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)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
(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)?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

DATA ANALYSIS FORM 4.2
Free Listing Tabulation of Women's Illnesses

Illness Terms (Categories)
Term	No. of Informants
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
(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
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
(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
1.
2.
3.
4.
5.
6.
7.
8.
9.

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.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

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"
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Most Distant (Top 5 - 6)
Illness	Illness	%	Explanations for "Distance"
1.
2.
3.
4.
5.
6.

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:

DATA COLLECTION FORM 11.2
Observation Event Matrix

			Page of
Time	Actor(s)	Activity/Event	Codes

DATA ANALYSIS FORM 11.3
Overall Tabulation of Women's Activities

Code	Activity	# Times Observed

DATA ANALYSIS FORM 11.4
Women's Daily Activities Composite

	Main Activities
Time	Child Care	Washing	Cooking	Income-Generating
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00

DATA COLLECTION FORM 12.1
Illness Severity Recording Sheet (sample)

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

		Severity Ratings
Illness Term	Pile 1 (Severe)	Pile 2 (Intermediate)	Pile 3 (Mild)

Why are (read Pile-1 illnesses) severe? ________________________
Why are (read Pile-2 illnesses) neither mild nor severe? ________________________
Why are (read Pile-3 illnesses) mild? ________________________

DATA ANALYSIS FORM 12.2
Illness Severity Tabulation Sheet

	Severity Ratings
Illness Term	Severe (2)	Intermediate (1)	Mild(0)	Raw Score	Rank

On a second copy of this form, illness terms can be re-ordered in order of decreasing severity scores.

DATA COLLECTION FORM 13.1
Perceived Causes of Common Illnesses

Interviewer:	Date:
/ID No:	Age:	Marital Status:
Location:	No. of Children:	Years of education:
Ethnic Background:	Occupation:

We want to learn more about these illnesses of women. We are interested in your opinion about the cause of these illnesses. What do you think is the cause of illness? [Probe to get complete answers ... in full sentences.]

Local Term/English Equivalent (e.g., Safed Paani/White Discharge)	Reported Causes (Write in full sentences. Use local language for key concepts).

DATA COLLECTION FORM 13.2
Differences and Similarities Between Common Women's Illnesses
_______________________________________________________________

1. How are ______ and ______ different from each other, and how are they related?

How different:

How related:
_______________________________________________________________

2. How are ______ and ______ different from each other, and how are they related?

How different:

How related:
_______________________________________________________________

3. How are ______ and ______ different from each other, and how are they related?

How different:

How related:
_______________________________________________________________

4. How are these three illnesses related to ______? To ______? To ______?

How different:

How related:
_______________________________________________________________

DATA ANALYSIS FORM 13.3
Comparing Interrelationships Between Illnesses

Illness 1	Illness 2	Reason For Difference	Frequency	Reason For Similarity	Frequency

DATA ANALYSIS FORM 13.4
Creating an Ethnomedical Model of Illnesses

Causes

Illnesses (Early Stage)

Illnesses (Later Stage)

Signs/Symptoms

DATA COLLECTION FORM 14.2
Location of Internal Organs

Short Free List:

What are the different organs in a woman's body?

1. _________________________
2. _________________________
3. _________________________
4. _________________________
5. _________________________
6. _________________________

Where are they located in a woman's body?

(Draw on this figure with the guidance of the informant, who can point to place on figure.)

Where does food go? (Draw)

Where does a baby grow? (Draw)
__________________________________________________

Printed with permission from Nandini Oomman
__________________________________________________

DATA RECORDING FORM 14.3
Location of Illnesses

Choose one of the health problems mentioned by the women:

Health Problem # _________________ Health Problem Name_________________

Code the following:
Where does it start?
Where does it go?
How does it relate to other organs?
__________________________________________________

Printed with permission from Nandini Oomman (1995)
__________________________________________________

DATA ANALYSIS FORM 14.4
Consensus Picture of Woman's Body: Location of Internal Organs and Important Illnesses

Key Organs:
A.
B.
C.
D.
E.
G.
H.
I.
Illness:
1.
2.

DATA COLLECTION FORM 15.1
Collection of Successive Pile Sort Data

Women's Health Problems en's Health Problems

Figure

DATA ANALYSIS FORM 15.2
Tabulation of Successive Pile Sort Responses

Level	Terms	#Responses
1.
2.
3.
4.

DATA COLLECTION FORM 16.1
Scenario Recording Form

Interviewer:	Date:
Name/lD No:	Age:	Type of Healer:
Location:	No. of Children:	Years of education:

Scenario No. and Type: 3 mother of two children with safed paani

Diagnosis:

What the woman should do:

What illness the woman has:

Other information respondent would like to have:
__________________________________________________________

Home Remedies:

What should be done:

How soon to see response:

Evidence she is getting better:
__________________________________________________________

Care-Seeking:

Place and type of provider:

Treatment expected:

How soon to see response:

Next steps if woman does not improve:
__________________________________________________________

DATA ANALYSIS FORM 16.2
Tabulation Sheet for Diagnosis with Scenarios

Diagnosis	Scenario Number
What the woman has	1	2	3	4
Other information respondent would like to have	1	2	3	4

DATA ANALYSIS FORM 16.3
Tabulation Sheet for Home Remedy Treatments with Scenarios

Home Remedy	Scenario Number
What the woman should do	1	2	3	4
How soon to see response	1	2	3	4
Next steps if woman does not improve	1	2	3	4

DATA ANALYSIS FORM 16.4
Tabulation Sheet for Outside Home Care-Seeking with Scenarios

Home Remedy	Scenario Number
What the woman should do	1	2	3	4
How soon to see response	1	2	3	4
Next steps if woman does not improve	1	2	3	4

DATA COLLECTION FORM 17.1
Direct Observation (sample)

Observer:	Date:
Name/lD No:	Age:
Location:	Ethnic Background:

Actors (healers, patients, etc.)

Identification	Sex	Age	Comments
A.
B.
C.
D.
E.
F.

Draw a picture of the observation site. (Show individual's locations using their identification letter (above).

DATA COLLECTION FORM 17.2
Observation Event Matrix

			Page __of __
Time	Actor(s)	Activity/Event	Codes

DATA ANALYSIS FORM 17.3
Tabulation of Events in Health Treatment Setting

Code	Activity	# Times Observed