏﯾ اﺟﺘﻤﺎع ﮐﯽ ﺿﺮورت ﮨﻮ ﺗﻮ 6 ﻓﭧ ﻓﺎﺻﻠﮯ ﮐﯽ ﻧﺸﺎﻧﺪﮨﯽ ﮐﺮﯾﮟ۔ 32 33 ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﻣﻌﻠﻮﻣﺎت ﮐﮯ ﺣﺼﻮل ﮐﮯ ﻟ ﮯﯿ ﮔﮭﺮوں ﮐﮯ دوره ﮐﮯ ﻟ ﮯﯿ ﮨﺪاﯾﺎت 34 ﻣﺎﺳﮏ اور دﺳﺘﺎﻧﮯ ﭘﮩﻨ ۔ﮟﯿ 35 36 ﮐﻼﺋﻨﭧ ﮐﮯ ﺳﺎﺗﮭ ﮔﻠﮯﻣﻠﻨﮯ ﺎﯾ ﮨﺎﺗﮭ ﻣﻼﻧﮯ ﺳﮯ ۔ﮟﯿﺑﭽ 37 38 اﮔﺮ ا ﮏﯾ اﺟﺘﻤﺎع ﮐﯽ ﺿﺮورت ﮨﻮ ﺗﻮ 6 ﻓﭧ ﻓﺎﺻﻠﮯ ﮐﯽ ﻧﺸﺎﻧﺪﮨﯽ ﮐﺮﯾﮟ۔ 39 ﮐﺴﯽ ﮔﮭﺮ ﻣ ﮟﯿ داﺧﻞ ﮨﻮﻧﮯ ﺳﮯ ﭘﮩﻠﮯ ﺑﺮاه ﻣﮩﺮﺑﺎﻧﯽ ﯽﻨﯿﻘﯾ ﺑﻨﺎﺋﯿﮟ ﮐہ: 40 41 ﮔﮭﺮ ﻣ ﮟﯿ ﮐﻮﺋﯽ ﺑﮭﯽ ﮐﺮوﻧﺎ ﮐﺎ ﺷﮑﺎر ﻧﮩﯿﮟ ﮨﮯ اور ﻧہ ﮨﯽ ﮐﺴﯽ ﻣﯿﮟ ﮏﯾا ﺎﯾ اس ﺳﮯ زﯾﺎده ﻋﻼﻣﺎت ﮨﯿﮟ 42 43 اﮔﺮ ﮐﺴﯽ ﻣﯿﮟ ﮐﺮوﻧﺎ ﻋﻼﻣﺎت ﮨ ﮟﯿ ، ﺗﻮ ﺑﺮاه ﮐﺮم 6 ﻓﭧ ﻓﺎﺻﻠﮯ ﮐﻮ ﺑﺮﻗﺮار رﮐﮭ ﮟﯿ ، اور اﭘﻨﮯ ﭼﮩﺮے ﮐﻮڈھﺎﻧﭗ ﻟ ۔ﮟﯿ 44 45 ان ﮐﻮ ﮐﺮوﻧﺎ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﻣﻌﻠﻮﻣﺎت ﮟﯾد اورﻗﺮﻧﻄﯿﻨہ ﮐﺮﻧﮯ ﮐﺎ ﮐﮩﯿﮟ۔ ﻗﺮﻧﻄﯿﻨہ ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ ﻣﻌﻠﻮﻣﺎت آپ ﮐﯽ ﯿﮢ ﺒﻠﭧ ﭘﺮ دی ﮔﺌﯽ ﮨﯿﮟ۔ 46 اﮔﺮ ﮐﻮﺋﯽ ﻋﻼﻣﺎت ﻧﮩ ﮟﯿ ﺗﻮ: 47 48 ﻣﺬاﮐﺮات ﮐﮯ اﻧﻌﻘﺎد ﮐﮯ دوران 6 ﻓﭧ ﮐﺎ ﻓﺎﺻﻠہ رﮐﮭ ۔ﮟﯿ 49 50 ﻋﺎم ﺻﺤﺖ ﭘﺮ ﺑﺤﺚ ﮐﺮﺗﮯ ﮨﻮﺋﮯ ، ﺑﺮاه ﮐﺮم ﮐﺮوﻧﺎ واﺋﺮس اور اس ﮐﮯ ﺣﻔﺎظﺘﯽ اﻗﺪاﻣﺎت ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ آﮔﺎﮨﯽ ﺑﮭﯽ ﭘﮭ ﻼﯿ ﺋﯽ ﺟﺎﺋﮯ ۔ 51 ﻮﯾﮉﯾو ﻣﺸﺎورت ﮐﮯ ﻟﺌﮯ ﮨﺪاﯾﺎت: 52 53 اﮔﺮ ﮐﺴﯽ ﻣﯿﮟ ﮐﺮوﻧﺎ ﻋﻼﻣﺎت ﮨ ﮟﯿ ﺗﻮ: 54 55 ﺑﺮاه ﮐﺮم 6 ﻓﭧ ﻓﺎﺻﻠﮯ ﮐﻮ ﺑﺮﻗﺮار رﮐﮭ ﮟﯿ ، اور اﭘﻨﮯ ﭼﮩﺮے ﮐﻮڈھﺎﻧﭗ ﻟ ۔ﮟﯿ 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 91 of 95 BMJ Open
1 2 اﻧﮩﯿﮟ ﮐﻠﮏ ﻣﯿﮉﯾﮑﺲ ﭘﺮ رﺟﺴﮣﺮ ﮐﺮﯾﮟ۔ 3 4 ڈاﮐﮣﺮ ﺳﮯ ﺑﺎت ﮐﺮﺗﮯ ﮨﻮﺋﮯ، ﺑﺮاه ﮐﺮم اﻧﮩ ﮟﯿ اﭘﻨﮯ ﻣﺮ ﺾﯾ ﯽﮐ ﺻﻮرت ﺣﺎل ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ ﺧﻮد ﺑﺘﺎﺋ ﮟﯿ ، اور ڈاﮐﮣﺮوں ﮐﯽ ﮨﺪاﯾﺎت ﮐﻮ ﻣﺮﯾﻀﻮں ﮐﻮ 5 ﻓﺮاﮨﻢ ﮐﺮ ۔ﮟﯾ 6 7 اﮔﺮ ڈاﮐﮣﺮ ﻣﺮﯾﻀﻮں ﺳﮯ ﺑﺎت ﮐﺮﻧﺎ ﭼﺎﮨﺘﺎ ﮨﮯﺗﻮ ﺑﺮاه ﻣﮩﺮﺑﺎﻧﯽ ﻞﯾﻣﻨﺪرﺟہ ذ ﭘﺮ ﻋﻤﻞ ﮐﺮ ﮟﯾ : 8 اﮔﺮ آپ ﮐﮯ ﭘﺎس دﺳﺘﺎﻧﮯ ﮨ ﮟﯿ ﺗﻮ ان ﮐﻮ ﻓﺮاﮨﻢ ﮐﺮ ۔ﮟﯾ 9 10 ﻣﺸﺎورت ﮐﮯ ﺳﯿﺸﻦ ﮐﮯ ﺑﻌﺪ ، ﮢﯿﺒﻠﯿﭧ ﮐﻮ ﺻﺎف ﮐﺮ ﮟﯾ ﺻﻔﺎﺋﯽ ﮐﮯ ﻟﯿﮯ آپ ﮐﻮﻣﻮاد ﻓﺮاﮨﻢ ﮐﯿﺎ ﮔﯿﺎ ﮨﮯ۔ 11 12 ﺑﺮاه ﮐﺮم اﭘﻨﮯ دﺳﺘﺎﻧﮯ ﮐﻮ اﺣﺘﯿﺎط ﺳﮯ ﭘﮭﯿﻨﮑﯿﮟ۔ 13 14 اﭘﻨﮯ ﮨﺎﺗﮭ دھﻮﺋ ﮟﯿ اور دﺳﺘﺎﻧﮯ ﭘﮩﻦ ﻟﯿﮟ۔ 15 ﻣﺮﯾﺾ ﮐﻮ ﻗﺮﻧﻄﯿﻨہ ﮐﺮﻧﮯ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﺳﻤﺠﮭﺎﺋﯿﮟ۔For peer review only 16 17 اﮔﺮ ﮐﻮﺋﯽ ﮐﺮوﻧﺎ واﺋﺮس ﻋﻼﻣﺎت ﻧہ ﮨﻮں ﺗﻮ: 18 19 ﺑﺮاه ﮐﺮم 6 ﻓﭧ ﻓﺎﺻﻠﮯ ﮐﻮ ﺑﺮﻗﺮار رﮐﮭ ﮟﯿ 20 ﻟﻮﮔﻮں ﮐﻮ ﭼﮩﺮه اور ﻧﺎک ڈھﺎﻧﭙﻨﮯ ﮐﺎ ﮐﮩﯿﮟ۔ 21 22 اﻧﮩﯿﮟ ﮐﻠﮏ ﻣﯿﮉﯾﮑﺲ ﭘﺮ رﺟﺴﮣﺮ ﮐﺮﯾﮟ۔ 23 24 ڈاﮐﮣﺮ ﺳﮯ ﺑﺎت ﮐﺮﺗﮯ ﮨﻮﺋﮯ، ﺑﺮاه ﮐﺮم اﻧﮩ ﮟﯿ اﭘﻨﮯ ﻣﺮ ﺾﯾ ﯽﮐ ﺻﻮرت ﺣﺎل ﮐﮯ ﺑﺎرے ﻣ ﮟﯿ ﺧﻮد ﺑﺘﺎﺋ ﮟﯿ ، اور ڈاﮐﮣﺮوں ﮐﯽ ﮨﺪاﯾﺎت ﮐﻮ ﻣﺮﯾﻀﻮں ﮐﻮ 25 ﻓﺮاﮨﻢ ﮐﺮ ۔ﮟﯾ 26 27 اﮔﺮ ڈاﮐﮣﺮ ﻣﺮﯾﻀﻮں ﺳﮯ ﺑﺎت ﮐﺮﻧﺎ ﭼﺎﮨﺘﺎ ﮨﮯﺗﻮ ﺑﺮاه ﻣﮩﺮﺑﺎﻧﯽ ﻞﯾﻣﻨﺪرﺟہ ذ ﭘﺮ ﻋﻤﻞ ﮐﺮ ﮟﯾ : 28 اﮔﺮ آپ ﮐﮯ ﭘﺎس دﺳﺘﺎﻧﮯ ﮨ ﮟﯿ ﺗﻮ ان ﮐﻮ ﻓﺮاﮨﻢ ﮐﺮ ۔ﮟﯾ 29 30 ﻣﺸﺎورت ﮐﮯ ﺳﯿﺸﻦ ﮐﮯ ﺑﻌﺪ ، ﮢﯿﺒﻠﯿﭧ ﮐﻮ ﺻﺎف ﮐﺮ ﮟﯾ ﺻﻔﺎﺋﯽ ﮐﮯ ﻟﯿﮯ آپ ﮐﻮﻣﻮاد ﻓﺮاﮨﻢ ﮐﯿﺎ ﮔﯿﺎ ﮨﮯ۔ 31 32 ﺑﺮاه ﮐﺮم اﭘﻨﮯ دﺳﺘﺎﻧﮯ ﮐﻮ اﺣﺘﯿﺎط ﺳﮯ ﭘﮭﯿﻨﮑﯿﮟ۔ 33 اﭘﻨﮯ ﮨﺎﺗﮭ دھﻮﺋ ﮟﯿ اور دﺳﺘﺎﻧﮯ ﭘﮩﻦ ﻟﯿﮟ۔ 34 35 ﻣﺮﯾﺾ ﮐﻮ ﻗﺮﻧﻄﯿﻨہ ﮐﺮﻧﮯ ﮐﮯ ﺑﺎرے ﻣﯿﮟ ﺳﻤﺠﮭﺎﺋﯿﮟ۔ 36 37 ﮔﮭﺮ ﺳﮯ و ﻮﯾﮉﯾ ﻣﺸﺎورت ﮐﮯ ﻟﺌﮯ ﮨﺪاﯾﺎت 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 92 of 95
1 2 3 4 Appendix G 5 6 Self-Management Chart for Improved Health behavior & Practices 7 8 (Experiment Group) 9 10 11 Guddi Baji Code District/ Area: 12 ﺿﻠﻊ /ﻋﻼﻗہ ﺑﺎﺟﯽ ﮐﺎ ﻧﻤﺒﺮ 13 ﺻﻮﺑہ /Participant Code 14 (name): 15 ﺷﺮﮐﺎء ﮐﺎ ﻧﺎم /ﯾﺎ ﻧﻤﺒﺮ 16 For peer review only 17 18 Self-management Health Chart 19 (to be filled by guddi bajis, and also given to patients for self-management over life-course) 20 Areas for literacy and discussion Tick/ Notes 21 cross 22 1.Nutrition and immunity building 23 Vegetables 24 Fruits 25 Water 26 Multivitamins 27 Walk/ exercize 28 2.Chronic ailment management= (dosage/ equipment management/ follow-up visits) 29 Arthritis 30 Diabetes 31 Hypertension 32 Chronic lungs 33 diseases (including 34 Asthma) 35 Acid Peptic diseases 36 Chronic back ache 37 Heart disease 38 Stroke 39 Blindness 40 Deafness 41 Dementia 42 Alcohol disorder 43 Cancer 44 Chronic kidney 45 disease 46 Epilepsy 47 Thyroid disease 48 Tuberculosis 49 Filariasis 50 3.Hygiene Sanitation 51 Personal hygiene 52 Family hygiene 53 Household sanitation 54 Clothes sanitation 55 Utensils and cutlery 56 sanitation 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 93 of 95 BMJ Open
1 2 3 Disposal of waste 4 (solid & liquid) 5 4.Coronavirus prevention & management 6 Physical distancing 7 Mask management 8 Disinfection of 9 house, clothes and 10 utensils 11 Washing hands 12 (frequency and when 13 it is necessary) 14 15 16 For peer review only ﻣﺮ ﺾﯾ ﯿﭘ ﺸﺮﻓﺖ ﮐﺎرڈ ( ﺗﺠﺮﺑﺎﺗﯽ ﮔﺮوپ) 17 18 یﮉﮔ ﺑﺎﺟﯽ ﮔﯽﺑﮭﺮﯾﮟ To be completed by Guddi Bajis 19 20 21 22 23 Self-management Health Chart 24 (to be filled by guddi bajis, and also given to patients for self-management over life-course) یﮔﮉ ﺑﺎﺟﯽ ﮔﯽﺑﮭﺮﯾﮟ ، اور ﻻﺋﻒ ﮐﻮرس ﮐﮯ دوران ﻣﺮﯾﻀﻮں ﮐﻮ ﺳﯿﻠﻒ ﯿﻣ ﻨﺠﻤﻨﭧ ﮐﮯ ﻟﺌﮯ ﺑﮭﯽ ﺎﯾد ﺟﺎﺋﮯ ﮔﺎ) 25 26 27 Areas for literacy and discussion Tick/ Notes ﻣﺸﺎﮨﺪات Cross 28 ﮐﺎﮢﺎ / درﺳﺖ ﮐﺎ ﻧﺸﺎن 29 30 1.Nutrition and immunity building 31 ﺧﻮراک ﮐﮯ زرﯾﻌﮯ ﺑﯿﻤﺎری ﺳﮯ ﺑﭽﻨﮯ ﮐﯽ طﺎﻗﺖ 32 Vegetables ﺳﺒﺰﯾﺎں 33 Fruits ﭘﮭﻞ 34 Water ﭘﺎﻧﯽ 35 Multivitamins طﺎﻗﺖ ﮐﯽ دواﺋﯽ 36 Walk/ exercise ورزش 37 38 2.Chronic ailment management= (dosage/ equipment management/ follow-up visits) داﺋﻤﯽ ﺑﯿﻤﺎری ﮐﮯ ﻟﯿﮯ دوا /ﻋﻼج ﮐﮯ ﻟﯿﮯ راﺑﻄہ 39 Arthritis ﮔﮣﮭﯿﺎ 40 Diabetes ذﯾﺎﺑﯿﻄﺲ 41 Hypertension ﮨﺎﺋﯽ ﺑﻠﮉ ﭘﺮﯾﺸﺮ 42 Chronic lungs ﭘﮭﯿﭙﮭﮍوں ﮐﯽ داﺋﻤﯽ 43 diseases (including ﯿﺑ ﻤﺎرﯾ ﺳﻤﺎں(دﻣہ ﺖﯿ ) 44 45 Asthma) Acid Peptic diseases ﻣﻌﺪه ﻣﯿﮟ ﺗﯿﺰاﺑﯿﺖ 46 Chronic back ache داﺋﻤﯽ ﮐﻤﺮ ﻣﯿﮟ درد 47 Heart disease دل ﮐﯽ ﺑﯿﻤﺎری 48 Stroke ﻓﺎﻟﺞ 49 Blindness اﻧﺪھﺎ ﭘﻦ 50 Deafness ﺑﮩﺮا ﭘﻦ 51 Dementia ﯾﺎداﺷﺖ ﮐﯽ ﮐﻤﯽ 52 Alcohol disorder ﻏﻨﻮدﮔﯽ 53 Cancer ﮐﯿﻨﺴﺮ 54 Chronic kidney ﮔﺮدے ﮐﯽ داﺋﻤﯽ ﺑﯿﻤﺎری 55 56 disease 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 94 of 95
1 2 Epilepsy ﻣﺮﮔﯽ 3 Thyroid disease ﮔﻠﮍه 4 Tuberculosis ﺗﭗ دق 5 Filariasis ﺧﻮن ﭼﻮﺳﻨﮯ وﻟﮯ ﮐﯿﮍوں 6 ﺳﮯ ﭘﮭﻠﻨﮯ واﻟﯽ ﺑﯿﻤﺎری 7 8 3.Hygiene Sanitation Personal hygiene ذاﺗﯽ ﺻﺤﺖ ﮐﯽ ﺣﻔﺎظﺖ 9 Family hygiene ﺧﺎﻧﺪان ﮐﯽ ﺻﺤﺖ ﮐﯽ 10 ﺣﻔﺎظﺖ 11 Household sanitation ﮔﮭﺮﯾﻠﻮ ﺻﻔﺎﺋﯽ ﺳﺘﮭﺮاﺋﯽ 12 Clothes sanitation ﮐﭙﮍے ﮐﯽ ﺻﻔﺎﺋﯽ 13 Utensils and cutlery ﺑﺮﺗﻦ اور ﭼﻤﭽﻮں ﮐﯽ 14 sanitation ﺻﻔﺎﺋﯽ 15 ForDisposal of peerwaste review only ﻓﻀﻠہ اور ﮐﻮڑا ﺿﺎﺋﻊ 16 (solid & liquid) ﮐﺮﻧﺎ 17 18 4.Coronavirus prevention & management ﮐﺮوﻧﺎ ﺳﮯ ﺑﭽﺎؤ اور ﻧﻤﮣﻨﮯ ﮐﯽ آﮔﺎﮨﯽ 19 Physical distancing ﺟﺴﻤﺎﻧﯽ دوری 20 Mask management ﻣﺎﺳﮏ ﻟﮕﺎﻧﺎ 21 Disinfection of ﮔﮭﺮ ، ﮐﭙﮍے اور ﺑﺮﺗﻨﻮں 22 house, clothes and ﯽﮐ ﺟﺮاﺛ ﻢﯿ ﮐﺸﯽ 23 24 utensils Washing hands ﺟﺐ ﺿﺮوری ﮨﻮ اور ﺑﺎر 25 frequency and when) ﺑﺎر ﮨﺎﺗﮭ دھﻮﻧﮯ 26 27 it is necessary) 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
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1 2 3 Translation 4 ﻣﺮﯾﺾ ﭘﯿﺸﺮﻓﺖ ﮐﺎرڈ (ﺗﺠﺮﺑہ ﮔﺮوپ) 5 6 ﮐﻤﯿﻮﻧﮣﯽ ﮨﯿﻠﺘﮭ ﮐﯿﺌﺮ ورﮐﺮز ﮐﮯ ذرﯾﻌہ ﻣﮑﻤﻞ ﮐﯿﺎ ﺟﺎﺋﮯ 7 8 ﺿﻠﻊ / ﻋﻼﻗہ: ﺷﺮﯾﮏ ﮐﻮڈ / (ﻧﺎم): 9 10 ﺳﯿﻞ ﻧﻤﺒﺮ: ﻋﻤﺮ 11 12 :اﻧﺪراج 13 ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﮐﮯ ﻟﺌﮯ ﺑﺎﺧﺒﺮ رﺿﺎﻣﻨﺪی 14 ﮐﺮاس ﺳﯿﮑﺸﻨﻞ ڈﯾﮣﺎ ﺳﺮوے ﻣﮑﻤﻞ ﮨﻮا 15 16 For peer review only 17 18 ﺧﻼﺻہ طﺒﯽ ﺣﺎﻟﺖ: 19 20 21 22 23 24 ﺗﺒﺼﺮه ﻧﻮٹ ﺗﺎرﯾﺦ ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﮐﺎ ﮢﺮﯾﮏ 25 ﺳﻤﺎرٹ ﻓﻮن اور واﺋﯽ 26 ﻓﺎﺋﯽ 27 ﭘﺮی ﮢﯿﺴﭧ ﺳﺮوے 28 دوﻧﻮں ﮐﻨﮣﺮول اور ﺗﺠﺮﺑﺎﺗﯽ ﮔﺮوپ ﮐﮯ ﺧﻮاﻧﺪﮔﯽ ﮐﺎ ﮐﺘﺎﺑﭽہ 29 ﻟﺌﮯ 30 وﯾﮉﯾﻮ 31 32 1 2 3 4 ورﭼﻮﺋﻞ اﻧﻔﺮادی ﺑﺎت 33 ﭼﯿﺖ - ﮨﻔﺘہ وار ﭘﯿﺮوی 34 ﮔﺮوپ ورﭼﻮﺋﻞ ﻣﯿﮣﻨﮕﺰ 35 (ﮔﺮوپ) 36 37 واﮢﺲ اﯾﭗ ﮔﺮوپ ﮐﯽ 38 دﺳﺘﯿﺎﺑﯽ اور ﻣﺴﺘﻘﻞ 39 راﺑﻄﮯ 40 - ﺟﺴﻤﺎﻧﯽ ورزش ﺳﯿﻠﻒ ﻣﯿﻨﺠﻤﻨﭧ ﭼﺎرٹ ﮐﯽ 41 - ﻏﺬاﺋﯿﺖ ﻓﺮاﮨﻤﯽ اور رﮨﻨﻤﺎﺋﯽ 42 - ﮔﮭﺮ اور ﺑﺎغ (زﺑﺎﻧﯽ + ﺗﺤﺮﯾﺮی / ﭘﺮﻧﭧ 43 - دواﺋﯽ ﮐﯽ ﻓﺮاﮨﻤﯽ) 44 - ﺣﻔﻈﺎن ﺻﺤﺖ ﺳﮯ ﻣﺘﻌﻠﻖ ﺣﻔﻈﺎن 45 ﺻﺤﺖ 46 روزاﻧہ ﮐﺎل / ﮢﯿﮑﺴﭧ 47 ﭘﯿﻐﺎﻣﺎت ﮐﺎ رﯾﮑﺎرڈ 48 ﮢﯿﺴﭧ ﮐﮯ ﺑﻌﺪ ﺳﺮوے 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 96 of 95
1 2 ﻣﺮﯾﻀﻮں ﯽﮐ ﮢﺮ ﮏﯾ ﭧﯿﺷ (ﮐﻨﮣﺮول ﮔﺮوپ) 3 4 ﮐﻤﯿﻮﻧﮣﯽ ﯿﮨ ﻠﺘﮭ ﯿﮐ ﺌﺮ ورﮐﺮز ﮐﮯ ذرﯾﻌہ ﻣﮑﻤﻞ ﮐ ﺎﯿ ﺟﺎﺋﮯ 5 6 :ﺿﻠﻊ / ﻋﻼﻗہ ﺷﺮﯾﮏ ﮐﻮڈ / (ﻧﺎم) 7 8 ﺳﯿﻞ ﻧﻤﺒﺮ: ﻋﻤﺮ 9 :اﻧﺪراج 10 ﮐﺘﺎﺑﭽﮯ ﮐﯽ ﻓﺮاﮨﻤﯽ ﮐﮯ ﻟﺌﮯ ﺑﺎﺧﺒﺮ رﺿﺎﻣﻨﺪی (دﮨﻠﯿﺰ 11 ﭘﺮ) 12 ﮐﺮاس ﺳﯿﮑﺸﻨﻞ ڈﯾﮣﺎ ﺳﺮوے ﻣﮑﻤﻞ ﮨﻮا 13 14 15 16 For peer review only ﺧﻼﺻہ طﺒﯽ ﺣﺎﻟﺖ: 17 18 19 20 21 22 ﺗﺒﺼﺮه ﻧﻮٹ ﺗﺎرﯾﺦ ﺗﻌﻠﯿﻤﯽ ﭘﺮوﮔﺮام ﮐﺎ ﮢﺮﯾﮏ 23 ﭘری ﮢﯾﺳٹ ﺳروے 24 دوﻧﻮں ﮐﻨﮣﺮول اور ﺗﺠﺮﺑﺎﺗﯽ ﮔﺮوپ ﮐﮯ ﺧواﻧدﮔﯽ ﮐﺎ ﮐﺗﺎﺑﭼہ 25 ﻟﺌﮯ 26 ﮢﯾﺳٹ ﮐﮯ ﺑﻌد ﺳروے 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml