MICS-6
Questionnaire for children age 5-17
2018 Georgia MICS
5-17 Child information panel: FS
FS1. Cluster number: _ _ _
FS2. Household number: _ _
FS3. Child's name and line number:
Name ____ _ _
FS4. Mother's/caretaker's name and line number:
Name ____ _ _
FS5. Interviewer's name and number:
Name ____ _ _
FS6. Supervisor's name and number:
Name ____ _ _
FS7. Day/month/year of interview
_ _ / _ _ / 201 _
FS8. Record the time
Hours : minutes_ _ : _ _
Check respondent's age in HL6 in list of household members, household questionnaire:
If age 15-17, verify that adult consent for interview is obtained (HH33 or HH39) or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in FS17. The respondent must be at least 15 years old. In the very few cases where a child age 15-17 has no mother or caretaker identified in the household (HL20=90), the respondent will be the child him/herself.
FS9. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?
[] 1 Yes, interviewed already (Go to FS10B)
[] 2 No, first interview (Go to FS10A)
[] 2 No, first interview (Go to FS10A)
FS10A. Hello, my name is (your name). We are from National Statistical Offices of Georgia. We are conducting a survey about the situation of children, families and households. I would like to talk to you about (child's name from FS3)'s health and well-being. This interview will take about 10 minutes. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
FS10B. Now I would like to talk to you about (child's name from FS3)'s health and well-being in more detail. This interview will take about 10 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
[] 1 Yes (Go to child's background module)
[] 2 No/not asked (Go to FS17)
[] 2 No/not asked (Go to FS17)
FS17. Result of interview for child age 5-17 years
Codes refer to the respondent. Discuss any result not completed with Supervisor.
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for mother/caretaker age 15-17
[] 96 Other (specify) ____
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for mother/caretaker age 15-17
[] 96 Other (specify) ____
Child's background: CB
CB1. Check the respondent's line number (FS4) in 5-17 child information panel and the respondent to the household questionnaire (HH47):
[] 1 FS4=HH47 (Go to CB11)
[] 2 FS4 does not equal HH47
[] 2 FS4 does not equal HH47
CB2. In what month and year was (name) born?
Month and year must be recorded.
Date of birth
_ _ Month
_ _ _ _ Year
_ _ _ _ Year
CB3. How old is (name)?
Probe: How old was (name) at (his/her) last birthday? Record age in completed years. If responses to CB2 and CB3 are inconsistent, probe further and correct.
Age (in completed years) _ _
CB4. Has (name) ever attended school or kindergarten?
[] 1 Yes
[] 2 No (Go to CB11)
[] 2 No (Go to CB11)
CB5. What is the highest level and grade or year of school (name) has ever attended?
[] 000 Kindergarten (Go to CB7)
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
CB6. Did (he/she) ever complete that (grade/year)?
[] 1 Yes
[] 2 No
[] 2 No
CB7. At any time during the2018-2019 school year did (name) attend school or kindergarten?
[] 1 Yes
[] 2 No (Go to CB9)
[] 2 No (Go to CB9)
CB8. During this 2018-2019 school year, which level and grade or year is (name) attending?
[] 000 Kindergarten
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
CB9. At any time during the 2017-2018 school year did (name) attend school or kindergarten?
[] 1 Yes
[] 2 No (Go to CB11)
[] 2 No (Go to CB11)
CB10. During that 2017-2018 school year, which level and grade or year did (name) attend?
[] 000 Kindergarten
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Vocational education on the base of lower secondary education _ _
[] 5 Vocational education on the base of upper secondary education _ _
[] 6 Higher _ _
CB11. Is (name) covered by any health insurance?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
CB12. What type of health insurance is (name) covered by?
Record all mentioned.
[] B Health insurance through employer
[] D Other privately purchased commercial health insurance
[] E Universal health care program
[] X Other (specify) ____
[] D Other privately purchased commercial health insurance
[] E Universal health care program
[] X Other (specify) ____
Child discipline: FCD
FCD1. Check CB3: Child's age?
[] 1 Age 5-14 years
[] 2 Age 15-17 years (Go to end of module)
[] 2 Age 15-17 years (Go to end of module)
FCD2. Now I'd like to talk to you about something else.
Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used. Please tell me if you or any other adult in your household has used this method with (name) in the past 30 days.
A. Took away privileges, forbade something (name) liked or did not allow (him/her) to leave the house.
Took away privileges
[] 1 Yes
[] 2 No
[] 2 No
B. Explained why (name)'s behaviour was wrong.
Explained wrong behavior
[] 1 Yes
[] 2 No
[] 2 No
C. Shook (him/her).
Shook him/her
[] 1 Yes
[] 2 No
[] 2 No
D. Shouted, yelled at or screamed at (him/her).
Shouted, yelled, screamed
[] 1 Yes
[] 2 No
[] 2 No
E. Gave (him/her) something else to do.
Gave something else to do
[] 1 Yes
[] 2 No
[] 2 No
F. Spanked, hit or slapped (him/her) on the bottom with bare hand.
Spanked, hit, slapped on bottom with bare hand
[] 1 Yes
[] 2 No
[] 2 No
G. Hit (him/her) on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.
Hit with belt, hairbrush, stick or other hard object
[] 1 Yes
[] 2 No
[] 2 No
H. Called (him/her) dumb, lazy or another name like that.
Called dumb, lazy or another name
[] 1 Yes
[] 2 No
[] 2 No
I. Hit or slapped (him/her) on the face, head or ears.
Hit/slapped on the face, head or ears
[] 1 Yes
[] 2 No
[] 2 No
J. Hit or slapped (him/her) on the hand, arm, or leg.
Hit/slapped on hand, arm or leg
[] 1 Yes
[] 2 No
[] 2 No
K. Beat (him/her) up, that is hit him/her over and over as hard as one could.
Beat up, hit over and over as hard as one could
[] 1 Yes
[] 2 No
[] 2 No
FCD3. Check FS4: Is this respondent the mother or caretaker of any other children under age 5?
[] 1 Yes
[] 2 No (Go to FCD5)
[] 2 No (Go to FCD5)
FCD4. Check FS4: Has this respondent already responded to the following question (UCD5) for another child?
[] 1 Yes (Go to end of module)
[] 2 No
[] 2 No
FCD5. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
[] 1 Yes
[] 2 No
[] 8 DK/no opinion
[] 2 No
[] 8 DK/no opinion
Child functioning: FCF
FCF1. I would like to ask you some questions about difficulties (name) may have.
Does (name) wear glasses or contact lenses?
[] 1 Yes
[] 2 No
[] 2 No
FCF2. Does (name) use a hearing aid?
[] 1 Yes
[] 2 No
[] 2 No
FCF3. Does (name) use any equipment or receive assistance for walking?
[] 1 Yes
[] 2 No
[] 2 No
FCF4. In the following questions, I will ask you to answer by selecting one of four possible answers. For each question, would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all.
Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember the four possible answers: Would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all?
Remember the four possible answers: Would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all?
FCF5. Check FCF1: Child wears glasses or contact lenses?
[] 1 Yes, FCF1=1 (Go to FCF6A)
[] 2 No, FCF1=2 (Go to FCF6B)
[] 2 No, FCF1=2 (Go to FCF6B)
FCF6A. When wearing (his/her) glasses or contact lenses, does (name) have difficulty seeing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
FCF6B. Does (name) have difficulty seeing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
FCF7. Check FCF2: Child uses a hearing aid?
[] 1 Yes, FCF2=1 (Go to FCF8A)
[] 2 No, FCF2=2 (Go to FCF8B)
[] 2 No, FCF2=2 (Go to FCF8B)
FCF8A. When using (his/her) hearing aid(s), does (name) have difficulty hearing sounds like peoples' voices or music?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
FCF8B. Does (name) have difficulty hearing sounds like peoples' voices or music?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
FCF9. Check FCF3: Child uses equipment or receives assistance for walking?
[] 1 Yes, FCF3=1
[] 2 No, FCF3=2 (Go to FCF14)
[] 2 No, FCF3=2 (Go to FCF14)
FCF10. Without (his/her) equipment or assistance, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field.
Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF12)
[] 4 Cannot walk 100 M at all (Go to FCF12)
[] 3 A lot of difficulty (Go to FCF12)
[] 4 Cannot walk 100 M at all (Go to FCF12)
[p. 9]
FCF11. Without (his/her) equipment or assistance, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields.
Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF12. With (his/her) equipment or assistance, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF13. With (his/her) equipment or assistance, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty (Go to FCF16)
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF14. Compared with children of the same age, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF15. Compared with children of the same age, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF16. Does (name) have difficulty with self-care such as feeding or dressing (himself/herself)?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
FCF17. When (name) speaks, does (he/she) have difficulty being understood by people inside of this household?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF18. When (name) speaks, does (he/she) have difficulty being understood by people outside of this household?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF19. Compared with children of the same age, does (name) have difficulty learning things?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all
FCF20. Compared with children of the same age, does (name) have difficulty remembering things?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all
FCF21. Does (name) have difficulty concentrating on an activity that (he/she) enjoys doing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all
FCF22. Does (name) have difficulty accepting changes in (his/her) routine?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all
FCF23. Compared with children of the same age, does (name) have difficulty controlling (his/her) behaviour?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all
FCF24. Does (name) have difficulty making friends?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot make friends at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot make friends at all
FCF25. The next questions have different options for answers. I am going to read these to you after each question.
I would like to know how often (name) seems very anxious, nervous or worried.
Would you say: daily, weekly, monthly, a few times a year or never?
[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
FCF26. I would also like to know how often (name) seems very sad or depressed.
Would you say: daily, weekly, monthly, a few times a year or never?
[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
Parental involvement: PR
PR1. Check CB3: Child's age?
[] 1 Age 5-6 years (Go to end of module)
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to end of module)
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to end of module)
PR3. Excluding school text books and holy books, how many books do you have for (name) to read at home?
[] 00 None
[] 0 Number of books _
[] 10 Ten or more books
[] 0 Number of books _
[] 10 Ten or more books
PR4. Check CB7: Did the child attend any school?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 1 Yes, CB7/ED9=1
[] 2 No, CB7/ED9=2 or blank (Go to end of module)
[] 2 No, CB7/ED9=2 or blank (Go to end of module)
PR5. Does (name) ever have homework?
[] 1 Yes
[] 2 No (Go to PR7)
[] 8 DK (Go to PR7)
[] 2 No (Go to PR7)
[] 8 DK (Go to PR7)
PR6. Does anyone help (name) with homework?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR7. Does (name)'s school have a school governing body in which parents can participate (such as a board of trustees, disciplinary commission, etc.)?
[] 1 Yes
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR8. In the last 12 months, have you or any other adult from your household attended a meeting called by this school governing body?
[] 1 Yes
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR9. During any of these meetings, was any of the following discussed:
A. A plan for addressing key education issues faced by (name)'s school?
Plan for addressing school's issues
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
B. School budget or use of funds received by (name)'s school?
School budget
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR10. In the last 12 months, have you or any other adult from your household received a children's school performance record, for example "mark sheet", "written assessment" for (name)?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR11. In the last 12 months, have you or any adult from your household gone to (name)'s school for any of the following reasons?
A. A school celebration or a sport event?
Celebration or sport event
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
B. To discuss (name)'s progress with (his/her) teachers?
To discuss progress with teachers
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR12. In the last 12 months, has (name)'s school been closed on a school day due to any of the following reasons:
A. Natural disasters, such as flood, heavy snowfall, epidemics or similar?
Natural disasters
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
B. Man-made disasters, such as fire, building collapse, riots or similar?
Man-made disasters
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
C. Teacher strike?
Teacher strike
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
X. Other?
Other
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR13. In the last 12 months, was (name) unable to attend class due to (his/her) teacher being absent?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR14. Check PR12[C] and PR13: Any 'Yes' recorded?
[] 1 Yes, PR12[C]=1 or PR13=1
[] 2 No (Go to end)
[] 2 No (Go to end)
PR15. When (teacher strike / teacher absence) happened did you or any other adult member of your household contact any school officials or school governing body representatives?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FS11. Record the time.
Hours and minutes _ _ : _ _
FS12. Language of the Questionnaire.
[] 1 Georgian
[] 2 Azerbaijani
[] 3 Armenian
[] 2 Azerbaijani
[] 3 Armenian
FS13. Language of the Interview.
[] 1 Georgian
[] 2 Azerbaijani
[] 3 Armenian
[] 6 Other language (specify) ____
[] 2 Azerbaijani
[] 3 Armenian
[] 6 Other language (specify) ____
FS14. Native language of the Respondent.
[] 1 Georgian
[] 2 Azerbaijani
[] 3 Armenian
[] 4 Russian
[] 6 Other language (specify) ____
[] 2 Azerbaijani
[] 3 Armenian
[] 4 Russian
[] 6 Other language (specify) ____
FS15. Was a translator used for any parts of this questionnaire?
[] 1 Yes, the entire questionnaire
[] 2 Yes, parts of the questionnaire
[] 3 No, not used
[] 2 Yes, parts of the questionnaire
[] 3 No, not used
FS16. Thank the respondent and the child for her/his cooperation.
Proceed to complete the result in FS17 in the 5-17 child information panel and then go to the household questionnaire and complete HH56.
Make arrangements for the administration of the remaining questionnaire(s) in this household.
Make arrangements for the administration of the remaining questionnaire(s) in this household.
Interviewer's observations
Supervisor's observations