Participant consent form

Bachelor of arts in mass communication and journalism, BA 2 nd year

Batch – 2076B.S (Running 2078 B.S)
Texas International College, Mitrapark Chabahil, Tribhuvan University
Namaste:
I am …… of Social Work student studying in Bachelor level second year mass communication group,
in Texas International College, Mitrapark, Chabahil affiliated to Tribhuvan University. This study is
conducted in a partial fulfillment of requirement for the degree of bachelor level in mass
communication.
Introduction:
The researcher is a student of Tribhuvan University. The study is being carried out as a partial
fulfillment of bachelor level in mass communication. Researcher would appreciate your co-operation in
answering the question.

Direction:
The respondents are requested to mark (√) to choose right answer and multiple response questions . The
respondent can write their own answer in other option and on blank spaces. Respondent can choose one
or more answer in multiple response question (MRQ). The respondents are requested to give their own
opinion on the basis of their knowledge.

The study consists of two parts:

Part I- Socio-demographic profile

Part II- Social media access of respondents

Part III- Uses of social media for social networking of Janajati

Part IV- Role of social networking for sensitization of stakeholders of Janajati issues and
Concerns

Part V-Role of social media in the empowerment of Janajati

Description of study

1. Project Title: Study on – “Social media for networking and empowerment of Janajati: A study
in …………………. Area.”
2. Student’s name: …………………. Bachelor in social work; mob- 9……., ……….@gmail.com
3. Supervisor: …………………. Bachelor in social work; lecturer of Texas International College,
mob- 9…., ……….@gmail.com
4. Purpose(s) and Objective(s) of the report:
The purpose of this study is to develop an understanding of Social media for networking and
empowerment of Janajati: A study in………………Area.
5. Procedures:
 Participants in this study will be required to participate semi structured/ structured interview
which will be recorded and transcribed by the researcher with the participant’s permission
 Participants are free to ask questions regarding the procedures and goals of the study or your
role.
6. Funded by: No Funding

7. Potential Risks:
 There are no known or anticipated risks to you by participating in this study.
8. Potential Benefits
 The results of these findings will be shared to the social work department of Texas International
College, Tribhuvan University to further enhance the learning experience and to social work
students and faculties.
9. Compensation:
 There will be no compensation for this study.
10. Confidentiality:
 All information shared will be kept confidential and will only be used for the purposes of this
study
 Information will be stored digitally in password protected files and kept under the safe keeping
of the researcher
11. Storage of Data:
 Digitally recorded and physical paper, and transcribed files will be kept by the researcher. The
information will be discarded after completion of thesis.
12. Right to Withdraw:
 Your participation is voluntary and you can answer only those questions that you are
comfortable with. You may withdraw from the study project for any reason, at any time without
explanation or penalty of any sort.
 Your decision to participate or not in this study will have no effect on your position [e.g.
employment, social standing, access to services] or how you will be treated.
 Should you wish to withdraw due to illness and unavailability of time your information will
not be used for this study.
13. Follow up:

 A brief summary outlining study findings will be provided to participants. Names will be kept
anonymous so that there can be no clear linkage between participants in this study.
14. Questions or Concerns:
 Contact the researcher(s) using the information provided.
 This project has been approved on ethical grounds by bachelor program in social work, Texas
International College, Tribhuvan University. Any questions regarding your rights as a
participant may be addressed to the committee at (phone no- 980164456) and
(anantantv@gmail.com).
 15. Continued or On-going Consent:
 Participants may be required to do a follow up interview only if it is necessary to clarify
information that was received during the initial interview process.

In this survey your personal experience and opinion is very important. We will keep the respondent’s
information anonymous. There is no right answer to the questions. Whatever answers you give is the
right answer for us. We believe that you will give us honest answers. Through random methods your
ward and your house were selected for the survey. This survey is about 40 minutes long. Respondent
must be a Nepali. The respondent must be living in the household for at least 6 months and should
be member of the family who eats in the same kitchen. In each ward 6 men and 6 women have to be
interviewed.

Your signature below indicates that you have read and understand the description provided; I have
had an opportunity to ask questions and my/our questions have been answered. I consent to
participate in the study project. A copy of this Consent Form has been given to me for my records.

…………………….. ……………………… …………………..

Name of participants researcher’s signature Date
 Part I- Sociodemographic information/ personal information

Instruction for the interviewer

Conduct the interview in an informal, conversational manner, asking questions gently in a soft
tone. Put the respondent at ease. Do not proceed in an interrogative manner or intimidate the
respondent in any way. Give sufficient time to the respondent to reflect and answer the question
without feeling rushed. If the respondent does not understand the questions, repeat it slowly.

QUESTIONAIRE

WARD NO…………………………..
TOLE…………………………………………………GROUP
………………………………………..
DATE ……………… INTERVIEWERS NAME……………………………….TIME
STARTED…………..FINISHED………………

A. SOCIO-DEMOGRAPHIC INFORMATION

1.1 NAME OF HOUSEHOLD HEAD

……………………………………………………………………………………………
1.2 HOUSEHOLD NUMBER
……………………………………………………………………………………………
1.3 ADDRESS
Present Previous
Province Province
District district
Rural/urban Rural/urban
municipality municipality
Ward no Ward no
Village/tole Village/tole

1.4 ETHNICITY/CASTE
a. _____Brahmin / (specify……………….)
b. _____ Chhetri/ (specify………………….)
c. _____Janajati / (specify………………….)
d. _____Dalit / (specify……………………)
 e. _____ others

1.5 EDUCATIONAL QUALIFICATION

Please very specific

Nursery / kG Class 9 Uttar madhyama

Class 1 Class 10 Sastri
Class 2 SLC/SEE Acharya
Class 3 Intermediate or 10 TSLC CTEVT
+2
Class 4 Bachelor degree Diploma CTEVT
Class 5 Master’s degree Non formal education
Class 6 Ph.D level Illiterate
Class 7 Prathamik Refused to say
Class 8 Purba Madhyama Other specify
Don’t know

1.6 HOUSEHOLD MEMBER INFORMATION

Male …………………………….. Female…………………… Total……………………

NO. Relation to Age Sex Ed. Main job Other job If children
household head Level under 15 is at
school

1. Wife

2. Mother/father

3. Son/ daughter

4. Son/ daughter in
law

5. Other specify

a. Nuclear household…………………………….
b. Joint household
(Three generations / married son or daughter in the same
house)……………………………………..
1.8 MARITAL STATUS
a. Married
b. Never married
c. Divorced/ separated/ widow

1.10 RELIGION
Hindu Buddhist Christian Sikh Bon Muslim
Islam Kirat jain Bahai Prakriti Undefined

1.11 WHAT IS YOUR MAIN OCCUPATION?

Agriculture Private sector Unemployed Social Refused Own
job protection business
transfers
Casual/ Private sector Household / Don’t Selling Business/
informal job( agri) housewife know goods tourism
labour ( agri)
Study/ Other specify Migration/ Rent Public Pension
students remittance sector/ civil holder
service
 PART II
Social media access of respondents
(Tick any one response; y= yes, n= no)

S.N SOCIAL MEDIA RESPONE

ASSOCIATIONS Yes No
1 Facebook
2 Google
3 LinkedIn
4 Skype
5 Talk
6 e- telegram
7 Tumblr
8 Twitter
9 WhatsApp
10 WeChat
11 Yahoo.com
12 YouTube
13 PLP Community Hub
14 Instagram
15 Reddit
16 Pinterest
17 Snapchat
18 Meetup
19 Flickr
20 KIK
21 Medium
22 Messenger
23 Ask Dot
24 Quora
25 Xing
 Part III
Uses of social media for social networking of Janajati
(Tick any one response; A= agree, D= disagree and NR= No response)

S.N Statement Response

A D NR
26 Social media are effective tools of social networking
27 Social media facilitate social networking of Janajati
28 Social media create networking for communication among the family members
out from the home
29 Social media create social networking for strategic intervention and lobby for
welfare of janajati
30 Social media create social networking for better transnational advocacy
networks for Janajati
31 Social media create social networking for better coordination among
stakeholders of social justice
32 Social media create social networking for better entrepreneurship development
among janajati
33 Social media create social networking for strengthening the empowerment for
janajati
34 Social media create social networking for grater transformative power for
janajati in all walks of life
35 Social media create social networking for better governance at various level for
janajati welfare
36 Social media create social networking for decision making about community
development of janajati
37 Social media create social networking for mobilization of ideas and actions for
Janajati
38 Social media create social networking for strong social ties among Janajati
39 Social media create social networking for better resources flow and sharing
among Janajati
40 Social media facilitate social networking for transformation of Janajati
41 Social media facilitate better social alliance development among Janajati
42 Social media provide a wide range of information for social networking of
Janajati
 PART – IV
Role of social networking for sensitization of stakeholders of janajati issues and concerns
(Tick any one response; E= excellent, G=good and A= average)
S.N Issues and concerns of janajati Response

E G A
43 Social networking has facilitated sensitization of stakeholders of janajati
about rights.
44 Social networking has facilitated sensitization of stakeholders of janajati
about oppression
45 Social networking has facilitated sensitization of stakeholders about
systematic marginalization
46 Social networking has facilitated sensitization of stakeholders of janajati
welfare about child marriage
47 Social networking has facilitated sensitization of stakeholders of janajati
about social exclusion
48 Social networking has facilitated sensitization of stakeholders of janajati
welfare about human rights violation
49 Social networking has facilitated sensitization of stakeholders of janajati
welfare about identity formation
50 Social networking has facilitated sensitization of stakeholders of janajati
welfare about religious reversion
51 Social networking has facilitated sensitization of stakeholders of janajati
about social movements
52 Social networking has facilitated sensitization of stakeholders about inter
caste marriage
53 Social networking has facilitated sensitization of stakeholders of janajati
welfare about social security
54 Social networking has facilitated sensitization of stakeholders of janajati
for opportunity by state
55 Social networking has facilitated sensitization of stakeholders of janajati
welfare about constitutional rights
56 Social networking has facilitated sensitization of stakeholder of janajati
welfare about reservation.
57 Social networking has facilitated sensitization of stakeholders of janajati
welfare about wrong going in state and society
58 Social networking has facilitated sensitization of stakeholders of janajati
about media intervention for janajati empowerment
59 Social networking has facilitated sensitization of stakeholders of janajati
welfare about self-employment opportunities
60 Social networking has facilitated sensitization of stakeholders of janajati
welfare about internationalization of janajagti issues
61 Social networking has facilitated sensitization of stakeholders of janajati
welfare about international collaboration for janajati empowerment
 PART- V
Role of social media in the empowerment of Janajati
(Tick any one response; A= agree, D= disagree and NR= No response)
S.N Statement Response

62 Social media enable janajati to achieve educational A D NR

progress
63 Social media enable janajati to develop their
communication skills
64 Social media enable janajati to develop their personality
65 Social media enable janajati to assert their rights and
privileges
66 Social media enable janajati to enhance social mobilization
for transformation
67 Social media enable janajati to participate actively in
progressive social movements
68 Social media enable Dalits to enhance their political
mobilization for transformation
69 Social media enable Dalits to participate actively in the
progressive political movements
70 Social media enable janajati to develop leadership qualities
and obtain political representation.
71 Social media enable janajati to understand the issues and
concerns of their lives
72 Social media enable janajati to increase their production and
productivity
73 Social media enable janajati to develop entrepreneurship
capacity
Social media enable janajati to achieve economic self-
reliance
Social media enable janajati to control population through
family planning
Social media enable janajati to generate productive
employment opportunities
Social media enable janajati to achieve the goal of inclusive
development
Social media enable janajati to adopt new technologies and
innovations in their lives.
Social media enable janajati to increase their social mobility.
Social media enable janajati to emulate success stories and
adopt healthy practices in their lives.
Social media enable janajati to obtain financial incentives
and benefits from banks, cooperatives and self-help groups
Social media enable janajati to actively participate in
developmental activities.
Social media enable janajati to utilize women, child and
youth development programmes.
Social media enable janajati to obtain preventive and
curative healthcare facilities.
Social media enable janajati to adapt themselves to the
changing economic and political environments.
Social media enable janajati to improve standards of living
in the age of globalization