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Monitoring Template -Form Fill
Respondent details & Background
Q01
Name of Respondent
Q02
Age of Respondent
Q03
Caste
General
SC
ST
OBC
Q04
Religion
Hindu
Muslim
Christian
Jain
Buddhist/Neo Buddhist
Other
Q05
How many children do you have aged 0-6 years? (numeric entries only)
Q06
Age of child in completed years (0-6) for whom you listen to the call (Surveyor will ask Parent to keep a focal child belonging to the age group they are listening to throughout the survey)
Q07
Relationship with child
Mother
Father
Other
Q08
Village Name
Q09
Block
Q10
District
Q11
State
Q12
Name of Child
Q13
What is the gender of the child for whom you are listening to the call?
Boy
Girl
Prefer not to say
Others (Specify)
Q14
Do you use a cell phone for personal use only?
Yes
No
Q15
How many people do you share your phone with? (multiple choice response)
Spouse
Other male members of the household
Other female members of the household
Children
Don’t know/not sure
Other
Q16
Have you received any program/calls/messages from Dost Education?
Yes
No
Q17
Are you the primary listener?
Yes
No
Q18
Are you the primary caregiver?
Yes
No
Q19
Primary listener's educational qualification
Completed Class 1
Completed Class 2
Completed Class 3
Completed Class 4
Completed Class 5
Completed Class 6
Completed Class 7
Completed Class 8
Completed Class 9
Completed secondary school (Class 10)
Completed Higher Secondary (Class 12)
Graduation (pass)
Graduation (honors)
Post-graduation
Madrasa
Never attended school
Other _______
Q20
Occupation of the primary listener
Farming/ Agriculture
Non-Timber Forest Product Collection
Livestock (goats, poultry, piggery, fishery & dairy)
Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor, etc.)
Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)
Salaried workers (teachers, AWW, ANM, etc.)
Contractual or task-based work (ASHAs, CSPs, Tuitions, para-teachers, etc.)
Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops, etc)
Housework
Unemployed
Old age/pensioner
Differently abled
Student
Other
Q21
Primary caregiver’s educational qualification
Completed Class 1
Completed Class 2
Completed Class 3
Completed Class 4
Completed Class 5
Completed Class 6
Completed Class 7
Completed Class 8
Completed Class 9
Completed secondary school (Class 10)
Completed Higher Secondary (Class 12)
Graduation (pass)
Graduation (honors)
Post-graduation
Madrasa
Never attended school
Other _______
Q22
Occupation of the primary caregiver
Farming/ Agriculture
Non-Timber Forest Product Collection
Livestock (goats, poultry, piggery, fishery & dairy)
Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor, etc.)
Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)
Salaried workers (teachers, AWW, ANM, etc.)
Contractual or task-based work (ASHAs, CSPs, Tuitions, para-teachers, etc.)
Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops, etc)
Housework
Unemployed
Old age/pensioner
Differently abled
Student
Other
Q23
Marital Status of respondent
Unmarried
Married
Widowed
Divorced
Separated
Deserted by spouse
Other
Engagement
A01
How regularly do you think you listen to our calls?
Four times a week
Thrice a week
Twice a week
Once a week
A02
For how many weeks have you listened to the messages?
0 TO 4
4 TO 8
8 TO 12
OTHER
A03
How many messages have you listened to in total?
0-20
20-40
40-60
60 AND ABOVE
OTHER
A04
What can you recall from the calls?
Baatein (TTP)
Sparsh (TTP)
Khel (TTP)
Brain development
Overall growth
Physical growth
Ensure nutrition/health
Quantitative (Parent-child interaction)
Qualitative (Parent-child interaction)
Art/ creativity/ talking/singing
Natural Home environment for playing/ learning
Outside environment for playing/learning
Avoid diseases/morbidity
Play
Other
A05
Do you regularly share messages with the primary caregiver?
Almost Never
Sometimes
Often
Almost Always
A06
What are some of the more memorable phrases that were repeated during the modules?
A07
What kind of growth and development can take place in the first 6 years?
motor development/movement
Brain development
emotional development
overall development
Don't know/not sure
Attitude/ Intention and Knowledge
B01
How can you stimulate brain development for children? (Multiple choice)
Engage the child through daily chores/tasks
Talking to them about things/events in the house
Conduct simple experiments at home
Take trips/travel outside the home to a field or a park
Encourage the child to speak to neighbours, other children etc.
Playing games and/or conducting other activities
Limit/manage the time spent by the child using mobile phones, TVs etc.
Others (Specify)
B02
Which of the following statements do you agree with for children
B02_1
Very young children (0-3 years) do not need parents to play with them
Yes
No
B02_2
It is not necessary to speak to very young children (0-3years) who are yet to start talking
Yes
No
B02_3
Children only learn foundational concepts when they start attending schools
Yes
No
Practice, Adoption & Caregiver’s awareness
C01
Apart from chores involving children, what do you do to engage/spend time with the child?
Teach or help with Homework
Play with them
Dost activities
Watch TV together
Stories
Talking to them
Taking the child out to play like taking them to a park etc, or anything else
Don't do anything
Refuse to answer
Don’t know/not sure
Other ________
C02
How much time did you spend with your child yesterday apart from hygiene/child-related chores? (in hours)
0 TO 2
2 TO 4
4 TO 6
6 TO 8
Above 8
Home environment & Outdoor/Creative engagement
D01
How many hours per day did you play with your child in the past 1-2 week? (in hours)
1
2
3
OTHER
Don't know/not sure
D02
How often did your child play outside or go outside in the past one week?
Almost never
Sometimes
Often
Almost Always
Don't know/not sure
D03
What did your child play with in the last one week?
Kitchen Utensils
body parts
Household objects as props
Items in a Basket
Socks for handpuppets
Don't know/not sure
Others (Specify) _____
D04
What did you use while playing or interacting with the child last week?
Kitchen Utensils
Clothes/ socks for handpuppets
body parts
water container
basket
Others (Specify)
Don't know/not sure
D05
How often did you keep your child occupied in the past week, when you were in the kitchen or doing some chores?
Almost Never
Sometimes
Often
Almost Always
D06
To what extent is your child's routine around sleep, play, meals, etc. followed?
To great extent
To some extent
Not at all
Don't know/not sure
D07
Have you been sharing your own childhood stories and lullabies with your infant? (stories about parent's own childhood)
Always/Mostly
Sometimes
Rarely
Never
Don't know/not sure
D08
Do you enourage your child to practice some form of art/dance/music etc.? with/without you?
Almost Never
Sometimes
Often
Almost Always
Don't know/not sure
D09
Based on the modules, which of the following do you agree with?
D09A
Studying in the early years is more important than practicing art
1
D09B
Singing and talking to very young children (0-3years) help their development
1
D09C
Very young children (0-3) get affected by parents fighting or using abuse
1
D09D
Stress and an adverse home environment can affect a child's entire life
1
D10
In the last one week did you fight in front of the child?
Yes
No
Don't know/not sure
D11
How often did you fight infront of your child last week?
Once
twice
thrice
Don't know/not sure
Others (Specify)
Behaviour & Interaction
E01
If your child is not listening to you and being stubborn, what do you do generally?
Scolding or beating the child
Talk lovingly to the child about it
Give into the demands
Distract with something or some other task
offer something to eat
offer something to eat
Others _______
E02
Is it okay to ignore a child's stubbornness and irritability?
Yes
No
Don't know/not sure
E03
When your child does something you don’t like, what do you do? (Surveyor should not read out the options)
Insult my child
Say mean things
Call my child names
offer something to eat
Talk lovingly, reason it out
I often let it go or end up doing it myself
Let my child do whatever he/she wants
I give a warning
I give a fair threat but don’t carry it out
Refused to answer
Don’t know/not sure
Others
E04
Do you set limits on what your child can or cannot do?
Yes
No
Don't know/not sure
E05
When I give I fair threat or warning to my child to not do something:
I always carry out what I say
Sometimes I carry out what I say
Sometimes I dont carry it out
I never carry it out
I dont give threats or warnings to my child
Don't know/not sure
E06
How often do you feel confident that your child is comfortable discussing difficulties they face?
Almost Never
Sometimes
Often
Almost Always
Don't know/not sure
E07
What do you do to build strong emotional connect and trust?
cradling
smiling, laughing or tickling the child
singing to the child
soothe when the child cries
I don't ignore my child's emotions
encourage my child to verbally express emotions through art, freeplay, dance, etc.
Don't know/not sure
Program Effectiveness & Feedback
F01
Have you felt like making a change since you started listening to the call?
Yes
No
Don't know/not sure
Other
F02
What is the one (or more) change you have made since the calls started? (Multiple choice)
Reduce child’s TV and mobile usage
Less shouting and fighting in front of the child at home
Increased time spent on talking and playing with the child
Teach something new to the child
A better understanding of a child’s needs and emotions
Less scolding or beating the child
Don't know/not sure
Other_________
F03
Are there any Dost activities that you have tried with your child? (multiple response)
Making bindi on paper with turmeric
Making music by playing utensils
Dance by waving a scarf or handkerchief
Back Horse
Massage
All of the above
None of these
Don't know/not sure
Other
F04
Was there any effect that you noticed the activities have on your child?
Positive
Neutral
Negative
No impact
Don't know/not sure
F05
Did your child enjoy the activity suggested by Dost?
Yes
No
Don't know/not sure
F06
What do you believe you can provide for your child? (Multiple choice)
Good Nutrition
More TTP
Reduce TV and mobile usage of the child
Natural and everyday environment for playing/ learning
Emotional support, trust and security
Create interesting learning experiences through trips, visits, expeditions etc.
Maintain physical safety of the child (no use of corporal punishment, encourage consent)
Building life skills such as empathy, responsibility etc.
Display positive actions and behaviour to inspire the child
Thinking of diferent ways to manage difficult behaviour (tantrums etc.) of the child
Encouragement to express emotions better through art, freeplay, dance, etc.
Teaching something new to the child
Other
F07
If you have to teach your child simple concepts like comparisons between objects or numbers, what will you use?
Paper Pen
Household Items
Don’t know/not sure
Other ______
F08
Do you find the activities mentioned in the call difficult to perform (with a skip logic if havent started listening to the calls)
Yes
No
Don't know/not sure
F09
What were the challenges you faced regarding these messages?
Difficult to understand
Messages relayed are not applicable
Long vocal messages
Hard to implement
Don’t know/not sure
Other
F10
What are you enjoying most in our calls?
Activities
New information
I feel supported
Don’t know/not sure
Other
F11
How have our calls helped you as a parent? (multiple choice)
More activity ideas
Teach something new to the child
More ideas for learning by playing
Understand needs, emotions
Awareness
To better understand a child's needs and emotions
All of the above
None of the above
Don’t know/not sure
Other ______
F12
How have our calls helped your child the most?
Routine
Learn new things
Better relationships with parents
Not much
Don't know/not sure
Other
F13
To what extent do you feel confident in facilitating early learning at home as a caregiver?
To great extent
To some extent
Not at all
Don't know/not sure
F14
What role did the program play in making you feel supported? What other resources do you use?
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