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Digital Green Quality Assurance -Form Fill

Respondent Identification

Q01

Name of the respondent

Q02

Husband name

Q03

District code (two digits)

Q04

Village Name/Code

Q05

Respondent Code (four digits)

Q06

Group Name

Q07

Interviewer's Name

Q08

Supervisor's name/code

General Questions related to the video

A01

Have you heard of Digital Green’s video sessions?

Yes

A02

How did you come to know about these video sessions?

Resource Person

Family Members

FLW’s

Panchayat Members

People who regularly attend

SHG

Self/No One

Prior Announcement

Others

A03

In your community, how frequently are these video sessions are being organÁed?

Weekly

Fortnightly

Monthly

No Fixed Pattern

DK/CS

A04

Have you ever attended these video sessions?

Yes

A05

If not attending regularly, what are the reasons for not attending the video sessions?

Busy with work

Get updates sitting at home

Uninteresting topics

Irrelevant topics

Difficult to understand

Already know about the topic

Venue arrangements are not to my liking

Venue far from home

Not informed of venue

Not informed of timing

Crowded Venue

Videos are not shown on time

Others

A06

How often are you informed of the topic of the session in advance?

Always

Often

Sometimes

Rarely

A07

Do you find the duration of the sessions appropriate?

Yes

No, Duration should be shortened

No, Duration should be lengthened

A08

What time of the day are these sessions conducted?

Early Morning(Till 9 Am)

Late Morning(9-12 Am)

Noon(12-2 Pm)

Late Noon(2-5 PM)

Evening(5-7 Pm)

Night(7pm onwards)

A09

Have you ever requested the facilitator to show a video on a topic of your choice?

Yes

A10

Were any efforts taken by the facilitator/ team to show the videos that you requested?

Yes

DK/CS

Overall experience of the video session

B01

I will read out some items which shape your experience of video sessions that you’ve seen since last month. Please tell me how good or poor your experience has been with each of these.

B01_1

Audio/Visual clarity of the video

Very Good

Good

Poor

Very Poor

B01_2

Comfort of the seating arrangement

Very Good

Good

Poor

Very Poor

B01_3

Ventilation of the room

Very Good

Good

Poor

Very Poor

B01_4

Cleanliness of the room

Very Good

Good

Poor

Very Poor

B01_5

Facilitators ability to handle the Pico/projector

Very Good

Good

Poor

Very Poor

B01_6

Facilitators knowledge of the topics

Very Good

Good

Poor

Very Poor

B01_7

Facilitators response to participants’ questions

Very Good

Good

Poor

Very Poor

B01_8

Facilitators skill in handling distractions(like children making noise)

Very Good

Good

Poor

Very Poor

Participation and other events related to the video session

C01

I will read out to you some statements which describe certain situations; please tell me how often you see/experience the situations.

C01_1

You actively participate in the sessions

Always

Mostly

Sometimes

Never

C01_2

You get opportunity to speak your mind

Always

Mostly

Sometimes

Never

C01_3

Adopters share their experiences during the sessions

Always

Mostly

Sometimes

Never

C01_4

Discussion on the experience sharing of the adopters

Always

Mostly

Sometimes

Never

C01_5

Questions are asked to the participants/ members

Always

Mostly

Sometimes

Never

C01_6

Information provided in the sessions is believable

Always

Mostly

Sometimes

Never

Facilitator’s discharge of duties

D01

I will read some statements related to the community resource person/facilitator’s behaviour with you and your community. Please tell me how often you experience these situations.

D01_1

Facilitator pays attention to you while he/she speaks to the crowd or when you speak to him/her

Always

Mostly

Sometimes

Never

D01_2

Facilitator pays attention to you when you speak to him/her

Always

Mostly

Sometimes

Never

D01_3

Facilitator ignores certain groups/individuals

Always

Mostly

Sometimes

Never

D01_4

Encourages the silent participants to speak

Always

Mostly

Sometimes

Never

D01_5

Encourages the members to adopt the practices shown in the video

Always

Mostly

Sometimes

Never

D01_6

Gives a clear, concise summary at the end of each dissemination

Always

Mostly

Sometimes

Never

D01_7

Facilitator is trusted and respected member of the community

Always

Mostly

Sometimes

Never

D01_8

Facilitator is friendly with the participants

Always

Mostly

Sometimes

Never

D01_9

Facilitator provides clear and useful answers to questions

Always

Mostly

Sometimes

Never

D01_10

Facilitator is in a hurry to complete the session

Always

Mostly

Sometimes

Never

D01_11

Facilitator explains issues/video content with clarity

Always

Mostly

Sometimes

Never

D01_12

Facilitator addresses unresolved queries asked by participants at a later stage

Always

Mostly

Sometimes

Never

Mood and Feel of the session

E01

I will read out some words. Please tell me how strongly they apply to the videos you have seen since April.

E01_1

Encouraging

Applies Strongly

Applies to a large extent

Applies to a lesser extent

Does not apply at all

E01_2

Interesting

Applies Strongly

Applies to a large extent

Applies to a lesser extent

Does not apply at all

E01_3

De-motivating

Applies Strongly

Applies to a large extent

Applies to a lesser extent

Does not apply at all

Statements of opinion

F01

I will read out some statements. Please tell me the extent to which you agree/disagree with each of these.

F01_1

The videos are a good way of disseminating information

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_2

I do recommend the video sessions to other people in my community

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_3

I discuss the videos with family members

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_4

I discuss the videos with other members of the community

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_5

I take time to think about the videos

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_6

I can understand the language of the video

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_7

I can retain the information shown in the video

Strongly Agree

Agree

Disagree

Strongly Disagree

F01_8

People in my community have a positive opinion of the video sessions

Strongly Agree

Agree

Disagree

Strongly Disagree

Specific questions related to the video (This section will be repeated for all the videos)

G01

Video Details

Not Shown in community

Seen by respondent

Not seen by respondent

G02

Video Code

G03

Did you like the video?

Yes, I liked it very much

Yes, I liked it

Neither liked or disliked

No, I didn’t like it

No, I completely disliked it

G04

What did you like about this video?

Video content was relevant to me

Video was easy to follow

Video content was informative

The video was in my language/dialect

People explaining the messages of the video

Performers of the video were familiar

Performance of the actors

Discussions and moderation around the video

Practices shown were easy to adopt

Practices shown were not expensive to adopt

Others

G05

What did you dislike about the video?

Video content was not relevant to me

Video content did not provide new information

The video was not in my language/dialect

People explaining the messages of the video

Performers of the video were not familiar

Performance of the actors

Discussions and moderation around the video

Practices shown were difficult to adopt

Practices shown were expensive to adopt

Others

G06

Did you adopt what was shown in the video?

Yes

Non Negotiable Table (This Table is repeated in the collection form for as many times as the number of non negotiable)

H01

Non Negotiable 1

Applicable

Not Applicable

H02

Whether adopted

Yes

H03

What were the reasons for not adopting this item?

I did not find it useful

I don’t know if this will work

This is very cost-intensive

I don’t have the knowledge

I don’t have the skills

I didn’t understand the method

No one else has adopted this method

Don’t trust the people who asked to adopt

Others

H04

Did you get a chance to share your experience of adoption of this video within the groups during the subsequent session?

Yes

H05

If No, why did you not share your experience?

Didn’t Get the time

I don’t see value in sharing

Most of the people have adopted

I did not know I had to share

I did not attend the next session when I was supposed to share

Mediator did not encourage to share

Someone else shared

Others

DK/CS

Respondent Profile

I01

What is your Name

I02

What is your age in completed years

I03

Gender

Male

Female

I04

Caste

Gen

OBC

I05

Religion

Hindu

Islam

Christian

Sikh

Others

I06

Can you read and write?

Yes, Can Read and Write

Yes, Can only Read

I07

What is your highest level of educational Qualification?

Illiterate

Literate, No formal Schooling

Primary School(Upto 7th)

Middle School (Upto 10th)

High School (Upto 12th)

Graduate

Post-Graduate

I08

What are the sources of income for your household ?

I08A

Primary

Agricultural labour

Trade/Business

Farming

Fishery

Animal Husbandry

Cottage Industry

Skilled Work

Remittance/Pension

Industrial Labour

Salaries

Others

DK/CS

I08B

Secondary

Agricultural labour

Trade/Business

Farming

Fishery

Animal Husbandry

Cottage Industry

Skilled Work

Remittance/Pension

Industrial Labour

Salaries

Others

DK/CS

I09

Number of members in the household

I10

Type of family

Nuclear

Joint

Extended

I11

Type of house(By observation)

Kutcha

Semi-Pucca

Pucca

I12

What is your main source of drinking water?

Piper water in house

Public Tap

Ground water/Hand pump in house

Public hand pump

Well in residence

Public Bore well/ tube well

River/Dam/lake/Pond/ water bodies

Bottled water

Others

I13

What type of toilet do you have in your house?

Flush/Pour toilet

Flushed to piped sewer system

Flush to specific tank

Flush to pit laterine

Flush to septic tank

Flush,don’t know where

Biogas laterine

Pit latrine with slab

Open pit/pit latrine without slab

Twin Pit/Composting toilet

Dry toilet

No toilet/Field/Open space

Others

I14

What is the main source of lighting?

Electricity

Kerosene Lamp

Gas Lamp

Candle

Gobar Gas

Solar Energy

Others

I15

What type of fuel do you mainly use for cooking?

Wood

Crop Residues

Dung Cakes

Coal/Charcoal

Kerosene

Gobar Gas

Electricity

Others

I16

Does anyone in your household have a bank account/ Post office?

Yes

I17

Do you own livestock?

Yes

I18

If Yes, Type of livestock

Bovines( Milch Cattle)

Sheep/Goats

Non Milch Cattle (Bulls,Ox)

Others

I19

Digital Green Quality Assurance -Form Fill

Name of the respondent

Husband name

District code (two digits)

Village Name/Code

Respondent Code (four digits)

Group Name

Interviewer's Name

Supervisor's name/code

Have you heard of Digital Green’s video sessions?

How did you come to know about these video sessions?

In your community, how frequently are these video sessions are being organÁed?

Have you ever attended these video sessions?

If not attending regularly, what are the reasons for not attending the video sessions?

How often are you informed of the topic of the session in advance?

Do you find the duration of the sessions appropriate?

What time of the day are these sessions conducted?

Have you ever requested the facilitator to show a video on a topic of your choice?

Were any efforts taken by the facilitator/ team to show the videos that you requested?

I will read out some items which shape your experience of video sessions that you’ve seen since last month. Please tell me how good or poor your experience has been with each of these. var statement=document.write(localStorage.getItem('total'));

Audio/Visual clarity of the video

Comfort of the seating arrangement

Ventilation of the room

Cleanliness of the room

Facilitators ability to handle the Pico/projector

Facilitators knowledge of the topics

Facilitators response to participants’ questions

Facilitators skill in handling distractions(like children making noise)

I will read out to you some statements which describe certain situations; please tell me how often you see/experience the situations. var statement=document.write(localStorage.getItem('total'));

You actively participate in the sessions

You get opportunity to speak your mind

Adopters share their experiences during the sessions

Discussion on the experience sharing of the adopters

Questions are asked to the participants/ members

Information provided in the sessions is believable

I will read some statements related to the community resource person/facilitator’s behaviour with you and your community. Please tell me how often you experience these situations. var statement=document.write(localStorage.getItem('total'));

Facilitator pays attention to you while he/she speaks to the crowd or when you speak to him/her

Facilitator pays attention to you when you speak to him/her

Facilitator ignores certain groups/individuals

Encourages the silent participants to speak

Encourages the members to adopt the practices shown in the video

Gives a clear, concise summary at the end of each dissemination

Facilitator is trusted and respected member of the community

Facilitator is friendly with the participants

Facilitator provides clear and useful answers to questions

Facilitator is in a hurry to complete the session

Facilitator explains issues/video content with clarity

Facilitator addresses unresolved queries asked by participants at a later stage

I will read out some words. Please tell me how strongly they apply to the videos you have seen since April. var statement=document.write(localStorage.getItem('total'));

Encouraging

Interesting

De-motivating

I will read out some statements. Please tell me the extent to which you agree/disagree with each of these. var statement=document.write(localStorage.getItem('total'));

The videos are a good way of disseminating information

I do recommend the video sessions to other people in my community

I discuss the videos with family members

I discuss the videos with other members of the community

I take time to think about the videos

I can understand the language of the video

I can retain the information shown in the video

People in my community have a positive opinion of the video sessions

Video Details

Video Code

Did you like the video?

What did you like about this video?

What did you dislike about the video?

Did you adopt what was shown in the video?

Non Negotiable 1

Whether adopted

What were the reasons for not adopting this item?

Did you get a chance to share your experience of adoption of this video within the groups during the subsequent session?

If No, why did you not share your experience?

What is your Name

What is your age in completed years

Gender

Caste

Religion

Can you read and write?

What is your highest level of educational Qualification?

What are the sources of income for your household ? var statement=document.write(localStorage.getItem('total'));

I will read out some items which shape your experience of video sessions that you’ve seen since last month. Please tell me how good or poor your experience has been with each of these.

I will read out to you some statements which describe certain situations; please tell me how often you see/experience the situations.

I will read some statements related to the community resource person/facilitator’s behaviour with you and your community. Please tell me how often you experience these situations.

I will read out some words. Please tell me how strongly they apply to the videos you have seen since April.

I will read out some statements. Please tell me the extent to which you agree/disagree with each of these.

What are the sources of income for your household ?