Thank you for your cooperation!

Appendix D 
24-hour Dietary Intake Questionnaire
10
 
Interviewer Observation Form 
[Do not read these questions to the respondent.] 
A. Who else helped in responding for this interview? (Circle all that apply) 
(0) No one 
(1) Sample person 
(2) Mother of sample person 
(3) Father of sample person 
(4) Wife of sample person 
(5) Husband of sample person 
(6) Daughter(s) of sample person 
(7) Son(s) of sample person 
(8) Sister(s) of sample person 
(9) Brother(s) of sample person 
(10) Grandparent(s) of sample person 
(11) Aunt(s) of sample person 
(12) Uncle(s) of sample person 
(13) Maid(s) of sample person 
(14) Someone else (specify) – other than interviewer ______________________ 
B. Did you or the respondent have difficulty with this intake interview? 
(0) No
(1) Yes 
C. What was the reason for this difficulty? 
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________ 
For office use only 
Date received: 
Data entry: 
Yes 
No 
Complete Questionnaire: Yes 
No 
Entered by: 
Missing data make up: 
Yes 
No 
Re-entry: 
Yes 
No 
Verified by: 
Entered by: 

Appendix D 
11
提示咭 一 Card 1

tải về 134.09 Kb.

Chia sẻ với bạn bè của bạn: