Informed Consent

Title of Study: Prevailing social obstacles in keeping tobacco-free homes in urban areas:
Realizing ways to overcome

Dear Research Participant

Assalamu alaikum
We are going to conduct a research entiled “Prevailing social obstacles in keeping tobacco-free homes
in urban areas: Realizing ways to overcome” The main purposes of this research is to identify the
social obstacles in keeping tobacco free homes as well as risk factors associated with it. Your
participation in this study is entirely voluntary. It will involve an interview of approximately 20
minutes in length. I will be taping the session along with taking some notes, because I do not want to
miss any of your comments. You can withdraw from the study at any time, and may decline to answer
any question, if you no wish. All information you provide is completely confidential. Our final report
resulting from this study, will not identify your response .There are no known or anticipated risks to
you as a participant in this study. I would like to assure you that this study has been reviewed and
received ethics clearance.

I hope that the results of my study will be of benefit to those organizations directly involved in the
study as well as to the broader research community. There is no monetary compensation to you for
your participation in this study.

If you give your consent to participate in this study, we can start your interview now.

___________________________
Signature & Name of the Respondent

Principal Investigator:
Name: Md Imdadul Haque
Department: Master of Public Health, Daffodil International University
E-mail: ianthrops@yahoo.com, Cell: +8801911840296
Title of Study: Prevailing social obstacles in keeping tobacco-free homes in urban areas:
Realizing ways to overcome

In-depth Interviews (IDIs) Instrument

ID No: Date:

Name: Cluster No:

Present Address: Clusters

Mohammadpur Uttara, Dhanmondi-27 Motijheel
Housing Society Sector-6 R/A Colony
Mobile No: (1) ( 2) (3) (4)

Open-Ended Questions for IDIs

1. Age:
2. Gender:
3. Number of family members:
4. Education:
5. Occupation:
6. Monthly income of your family:
7. Are you living at this residential area?
i. Yes ii. No
8. Do you use tobacco?
i. Yes ii. No
9. If yes, what type of tobacco you use (smoking or smokeless tobacco)?
i. Smoking tobacco ii. Smokeless tobacco
10. If you smoke,
a. Do you smoke at home?
i. Yes ii. No
b. Do you smoke at any of your meeting place?
i. Yes ii. No
11. Is any of your family member use tobacco?

i. Yes ii. No

12. If they smoke, do they smoke at home?

i. Yes ii. No
13. What are the factors for tobacco intake (both smoking and smokeless):

Individual factor (Probing):

Familial factor (Probing):

Social factor (Probing):

14. What are possible prevailing social obstacles that prevent home tobacco free especially in urban
residential area?
15. What initiative can be taken to prevent smoking at family level?
16. What initiative can be taken to prevent smoking at society level?
17. What is your idea about the governmental law and policy about tobacco intake? Please share your
ideas.
18. What initiatives should be given by Government?
19. What are the NGO interventions exited addressing the attempt to keep home tobacco free? Please
tell in this regard.
20. What are practices, you suggest, for the tobacco free homes in urban residential areas in individual
or family level?