ABCDEFGHIJKLMNOPQRSTUVWXYZAA
1
typenamelabelhintdefaultappearanceconstraintconstraint messagerelevancedisabledrequiredrequired messageread onlycalculationrepeat_countmedia:imagemedia:audioautoplayminimum_secondsmedia:videochoice_filternoteresponse_notepublishable
2
startstarttime
3
endendtime
4
deviceiddeviceid
5
phonenumberdevicephonenum
6
usernameusername
7
calculatedevice_infodevice-info()
8
calculatedurationduration()
9
caseidcaseid
10
11
notewelcome<p><b>Welcome to Audio Computer-Assisted Self-Interview(ACASI) Sample form!</b></p>
<br>
<ul>
<p style="text-align: left;">- <b>IMPORTANT: This sample form is optimized for quickly understanding how ACASI works. However, it is is not best practice to include labels in fields or choice lists without images. Test the accompanying <a href="https://docs.google.com/spreadsheets/d/1vqPEqZSMv-3b1MWapVNwjXarS8yo8DWy/edit#gid=32877876" target="_blank">sample form</a>
on the SurveyCTO Collect app for a field-ready experience. Click <a href="https://support.surveycto.com/hc/en-us/articles/27123753087251-Design-a-simple-Audio-Computer-Assisted-Self-Interview-ACASI-using-SurveyCTO" target="_blank">here</a> to read the article that accompanies this sample.</b></p>
<br>
<p style="text-align: left;">- Instructions for enumerators are in <b><span style="color: #ff0000;">RED</span></b>, and these are not to be read out.</p>
<br>
<p style="text-align: left;">- Practice module was made by reference to ICF International's use case mentioned in our <a href="https://www.surveycto.com/videos/gfems-icf-acasi/" target="_blank">webinar</a> and the <a href="https://www.surveycto.com/case-studies/gfems-acasi-survey/" target="_blank">blog</a> article.</p>
<br>
Survey questions used in this sample workflow are from the sexual health module from the <a href="https://www.unaids.org/sites/default/files/country/documents/BLZ_narrative_report_2015.pdf" target="_blank">UNAIDS report (title: “Knowledge, Attitude and Practices in Sexual Behaviour and HIV/AIDS in Belize”, page 104 - 106)</a>
<br>
</ul>
<br>
<p>Swipe left on the screen to page forward.</p>		 intro
12
notetechnical_note<b>Technical notes:</b>
<li> This workflow is optimized for Android.
<li>Audio were created using <a href="https://mdn.github.io/dom-examples/web-speech-api/speak-easy-synthesis/" target="_blank">Mozilla's Speech synthesiser demo</a>, which were then recorded and edited using <a href="https://www.audacityteam.org/download/" target="_blank">Audacity.</a></li>
<li>Speech synthesiser setup - Rate: 0.8, Pitch: 1, Voice: Samantha(en-US)</li>
<li>Image files were created using <a href="https://autodraw.com/" target="_blank">AutoDraw.</a></li>
</ul>
<br>
<p>Swipe left on the screen to page forward.</p>
13
select_one yesnoconsent<span style="color: #ff0000;">ENUMERATOR to ask the respondent:</span>
Do you agree to take this survey?		quickyes
14
begin groupconsentedConsentedselected(${consent}, 1)
15
textname<span style="color: #ff0000;">ENUMERATOR: Enter the name of the respondent.</span>yes
16
notenote<span style="color: #ff0000;">FOR ENUMERATOR: GIVE TABLET TO THE RESPONDENT. WHEN THE RESPONDENT IS READY, SWIPE LEFT TO CONTINUE.</span>
17
begin groupa_practice_moduleA. Practice Module
18
select_one continuea_instructions<span style="color: #ff0000;">(NOTE: This instruction is designed for the SurveyCTO Collect app interface)</span>

Hello and welcome! Here, we will do some practice so that you feel comfortable using this device to take the survey. Listen carefully to the instructions and follow the steps. If you ever want to hear the question and choices again, press the button on the upper right side of the screen. Touch the blue circle to continue.		Select the radio button above the blue circle.quick1_a_instructions.mp3audio25
19
select_one yesno2a_yes<span style="color: #ff0000;">FOR ENUMERATOR: ACCOMPANY THE RESPONDENT FOR THIS QUESTION. MAKE SURE THAT THE RESPONDENT LISTENS TO THE ENTIRE INSTRUCTIONS AND HELP HER/HIM SELECT THE BLUE CIRCLE AT THE END OF THE AUDIO.</span>

Now, let’s make sure that you can answer some questions. At the end of each question, we will tell you what to press based on your response.
The blue circle means YES.
The orange triangle means NO.
The yellow square means PREFER NOT TO ANSWER.
And the black square means I DON'T KNOW.

For this question, select YES by touching the blue circle.
quickcompact-4
yes2_a_yes.mp3audio30
20
begin repeata_yes_followupFollow up - YESnot(selected(${a_yes}, 1))
sum(${a_yes_fu_eval}) + 1
21
select_one yesno2feedback_yesSorry, that wasn’t correct. Touch the blue circle to select YES.
quickcompact-4
3_feedback_yes.mp3audio10
22
calculate_herea_yes_fu_eval
if(selected(${feedback_yes}, 1), 0,1)
23
end repeata_yes_followup
24
select_one yesno2a_no<span style="color: #ff0000;">FOR ENUMERATOR: NOW HAND OVER THE DEVICE TO THE RESPONDENT AND JUST OBSERVE HIM/HER COMPLETING THE REST OF THE TRAINING MODULE.</span>

For this question, select NO by touching the orange triangle.
quickcompact-4
yes4_a_no.mp3audio10
25
begin repeata_no_followupFollow up - NOnot(selected(${a_no}, 0))
sum(${a_no_eval}) + 1
26
select_one yesno2feedback_noSorry, that wasn’t correct. Touch the orange triangle to select NO.
quickcompact-4
yes5_feedback_no.mp3audio10
27
calculate_herea_no_eval
if(selected(${feedback_no}, 0), 0,1)
28
end repeata_no_followup
29
select_one yesno2a_noanswerFor this question, select PREFER NOT TO ANSWER by touching the yellow square.
quickcompact-4
yes6_a_noanswer.mp3audio10
30
begin repeata_noanswer_followupFollow up - PREFER NOT TO ANSWERnot(selected(${a_noanswer}, 88))
sum(${a_noanswer_eval}) + 1
31
select_one yesno2feedback_noanswerSorry, that wasn’t correct. Touch the yellow square to select PREFER NOT TO ANSWER.
quickcompact-4
yes
7_feedback_noanswer.mp3
audio10
32
calculate_herea_noanswer_eval
if(selected(${feedback_noanswer}, 88), 0,1)
33
end repeata_noanswer_followup
34
select_one yesno2a_dontknowFor this question, select I DON'T KNOW by touching the black square.
quickcompact-4
yes8_a_dontknow.mp3audio10
35
begin repeat
a_dontknow_followup
Follow up - I DON'T KNOWnot(selected(${a_dontknow}, 99))
sum(${a_dontknow_eval}) + 1
36
select_one yesno2feedback_dontknowSorry, that wasn’t correct. Touch the black square to select I DON'T KNOW.
quickcompact-4
yes
9_feedback_dontknow.mp3
audio10
37
calculate_herea_dontknow_eval
if(selected(${feedback_dontknow}, 99), 0,1)
38
end repeat
a_dontknow_followup
39
select_one scalea_notatallSome questions you see will have multiple options like this one.

For example, the egg means NOT AT ALL.
The tomato means NOT TOO MUCH.
The watermelon means SOME.
The pineapple means A LOT.

To practice, select NOT AT ALL by touching the egg.
quickcompact-4
yes 10_a_notatall.mp3audio30
40
begin repeata_notatall_followupFollow up - NOT AT ALLnot(selected(${a_notatall}, 1))
sum(${a_notatall_eval}) + 1
41
select_one scalefeedback_notatallSorry, that wasn’t correct. Touch the egg to select NOT AT ALL.
quickcompact-4
yes
11_feedback_notatall.mp3
audio10
42
calculate_herea_notatall_eval
if(selected(${feedback_notatall}, 1), 0,1)
43
end repeata_notatall_followup
44
select_one scalea_nottoomuchTo practice, select NOT TOO MUCH by touching the tomato.
quickcompact-4
yes 12_a_nottoomuch.mp3audio10
45
begin repeat
a_nottoomuch_followup
Follow up - NOT TOO MUCHnot(selected(${a_nottoomuch}, 2))
sum(${a_nottoomuch_eval}) + 1
46
select_one scale
feedback_nottoomuch
Sorry, that wasn’t correct. Touch the tomato to select NOT TOO MUCH.
quickcompact-4
yes
13_feedback_nottoomuch.mp3
audio10
47
calculate_herea_nottoomuch_eval
if(selected(${feedback_nottoomuch}, 2), 0,1)
48
end repeat
a_nottoomuch_followup
49
select_one scalea_someTo practice, select SOME by touching the watermelon.
quickcompact-4
yes14_a_some.mp3audio10
50
begin repeata_some_followupPractice - SOMEnot(selected(${a_some}, 3))
sum(${a_some_eval}) + 1
51
select_one scalefeedback_someSorry, that wasn’t correct. Touch the watermelon to select SOME.
quickcompact-4
yes
15_feedback_some.mp3
audio10
52
calculate_herea_some_eval
if(selected(${feedback_some}, 3), 0,1)
53
end repeata_some_followup
54
select_one scalea_alotTo practice, select A LOT by touching the pineapple.
quickcompact-4
yes16_a_alot.mp3audio10
55
begin repeata_alot_followupPractice - A LOTnot(selected(${a_alot}, 4))
sum(${a_alot_eval}) + 1
56
select_one scalefeedback_alotSorry, that wasn’t correct. Touch the pineapple to select A LOT.
quickcompact-4
yes17_feedback_alot.mp3audio10
57
calculate_herea_alot_eval
if(selected(${feedback_alot}, 4), 0,1)
58
end repeata_alot_followup
59
integera_numNow, using the keypad, type the number of bananas that you see on the screen. And then swipe left to go to the next section.yesbananas.png18_a_num.mp3audio20
60
begin repeata_num_followupPractice - INSERT A NUMBER${a_num}!=2
sum(${a_num_eval}) + 1
61
integerfeedback_numSorry, that wasn’t correct. Type the number of bananas on the screen. And then swipe left to go to the next section.yesbananas.png19_feedback_num.mp3audio15
62
calculate_herea_num_eval
if(${feedback_num} = 2, 0,1)
63
end repeata_num_followup
64
end grouppractice_module
65
begin group
self_response_module
B. Self-Response Module
66
select_one continuesr_module_noteGreat job! You successfully completed the practice section and learned how to respond to questions using a mobile device.
Now, we're at the beginning of the Self-Response Module. Touch the blue circle to continue.		Select the radio button above the blue circle.quick
20_sr_module_note.mp3
audio15
67
begin groupsb_sexual_behaviorSexual Behavior module
68
select_one continue1sb_intro<span style="color: #ff0000;">FOR ENUMERATOR: CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, ENSURE PRIVACY. IN CASE THE RESPONDENT DOESN'T WANT TO CONTINUE WITH THE SURVEY, HELP THE RESPONDENT COMPLETE THE SURVEY BY CLICKING THE BLACK SQUARE, SUBMIT THE FORM AND RETRIEVE THE DEVICE. MAKE SURE TO THANK THE RESPONDENT FOR THEIR TIME.</span>

Now I'm going to ask you some confidential questions about sexual activity in order to gain a better understanding of some important life issues. The information you supply will remain strictly confidential.

Touch the blue circle to continue.
Touch the black square if you don't want to continue with the survey. And then hand over the device to the enumerator.
quickcompact-2
 21_sb_intro.mp3audio28
69
begin groupsb_consentedSexual Behavior module - Consentedselected(${sb_intro}, 1)
70
select_one yesno0sb_si_experienceHave you had sexual intercourse?

Touch the blue circle, if your response is yes.
Touch the orange triangle, if your response is no.
quickcompact-2
yes
22_sb_si_experience.mp3
audio15
71
begin groupsb_si_yes
selected(${sb_si_experience}, 1)
72
integersb_si_ageHow old were you when you had sexual intercourse for the very first time? Type your response using the keypad. And then swipe left to go to the next question.0<=. and .<=49Please insert the valid age(up to 49 years old)yes23_sb_si_age.mp3audio15
73
select_one yesno3sb_condom_useThe first time you had sexual intercourse, was a condom used?

Touch the blue circle, if your response is yes.
Touch the orange triangle, if your response is no.
Touch the yellow square, if you prefer not to say.
Touch the black square, if you don't remember.
quickcompact-4
yes
24_sb_condom_use.mp3
audio25
74
select_one periodssb_si_timeHow much time has passed since the last time you had sexual intercourse?

Touch the egg, if it has been between 0 and 1 month.
Touch the tomato, if it has been between 1 month and 6 months.
Touch the watermelon, if it has been between 6 months and 1 year.
Touch the pineapple, if it has been more than 1 year.
quickcompact-4
yes25_sb_si_time.mp3audio30
75
select_one yesno3
sb_si_recent_condom_use
The last time you had sexual intercourse, was a condom used?

Touch the blue circle, if your response is yes.
Touch the orange triangle, if your response is no.
Touch the yellow square, if you prefer not to say.
Touch the black square, if you don't remember.
quickcompact-4
yes
26_sb_si_recent_condom_use.mp3
audio23
76
select_one relationshipsb_sb_relationshipWhat was your relationship to this person with whom you last had sexual intercourse?

Touch the bird, if the person was your Wife or Husband.
Touch the flower, if the person was your Cohabiting partner.
Touch the motorbike, if the person was your Girlfriend or Boyfriend.
Touch the football, if the person was your Casual acquaintance.
Touch the house, if the person was a Sex worker.
Touch the black square, if none of the above options apply.
quickcompact-6
yes
27_sb_sb_relationship.mp3
audio37
77
end groupsb_si_yes
78
end groupsb_consented
79
end groupsexual_behavior
80
end group
self_response_module
81
select_one scale1feedbackWe're at the end of the survey. Before we finish, can you tell us whether you feel the questions were easy to understand?

Touch the egg, if you feel the questions were very difficult to understand.
Touch the tomato, if you feel the questions were a bit difficult to understand.
Touch the watermelon, if you feel the questions were a bit easy to understand.
Touch the pineapple, if you feel the questions were very easy to understand.
quickcompact-4
28_feedback.mp3audio30
82
end groupconsented
83
calculate_herecompleted1
84
noteendofsurveyThank you for your time!selected(${consent}, 0) or selected(${sb_si_experience}, 0) or selected(${sb_intro}, 2) or ${completed}=129_endofsurvey.mp3audio
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100