Please Wait...

AWW Template -Form Fill

VILLAGE LOCATION
Q01

District name
Q02

District code
Q03

Block name
Q04

Block code
Q05

Sub-center name
Q06

Sub-center code
Q07

Sub-center type
Q08

Village name
Q09

Village code
Q10

Awc name
Q11

Awc code
Q12

Name of respondent
Q13

WAS THE SAME ANGANWADI WORKER INTERVIEWED DURING THE FIRST ROUND ENDLINE SURVEY?
Q14

Anganwadi worker in selected segment
Q15

Anganwadi worker in listing village

INTERVIEWER VISITS
A01

FIRST VISIT

A01_1

Interviewer name
A01_2

Interviewer id
A01_3

Date of visit
A01_4

Result code
A02

Second visit

A02_1

Interviewer name
A02_2

Interviewer id
A02_3

Date of visit
A02_4

Result code
A03

Third visit

A03_1

Interviewer name
A03_2

Interviewer id
A03_3

Date of visit
A03_4

Result code
Respondent and community characteristics
B01

Do you live in this village?
B02

How long have you lived in this village?
B03

How far from this village do you live?
B04

How do you usually travel to this village from where you live?
B05

How long does it take you to commute by [mode of transportation] to this village from where you live?
B06

What is your current age?
B07

What is your religion?
B08

What is your caste/category?
B09

if the caste is a scheduled caste, scheduled tribe, other backward caste or other.
B10

Which group is the predominantly served by your AWC? Would you say Muslims, Dalits, other backward caste or general caste?
B11

What is your marital status?
B12

Can you read and write?
B13

What is the highest standard or class you completed?
B14

For how long have you been working as an Anganwadi worker?

B15

How many Anganwadi Centers (AWC) are located in this village?
B16

Do you have an Anganwadi Helper at your AWC?
B17

Do you have a currently functioning ____ in your possession?

B17_1

Height/length measuring scales

B17_2

Infant weighing scale
B17_3

Salter scale

B17_4

Mothers weighing machine

B18

Is there a _________ in this village?

B18_1

Trained Dai
B18_2

Chemist shop or pharmacy
B18_3

Private allopathic doctor (mbbs doctor)
B18_4

Private Ayurvedic/Homeo/Unani doctor/ AYUSH
B19

How many kilometers is your sub-center from this village?
B20

What is the most common mode of transport used by people in your village to reach the sub-center?
B21

How long does it take to get to the sub-center by [MODE OF TRANSPORT]?
Sub center meetings
C01

During the past 12 calendar months, did you attend any sub-center meetings?
C02

In the past three calendar months how many times did you participate in these sub-center meetings?
C03

Why have you not attended any sub-center meetings in the last 3 months?
C04

When was the last time you attended a sub-center meeting?
C05

In the last sub-center meeting you attended, did someone ask you how many home visits you and the ASHA of your village had done since the previous meeting?
C06

In the last sub-center meeting you attended, did someone ask you and the ASHA to discuss and plan the home visits to conduct before the next meeting?
C07

In the last sub-center meeting you attended, were any goals or targets set at the sub-center meeting related to what should be achieved in next month?

C08

Do you receive new information in these subcenter meetings or are the topics covered things you already know?

C09

At the sub-center meetings, do ASHAs and Anganwadi workers have the opportunity to ask questions/offer their opinions?

C10

How often do ASHAs and Anganwadi workers ask your ANM to demonstrate or show you how to use tools during sub-centre meetings? Would you say almost never, infrequently, sometimes, or all the time?
C11

How often does your ANM talk to ASHAs/Anganwadi workers about how well other sub-centres are performing? Would you say almost never, infrequently, sometimes, or all the time?
C12

In any of the subcenter meetings in the past 12 months, were any topics covered related to how to take care of health during pregnancy?
C13

What topics were covered related to taking care of your health during pregnancy?
C14

In any of the subcenter meetings in the past 12 months, were any topics covered related to arranging transportation for delivery?
C15

What topics were covered related to arranging transportation for delivery?

C16

In any of the subcenter meetings in the past 12 months, were any topics covered related to how to prepare for delivery?
C17

What topics were covered related to how to prepare for delivery?
C18

In any of these sub-center meetings in the past 12 months, were any topics covered related to immediate newborn care?
C19

What topics were covered related to immediate newborn care?
C20

In any of the sub-center meetings in the past 12 months, were any topics covered related to danger signs that can appear for the newborn that would require a mother to take the child to the doctor?
C21

What newborn danger signs were covered?
C22

In any of the sub-center meetings in the past 12 months, were any topics covered related to pregnancy and delivery danger signs that would require the mother to see a doctor?
C23

What were the danger signs covered during pregnancy and delivey?
C24

In any of these sub-center meetings in the past 12 months, were any topics covered related to feeding the child semi-solid foods?
C25

In any of these sub-center meetings in the past 12 months, were any topics covered related to Immunization?
C26

What issues related to immunization were discussed?
C27

In any of the meetings in the past 12 months, were benefits of reproductive health/family planning discussed?
C28

What issues related to the benefits of reproductive health/family planning were covered during the meeting?
C29

In any of these sub-center meetings in the past 12 months, were any topics covered related to IUCD for birth spcing?
C30

What issues related to IUCD for birth spacing were discussed?
SERVICES
D01

Let start with home visits
D02

How many visits are you required to make in a given day?
D03

Do you have a planner or home visit register for keeping track of women and children you serve?
D04

Was it an official register or a notebook/diary? If it was an official register, what type of register?
D05

When was the last time you updated the planner/home visit register with details of visit conducted?
D06

How often do you update your planner/home visit register with details of visit conducted? Would you say daily, weekly, every other week or once a month?
D07

When do you usually update the planner/register? Is it usually before visiting the household, or after you visit the household or both?

D08

Did anyone verify the planner/home visit register in the past 3 calendar months?

D09

Who all verified the planner/home visit register?
D10

How do you decide which families to visit on a given day? Do you decide on your own or do you make the decision based on information from a notebook or planner?
D11

While selecting homes that you need to visit in a day, which type of beneficiary do you generally regard as most important and who need to be visited as the highest priority?
D12

In total, how many home visits were recorded in the home visit planner in the past calendar month?
D13

Based on your observations of how filled or updated does the planner look?
D14

In the past calendar month, did you visit any pregnant women in the last trimester of pregnancy at home?
D15

How many times do you usually conduct home visits to each pregnant woman during the 7th, 8th, 9th month of her pregnancy?
D16

Where do you record information about pregnancies in your catchment area?
D17

What is the name of that woman?

D18

How many months of her pregnancy had she completed?
D19

Now think about all your home visits with her during her pregnancy
D20

What information did you provide related to preparing for birth?

D20_1

Providing ambulance number
D20_2

What was the ambulance number you gave her?
D20_3

Identifying other private ambulance/vehicle for delivery
D20_4

Provided the Anganwadi worker or ASHA’s phone number

D20_5

Saving money
D20_6

Registering birth with Anganwadi worker/ASHA
D20_7

Identifying the facility for delivery
D21

During any of your home visits with [NAME] during pregnancy, did you provide information on what to apply to the cord or umbilicus of the newborn?
D22

What did you advise [NAME] to apply?
D23

Did you explain the benefits of not applying anything on the cord to her?
D24

What are the benefits of not applying anything on the cord?
D25

During any of your visits with [NAME] during pregnancy, did you yourself provide her with IFA tablets/Iron syrup?
D26

In total, how many tablets or bottles of syrup did you provide her?
D27

Did you explain to her the benefits of taking IFA tablets/Iron syrup to [NAME]?
D28

What are the benefits of consuming IFA tablets/ Iron syrup?

D29

During any of your home visits with [NAME] during pregnancy, did you provide information on when to start breastfeeding?
D30

In general, when do you usually advise a mother to start breastfeeding her child?
D31

Did you explain to this woman the benefits of breastfeeding immediately after birth?
D32

Apart from home visits, did you meet the woman anywhere else during her pregnancy to discuss her or her child’s health?
D33

Where did you meet the women?
D34

In the past calendar month, how many institutional deliveries took place in your community?
D35

Did you accompany the woman to the facility for any of these deliveries?
D36

How many women did you accompany to the facility for these deliveries?
D37

In the past calendar month, how many home deliveries took place in your community?
D38

Were you present at any of these home deliveries?
D39

How many home deliveries were you present for?
D40

Thinking of these women who had a delivery in the past calendar month, did you conduct a home visit with any of these women?

D41

Did you visit any of these women within 24 hours of the delivery?
D42

Did you conduct a home visit with any of these women who had a delivery after the first day but within the first month of the child’s birth?
D43

How many times do you usually visit each new mother after the first day but within the first month of the child’s birth?
D44

Where do you record information about births in your catchment area?

D45

What is the name of that woman?
D46

How old is her child now?
D47

Did [NAME] have a normal delivery or were there any complications?
D48

How many times have you visited [NAME] at her home since her child was born?
D49

In all your home visits to [NAME] since the birth of her child, what topics did you discuss relating to newborn care?

D50

Did you talk to [NAME] about danger signs for newborns after birth?

D51

Did you talk to [NAME] about maternal danger signs after delivery?

D52

Apart from home visits, did you meet the woman within one month after her delivery to discuss her or her child’s health?
D53

Where did you meet the women?
D54

In the past three months, have you referred any woman to a PHC or a doctor to treat a maternal or newborn danger sign?
D55

How many women have you referred to a PHC or a doctor to treat a maternal or newborn danger sign?
D56

In the past 12 months, have you referred any woman to a PHC or a doctor to treat a maternal or newborn danger sign?
D57

In the past calendar month, did you visit any mothers of children around 5-7 months of age to discuss infant feeding?
D58

On average, how many times do you usually visit each woman when the child is 5-7 months of age to discuss infant feeding?
D59

What is the name of the mother?
D60

How old is her child?
D61

When did you advise [NAME] to start feeding for her child solid or semi-solid food?
D62

How many times a day did you ask [NAME] to feed her child?
D63

In total, how much food did you advise [NAME] to feed her child EACH time?
D64

What are the kinds of food you advised [NAME] to feed her child?
D65

What did you tell [NAME] are the benefits of feeding a child solid or semi-solid foods starting at age 6 months?
D66

Do mothers discuss any concerns about starting complementary feeding for their children?
D67

What reasons do mothers give you for not starting complimentary feeding for their children?
D68

What do you tell mothers to address their concerns?
D69

Apart from home visits, did you meet the woman anywhere elsewheh her child was around 5-7 months to discuss infant feeding?
D70

Where did you meet the women?
D71

In the past calendar month, did you discuss the benefits of immunizations during any of your home visits?
D72

During the past calendar month, did you have any discussions with women who did not give or were not able to give their children follow up shots?
D73

What were the reasons mothers gave for not giving their children follow up shots? What were the concerns they had?
D74

In the past calendar month, have you discussed family planning with any of the women you visited?
D75

What did you discuss about family planning with these women?
D76

Have you discussed any concern women may have using IUD?

D77

What types of concerns of women have you dicussed with women about using IUD?
D78

How much time do you usually spend during each home visit?

D79

In all the home visits you made last week, did you have any discussions with the husbands in the household? If yes, ask would you say most of the times or some of the times, or very few times?
D80

In all the home visits you made last week,, did you have any discussions with the mother in laws in the households? If yes, ask would you say most of the times or some of the times, or very few time?

D81

When you do home visits in general, how often do you take the job aid kit with you? Would you say most of the times, some of times, infrequently or never?

D82

Which of the job aid tools do you use most often?
D83

When you visit households, how often do you show the uterous model? Would you say most of the times, some of times, infrequently or never?

D84

When you visit households, how often do you show the katori? Would you say most of the times, some of times, infrequently or never?

D85

When you visit households, how often do you take the mobile kunji with you? Would do you say most of the times, some of the times, infrequently or never?
D86

When you take the Mobile Kunji to a household, do you usually show the card or do you usually dial the phone to play Dr. Anita’s message or both?
D87

What do you think most of the households prefer? The cards or the phone?
D88

How many free minutes did you have in the previous calendar month as part of Mobile Kunji?
D89

Did you run out of free minutes in the previous calender month?
D90

Have you ever run out of minutes any month since you got the Mobile Kunji?
D91

Did you have any problems in using the Mobile Kunji audio messages in the previous calendar month?
D92

What problems?
TEAM WORK AND COORDINATION
E01

Let’s start with home visits. When you do home visits, do you usually do them jointly with the ASHA or do you do them on your own?

E02

In the past 7 days did you do any home visits jointly with the ASHA? If so, how many?
E03

Have you ever asked the ASHA to help you by conducting a home visit when you are unable to do one?
E04

How many times in the past 30 days have you asked the ASHA to cover a home visit for you?
E05

Has the ASHA ever asked you to help her by conducting a home visit when she is unable to do one?
E06

How many times in the past 30 days has the ASHA asked you to cover a home visit for her?
E07

Besides home visits, do you share any other responsibilities with the ASHA?
E08

Which responsibilities do you share with the ASHA?
E09

How many times did you meet with the ASHA in the past 7 days to talk about work or home visits?
E10

Now let’s talk about any support you receive from the ANM.
E11

How many joint visits did you conduct with the ANM in the past seven days?

E12

When you are having difficulty dealing with a case, do you ask the ANM from your sub-center for help or advice? Would you say most fo the times, sometimes, or rarely?
E13

When you are having difficulty dealing with a case, do you ask other Anganwadi workers and ASHAs from your sub-center for help or advice? Would you say often, sometimes, or rarely?
E14

When other Anganwadi workers and ASHAs at your sub-center are having trouble with a case, do they come to you for help or advice? Would you say often, sometimes, or rarely?
E15

Thinking about the people you work with to improve the health of women and children in your village, whom do you consider to be your “team”?

E16

What are the ways in which you work together as a team with [ALL THE RESPONSES IN D15]?
E17

Do you feel that you can get help from others on the team when you need it? Would you say always, sometimes, or never?
E18

Are you and your team expected to plan for each week or month with each other? Would you say always, sometimes, or never?
E19

Are you expected to meet regularly with other team members? Would you say always, sometimes, or never?

E20

Are you expected to help others on the team? Would you say always, sometimes, or never?
E21

Do you feel that some members of your team do not contribute?

E22

Do you feel that working as a team improves your standing in the community? Would you say always, sometimes, or never?

E23

Do you feel that you can accomplish more in your job by working as part of a team? Would you say often, sometimes, or never?
E24

Do you set joint goals along with your team in order to serve beneficiaries?

E25

What types of things do you set goals about? Such as home visits and other maternal and child health practices?
E26

I am going to read statements about the goals that you set with your team. Please indicate whether you agree or disagree with each of these statements.

E26_1

The goals are clear to everyone on the team.
E26_2

Your team works together to decide on the team goals.
E26_3

Your team cares about whether it meets the team goals
E26_4

People on your team keep track of progress toward team goals

E26_5

Your team works hard to reach its targets
E26_6

Your team can reach most of its targets
TEAM-BASED GOAL INCENTIVES
F01

Can you show me the TBGI diary in which to track your progress towards each goal?
F02

Let’s take one of the goals given to you an example. Let’s talk about women making arrangements for transportation to the facility for delivery.

F03

Ok, let me ask this differently. Imagine there are 20 women in your catchment area who are in the last trimester of their pregnancy. In the TBGI diary what will you record as the total number of women who will need to make arrangements for transportation to the facility?
F04

Based on your observation, does the AWW understand how to identify the total number of beneficiaries that require to make arrangements for transportation?
F05

Where did you get the information you needed to determine this total number?

F06

While calculating the total number do you also include those women who have come to their parent’s homes for delivery?
F07

Out of this total number, how many women have to make arrangements for transportation in order for you to reach the target?
F08

Ok, let me ask this differently. If for the TBGI diary you determine that there are 20 women in total who will need to make arrangements for transportation to the facility, out of these how many women will have to make arrangements for transportation in order for you to reach your target?
F09

Based on your observation, does the AWW understand how to calculate the number of women that need to make arrangements for transportation in order for them to reach their target?
F10

Were you able to calculate this target yourself or did someone help you figure out this target?
F11

Who filled out the diary with the targets? Did you do this yourself or did someone help you fill the diary?
F12

When you have met the target, do you stop, or do you continue to try to make sure that all the identified households have made arrangements for transportation?
F13

please tell me how you determine when a goal has been achieved by a household.

F13A

To determine if a woman has received at least 90 IFA tablets during her last pregnancy. Do you consider this goal achieved after you have given her IFA tablets or do you do something else?
F13B

To determine if a child in the age group of 6-11 months is given quantity of food that is age-appropriate and nutritious. Do you consider the goal achieved after you have told the mother about complementary feeding or do you do something else?
F13C

To determine if a mother has used any modern methods of family planning. Do you consider the goal is achieved after you have told them about any modern methods of family planning or do you do something else?
F13D

To determine if a child has received a DPT-3 injection within 6 months. Do you consider the goal achieved after you have told the mother about the importance of getting the DPT-3 or do you do something else?
F14

Do you share this diary with the ASHA, or do you each have your own diary?
F15

In your catchment area, do you take responsibility for some of the targets and does the ASHA take responsibility for the other targets, or do you both share responsibility for all the targets?
F16

In your catchment area, are there some households for which you are responsible and other households for which the ASHA is responsible or do you both share responsibility for all households?
F17

Do you and the ASHA ever meet to update each other on the households’ adoption of the practices?

F18

How often do you usually meet with the ASHA to talk about how to reach your targets and to update each other on the households that have adopted the goals/practices?

F19

In the past calendar month, did anyone review your diary?
F20

Who reviewed your diary?
F21

Does someone verify these numbers you record in your diary by confirming with households in your catchment area? Who verifies this information?
F22

Now I have a few questions on advice you receive on meeting your targets. Does the ANM provide any advice on what to do to reach your targets? Would you say most of the times, sometimes, or not very often?
F23

At the sub-center meetings, do you receive any advice on what to do to reach your targets? Would you say most of the times, sometimes, or not very often?
F24

In general, which target have you found the easiest to achieve in your community?
F25

In general, which target have you found most difficult to achieve in your community?
F26

What about your sub-center? Since the targets has incresesed from 7 to 17, did your subcenter ever meet 14 out of 17 targets in a quarter?

F27

In how many quarters has the sub-center met 14 out of 17 targets?
F28

Have the frontline workers in your sub-center, including you, received any gifts for achieving targets?
F29

How many times have you received gifts since the goals increased?
F30

What gifts did you receive since the goals increased?

F31

Overall, how satisfied with the quality of the gifts you have received so far? Would you say you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied?
F32

How often do you use the most recent gift you received?
F33

What form of recognition would you prefer in the future? Would you prefer getting gifts or prefer getting a certificate?
F34

Since last year, 10 new goals have been added. How easy or difficult has it been to work on reaching a larger number of goals?
F35

Now that you have more goals to achieve, do you spend more time doing home visits, or are you able to achieve the goals in the same amount of time?
F36

Do you read a pledge during your sub-center meetings?
F37

Does reading the pledge motivate you to do you work better? Would you say it motivates you a lot, a little or not so much?
Supervision and job satisfaction
G01

Do you feel like your work or efforts are recognized by others?
G02

Who recognized your work or efforts?

G03

Do you feel like you have the skills needed to do your job or do you feel you need more skills?

G04

What kind of skills do you need?

G05

Does the ANM monitor your work?
G06

In the last 3 calendar months, did you meet the ANM not counting the sub-center meetings?
G07

When was the last time you met with the ANM?
G08

How many times did you meet with the ANM in the last 3 calendar months, not counting the subcenter meetings?
G09

During any of your recent meetings, did the ANM

G09_1

Ask you about home visits you make to pregnant women as well as newborns and their mothers? Would you say most of the time, some of the time or none of the time?
G09_2

Review your registers where you record your home visits and check for accuracy? Would you say most of the time, some of the time or none of the time?
G09_3

Accompany you during home visits? Would you say most of the time, some of the time or none of the time?
G09_4

Talked to households that you were finding difficult to convince? Would you say most of the time, some of the time or none of the time?
G09_5

Provide you with direct feedback about your performance? Would you say most of the time, some of the time or none of the time?
Knowledge
H01

What are ways to prevent anemia in pregnant women?
H02

By what month during their pregnancy should mothers start consuming IFA tablets?

H03

How many adult dose iron (IFA) tablets should a healthy pregnant woman consume in all?
H04

Is there any side-effect of consuming IFA tablets?
H05

What are the side effects of consuming IFA tablets?
H06

What instrument should be used to cut the umbilical cord?
H07

What advice would you give a mother for cleaning the child immediately after delivery?
H08

What advice would you give a mother for keeping the child warm after birth?
H09

Do you know or has someone told you how many times you are supposed to visit a mother and her newborn in the first week after delivery? If so, how many times?
H10

What advice would you give a mother whose baby is born particularly weak or particularly small?
H11

How soon after delivery should the child be given his/her first bath?
H12

What are the benefits of waiting for 24 hours before bathing the baby?
H13

At what time period after birth do most infant deaths occur?
H14

Do you know the most common causes of neonatal deaths?
H15

What do you think are the benefits of breastfeeding the child immediately after birth?
H16

A 4 month old baby seems thirsty during summer months. Is it okay to give the baby some water to drink?
H17

A mother has started feeding rice to an infant in the fifth month of age. Is that the right time, too early or too late?
H18

For how many months after birth should a child receive only breast milk?
H19

Let us say there is a 5-month old child. She develops diarrhea. What breastfeeding related advice would you give a mother? Would you advise her to do more breastfeeding, less breastfeeding, or to continue breastfeeding as before?
H20

An infant is 11 months old. The mother says she feeds her infant three times a day. Would you advise her to feed more often, less often or continue three times a day?

H21

In what month should an infant first start to receive semi-solid foods in addition to breast milk?
H22

At what age should an infant start eating the following foods?

H22_1

Curd

H22_2

Milk

H22_3

Water

H22_4

Rice

H22_5

Roti

H22_6

Legume: daal

H22_7

Vegetables

H22_8

Fruits

H22_9

Meat/chicken

H22_10

Fish

H22_11

Eggs

H22_12

Additional oil or ghee in meals (Exclude oil for cooking)

H23

What immunizations should be given to a child at birth /within the first 15 days of birth?
H24

What vaccines should have been given to a child within 6 months of age?
H25

How soon after giving birth can a woman become pregnant again?
H26

What family planning methods can be used by the woman/her husband within 6 months of the delivery?
Interaction with households and behavior change
I01

Please give your opinion about each of the following questions using the scale provided.

I01_1

How likely is it that you could convince a mother of a 6 month old baby to start giving the baby food at least twice a day?
I01_2

How likely is it that you could convince a dalit mother of a 6 month old baby to start giving the baby food at least twice a day?
I01_3

How about if the mother-in-law wanted to wait until the baby is 9 months old? How likely is it that you could convince amother of a 6 month old baby to start giving the baby food at least twice a day
I01_4

How likely is it that you could convince the mother of a newborn not to put anything on the baby's umbilical cord — that is, to keep the cord clean and dry?
I01_5

How likely is it that you could convince a dalit mother of a newborn not to put anything on the baby's umbilical cord — that is, to keep the cord clean and dry?
I01_6

How likely is it that you could convince the mother of a newborn not to put anything on the baby's umbilical cord — that is, to keep the cord clean and dry — if the mother-in-law wanted to put some gentian violet on the cord?
I01_7

How likely is it that you could convince a pregnant woman or new mother to use an IUD to delay another pregnancy?
I01_8

How likely is it that you could convince a dalit pregnant woman or new mother to use an IUD to delay another pregnancy?
I01_9

How likely is it that you could convince a pregnant woman or new mother to use an IUD to delay another pregnancy if her mother-in-law wanted her to have another baby as soon as possible?
I01_10

How likely is it that you could convince a muslim pregnant woman or new mother to use an IUD to delay another pregnancy?
Reading proficiency
J01

How did you find that passage? Would you say it was very difficult to understand, a little difficult to understand or very easy to understand?

J02

Now think about the ASHA/Anganwadi workers in your sub-centre. Do you think they would be able to understand this passage? [If yes, ask] Would you say all of them, most of them or few of them would be able to understand this passage?
J03

How did you think the ASHA/Anganwadi worker read the passage? Would you say she read fluently, read abruptly, could not read or declined to read?
J04

How many mistakes did the ASHA/Anganwadi worker make while reading the passage?
Investigator’s perception
K01

Please rate your perceptions of the following qualities of the respondent, the interviewing situation, and the data.In your opinion, the respondent

K01_1

Was truthful, accurate
K01_2

Was confident and knowledgeable
K01_3

Answered questions without consulting anyone

K01_4

Was able to understand Hindi well
K01_5

Was interviewed without interruptions
K01_6

Please rate your opinion about the overall quality of the interview/respondent.