Date:

Name :

Age:

Gender: M/F

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Have you ever used a mobile phone?
  1. Yes
  2. No

* Skip to question 11 if the answer is “No”.

 

  1. Do you own a phone?
  1. Yes
  2. No

* Skip to question 4 if the answer is “No”.

 

  1. What type of phone is it?
  1. A phone with touch screen (eg. Android or Iphone)
  2. A phone without touch screen, but with buttons (eg. Nokia)

 

  1. Do you share your phone with someone else?
  1. Yes
  2. No

 

 

  1. Have you used a phone for taking photos?
  1. Yes
  2. No

 

  1. Have you used a phone for listening to music?
  1. Yes
  2. No

 

  1. Have you used a phone for internet?
  1. Yes
  2. No

 

  1. Do you know how to read an SMS?
  1. Yes
  2. No

 

  1. Do you know how to send an SMS?
  1. Yes
  2. No

 

  1. How often do you send an SMS on average?
  1. Daily
  2. Weekly
  3. Monthly
  4. Very rarely, less than once a month

 

  1. Do you know how what a memory card is?
  1. Yes
  2. No

 

  1. Do you have good network coverage where you live?
  1. Yes
  2. No

 

  1. Have you ever been trained on CommCare before?
  1. Yes
  2. No

 

  1. Which network provider has the best coverage where you live/work?

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