Blank data collection and data analysis forms

DATA COLLECTION FORM 1.1. Diagram of Study Community

DATA ANALYSIS FORM 2.2
Sample Data Presentation Matrix

Instructions: Fill out the following matrix on health providers interviewed in the community. Use local terms and expressions whenever possible.

Type of Health Practitioner	Illnesses Treated (Main Categories)	Types of Treatments Provided

DATA COLLECTION FORM 3.1
Free Listing of Women's General Problems (sample)

Interviewer:	Date:
Name/lD No:	Age:	Marital Status:
Location:	No. of Children:	Years of Education:
Ethnic Background:	Occupation:

A. What are the problems that women have in (name of community/area)? (COMPLETE BEFORE MOVING ON TO QUESTION C)

*PROBLEMS:* Probe to complete the list using the following question: B. Are there other kinds of (problem type)?	*FURTHER EXPLANATION:* Fill in this column by asking the following question for each problem: C. What should a woman do when she has (problem type)?

DATA ANALYSIS FORM 3.2
Free Listing Tabulation of General Women's Health Problems

Types of Problems (Categories)
Term	No. of Informants (N=15)
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(Add lines and paper as needed)

DATA COLLECTION FORM 4.1
Free Listing of Women's Health Problems

Interviewer:	Date:
Name/lD No.	Age:	Marital Status:
Location:	No. of Children:	Years of Education:
Ethnic Background:	Occupation:

A. What are the illnesses that women suffer from in (name of community/area)?

*ILLNESSES:* Probe to complete the list using the following question: B. Are there other kinds of (illness type)?	*SIGNS & SYMPTOMS:* Fill in this column by asking the following question for each illness. This will help in identifying which are illnesses and which are symptoms. C. What happens when you get (illness name)?
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DATA ANALYSIS FORM 4.2
Free Listing Tabulation of Women's Illnesses

Illness Terms (Categories)
Term	No. of Informants
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(Add lines and paper as needed)

DATA ANALYSIS FORM 4.3
Free Listing Tabulation of Signs and Symptoms of a Women's Illness (sample)

Signs and Symptoms Manifestation

General Class:

Manifestation Description	No. of Informants
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(Add lines and paper as needed)

DATA COLLECTION FORM 5.1
Pile Sort of Women's Illnesses and Symptoms/Signs

Interviewer:	Date:
Name/lD No:	Age:	Marital Status:
Location:	No. of Children:	Years of Education:
Ethnic Background:	Occupation:

Instructions: Write the number (found on the opposite side of each card) in the row of the appropriate pile.
After recording all the piles, for each pile ask the informant for the reasons items were sorted into the same pile. Record their responses in the column marked "Explanation".

Pile	Cards	Explanation
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DATA ANALYSIS FORM 5.2
Proximities Matrix for Pile Sorts of Women's Illnesses and Symptoms

Instructions: For ease of reference, record each illness category used for the pile sort in the appropriate space below.

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Instructions:

Examine the pile sort data (Form 5.1). Each time two illnesses are in the same pile, place a hatch mark ('|') in the appropriate intersection box in the matrix below. Use only the unshaded boxes.

Aggregate Proximities Matrix

	ILLNESS NUMBER :
		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
I	1	X
L	2		X
L	3			X
N	4				X
E	5					X
S	6						X
S	7							X
	8								X
	9									X
N	10										X
U	11											X
M	12												X
B	13													X
E	14														X
R	15															X

DATA ANALYSIS FORM 5.3
Tabulation Sheet for the Pile Sorts of Women's Illnesses (sample)

Instructions:

Most Close: From Form 5.2, find the 8 to 10 pairs of illnesses that were most frequently placed in the same pile. Write the names of the two illnesses and the percent of times they were put together in the same pile in descending order of frequency. On the righthand side, write the most common explanations for why items were seen as similar.

Most Distant: Now find the 5 to 6 pairs of illnesses that were least frequently placed in the same pile. Write the names of the two illnesses and the percent of times they were put together in the same pile in descending order of frequency. On the righthand side, write the most common explanations for why items were seen as different.

Most Close (Top 8 - 10)
Illness	Illness	%	Explanations for "Closeness"
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Most Distant (Top 5 - 6)
Illness	Illness	%	Explanations for "Distance"
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