Blank data collection and data analysis forms(cont.1)

DATA ANALYSIS FORM 6.2
Tabulation of Practioners who Serve Women

Type of Practitioners

Illness Term: ______

Practitioner Name	Type	Location	No. Informants
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
(Add lines and paper as needed)

DATA COLLECTION FORM 7.1
Recording Form for Paired Comparison of Practitioners and Illness Term

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

Directions: As you conduct the interview, circle the respondent's choice of provider and write down the reason given for each pair. Remember: Each worksheet should present the pairs in a different randomized order.

	Pairs Of Practitioners
Letter Code	Practitioners Names	Explanation For Why Practitioner Was Selected

DATA ANALYSIS FORM 7.2
Ranking of Practitioners

Illness Term: _______

Number of "Votes"
Informant	Practitioner
	A	B	C	D	E	F
1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

DATA ANALYSIS FORM 7.3
Tabulation Sheet for Practitioner Characteristics

Illness Term: ______

Practitioner Codes
A.	C.	E.
B.	D.	F.

	Number of Respondents Giving Reason
	Practitioner
Reason for Choosing:	A	B	C	D	E	F	TOTAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

DATA COLLECTION FORM 10.1
Illness Narrative Recording Form

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

When episode occurred:
______________________________________________________________________

Main signs/symptoms:
______________________________________________________________________

Illness name:
______________________________________________________________________

Perceived cause(s):
______________________________________________________________________

Triggering symptoms (or length of time that symptoms persist) for care-seeking:
______________________________________________________________________

Home use of drugs before care-seeking (and who in the home suggested or prepared)

Remedies:

Drugs:
______________________________________________________________________

Who made decision and who went to provider:
______________________________________________________________________

Financial arrangements and other constraints to care:
______________________________________________________________________

Appetite, fluid, and food intake during episode:

DATA COLLECTION FORM 10.2
Day-to-Day Illness Narrative Recording Form

Illness Term: ______

*Record sequence of symptoms and care, by day, in the calendar below:*
Day of Illness Episode	Signs/symptoms	Home remedies used (give order)	Treatment sought
1
2
3
4
5
6
7
8
9

DATA ANALYSIS FORM 10.3
Case Summary Form for an Illness Category

Illness Name:

Case __

Woman's Age: __

Signs and Symptoms:	Cause(s):	Home Treatment:	Practitioner:
		1.	1.
		2.	2.
		3.	3.
		4.	4.
		5.	5.

Case __

Woman's Age: __

Signs and Symptoms:	Cause(s):	Home Treatment:	Practitioner:
		1.	1.
		2.	2.
		3.	3.
		4.	4.
		5.	5.

Case __

Woman's Age: __

Signs and Symptoms:	Cause(s):	Home Treatment:	Practitioner:
		1.	1.
		2.	2.
		3.	3.
		4.	4.
		5.	5.

DATA ANALYSIS FORM 10.4
Illness Summary Sheet

Illness Name:

Signs and Symptoms:	Number	Comments:




Causes:		Comments:




Home treatment :		Comments:




Practitioner:		Comments:

DATA COLLECTION FORM 11.1
Direct Observation Identification

Observer:	Date:
Name/lD No. of Focal Woman		Age:
Location:	Ethnic Background:	Occupation:

Important Actors
Identification	Sex	Age	Other
A.
B.
C.
D.
E.
F.
G.
H.
Draw a picture of the observation site. (You may wish to mark individual's locations using their identification letter above.)

Key:

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