No.
Kuesioner ________________
LEMBAR KUISIONER STUDI KOMUNIKASI
Dari manakah ibu biasanya
mendapatkan informasi atau
berita (sumber informasi
utama)?
M01
Surat kabar apa yang paling
sering ibu baca ?
(Untuk surat kabar, mohon
M02 disesuaikan dengan keadaan
kabupaten/kota)
Isi berita di surat kabar yang
paling sering ibu baca?
M03
Stasiun Radio apa yang paling
sering ibu dengar ?
(Untuk stasiun radio lokal,
mohon disesuaikan dengan
keadaan kabupaten/kota)
M04
Jenis atau program acara apa
yang paling sering ibu dengar di
radio?
M05
Stasiun televisi apa yang paling
sering ibu tonton?
(Untuk stasiun televisi lokal,
mohon disesuaikan dengan
keadaan kabupaten/kota)
M06
Jenis atau program acara apa
yang paling sering ibu tonton di
televisi?
M07
_
SURAT KABAR .................................................................................A
RADIO................................................................................................B
TELEVISI ...........................................................................................C
PAPAN PENGUMUMAN DI LINGKUNGAN.......................................D
LAINNYA (SEBUTKAN) ....................................................................E
TIDAK TAHU.......................................................................................F
KOMPAS.............................................................................................1
RADAR BANTEN................................................................................2
FAJAR BANTEN.................................................................................3
BANTEN RAYA POS..........................................................................4
LAINNYA (SEBUTKAN).....................................................................5
TIDAK/ JARANG BACA SURAT KABAR............................................8
SOSIAL...............................................................................................1
EKONOMI...........................................................................................2
POLITIK..............................................................................................3
BUDAYA.............................................................................................4
KESEHATAN......................................................................................5
LAINNYA (SEBUTKAN......................................................................6
TIDAK TAHU.......................................................................................7
RSPD..................................................................................................1
RRI/PRO 2 FM....................................................................................2
ELSHINTA...........................................................................................3
PBS.....................................................................................................4
HOT RADIO........................................................................................5
HARMONI...........................................................................................6
TOP FM...............................................................................................7
LAINNYA (SEBUTKAN).....................................................................8
TIDAK/ JARANG DENGAR RADIO....................................................9
BERITA...............................................................................................1
TALK SHOW.......................................................................................2
SANDIWARA......................................................................................3
KUIS....................................................................................................4
MUSIK.................................................................................................5
KIRIM KIRIM LAGU............................................................................6
LAINNYA (SEBUTKAN......................................................................7
TIDAK TAHU.......................................................................................8
TVRI....................................................................................................1
RCTI....................................................................................................2
SCTV ..................................................................................................3
METRO TV..........................................................................................4
TV ONE...............................................................................................5
BANTEN TV........................................................................................5
LAINNYA (SEBUTKAN).....................................................................6
TIDAK TAHU.......................................................................................8
TIDAK/ JARANG NONTON TV...........................................................9
SINETRON..........................................................................................1
MUSIK POP........................................................................................2
MUSIK DANGDUT .............................................................................3
KUIS....................................................................................................4
BERITA...............................................................................................5
INFOTAINMENT.................................................................................6
LAINNYA (SEBUTKAN......................................................................7
TIDAK TAHU.......................................................................................8
1
 Umumnya, dari siapa atau dari
mana ibu mendapatkan
informasi tentang masalah air
bersih, sampah, saluran air
limbah rumah tangga?
M08
Sumber informasi apa yang ibu
percayai, tentang masalah air
bersih, sampah, saluran air
limbah rumah tangga?
M09
Pertemuan apa yang pernah ibu
ikuti di RT/RW/Kelurahan/Desa
tempat tinggal ibu?
M10
Penyuluhan apa saja yang
pernah ibu ikuti?
M11
Apakah di daerah ibu terdapat
M12 papan pengumuman?
Seberapa sering ibu membaca
papan pengumuman?
M13
Jenis kesenian tradisional apa
yang ibu biasanya tonton?
(Untuk jenis kesenian
M14 tradisional, mohon disesuaikan
dengan keadaan
kabupaten/kota)
Kegiatan yang orang ramai
berkumpul, seperti pesta rakyat,
apa saja yang pernah ibu hadiri?
M15
KETUA/ PENGURUS RT....................................................................A
KETUA/ PENGURUS RW..................................................................B
LURAH/KEPALA DESA ATAU STAFNYA.........................................C
KADER POS YANDU/JUMANTIK/KARANG TARUNA......................D
PETUGAS PUSKESMAS...................................................................E
LAINNYA (SEBUTKAN).....................................................................F
SPANDUK..........................................................................................G
POSTER.............................................................................................H
BILLBOARD.........................................................................................I
LEAFLET/SELEBARAN......................................................................J
LAINNYA (SEBUTKAN).....................................................................K
TIDAK ADA / TIDAK DAPAT INFO.....................................................L
TOKOH AGAMA.................................................................................A
KELURAHAN RT / RW.......................................................................B
PENYULUH KESEHATAN.................................................................C
GURU / SEKOLAH ANAK..................................................................D
MEDIA MASSA (TV / RADIO / KORAN).............................................E
PAPAN PENGUMUMAN / SPANDUK................................................F
LAINNYA (SEBUTKAN).....................................................................G
ARISAN..............................................................................................A
PENGAJIAN.......................................................................................B
RAPAT RT..........................................................................................C
PENYULUHAN KESEHATAN............................................................D
LAINNYA (SEBUTKAN).....................................................................E
TIDAK PERNAH IKUT........................................................................F
MASALAH SAMPAH DAN KEBERSIHAN LINGKUNGAN.................A
AIR LIMBAH DAN JAMBAN KELUARGA...........................................B
SALURAN AIR KOTOR (DRAINASE) ...............................................C
STOP BUANG AIR BESAR SEMBARANGAN...................................D
CUCI TANGAN PAKAI SABUN..........................................................E
AIR BERSIH........................................................................................F
LAINNYA (SEBUTKAN)....................................................................G
TIDAK ADA.........................................................................................H
ADA....................................................................................................A
TIDAK ADA.........................................................................................B
SETIAP MINGGU...............................................................................A
SETIAP BULAN..................................................................................B
TIDAK TENTU....................................................................................C
TIDAK PERNAH.................................................................................D
LUDRUK/LAWAK/KOMEDI................................................................A
WAYANG GOLEK..............................................................................B
WAYANG KULIT................................................................................C
TARI DAN NYANYI............................................................................D
LAINNYA (SEBUTKAN).....................................................................E
TIDAK ADA ........................................................................................F
PERINGATAN HARI-HARI BESAR....................................................A
UPACARA ADAT................................................................................B
FASTIVAL DAERAH...........................................................................C
LAINNYA (SEBUTKAN).....................................................................D
TIDAK ADA.........................................................................................E