Reproductive Health Assessment After Disasters – Tracking Form

Organization:

Date: ______Interview Team: ______

Status Codes:

IC – Interview ConductedNE – No resident eligible (F age 18-44)

NO – Not Occupied / No one at homeREF (#) – Gave a referral (#)

IR – Interview RefusedLB – Language Barrier

Cluster 1 – 30 and Housing Unit 1-7 / Address / Status Code

SAMPLE

Reproductive Health Assessment After Disasters – Tracking Form

[Your County] Health District

Date: ______10/29/09______Interview Team: _____Team 1______

Status Codes:

IC – Interview ConductedNE – No resident eligible (F age 18-44)

NO – Not Occupied / No one at homeREF (#) – Gave a referral (#)

IR – Interview RefusedLB – Language Barrier

Cluster 1 – 30 and Housing Unit 1-7 / Address / Status Code
2.1 – 1st point / 123 Main Street / IC, REF 1
2.2 REFERRAL 1 / 127 Main Street / IC
2.3 – 2nd point / 141 Main Street / IR
2.3 – next nearest house to 2nd point / 100 First Street / NE, REF 2
2.3 REFERRAL 2 / 102 Second Street / IC
2.4 – 3rd point / 300 Elm Street / NO
2.4 – next nearest house to 3rd point / 302 Elm Street / IC
2.5 – 4th point / 403 Spruce Street / NO
2.5 - next nearest house to 4th point / 404 Spruce Street / IR
2.5 - next nearest house to 4th point / 406 Spruce Street / IC, REF 3
2.6 REFERRAL 3 / 408 Spruce Street / IC
2.7 – 5th point / 100 Oak Street / IC
CLUSTER 2 COMPLETE, 7 INTERVIEWS, 3 REFERRALS

During training, each interview team will be assigned one or more Clusters. In each Cluster, the interview team will attempt to collect seven interviews, or Units. This form helpsteams track each attempted interview and should be collected at the end of the project to calculate the questionnaire response rate.

The sample data above is for Cluster 2 and begins at thedwelling closest to the first geographical point, which we will label “Unit 1”. Each interview attempt is recorded on a separate row in the Tracking Form. For each attempt, the “Cluster.Unit” shorthandisnoted in the first column, the address is recorded in the second column, and Status Codes are documented in the last column.

As you can see, the first attempt was successful, as IC was recorded in row 1. This person also gave a referral, which is denoted as “REF 1” in the Status Code column. As such, the next row begins with a new Unit number and a note indicating that this attempt was a referral given at the last address – “2.2 – REFERRAL 1”. The resident at our first referral address also gave us an interview but did not give us another referral. As a result, the next row begins with “2.3,” but since we do not have another referral, we move to the second GPS point, as we have already completed an interview at the first GPS point. At this address (141 Main Street), the resident refused to be interviewed, so we do not have a third completed interview. As such, the fourth row begins with the same Cluster.Unit abbreviation as in row 3, and we move to the next nearest home.This process is repeated until all seven interviews have been completed in your cluster or there are no more eligible people in that cluster willing to participate.

Since a different team may work in the same cluster on another day, the Tracking Form provides essential information about which houses to try again and which houses to skip – such as ones where residents already completed an interview, refused an interview, are ineligible, or have a language barrier. Therefore, it is important to review any previous Tracking Forms before continuing work in a cluster to avoid unnecessary visits.