SAMPLE INTERVIEW SCRIPT

Good day. My name is _____insert name__________ and I am here on behalf of the Zonal Health
Department. We are conducting some brief interviews to understand how the current distribution of
MDA is functioning. Your household has been randomly selected for inclusion in our survey. With
your permission we would like to randomly select one person in your household to ask a few
questions about the distribution. The questionnaire should take approximately 5 minutes. Would
you be willing to let us select a member of your household to participate in this survey?”

If the response is “No”:

“Thank you for your time.” Leave household and proceed to the next numbered household to
replace this household.

If the response is “Yes”:

Can you please tell me the names and ages of family in the household?

The SCT team member should then write each name on a scrap piece of paper then randomly select
one for interview (by drawing names from a hat or using a random number table). If there is no one
in the survey population who lives in the household, the team should proceed to the next numbered
household.

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ANNEX A: DATA COLLECTION FORM
Supervision Area (SA): kebele________________________________ Village_______ Interviewer: ______________________ Date:___________
Drug: ________________________ Disease being assessed: ___________________ Survey population: ______________________________
N Name of Numbe Number Respondent1 Type of Were you If not, Did you If not, Have If not, Do you If not,
o. House rs of s of Ag Sex Response offered why? A = swallow why? you ever why? intend to why?
holder Family family Name : _________ away at _______ F=fear taken F=fear of take F=fear of
e (M/F)
work/ _ during of side _______ side ________ side
membe member of S= during the
traveling, the last effects, _? Show effects, in the effects,
r s took respo answerin last MDA? S=supply MDA? N=not respond N=not future? N=not
the ndent g for Show ran out, Show enough ent enough Show enough
drugs him/hers respondent D=distribu responde info, example info, respondent info,
elf, P = example of tor never nt T=taste, of drug T=taste, example of T=taste, O
Proxy2, M drug came, O = example O= O= drug = other3
=mobile other3 of drug other3 other3
1 M F Yes/No Yes/No Yes/No Yes/No Yes No
2 M F Yes/No Yes No Yes/No Yes/No Yes No
3 M F Yes/No Yes No Yes/No Yes/No Yes No
4 M F Yes/No Yes No Yes/No Yes/No Yes No
5 M F Yes/No Yes No Yes/No Yes/No Yes No
6 M F Yes/No Yes No Yes/No Yes/No Yes No
7 M F Yes/No Yes No Yes/No Yes/No Yes No
8 M F Yes/No Yes No Yes/No Yes/No Yes No
9 M F Yes/No Yes No Yes/No Yes/No Yes No
10 M F Yes/No Yes No Yes/No Yes/No Yes No
11 M F Yes/No Yes No Yes/No Yes/No Yes No
12 M F Yes/No Yes No Yes/No Yes/No Yes No
13 M F Yes/No Yes No Yes/No Yes/No Yes No
14 M F Yes/No Yes No Yes/No Yes/No Yes No
15 M F Yes/No Yes No Yes/No Yes/No Yes No
16 M F Yes/No Yes No Yes/No Yes/No Yes No
17 M F Yes/No Yes No Yes/No Yes/No Yes No
18 M F Yes/No Yes No Yes/No Yes/No Yes No
19 M F Yes/No Yes No Yes/No Yes/No Yes No
20 M F Yes/No Yes No Yes/No Yes/No Yes No
Total Yes: Yes: Yes/No Yes: Yes No Yes/No Yes/No
No: No: No:
1
Refer to root cause analysis form (Annex B) to ask about disability, occupation and marital status, record in root cause analysis form; for questions to guide in defining disability, refer to supplemental questions in
Annex F
2
The principal caretaker should respond on behalf of children <10 years; conversely, all children may respond for themselves when drugs are distributed in schools
3
If answer is ‘other’, refer to Annex E for gender equity and social inclusion (GESI) root cause analysis question
ANNEX B: SCT DATA SUMMARY

Name:_____________________________ Title:_______________________________ Supervision Area: ___________________

Drug:_______________________________

Data collection start date: _____________Total days of data collection: ____________

Administrative coverage (note if the reported coverage is district-wide or specific to the Supervision Area):____________________

SCT DATA SUMMARY

For each question, enter the total number of people who responded “yes” or “no”. In the last row write the appropriate interpretation of the results (e.g. “good
coverage”, “cannot conclude coverage is good” or “inadequate coverage”

Were you offered the drug? Did you swallow the drug? Supplemental Questions – Do not factor
into classification of coverage
Ever take MDA? Intend to take next
MDA?
Yes

No

Classification of coverage according to SCT

(only applies to the question “did you
swallow the drug”): Good/Cannot conclude
good/Inadequate
ROOT CAUSE ANALYSIS SUMMARY
Using additional questions for ‘other’ (from Annex E) and then the supplemental background questions, record data gathered during the household visit here.

Household No.
Background Information 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age
Sex
Disability (Y/N)
Occupation: (number commonly listed professions, for example 1. Farmer, 2. Housewife, etc.)
Marital status: 1. Married or cohabiting and partner is currently living in the same household; 2. Married or cohabiting
but husband/wife/partner is temporarily living/working away from home; 3. In a relationship but not living together; 4.
Single; 5. Divorced/separated; 6. Widow/widower
Reasons for not being offered, swallowing, ever taking or no future intent
What are the MAIN REASONS for answering ‘no’ to the questions? List reasons here, using 1 line, per reason

Gender equity and social inclusion (GESI) barriers/reasons for not being offered, swallowing, ever taking or no future intent
What are the GESI barriers/reasons? List reasons here, using 1 line, per reason

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 ANNEX C: SCT CRITICAL REVIEW

Question Response (to be completed by the SCT Implementer)

How did the results from the SCT compare with

the administrative coverage?
For example, if the SCT suggests the coverage was
“good”, is the administrative coverage also good
(i.e., above the target coverage threshold)?

What were the reasons given for not being offered

the drug? Were any of these reasons given more
than once? Refer to root cause analysis table for
further details on ‘other.’

What were the main reasons given for not

swallowing the drug? Were any of these
reasons given more than once? Refer to root
cause analysis table for further details on
‘other.’

What were the main reasons given for never

accepting the drug? Were any of these reasons
given more than once? Refer to root cause
analysis table for further details on ‘other.’

What were the main reasons given for not

intending to accept the drug in the future? Were
any of these reasons given more than once? Refer
to root cause analysis table for further details on
‘other.’

If the results from your SCT suggest the

supervision area had coverage that was “cannot
conclude coverage is good” or “inadequate,” why
do you think the coverage might have been low?

If the results of the SCT classified your supervision

area as having “inadequate” coverage, what do
you plan to do between now and the next MDA
round to ensure that coverage is better in the next
round?

Based on the results of the SCT, will you do

anything else differently in the next MDA round?
 ANNEX D: SCT ACTION PLAN
Problem/Need Goal Action Required Gender equality and Success Criteria Timeframe Resources
Identified (what tasks do you social inclusion (how will you (by when you need (who or what can
need to do to (GESI) barriers to identify your to complete the help you complete
address the achieving goal success) tasks) the tasks)
problem) (pull from root cause
analysis)

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ANNEX E. ROOT CAUSE ANALYSIS QUESTIONS

Pose the questions below, to screen for GESI barriers to MDA access, uptake, and intent. Use these
questions when a respondent indicates the reason as ‘other.’ You do not have to use all questions
and some can be used as probes, depending on the direction of the conversation. You can also
pose your own questions. The questions below are simply meant to be a reference.

Knowledge of MDA/drug______ (insert drug name):

 What you know about the purpose of MDA/drug _________ (insert drug name)? 
 What have you heard about MDA/drug_______ (insert drug name)? Probe for misbeliefs,
myths, etc.
 What do you think will happen if you take MDA/drug_____ (insert drug name)?
o Probe on what specific outcomes one has heard that relates to her/his sex [what
outcomes would a man/woman experience, why do you say so? Have seen any
person with these effects]
 What are you told about MDA/drug_____ (insert drug name)? Who tells you (e.g., mother-
in-law, traditional healer?) Where were you told this information (e.g., at coffee, at a
women’s meeting, or by the village broadcaster)?
 Outcome expectations (what will happen if they take MDA) i.e., “If I take MDA, I
will be protected against trachoma the for the rest of the year, 1= disagree, 2=
unsure, 3 = agree, or “If I take MDA, I may experience bad side effects, 1=
disagree, 2= unsure, 3 = agree)
 Behavioral beliefs (positive/negative evaluation of taking MDA) i.e., “When it
comes to preventing trachoma, taking MDA is, 1= bad, 2= not sure, 3 = good)

Perceived risk/threat of NTDs (comprised of perceived susceptibility and perceived severity)

 How concerned are you about trachoma? What do you think would happen if you
got one? What concerns you the most? 
 Perceived susceptibility - i.e., “I worry about the possibility of getting trachoma” 1=
disagree, 2= unsure, 3 = agree
 Perceived severity - i.e., “I am afraid of even thinking about trachoma” 1= disagree,
2= unsure, 3 = agree
 Do you associate any form of abuse to making decisions about taking the drug? 

Perceived norms (comprised of descriptive norm “beliefs about what most others do” and
injunctive norms “motivation to comply”)
 Do others in your community participate in MDA? What are the reasons people do
not participate? (Probe for: being away due to work/livelihoods, opportunity costs
of going, not being able to attend because the drug distributor is not a woman
etc.)
 Do other men and women have different views about MDA, treatment for
trachoma than you? Do you feel that they have better access to MDA or
preventive medications than you?
 Descriptive norms: i.e., 
o “In your opinion, how many people in your community took MDA last
year/last time?” 1 = none, 2=unsure, 3 = everyone
o “Most people like me took MDA last year/last time.” 1 = disagree,

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 2=unsure, 3 = agree 
o “Most people who are important to me (such as my partner, family, and
friends), took MDA last year/last time.” 1 = disagree, 2=unsure, 3 = agree
 Injunctive norms: i.e., 
o “Most people who are important to me (my partner, family, and close
friends) think I should take MDA.” 1 = disagree, 3= unsure, 3 = agree
o “When it comes to MDA, I want to do what my partner/family/close
friends think I should do.” 1 = disagree, 2=unsure, 3 = agree

Perceived Behavioral Control (overall measure of perceived control over the behavior): 
 Who decides if you take MDA? Probe for whether the respondent perceives that
they have control over whether they take the drug
 To what extent is financial capacity a factor to your decision about accessing or
taking MDA?
 Who influences you? Probe for nuclear and extended family members,
husband/wife; friends, neighbors, leaders, media, politicians, others. Probe for
how they are influenced--i.e., how, and when they interact with their influencers.
 Are you married? Have a partner? Did they take MDA last time?
 i.e., “Taking MDA is completely up to me,” 1 = disagree, 2= unsure, 3 = agree. “I
am confident I can take MDA next time it is offered, 1 = disagree, 2= unsure, 3 =
strongly agree

Opinions about DDs and services offered

 What you think about the HEWs distributing the drug/MDA in your community?
How knowledgeable and skillful do you see them to be? Do you think that male or
female HEWs are equally effective? Why or why not?
 Would you prefer to receive medications from a male or female HEW? Why or
why not?
If intent to take is ‘yes’ and previous acceptance is no [important to avoid social desirability bias]
 [draw on previous answers of ‘no’ if they did not swallow/take in current MDA,
have not ever taken, or were not offered] You intend to take in future MDA, but
you noted that you did not take in this previous MDA, or in earlier MDAs, what has
changed? Why do you feel differently?
 During this MDA [if did not take or was not offered], did you intend to take?

8
ANNEX F. QUESTIONS ON DISABILITY ENDORSED BY THE
WASHINGTON GROUP
Introductory phrase:
The next questions ask about difficulties you may have doing certain activities because of a
HEALTH PROBLEM.
1. Do you have difficulty seeing, even if wearing glasses?
a. No - no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all

2. Do you have difficulty hearing, even if using a hearing aid?

a. No- no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all

3. Do you have difficulty walking or climbing steps?

a. No- no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all

4. Do you have difficulty remembering or concentrating?

a. No – no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all

5. Do you have difficulty (with self-care such as) washing all over or dressing?
a. No – no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all

6. Using your usual (customary) language, do you have difficulty communicating, for example
understanding or being understood?
a. No – no difficulty
b. Yes – some difficulty
c. Yes – a lot of difficulty
d. Cannot do at all