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Pba Intro Template -Form Fill
Question
Q01
Interviewer name
Q02
Interviewer code
Q03
Date of the interview
Q04
State Name
Q05
District Name
Q06
District Code
Q07
Block Name
Kalsi
Doiwala
Q08
Block Code
Q09
Village/City Name
Q10
Type of Area
Urban
Rural
Q11
Phone Number
Q12
Sample From
Original Sample
New Sample
Q13
Relationship with the child
Mother
Father
Elder brother/sister
Dada/Dadi
Other
Q14
Age of the child
Q15
Caste
General
OBC
SC
ST
Q16
Religion
Hindu
Muslim
Sikh
Christian
Buddhist
Others
Q17
No. of Children at home
Q18
Sequence of Focal Child
Q19
Gender of the Focal Child
Male
Female
Q20
Family Type
Joint
Nuclear
Q21
Household Annual Income
Livelihood
A01
Please tell me the names of all the people who live and take meals in this house
A02
Sex
male
Female
Prefer not to say
Others
A03
What is the relationship of this person with the head?
Head
Wife/Husband
Son/Daughter
Daughter-in-law/Son-in law
Grandchild
Father /Mother
Brother/Sister
Father-in law/Mother-in law
Nephew/Niece
Brother-in-law/Sister-in law
Other relatives
Domestic help
A04
What is the age of this person (in completed years)?
A05
What is highest education this person has achieved?
A06
Primary Activity Status of the person
Cultivation
Allied Agriculture (Livestock Rearing)
Agricultural Wage Labour
Non-agricultural wage labour/wage work
Artisan/Independent work
Petty shop/small business
Organized trade/business (if >5 employees)
Salaried employee
Profession NEC (specialties within a vocational group)
Retired/Pension
Household work/ Housewife
Student
Looking for work/unemployed
Too young/unfit to work
Others (Specify)
A07
Monthly Income Generated by the Person
A08
Who will be onboarded for Picture Book Activity (PBA)?
Yes
No
A09
Type of school the focal child attends
Private
Public
Pre-school
Nursery
Anganwadi
Other
A10
How do you spend time with your child?
Nutrition & hygiene
storytelling
siblings playing together
studying
crafts
physical play
going outside (not for play)
talking
others (specify)
A11
How much time do you spend in each of these activities?
A12
How many books do you have at home for your child?
A13
How many toys does your child has at home? - to understand the types of toys in your home (store, handmade or household)
A14
Do you already have any picture book or story book at home
Yes
No
A15
If yes, How many picturebook or storybook you have at home?
A16
If yes, What type of stories do you tell to your child?
Traditional storybooks
Retelling personal childhood stories
Sharing mythology or religious tales
Narrating fictional stories
Incorporating moral stories or fables
Creating impromptu stories
Cartoon stories (including digital platforms like YouTube, facebook etc)
Reading from picture book
Other books storybooks, magazine, comics, anime
A17
After reading a story, does your child engage in imaginative play related to the story? (Agreement Scale)
Never
Rarely
Sometimes
Often
A18
Do you teach or tell the child about any of the following?
Names of fruits, flowers, or animals
Festivals
Household items
Colors
None
Oth
A19
Which of the following activities do you usually engage in? (specific to caregiver only)
Reading newspapers
Reading about new things on mobile/TV
Listening to/watching new things on mobile/TV
Reading books/magazines
Typing messages on WhatsApp
None
Observed by Invigilator during activity
B01
During picturebook, how did the parent involved the child?
Parents ask questions about the story
Parents encourage the child to describe pictures and/or to make sounds of the characters
Parent prompt the child to guess what happens next
Parent prompts the child to tell and retell part of the stories
Parent making sounds and mimicking the characters
B02
During picturebook, how did child involved in the activity?
Actively pointed at pictures while listening to the story.
Asked questions about the pictures or story content.
Engaged in discussions about the characters or events in the book.
Reenacted scenes from the book
Made predictions about what would happen next in the story.
Showed enthusiasm by smiling, laughing, or expressing excitement during the activity.
After the Activity (Ask Child)
C01
Ask the child to retell the story using the book provided by the caregiver. The invigilator will assess the child's ability to reproduce the story, words, and characters based on the caregiver's narration. The rating scale ranges from 1 to 5, reflecting the child's proficiency
C01A
Could the child identify main characters of the story
Yes
No
C01B
Can the child recall and sequence events from the story?
Not at all
With some prompt/Nudge
To some extent without prompt/nudge
Mostly correct
Accurately and in detail
C01C
How many incidents child could retell from the story
0
1 TO 2
3 TO 5
6 TO 9
More than 9
C01D
Rate the child’s ability to retell a story in their own words.
Unable to retell the story
Partially able to retell the story
Moderately able to retell the story
Mostly able to retell the story
Completely able to retell the story
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