concurrent evaluation of the reach and effectiveness of second phase of the national rural health...
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Men Questionnaire
Concurrent Evaluation of the Reach and Effectiveness of Second Phase of the National Rural Health Mission BCC Campaign 1
CONCURRENT EVALUATION OF THE REACH AND EFFECTIVENESS OF SECOND PHASE OF THE NATIONAL RURAL HEALTH
MISSION BCC CAMPAIGN
MEN QUESTIONNAIRE
INTRODUCTION
My name is I am working with ORG Centre for Social Research, a pionoring research organization specialized in conducting surveys among different
population groups. We are conducting a study for assessing the reach and effectiveness of theNational Rural Health Mission (NRHM) behaviour change
communication (BCC) campaign in collaboration with Population Foundation of India (PFI), New Delhi , a national level organization providingtechnical assistance for various health programmesin the country .
In this regard, I would like to discuss with you for about 30 minutes. We will maintain the confidentiality of the information you would provide and use the
information for the purpose of research and give feedback on the communication campaign conducted during last one month.This feedback is expected to
provide an opportunity to improve the communication strategy.
Identification Details Code
Questionnaire Serial No
Type of State. High Focus State
Other State
1
2
Name of the state High Focus Others
Uttar Pradesh 01 West Bengal 07Orissa 02 Karnataka 08
Chattisgarh 03 Maharashtra 09
Madhya Pradesh 04 Tamil Nadu 10
Mizoram 05 Haryana 11
Bihar 06
Name of the District
Bareilly 01 North Twenty Four Parganas 10
Meerut 02 Murshidabad 11
Barabanki 03 Belgaum 12
Mirzapur 04 Tumkur 13
Sundargarh 05 Kolhapur 14
Madhepura 06 Gondiya 15
Rajnandgaon 07 Salem 16
Narsimhapur 08 Kanniyakumari 17
Mamit 09 Faridabad 18
Type of Settlement /PSU Rural 1 Urban 2
Name of the Tehsil
(For Rural PSU)
Name of the City/Town
(For Urban PSU)
Name of the Village/Ward
HH Number (PSU wise code-1-10)
Name of the respondent
Full address (With Landmark)
________________________________________________
________________________________________________
________________________________________________
Interview Details
Result of the Interview
Completed . . .1
Respondent unavailable . ..2
Partially Completed ................... . 3
Refused ... . 4
Other (Specify) .. 5
Interview Date
Day Month Year
Interviewed by
_____________
Backchecked by
_____________
Scrutinised by
_______________
Entered by
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SECTION 1: BACKGROUND CHARACTERISTICS OF THE RESPONDENT
No. Questions and Filters Coding Categories Code Skip to
Q 101 How old are you?
Age (completed years)
Q 102 What is the current age of your wife?Age of wife (completed years)__________
Q 103 Educational Status (completed so far)? Illiterate
Literate without schooling
Primary
Middle
Secondary
Higher Secondary
Graduate and above
Other (Specify)________
1
2
3
4
5
6
7
8
Q 104 What is your present occupation? Housewife
Business/Petty business
Service
Farmer
Agricultural labour
Skilled worker
Unskilled labour
Student
Self Employed ProfessionalOther (specify)_____________
01
02
03
04
05
06
07
08
0977
Q 105
How many living children do you have?
No child
9 Q 109Sons
Daughters
Total
Q 106 Do you have any child in the age group of 0-59 months ? Yes
No
1
2 Q 108Q 107
How many children do you have in the following age groups?
< 6 Months Male Female Total
Male Female Total
Male Female Total
Male Female Total
Male Female Total
6-11 Months
12-23 Months
2459 Months
Total
Q 108 What is the age of your youngest living child? < 6 Months
6-11 Months
12-23 Months
24-59 Months
60+ months
1
2
3
4
5
Q 109 Is there any unmarried adolescent girl(s)/boy(s) in the age group
of 10-19 years in your household?
Yes
No
1
2 Q 111Q 110 How many adolescents are there in your household?
Girl (s)
Boy (s)
Total
Q 111 Is your wife pregnant now? YesNo
Not sure
1
2
3
Q 112 Is your wife lactatining now? YesNo
1
2
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SECTIONII: HOUSEHOLDCHARACTERTISTICS
Sl. No. Question Coding Categories Codes Skip
Q201 What is your religion? Hindu
SikhChristian
Muslim
Other (Specify) _______
1
23
4
7
Q202 Which social category do you belong to? SC
ST
General
OBC
1
2
3
4
Q203 Type of family Nuclear
Joint/ Extended
1
2
Q204 Does your household own this or any other house? Yes
No1
2
Q205 Type of house: (OBSERVE Material USED& RECORD)
Roof :___________________
Walls:_________________
Floor :___________________
Pucca
Semi-pucca
Kutcha
1
2
3
Q206 What is the main source of drinking water for the members of
the HH?Piped water within house/plot
Public tap
Hand pump within house/plot
Public hand pump
Well in residence/plot
Well in village/ward
Well outside village/ward
River/Stream/pond, etc
Rain water
Tanker/truck
Other (specify) ____________
01
02
03
04
05
06
07
08
09
10
77
Q207 What kind of toilet facilities does your HH use? Flush toilet
Pit toilet/latrine
Public toilet
In open
Other (Specify)_____________
1
2
3
4
7
Q208 What is the main source of lighting for your HH? Electricity
Solar
Kerosene
GasOther (Specify)______________
1
2
3
47
Q209 What type of fuel does your household mainly use for cooking? Wood
Crop Residues
Dung Cakes
Coal/Coke/Lignite
Charcoal
Kerosene
Electricity
Liquid Petroleum Gas
Bio-gas
Other (Specify)_________________
01
02
03
04
05
06
07
08
09
77
Q210 Does your household own any agricultural land? Yes
No
1
2
Q211 Does your household own any livestock? Yes
No
1
2Q. 212 Does your household own any of the
Following assets? (Read out Options)
Assets Yes No
Mattress 1 2
Pressure Cooker 1 2
Chair 1 2
Cot/Bed 1 2
Table 1 2
Clock/Watch 1 2
Electric Fan 1 2
Bicycle 1 2
Radio/Transistor 1 2
Sewing Machine 1 2
Landline Telephone 1 2
Mobile Phone with FM/Radio 1 2
Mobile Phone with out FM /Radio 1 2Refrigerator 1 2
Black and White TV 1 2
Colour TV 1 2
Moped/Scooter/Motor Cycle 1 2
Car 1 2
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Air Conditioner 1 2
Water Pump 1 2
Bullock Cart 1 2
Tractor 1 2
Thresher 1 2
INS: If coded 1 in Q 212 against Black and White and/or Coloured Television ask Q 212a.
Q. 212a Whether the television your HH owns is in
working condition?
Yes
No
1
2
INS: If coded 1 in Q 212 against Radio/Transistor or Mobile Phone with FM/Radio ask Q 212b.
Q. 212b Whether the Radio/Transistor / FM/Radio in
your mobile phone is in working condition?
Yes
No
1
2
SECTION III: EXPOSURE TO TV
No. Questions and Filters Coding Categories Code Skip to
Q301 How frequently do you watch TV? Everyday
At least three times a week
Once or twice in a week
Once a fortnightOnce a month
Occasionally
CS/ No response
No exposure
1
2
3
45
6
7
8 SECVIQ302 What channels you usually watch/view on TV?
(DO NOT PROMPT)
INS: MULTIPLE RESPONSE POSSIBLE
9X 1 Sab TV 45
Aj Tak 2 Sahara filmy 46
Asianet 3 Sahara one 47
Awaz 4 Sahara UP 48AXN 5 Set fix 49
B4U 6 Set max 50
BBC world 7 Sony 51
Bindass 8 Star gold 52
CNBC 9 Star movies 53
CNBS TV 18 10 Star News 54
CNN 11 Star one 55
Color 12 Star plus 56
DD Regional 13 Star sports 57
DD National 14 Star Ustav 58
DD News 15 Star Vijay 59
DD Sports 16 Star world 60
Discovery 17 Sun music 61
ESPN 18 Sun news 62
ETC Punjabi 19 Sun TV 63
ETV Bihar 20 Surya TV 64
ETV Gujarati 21 Teja 65
ETV Kannada 22 Ten sports 66
ETV Marathi 23 Udaya TV 67
ETV Oriya 24 UTV 68
ETV Telugu 25 UTV Movies 69
ETV Urdu 26 Vissa TV 70
EV Bangla 27 Zee action 71
Gemini 28 Zee Bangla 72
HBO 29 Zee business 73
Jagaran 31 Zee cinema 74
Jaya TV 32 Zee classic 75
Kairali 33 Zee Gujarati 76
KTV 34 Zee Kanada 77Maa TV 35 Zee Marathi 78
Mega TV 36 Zee news 79
National geography 37 Zee premier 80
NDTV 24/7 38 Zee Punjabi 81
NDTV Imagine 39 Zee smile 82
NDTV profit 40 Zee studio 83
NEO spore 41 Zee T.V. 84
NEO sports plus 42 Zee Telugu 85
Raj digital plus 43 Other 1.... 86
Raj TV 44 Other 2 87
Q303 When do you usually watch television?
INS: MULTIPLE RESPONSE POSSIBLE
Before 9 am
9 am to 12 pm
12 3 pm
3 6 pm
6 -9 pmAfter 9 pm
Not fixed slot
1
2
3
4
56
7
Q304 What programs do you watch on these channels most of the
time?
Films
News
Reality Show
01
02
03
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INS: MULTIPLE RESPONSE POSSIBLE Serials
Educational Programs
Songs
Talk shows
Live Shows
Sports
Choupal (prog. for farmers)Other (Specify)___________
04
05
06
07
08
09
1011
SECTION IV: EXPOSURE TO TV CAMPAIGNNo. Questions and Filters Whether seen in last
six months?
Whether seenduring the period starting from
Christmas to Republic day (27th December 2008 to
26th January 2009)
Any Ad Any NRHM Ad
Q 401 Have you seen any Ad on television on any health issues? Yes 1 No 2 Yes 1 No 2
Q 402 Have you seen any Ad on television on antenatal
care/institutional delivery/JSY?Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
Q 403 Have you seen any Ad on television on new born care?
Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
Q 404 Have you seen any Ad on television on immunisation?
Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2Aided 3
No 4
Q 405 Have you seen any Ad on television on nutrition and breast
feeding?Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
Q 406 Have you seen any Ad on television on family planning/birth
spacing/small family?Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
Q 407 Have you seen any Ad on television on age of marriage?
Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2Aided 3
No 4
Q 408 Have you seen any Ad on television on ASHA?
Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
Q 409 Have you seen any Ad on television on health services at
Government hospitals?Yes 1 No 2 Yes 1 No 2
Spontaneous 1
On Prompting 2
Aided 3
No 4
INS: CHECK ALL QUESTIONS FROM 401 TO 409 CODED 1 OR 2 OR 3 IN ANY QUESTION
CODED 4 IN ALL QUESTIONS
1
2
Q 410 SEC. V
Q 410 Which ad have you seen during the period starting
from Christmas to Republic day (27th
December
2008 to 26th
January 2009)?
(DO NOT PROMPT - CIRCLE ALL
SPONTANEOUSLY MENTIONED
RESPONSES)
INS: MULTIPLE RESPONSE POSSIBLE
Juhi Chawla-Antenatal care/Institutional delivery
Juhi Chawala- immunisation
Juhi Chawala- family planning/small family
Supriya-Sachin - Antenatal care / Institutional Delivery
Supriya-Sachin - Family planning/small family
Mona Singh (Jassi)- Immunisation
Crystall Ball- Antenatal care /Institutional Delivery /JSY
Four Birds- JSY/ Antenatal care
Radhe Shyams Motror Cycle- New born care
Train- Family planning/oral pills
Breast feeding/child nutrition
Holi/Colourful moments-Family planning/IUD /Cu.T
Mehendi Occasion-Family planning/small family
Pragati on Medical Tour - NRHM /Health Services
Ek Savera , Ek Aakash- NRHM /Health Services
Black and White Ad- Age of marriage
Other 1(Specify)______________________________
Other 2(Specify)______________________________
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
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SECTION V: DETAILS OF EXPOSURE TO NRHM TV CAMPAIGN
The ministry of Health & Family Welfare (MOHFW), Government of India (GoI) has implemented the 2nd
phase of Behavior Change Communication
(BCC) program as part of the National Rural Health Mission (NRHM) during the period 27th December 2008 to January 26, 2009. As a part of the NRHM
communication campaign a number of TV advertisements on issues relating to ANC, institutional delivery, JSY , immunization, breast feeding and child
nutrition , family planning, birth spacing and the role of ASHA have been aired on various TV channels. We would like to know whether you have watched
any of the NRHM TV advertisements aired on TV during the period 27th December 2008 to January 26, 2009 as well as your feedback on these TV
advertisements.
No. Questions and Filters Coding Categories Code Skip to
ANC AD. NO. 1 CRYSTAL BALL
Q 501 Have you seen any NRHM ad on Antenatal Care/Institutional
Delivery /JSY shown using a Crystal Ball during the period
starting from Christmas to Republic day (27th December 2008 to
26th January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 514Q 502 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 503 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd week of January
3rd week of January
4th week of January
1
2
3
4
5Q 504 What all you could understand from this Ad?
Q 505 Can you tell us what message was given in this ad? Spontaneous On
Prompting
No Were you aware
about it before
watching the Ad?
Safety of both mother and child is in the hands of both husband
and wife
1 2 3 Yes 1 No 2
Checkup in health centre 1 2 3 Yes 1 No 2
Iron tablet for 100 days 1 2 3 Yes 1 No 2
Prepare Jachcha bachcha (Mother and Child) Card 1 2 3 Yes 1 No 2
Administer 2 doses of TT injection 1 2 3 Yes 1 No 2
Deliver the child at hospital only 1 2 3 Yes 1 No 2
Feed additional diet/food 1 2 3 Yes 1 No 2
Every body remember that ASHA knows everything 1 2 3 Yes 1 No 2
Visit health centre, Register in JSY and get both safe familly and
financial benefits
1 2 3 Yes 1 No 2
Q 506 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4vii Overall 1 2 3 4
Q 507 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 509Q 508 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 509 Do you feel that you have learnt some new things due to this ad? YesNo
12
Q 510 Have you taken any action after watching this ad? Yes
No
1
2 Q 512Q 511 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged spouse for 2 TT shots during pregnancyEncouraged spouse for taking 100 IFA tablets during
pregnancyConsulted a health center during pregnancy of spouse
Helped spouse during pregnancyEnsured rest during pregnancy
Consumed additional food during pregnancyPreferred institutional deliveries
01
020304050607
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Prepared Jachcha bachcha cardConsulted ASHA
Took benefits of JSYAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others for availing servicesOther (Specify)_______________
0809101112131415
Q 512 Do you intend to take any action after watching this ad? YesNo
12 Q 514
Q 513 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse for taking 2 TT shots duringpregnancyEncourage spouse for taking 100 IFA tablets during
pregnancyConsult a health center during pregnancy of spouse
Help spouse during pregnancyEnsure rest during pregnancy
Consume additional food during pregnancyPrefer institutional deliveries
Prepare Jachcha bachcha cardConsult ASHA
Take benefits of JSYAquire more information
Discuss with spouse/ family membersDiscuss with friends/ relatives
Encourage others for availing services
Other (Specify)_______________
01
02
030405060708091011121314
15
ANC AD NO. 2 SACHIN & SUPRIYA
Q 514 Have you seen any NRHM ad on Antenatal Care/ Institutional
Delivery featuring Supriya-Sachin during the period starting
from Christmas to Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided responseNo
1
2
34 Q 527
Q 515 How many times have you watched this ad during this period ? Once
TwiceThrice
Four time
Five or more time
1
23
4
5
Q 516 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January
3rd week of January4
thweek of January
1
2
3
45
Q 517 What all you could understand from this Ad?
Q 518 Can you tell us what message was given in this ad? Spontaneous On
Prompting
No Were you aware
about it before
watching the Ad?
Pregnant women should take rest 1 2 3 Yes 1 No 2
Pregnant women should take iron tablets 1 2 3 Yes 1 No 2
Pregnant women should be administered TT injection 1 2 3 Yes 1 No 2
Pregnant women should be checkup by doctor 1 2 3 Yes 1 No 2If every husband take care of his wife by taking her to right
doctor for checkup and provide all love to her wife before
delivery, then every mother and her child will be healthy
1 2 3 Yes 1 No 2
Healthy Nation/Bharat begins with healthy family from you 1 2 3 Yes 1 No 2
Q 519 Now we are going to ask some questions regarding this ad. forwhich you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither likednor disliked
Disliked DontKnow
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
vii Music 1 2 3 4viii Overall 1 2 3 4
Q 520 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 522
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Q 521 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 522 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 523 Have you taken any action after watching this ad? Yes
No
1
2 Q 525
Q 524 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged spouse for taking TT during pregnancyEncouraged spouse for taking IFA during pregnancy
Consulted a doctor during pregnancy of spuseProvided help to spouse during pregnancy
Ensured rest during pregnancyAquired more information
Discussed with spouse/ family membersDiscussed with relatives/ friends
Encouraged others for taking TT during pregnancyOther (Specify)_______________
12345678910
Q 525 Do you intend to take any action after watching this ad? YesNo
12 Q 527
Q 526 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse for taking TT during pregnancyEncourage spouse for taking IFA during pregnancy
Consult a doctor during pregnancy of spouseHelp spouse during pregnancy
Ensure rest during pregnancyAquire more information
Discuss with spouse/ family membersDiscuss with friends/ relatives
Encourage others for taking TT during pregnancyOther (Specify)_______________
0102
0304050607080910
ANC AD NO. 3 JUHI CHAWLA
Q 527 Have you seen any NRHM ad on Antenatal Care/Institutional
Deliveryfeaturing Juhi Chawla during the period starting from
Christmas to Republic day (27th
December 2008 to 26th
January
2009) ?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 540Q 528 How many times have you watched this ad during this period ? Once
TwiceThrice
Four time
Five or more time
1
23
4
5
Q 529 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January2nd week of January
3rd week of January
4th week of January
1
23
4
5
Q 530 What all you could understand from this Ad?
Q 531 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware
about it before
watching the Ad?
Take care of woman during pregnancy and keep her happy 1 2 3 Yes 1 No 2
Keep in mind that she should take proper food and rest 1 2 3 Yes 1 No 2
Checkup from a doctor atleast three times 1 2 3 Yes 1 No 2
In every checkup the blood pressure should measure normal/OK 1 2 3 Yes 1 No 2
In every checkup the weight should measure normal/OK 1 2 3 Yes 1 No 2
In every ckeckup the iron measure in the blood should be OK 1 2 3 Yes 1 No 2
Delivery should take place in a hospital or under the supervision
of a doctor
1 2 3 Yes 1 No 2
Health of mother is health of family 1 2 3 Yes 1 No 2
Healthy Nation/Bharat begins with healthy family from you 1 2 3 Yes 1 No 2
Q 532 Now we are going to ask some questions regarding this ad. forwhich you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither likednor disliked
Disliked DontKnow
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
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iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
vii Music 1 2 3 4
viii Overall 1 2 3 4
Q 533 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 535Q 534 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fastToo many messages
Other (Specify)____________
1
2
34
5
Q 535 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 536 Have you taken any action after watching this ad? Yes
No
1
2 Q 538Q 537 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged spouse to avail ANC Check upsEncouraged spouse for measuring BP/ weights / Hb.
level during ANCEncouraged spouse for good food during pregnancy
Encouraged spouse for rest during pregnancyPreferred institutional deliveries
Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for availing ANC services
Other (Specify)_______________
0102
0304050607
080910
Q 538 Do you intend to take any action after watching this ad? YesNo
12 Q 540
Q 539 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse to avail ANC Check upsEncourage spouse for measuring BP/ weights / Hb.
level during ANCEncourage spouse for good food during pregnancy
Encourage spouse for rest during pregnancyPrefer institutional deliveries
Aquire more informationDiscuss with spouse/ family members
Discuss with friends/ relativesEncourage others for availing ANC services
Other (Specify)_______________
0102
03040506070809
10
JSY AD. NO. 4 ANIMATION 4 BIRDS/ JAGMAG
Q 540 Have you seen any NRHM ad on JSY/ANC of mothers
featuring Four Birds during the period starting from Christmas
to Republic day (27th December 2008 to 26th January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 553Q 541 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 542 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of DecemberFirst week of January
2nd week of January3rd week of January
4th week of January
12
34
5
Q 543 What all you could understand from this Ad?
Q 544 Can you tell us what message was given in this ad? Spontaneous On
Prompting
No Were you aware about it
before watching the Ad?
Keep in mind that all care is taken till the time of delivery 1 2 3 Yes 1 No 2
It is necessary to give TT and tablets at right time 1 2 3 Yes 1 No 2
All listen to advice of ANM and ASHA 1 2 3 Yes 1 No 2Delivering at hospital is the right decision 1 2 3 Yes 1 No 2
You also get attention of doctor, services and medicines at
hospitals
1 2 3 Yes 1 No 2
Go go go and find out the hospital near to your house 1 2 3 Yes 1 No 2
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In order to reach there keep the means of transport ready day
and night
1 2 3 Yes 1 No 2
Safety of mother and child is in the hands of family 1 2 3 Yes 1 No 2
Q 545 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 546 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 548Q 547 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 548 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 549 Have you taken any action after watching this ad? YesNo
12 Q 551
Q 550 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSES POSSIBLE
Encouraged spouse for TT during pregnancyConsulted with ASHA/ANMDelivered the child in hospital
Arranged transport for delivery in advanceAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others for availing servicesOther (Specify)_______________
010203040506070809
Q 551 Do you intend to take any action after watching this ad? YesNo
12 Q 553
Q 552 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse for TT during pregnancyConsult with ASHA/ANMDeliver the child in hospital
Arrange transport for delivery in advanceAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others for availing servicesOther (Specify)_______________
0102030405
06070809
Q 553 Have you received any information/messages on Antenatal
Care/Institutional Delivery /JSY from any other source (other
than this advertisement) during the period starting from
Christmas to Republic day (27th December 2008 to 26th January2009?
Yes
No
1
2 Q 555
Q 554 What is/are the source(s) from where you have received any
information/messages on Antenatal Care/Institutional Delivery
/JSY during this period
INS: MULTIPLE RESPONSES POSSIBLE
Radio advertisements
News paper/magazines
Posters/pamphlets/booklets/hand bills
Banners,wall hoardings/writingsPublic announcements
Cultural events/Melas
ASHA/ANM/AWWOther Govt. health functionaries
Private health functionaries
Spouse
Father/Mother Inlaw
Other family members/relatives
Friends/Neighbours
Others (Specify)______________________
01
02
03
0405
06
0708
09
10
11
12
13
14
Q 555 To what extent do you agree with the following statements ? Agree to a greaterextent
Agree to some
extent
Disagree Cant
Say
A Registration of pregnancy should be done as soon as pregnancy
is identified
1 2 3 4
B It is necessary to go for physical examination once the
pregnancy is identified
1 2 3 4
C A pregnant women must get 3 ANC Check Ups 1 2 3 4
D A pregnant women must consume 100 IFA tablets 1 2 3 4E A pregnant women should be given 2 shots of TT 1 2 3 4
F Delivery should be planned in the hospitals 1 2 3 4
G Pregnant women should take good food and rest during
pregnancy
1 2 3 4
H Only a healthy women can deliver a healthy child 1 2 3 4
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I Women should take benefits of JSY scheme 1 2 3 4
J You feel confident to initiate discussions with any one about
ANC/Institutional delivery
1 2 3 4
K You can convince anyone on importance of ANC/Institutional
delivery
1 2 3 4
NEW BORN CARE AD. NO. 5 RADHE SHYAM KI MOTORCYCLE
Q 556 Have you seen any NRHM ad on new barn careon Radhe
Shyams Motror Cycle during the period starting from
Christmas to Republic day (27th
December 2008 to 26th
January
2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 572Q 557 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 558 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January2nd week of January
3rd week of January
4th week of January
1
23
4
5
Q 559 What all you could understand from this Ad?
Q 560 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware about it
before watching the Ad?
Keep new born with the mother 1 2 3 Yes 1 No 2
Initiate breastfeeding immediately after birth 1 2 3 Yes 1 No 2
Save the newborn from getting cold 1 2 3 Yes 1 No 2
Do not bath the child till 24 hours of birth 1 2 3 Yes 1 No 2
Take special care if the babys weight is less than 2 kg at the
time of birth Such baby should be given bath only after the
umbilical cord waves off
1 2 3 Yes 1 No 2
Listen to advices of ASHA and ANM 1 2 3 Yes 1 No 2
Q 561 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 562 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 564Q 563 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fastToo many messages
Other (Specify)____________
1
2
34
5Q 564 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 565 Have you taken any action after watching this ad? Yes
No
1
2 Q 567Q 566 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged for Keeping new born child with motherEncouraged for initiating breast feeding immediately
after birthEncouraged for Protectecting the child from cold
Encouraged for not bathing the baby till first 24hours
Took birth wight of the childConsulted ASHA
Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for for proper new born careOther (Specify)_______________
0102
0304
05060708
091011
Q 567 Do you intend to take any action after watching this ad? YesNo
12 Q 569
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Q 568 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage for Keeping new born child with motherEncourage for Initiating breast feeding immediately
after birthEncourage for Protectecting the child from cold
Encourage for not to bath the baby till first 24 hoursTake birth weight of the child
Consult ASHAAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others for proper new born careOther (Specify)_______________
0102
030405060708091011
Q 569 Have you received any information/messages on New Born Care
from any other source (other than this advertisement) during the
period starting from Christmas to Republic day (27th December
2008 to 26th
January 2009?
Yes
No
1
2 Q 571
Q 570 What is/are the source(s) from where you have received any
information/messages on New Born Care during this period?
Radio advertisements
News paper/magazines
Posters/pamphlets/booklets/hand bills
Banners,wall hoardings/writings
Public announcements
Cultural events/Melas
ASHA/ANM/AWW
Other Govt. health functionaries
Private health functionaries
Spouse
Father/Mother Inlaw
Other family members/relativesFriends/Neighbours
Others (Specify)______________________
01
02
03
04
05
06
07
08
09
10
11
1213
14
Q 571 To what extent do you agree with the following statement on
new born care
Agree to a
greater
extent
Agree to some
extent
Disagree Cant Say
A The new born child should be kept with the mother 1 2 3 4
B Breast feeding of the new born child should be initiated
immediately after birth
1 2 3 4
C The new born child should be protect from cold 1 2 3 4
D Bathing of the new born child should be avoided in first 24 hours 1 2 3 4
E Special care should be taken for the new born child having
weight less than 2 Kgs
1 2 3 4
F ASHA should be consulted for care of the new born child 1 2 3 4
FAMILY PLANNING/SMALL FAMILY AD. NO. 6 -MEHENDI OCCASION
Q 572 Have you seen any NRHM ad on family planning/small family
shown in Mehendi Occasion during the period starting from
Christmas to Republic day (27th
December 2008 to 26th
January
2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 585Q 573 How many times have you watched this ad during this period ? Once
TwiceThrice
Four time
Five or more time
1
23
4
5
Q 574 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January2
ndweek of January
3rd
week of January4th week of January
1
23
45
Q 575 What all you could understand from this Ad?
Q 576 Can you tell us what message was given in this ad? Spontaneous On
Prompting
No Were you aware
about it before
watching the Ad?
We are happy as lifes every decision is taken jointly (by husband
and wife) like when to have child, spacing between children
1 2 3 Yes 1 No 2
Both of you meet ASHA in your village , She will arrange toprovide you complete information on family planning methods
from nearby health centre
1 2 3 Yes 1 No 2
Birth at right time and right interval give mother and the childgood/complete health
1 2 3 Yes 1 No 2
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Because , Healthy Nation/Bharat begins with healthy family
from you
1 2 3 Yes 1 No 2
Q 577 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither likednor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4vii Overall 1 2 3 4
Q 578 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 580Q 579 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 580 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 581 Have you taken any action after watching this ad? Yes
No
1
2 Q 583Q 582 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Interacted with ASHA regarding family planning
Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for family planning/spacing
Encouraged others for small familyOther (Specify)_______________
01
020304050607
Q 583 Do you intend to take any action after watching this ad? YesNo
12 Q 585
Q 584 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Interact with ASHA regarding family planningAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others for family planning/spacingEncouraged others for small family
Other (Specify)_______________
01020304050607
FAMILY PLANNING/IUD/CU.T AD. NO. - 7 HOLI /
COLOURFUL MOMENTS
Q 585 Have you seen any NRHM ad on family planning/IUD/Cu.T
shown in Holi/Colourful moments during the period starting
from Christmas to Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 598Q 586 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 587 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd week of January
3
rd
week of January4th
week of January
1
2
3
45
Q 588 What all you could understand from this Ad?
Q 589 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware about
it before watching the
Ad?
There is no tension in the sweet momentsof life because new
Cu.Ts safety is always with me
1 2 3 Yes 1 No 2
In case you want to become a mother for second time it can be
easily removed also
1 2 3 Yes 1 No 2
With this new Cu.T there is no tension 1 2 3 Yes 1 No 2
Get more information from ANM of nearby health centre 1 2 3 Yes 1 No 2
Accept Cu.T from local trained health worker at the right time 1 2 3 Yes 1 No 2
This is the time of new and safe Cu.T 1 2 3 Yes 1 No 2
Because , Healthy Nation/Bharat begins with healthy family 1 2 3 Yes 1 No 2
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Men Questionnaire
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from you
Q 590 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4Q 591 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 593Q 592 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 593 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 594 Have you taken any action after watching this ad? Yes
No
12 Q 596
Q 595 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged spouse for accepting Cu.T
Visited nearest health center for Cu.TConsulted ANM
Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for Cu.T
Other (Specify)_______________
01
02030405060708
Q 596 Do you intend to take any action after watching this ad? YesNo
12 Q 598
Q 597 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse for accepting Cu.TVisit nearest health center for Cu.T
Consult ANMAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others for Cu.TOther (Specify)_______________
0102030405060708
FAMILY PLANNING/ORAL PILLS AD. NO. - 8 TRAIN
Q 598 Have you seen any NRHM ad on family planning/oral pills
shown on train during the period starting from Christmas to
Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 5012Q 599 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four timeFive or more time
1
2
3
45
Q 5001 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January
3rd week of January
4th
week of January
1
2
3
4
5
Q 5002 What all you could understand from this Ad?
Q 5003 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware
about it before
watching the Ad?
This is new generation contraceptive pill Fully safe 1 2 3 Yes 1 No 2
Take one contraceptibe pill daily, If you forget take 2 pills the
next day
1 2 3 Yes 1 No 2
Around 8 coror women in the world use contraceptive pills youalso use it
1 2 3 Yes 1 No 2
Q 5004 Now we are going to ask some questions regarding this ad. forwhich you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither likednor disliked
Disliked DontKnow
i The Message Conveyed 1 2 3 4
-
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ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 5005 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5007Q 5006 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fastToo many messages
Other (Specify)____________
1
2
34
5
Q 5007 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5008 Have you taken any action after watching this ad? Yes
No
1
2 Q 5010Q 5009 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged spouse for use of oral pillsAquired more information
Discussed with spouse/ family membersDiscussed with friends/relativesEncouraged others for oral pillsOther (Specify)_______________
010203040506
Q 5010 Do you intend to take any action after watching this ad? YesNo
12 Q 5012
Q 5011 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Encourage spouse for use of oral pillsAquire more information
Discuss with spouse/ family membersDiscuss with friends/relativesEncourage others for oral pills
Other (Specify)_______________
010203040506
FAMILY PLANNING AD. NO. 9 SACHIN SUPRIYA
Q 5012 Have you seen any NRHM ad on family planning/small family
featuring Sachin-Supriya during the period starting from
Christmas to Republic day (27th December 2008 to 26th January
2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 5025Q 5013 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four timeFive or more time
1
2
3
45
Q 5014 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd week of January
3rd week of January
4th week of January
1
2
3
4
5
Q 5015 What all you could understand from this Ad?
Q 5016 Can you tell us what message was given in this ad? Spontaneous On Prompting
No Were you awareabout it before
watching the Ad?
One should have family where they can give right education ,
better life and maintain health of children
1 2 3 Yes 1 No 2
If the family is small and there is spacing between birth of children
then both mother and children will remain healthy
1 2 3 Yes 1 No 2
Today ther are also many choices like condom, Cu.T, pill 1 2 3 Yes 1 No 2
Select any one of the method on the basis of advice of doctor or
health worker
1 2 3 Yes 1 No 2
Because , Healthy Nation/Bharat begins with healthy family
from you
1 2 3 Yes 1 No 2
Q 5017 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4ii Clarity of the Message 1 2 3 4
iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
-
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vii Music 1 2 3 4
viii Overall 1 2 3 4
Q 5018 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5020Q 5019 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 5020 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5021 Have you taken any action after watching this ad? YesNo
12 Q 5023
Q 5022 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Adopting small familyEnsuring proper spacing between birthsAccepted some family planning method
Consulted doctor/health centerAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others for small familyEncouraged others for family planning/spacing
Other (Specify)_______________
01020304050607080910
Q 5023 Do you intend to take any action after watching this ad? YesNo
12 Q 5025
Q 5024 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Adopt small familyEnsure proper spacing between birthsAccept some family planning method
Consult doctor/health centerAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others for small familyEncourage others for family planning/spacing
Other (Specify)_______________
01020304050607080910
FAMILY PLANNING AD NO.- 10 JUHI CHAWLA
Q 5025 Have you seen any NRHM ad on family planning/small family
featuring Juhi Chawla during the period starting from Christmas
to Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided responseNo
1
2
34 Q 5038
Q 5026 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 5027 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January
3rd
week of January
4th
week of January
1
2
3
4
5
Q 5028 What all you could understand from this Ad?
Q 5029 Can you tell us what message was given in this ad? Spontaneous On
Prompting
No Were you aware about it
before watching the Ad?
Daughter or son good care of children is taken in small family 1 2 3 Yes 1 No 2
By spacing the birth of children for two to three years mothers
health is maintained
Yes 1 No 2
Frequent births badly affects the health of the mother 1 2 3 Yes 1 No 2
If children are born at close birth intervals , they remain weak
from the time of birth onwards
1 2 3 Yes 1 No 2
At your convenience and doctors advice select any one of the
family planning methods
1 2 3 Yes 1 No 2
For permanent protection operation is the easy and reliable
method
1 2 3 Yes 1 No 2
Government has made available all the facilities at your nearyby
health centre now what is the delay for
1 2 3 Yes 1 No 2
Healthy Nation/Bharat begins with healthy family from you 1 2 3 Yes 1 No 2
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Q 5030 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
vii Music 1 2 3 4
viii Overall 1 2 3 4Q 5031 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5033Q 5032 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 5033 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5034 Have you taken any action after watching this ad? Yes
No
1
2 Q 5036Q 5035 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Adopting small family
Ensuring proper spacing between birthsAccepted some family planning method
Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for small family
Encouraged others for family planning/spacingOther (Specify)_______________
01
0203040506070809
Q 5036 Do you intend to take any action after watching this ad? YesNo
12 Q 5038
Q 5037 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Adopt small familyEnsure proper spacing between birthsAccept some family planning method
Aquire more informationDiscuss with spouse/ family members
Discuss with friends/relativesEncourage others for small family
Encourage others for family planning/spacingOther (Specify)_______________
010203040506070809
Q 5038 Have you received any information/messages on Family planning/
Small family / Birth spacing from any other source (other than
this advertisement) during the period starting from Christmas to
Republic day (27th
December 2008 to 26th
January 2009?
Yes
No
1
2 Q 5040
Q 5039 What is/are the source(s) from where you have received any
information/messages on Family planning/ Small family / Birth
spacing during this period?
INS: MULTIPLE RESPONSES POSSIBLE
Radio advertisements
News paper/magazines
Posters/pamphlets/booklets/hand bills
Banners,wall hoardings/writings
Public announcements
Cultural events/Melas
ASHA/ANM/AWWOther Govt. health functionaries
Private health functionariesSpouse
Father/Mother Inlaw
Other family members/relatives
Friends/Neighbours
Others (Specify)______________________
01
02
03
04
05
06
0708
0910
11
12
13
14
Q 5040 To what extent do you agree with the following statements ? Agree to a
greater
extent
Agree to some
extent
Disagree Cant Say
A The decisions on when to have child and spacing between
children should be jointly taken by husband and wife
1 2 3 4
B Small family is a happy family 1 2 3 4
C There should be 2-3 years spacing between the birth of two
children
1 2 3 4
D 2-3 years spacing between the birth of two children is good for the
health of the mother and children
1 2 3 4
E There is no tension in accepting new Cu.T as it is easy to insert
and safe
1 2 3 4
F The oral pills offered now are very safe 1 2 3 4
G If one forgets to take oral pills on a particular day she cab take it 1 2 3 4
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next day
H Family planning operations are reliable permanent family
planning methods
1 2 3 4
I ASHA should be contacted for getting information on various
family planning methods
1 2 3 4
J All family planning services are available in nearby health
facilities
1 2 3 4
K You feel confident to initiate discussions with any one about
advantages of small family
1 2 3 4
L You feel confident to initiate discussions with any one about
advantages of spacing of children
1 2 3 4
M You feel confident to initiate discussions with any one about
family planning methods
1 2 3 4
NRHM SERVICES/HEALTH SERVICES AD NO. 11 -PRAGATI ON MEDICAL TOUR
Q 5041 Have you seen any ad on NRHM services/Health Services
shown on Pragati on Medical Tour during the period starting
from Christmas to Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 5054Q 5042 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 5043 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January2nd week of January
3rd week of January
4th
week of January
1
23
4
5
Q 5044 What all you could understand from this Ad?
Q 5045 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware
about it before
watching the Ad?
Feel proud to see the improvement in health services in such small
villages
1 2 3 Yes 1 No 2
Fast spreading health centers 1 2 3 Yes 1 No 2Better services, instruments, doctors, nurses 1 2 3 Yes 1 No 2
Care of new born 1 2 3 Yes 1 No 2
Increased utilization of hospitals for delivery 1 2 3 Yes 1 No 2
Increasing OPD services 1 2 3 Yes 1 No 2
Due increased funds, people themselves take decisions to fulfill
the local needs by forming Rogi Kalyan Samitis and Village
Health and Sanitation committees
1 2 3 Yes 1 No 2
Q 5046 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 5047 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5049Q 5048 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 5049 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5050 Have you taken any action after watching this ad? Yes
No
1
2 Q 5052
Q 5051 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Aquired more knowledge about health servicesVisited government hospitals
Interacted with Rogi Kalyan SamiltisInteracted with Village Health & Sanitation
Committees
010203
04
-
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Aquired more informationDiscussed with spouse/ family members
Discussed with friends/relativesEncouraged others for using govt health services
Other (Specify)_______________
0506070809
Q 5052 Do you intend to take any action after watching this ad? YesNo
12 Q 5054
Q 5053 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Aquire more knowledge about health servicesVisit government hospitals
Interact with Rogi Kalyan Samiltis
Interact with Village Health & SanitationCommitteesAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others for using govt health servicesOther (Specify)_______________
010203
040506070809
NRHM SERVICES/HEALTH SERVICES AD. NO. 12 - EK SAVERA , EK AAKASH
Q 5054 Have you seen any ad on NRHM services/Health Services shown
on Ek Savera , Ek Aakash during the period starting from
Christmas to Republic day (27th December 2008 to 26th January
2009)?
Spontaneous ResponsePrompted Response
Aided response
No
12
3
4 Q 5067Q 5055 How many times have you watched this ad during this period ? Once
Twice
ThriceFour time
Five or more time
1
2
34
5
Q 5056 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January
3rd
week of January
4th
week of January
1
2
3
4
5
Q 5057 What all you could understand from this Ad?
Q 5058 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware
about it beforewatching the Ad?
Healthy Nation/Bharat begins with healthy family 1 2 3 Yes 1 No 2
Trained health worker is available in every village 1 2 3 Yes 1 No 2
Every mother get proper antenatal care 1 2 3 Yes 1 No 2
See healthy child in lap of every mother 1 2 3 Yes 1 No 2
Every family get better nutrition 1 2 3 Yes 1 No 2
Let us take the oath that better health services reach every village 1 2 3 Yes 1 No 2
National Rural Health Mission 1 2 3 Yes 1 No 2
Q 5059 Now we are going to ask some questions regarding this ad. forwhich you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither likednor disliked
Disliked DontKnow
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 5060 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5062Q 5061 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messagesOther (Specify)____________
1
2
3
45
Q 5062 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5063 Have you taken any action after watching this ad? Yes
No
1
2 Q 5065
Q 5064 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Aquired more knowledge about health services
Visited government hospitals
Discussed with spouse/ family members
01
02
03
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Discussed with friends/relatives
Encouraged others for using govt health services
Other (Specify)_______________
04
05
06
Q 5065 Do you intend to take any action after watching this ad? Yes
No
1
2 Q 5067Q 5066 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Aquire more knowledge about health services
Visit government hospitals
Discuss with spouse/ family members
Discuss with friends/relatives
Encourage others for using govt health services
Other (Specify)_______________
01
02
03
04
05
06Q 5067 Have you received any information/messages on NRHM/Health
Services at Govt. hospitals from any other source (other than this
advertisement) during the period starting from Christmas to
Republic day (27th
December 2008 to 26th
January 2009?
Yes
No
1
2 Q 5069
Q 5068 What is/are the source(s) from where you have received any
information/messages on NRHM/Health Services at Govt.
hospitals during this period?
INS: MULTIPLE RESPONSES POSSIBLE
Radio advertisements
News paper/magazines
Posters/pamphlets/booklets/hand bills
Banners,wall hoardings/writings
Public announcements
Cultural events/Melas
ASHA/ANM/AWW
Other Govt. health functionaries
Private health functionariesSpouse
Father/Mother Inlaw
Other family members/relatives
Friends/Neighbours
Others (Specify)______________________
01
02
03
04
05
06
07
08
091011
12
13
14
Q 5069 To what extent do you agree with the following statements? Agree to a
greater
extent
Agree to some
extent
Disagree Cant
Say
A The health services in Government Hospitals has significantly
improved in the recent past
1 2 3 4
B The health services are more accessible now 1 2 3 4
C The health services, instruments,doctors and nurses are better
now
1 2 3 4
D The OPD services in Government hospitals are better now 1 2 3 4
E The new born care services in Government hospitals are betternow
1 2 3 4
F The services in Government hospitals for pregnant women are
better now
1 2 3 4
G You feel confident to initiate discussions with any one about
health services in Government hos[itals
1 2 3 4
IMMUNISATION - AD. NO. 13 JUHI CHAWLA
Q 5070 Have you seen any NRHM ad on child Immunisationfeaturing
Juhi Chawla during the period starting from Christmas to
Republic day (27th
December 2008 to 26th
January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q5083
Q 5071 How many times have you watched this ad during this period ? OnceTwice
ThriceFour time
Five or more time
12
34
5
Q 5072 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January3rd week of January
4th week of January
1
2
34
5
Q 5073 What all you could understand from this Ad?
Q 5074 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you
aware about itbefore watching
the Ad?
Come out of home and immunize your child 1 2 3 Yes 1 No 2
In the fist year, vaccination/immunisation for 4 times not 2 or 3 1 2 3 Yes 1 No 2
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Men Questionnaire
Concurrent Evaluation of the Reach and Effectiveness of Second Phase of the National Rural Health Mission BCC Campaign 21
After iimunization some children might get fever but it protects
the entire life of the child from dangerous diseases
1 2 3 Yes 1 No 2
There is only protection against measeal and that is immunization 1 2 3 Yes 1 No 2
At the age of 9 month it is necessary to administer measles
vaccine and if it is not administered due to some reason then go
immediately for administering it
1 2 3 Yes 1 No 2
Measeals make your child weak and susceptible to diarrhea andPneumonia
1 2 3 Yes 1 No 2
Immunization at right time will protect from measles 1 2 3 Yes 1 No 2
For immunization contact ANM or ASHA or AWW 1 2 3 Yes 1 No 2
May god save such mothers from bad eyes 1 2 3 Yes 1 No 2Q 5075 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither liked
nor disliked or disliked the ad?
Liked Neither
liked nor
disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
vii Music 1 2 3 4
viii Overall 1 2 3 4
Q 5076 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5078Q 5077 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 5078 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5079 Have you taken any action after watching this ad? Yes
No
1
2 Q 5081
Q 5080 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Immunisied the childGot child immunized against measles
Consulted ASHA/ANM/AWWAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others for availing servicesOther (Specify)_______________
01020304
05060708
Q 5081 Do you intend to take any action after watching this ad? YesNo
12 Q 5083
Q 5082 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Administer 4 vaccines to the child in first 1year
Get child immunized against measlesConsult ASHA/ANM/AWW
Aquire more informationDiscuss with spouse/ family members
Discuss with friends/ relativesEncourage others for availing services
Other (Specify)_______________
01
02030405060708
IMMUNISATION AD. NO. 14 MONA SINGH
Q 5083 Have you seen any NRHM ad on TT to mothers and/or child
Immunisationfeaturing Mona Singh (Jassi) during the period
starting from Christmas to Republic day (27th
December 2008 to
26th
January 2009)?
Spontaneous Response
Prompted Response
Aided response
No
1
2
3
4 Q 5097Q 5084 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 5085 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd week of January
3rd
week of January
4th
week of January
1
2
3
4
5Q 5086 What all you could understand from this Ad?
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Q 5087 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you aware about it
before watching the Ad?
Now you get free AD injection for each immunization now
there is no fear of infection
1 2 3 Yes 1 No 2
It is your right to ask for free AD injection for your child 1 2 3 Yes 1 No 2
Free AD injection is totally safe 1 2 3 Yes 1 No 2
Just one injection one time so what to fear of 1 2 3 Yes 1 No 2
On confirmation of pregnancy it is extremely necessary to take 2
TT injection so that at time of birth both mother and child are safe
1 2 3 Yes 1 No 2
This way in next month remember to take second dose of TT
injection
1 2 3 Yes 1 No 2
For TT injection contact ANM, ASHA or AWW 1 2 3 Yes 1 No 2
May god save such mothers from bad eyes 1 2 3 Yes 1 No 2
Q 5088 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked the ad, neither likednor disliked or disliked the ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Celebrity 1 2 3 4
iv Storyline 1 2 3 4
v Presentation style 1 2 3 4
vi Characters 1 2 3 4
vii Music 1 2 3 4viii Overall 1 2 3 4
Q 5089 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5091Q 5090 What did you find difficult in this Ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fastToo many messages
Other (Specify)____________
1
2
34
5
Q 5091 Do you feel that you have learnt some new things due to this ad? Yes
No
1
2
Q 5092 Have you taken any action after watching this ad? Yes
No
1
2 Q 5094
Q 5093 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Uses one injection only one time
Uses AD injections
Immunisied the childTook 2 doses of TT during pregnancy
Consulting ASHA/ANM/AWW
Aquired more information
Discussed with spouse/ family members
Discussed with friends/relatives
Encouraged others for availing services
Other (Specify)_______________
01
02
0304
05
06
07
08
09
10
Q 5094 Do you intend to take any action after watching this ad? Yes
No
1
2 Q 5097Q 5095 What action do you intend to take?
INS: MULTIPLE RESPONSE POSSIBLE
Use one injection only one time
Use AD injections
Immunisie the child
Take 2 doses of TT during pregnancy
Consult ASHA/ANM/AWWAquire more information
Discuss with spouse/ family members
Discuss with friends/relatives
Encourag others for availing services
Other (Specify)_______________
01
02
03
04
0506
07
08
09
10
Q 5097 Have you received any information/messages on immunisation
from any other source (other than this advertisement) during theperiod starting from Christmas to Republic day (27th December
2008 to 26th January 2009?
Yes
No
1
2 Q 5099
Q 5098 What is/are the source(s) from where you have received any
information/messages on immunisation during this period?
INS: MULTIPLE RESPONSES POSSIBLE
Radio advertisements
News paper/magazinesPosters/pamphlets/booklets/hand bills
Banners,wall hoardings/writingsPublic announcements
Cultural events/Melas
ASHA/ANM/AWW
Other Govt. health functionaries
Private health functionaries
01
0203
0405
06
07
08
09
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Men Questionnaire
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Spouse
Father/Mother Inlaw
Other family members/relatives
Friends/Neighbours
Others (Specify)______________________
10
11
12
13
14
Q 5099 To what extent do you agree with the following statements? Agree to agreater
extent
Agree to
some
extent
Disagree Cant Say
A Mothers should not get scared of immunizing the children 1 2 3 4
B One injection should be used only one time 1 2 3 4
C Four injections/shots should be given to the child in first oneyear
1 2 3 4
D Four injection protects the child life time 1 2 3 4
E Measles should be administered at ninth month of the child 1 2 3 4
F On confirmation of pregnancy mother should immediately go to
ASHA for registration and immunisation
1 2 3 4
G During pregnancy it is essential for mother to take 2 TT injection 1 2 3 4
H You feel confident to initiate discussions with any one about
immunisatin of mothers and children
1 2 3 4
I You can convince anyone on importance of immunization of
mothers and children
1 2 3 4
BREAST FEEDING/CHILD NUTRITION AD. NO. 15 BADHTE SHISHU KI BADHATI JARURATE/MAA KA
DUDH 6 MAHINE TAK
Q 5100 Have you seen any NRHM ad on breast feeding/child nutrition
during the period starting from Christmas to Republic day (27th
December 2008 to 26
thJanuary 2009)?
Spontaneous Response
Prompted ResponseAided response
No
1
23
4 Q 5116Q 5101 How many times have you watched this ad during this period ? Once
Twice
Thrice
Four time
Five or more time
1
2
3
4
5
Q 5102 When was the last time you watched this ad?
READ OUT ONE BY ONE AND CIRCLE ONE
Last week of December
First week of January
2nd
week of January
3rd
week of January
4th
week of January
1
2
3
4
5
Q 5103 What all you could understand from this Ad?
Q 5104 Can you tell us what message was given in this ad? Spontaneous On Prompting No Were you
aware about it
before watching
this ad?
For better growth of the child feed the child only mothers milk
for first 6 months , After that along with breastmilk give child
other supplementary food
1 2 3 Yes 1 No 2
At the age of 6 months start feeding the child daliya made of riceand floor
1 2 3 Yes 1 No 2
Feed the child home made Paste/Semi-solid food without spice 1 2 3 Yes 1 No 2
Give the child fruits and vegetables 1 2 3 Yes 1 No 2
Give supplementary food 5-6 times in a day) 1 2 3 Yes 1 No 2Continue breastfeeding for 2 years 1 2 3 Yes 1 No 2
Fulfill the growing needs of the growing child through adequate
supplementary food
1 2 3 Yes 1 No 2
Immediately after birth, should definitely initiate breastfeeding
within one hour of birth
1 2 3 Yes 1 No 2
Mother first thik yellowish milk meaninig colostrum keeps the
child away from diseases
1 2 3 Yes 1 No 2
Mother fist milk also provide adequate quantities of vitamins
and proteins
1 2 3 Yes 1 No 2
For fist 6 months feed the child mothers milk only, Do not feed
any thing else other than this
1 2 3 Yes 1 No 2
Remember for first 6 months mother milk is best and complete
nutrition for the child
1 2 3 Yes 1 No 2
Q 5105 Now we are going to ask some questions regarding this ad. for
which you have to tell us whether you liked this ad, neither likednor disliked or disliked this ad?
Liked Neither liked
nor disliked
Disliked Dont
Know
i The Message Conveyed 1 2 3 4
ii Clarity of the Message 1 2 3 4
iii Storyline 1 2 3 4
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iv Presentation style 1 2 3 4
v Characters 1 2 3 4
vi Music 1 2 3 4
vii Overall 1 2 3 4
Q 5106 Did you find anything difficult to understand in this ad? Yes
No
1
2 Q 5108Q 5107 What did you find difficult in this ad.?
INS: MULITIPLE RESPONSE POSSIBLE
Language
Wordings
Message too fast
Too many messages
Other (Specify)____________
1
2
3
4
5
Q 5108 Do you feel that you have learnt some new things due to this ad? YesNo
12
Q 5109 Have you taken any action after watching this ad? Yes
No
1
2 Q 5111Q 5110 What action has been taken after watching this ad?
INS: MULTIPLE RESPONSE POSSIBLE
Encouraged for ensuring exclusive breast feedingfor 1st 6 months
Encouraged for Initiating supplementary feedingfrom 6 months
Encouraged for Initiatiating breast feeding withinone hour of birth
Encouraged for Feeding cholostrum to the childAquired more information
Discussed with spouse/ family membersDiscussed with friends/relatives
Encouraged others on child feeding practicesOther (Specify)_______________
01
02
03
04050607
0809
Q 5111 Do you intend to take any action after watching this ad? YesNo
12 Q 5113
Q 5112 What action do you intend to take?
INS: MULTIPLE RESPONSES POSSIBLE
Encourage for ensuring exclusive breast feedingfor 1st 6 months
Encourage for Initiating supplementary feedingfrom 6 months
Encourage for Initiatiating breast feeding withinone hour of birth
Encouraged for Feeding cholostrum to the childAquire more information
Discuss with spouse/ family membersDiscuss with friends/relatives
Encourage others on child feeding practices
Other (Specify)_______________
01
02
03
0405060708
09Q 5113 Have you received any information/messages on Breast feeding/
Child nutrition from any other source (other than this
advertisement) during the period starting from Christmas to
Republic day (27th
December 2008 to 26th
January 2009?
Yes
No
1
2 Q 5115
Q 5114 What is/are the source(s) from where you have received any
information/messages on Breast feeding/ Child nutrition during
this period?
INS: MULTIPLE RESPONSES POSSIBLE
Radio advertisements
News paper/magazines
Posters/pamphlets/booklets/hand bills
Banners,wall hoardings/writings
Public announcementsCultural events/Melas
ASHA/ANM/AWW
Other Govt. health functionaries
Private