household_water_survey
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ABCDEFGHIJKL
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typenamelabelchoice_filtercalculationappearancehintrelevantconstraintconstraint_messagerequired
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startstart
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endend
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deviceiddevice_id
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subscriberidsubscriber_id
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simserialsim_serial
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phonenumberphone_number
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notenote_consent
Administer informed consent. If subject agrees to participate, proceed with survey.
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begin groupsectionASection A - Household Information
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textinterviewerA1 Interviewer nameyes
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integerhh_idA2 Enter the household numberyes
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geopointhh_location
A3 Collect the GPS coordinates of this household
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imagehh_photoA4 Take a picture of the front of the household
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textrespondent_nameA5 Enter the full name of the respondentyes
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integerrespondent_ageA6 Enter the age of the respondent
If respondent does not know, put 999
(. >= 0 and .<=150) or .=999
Age has to be between 0 and 150, enter 999 if unknown
yes
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select_one gender_listrespondent_genderA7 Enter the gender of the respondentyes
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integerhh_peopleA8 How many people live in this household?
Including the respondent
yes
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integerhh_adultA9 How many adults live in this household?. <= ${hh_people}
Has to be less than or equal to the number of people in the household
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calculatehh_children
${hh_people} - ${hh_adult}
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acknowledgehh_summary
This household is composed of ${hh_adult} adults and ${hh_children} child(ren)
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select_one ownership_listhh_ownershipA10 This house is …
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texthh_ownership_otherPlease specify other
${hh_ownership} = 'other'
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end group
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begin groupsectionBSection B - Water use practices
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select_multiple water_sourceshh_water_source
B1 What are all of the sources of water that you use at home?
(select all that apply)yes
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texthh_water_source_otherPlease specify other
selected(${hh_water_source}, 'other')
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select_one water_sources2hh_drinking
B2 Of these, what is your primary source of water for drinking?
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select_one water_sources2hh_cooking
B3 Of these, what is your primary source of water for cooking?
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select_one water_sources2hh_bathing
B4 Of these, what is your primary source of water for bathing?
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select_one qualityhh_drinking_quality
B5 How would you rank the quality of the water you use for drinking?
likert
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select_one qualityhh_cooking_quality
B6 How would you rank the quality of the water you use for cooking?
likert
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select_one qualityhh_bathing_quality
B7 How would you rank the quality of the water you use for bathing?
likert
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select_one reliablehh_drinking_reliable
B8 How reliable is the supply of water that you use for drinking?
likert
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select_one reliablehh_cooking_reliable
B9 How reliable is the supply of water that you use for cooking?
likert
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select_one reliablehh_bathing_reliable
B10 How reliable is the supply of water that you use for bathing?
likert
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select_one y_nseven_days_access
B11 In the past 7 days, have you or anyone in your household not had enough water to meet their daily needs?
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select_one worryworry_water
B12 How often would you say you worry about not having enough water to meet all of the household's daily needs?
likert
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select_one y_nthirty_days_dispute
B13 In the past 30 days, have you or anyone in your household gotten into a dispute over water access or usage?
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select_one y_nsafer_water
B14 Do you do anything to your drinking water to make it safer to drink?
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select_multiple safe_watersafer_water_method
B15 What do you do to your water to make it safer to drink?
(select all that apply)
${safer_water} = 'yes'
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textsafer_water_method_otherPlease specify other
selected(${safer_water_method}, 'other')
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decimalhh_bottle_expenditure
How much do you spend on bottled water per month?
selected(${hh_water_source}, 'bottled')
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select_one currencieshh_bottle_currencyCurrency (specify one)
selected(${hh_water_source}, 'bottled')
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integerpercent_weekly_income
B16 What percentage of the household's weekly income is spent on obtaining water (for all uses)?
.>=0 and .<=100
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end group
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begin groupsectionCSection C - Geographic Location
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select_one countiescountyC1 County
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select_one districtsdistrictC2 Districtcounty=${county}
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end group
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