Professional Documents
Culture Documents
quest_ interview caregiver
quest_ interview caregiver
A. Parents/guardian sociodemographic
No Questions Code
A1 Gender 1[ ] female 2[ ] male
A2 Date of birth (dd / mm / yyyy) (_____/________/________)
A3 Marital status 1[] single 2[] married 3[] widowed 4[] divorced
A4 Your ethnicity ?
1[] Minangkabau 2[] Javanese 3[] batak 4[] other, specify _____________
A5 What is your highest education ? 1[] don’t have education 2[] primary school
3[] junior high school 4[] senior high school 5[] bachelor 6[] above bachelor
A6 what is your current occupation ? (multiple choice) 1[] housewife / house keeper
2[] entrepreneur / self employed 3[] agriculture /farmer 4[] fisherman 5[] lecturer
6[] civil servant 7[] private employees 8[] retired 9[] other , specify___________
A7 How many hours of work per day________ hour
For researcher : 1. High >8 hr 2. Moderate 5-7 hr 3. Low <4 hr
A8 Average monthly household income (IDR) ? 1[] < 1,000,000 2[] 1,000,000 – 3,000,000
3[] 4,000,000 – 5,000,000 4[] > 5,000,000
For researcher : 1. Very poor 2. Poor 3. Middle 4. High
A9 Spending on food per month 1[] ≤ 600,000 2[] 600,000 – 1,000,000 3[] ≥ 1,000,000
A10 How many people living in your house including yourself ? ______ (specify)
A11 How many children <15 yo living there ? ______ (specify)
A12 What is your relationship with the child ?
1[] mother 2[] father 3[] grandparents 4[] relatives 5[] other, __________
A15 Have you ever received nutritional counselling from healthcare worker
1[] yes 2[] no 3[] not sure
Questionnaire for Parents/guardians
B. Household characteristics
13 Who determines your main child daily menu ? 1[] mother 2[] caregiver 3[] father
4[] parents /in-laws 5[] helper 6[] Others, specify ________________
A14 How do you get your child daily menu ? 1[] cook at home 2[] buy ready made
3[] instant food 4[] Others, specify______________
A15 What are the considerations in choosing a menu for your child ? (multiple choices)
1[] nutrition 2[] finance 3[] ease of obtaining/food availability
4[] children’s tastes/likes 5[] Others, specify___________________
How often does your family eat meals together at home?
a) Almost always; everyday b) Fairly often, not everyday
c) Occasionally, only when there an event d) Rarely, once a week
How much time does your child typically spend on screens (e.g., TV, computer, tablet, s
martphone) each day?
1[] Less than 1 hour 2[] 1-2 hours 3[] 2-4 hours 4[] More than 4 hours
For researcher : if parents answer no/don’t know, need to ask the child for age >10 yo
B3.1 If yes, how many pack per day ?_______ cigarettes/pack per day
B3.2 How long have s/he been smoking?________ years
For researcher : Pack years 1) 0.1 - 10 2) 11 - 20 3) 20 - 40 4) >40
F. Children Medical Record (if this section completed already by hospital based data, than skip)
No Questions Code
When was she/he diagnosed with tuberculosis? _______ month ________ year
E4
E10 Is s/he has any underlying disease ? 1[] Hypertension 2[] Diabetes 3[] COPD
4[]Asthma 5[] Cancer 6[] Psychiatric problem 7[] HIV
8[] Other (specify)________________ 9[] don’t have
F. Feeding style
No Questions Code
1 How you feed your child?
1[] I am authoritative, setting clear expectations while being supportive and responsive to my
child's needs.
2[] I am indulgent, allowing my child to eat whatever they want without much restriction.
3[] I am authoritarian, enforcing strict rules without much warmth or responsiveness.
2 How do you react when your child expresses a preference for unhealthy snacks or treats?
1[] I allow my child to eat whatever they want, even if it's not nutritious.
2[] I try to balance treats with healthier options and encourage moderation.
3[] I ignore their preferences and insist they eat what I provide
G. Child eating behavior
No Questions Code
1 How child's enjoy of eating food?
1[] They consistently express excitement and pleasure while eating.
2[] They rarely show enjoyment while eating and may seem disinterested.
Questionnaire for Parents/guardians
4.1 If no, what type of milk/liquid you give to your child ? Multiple choices
[] 1 formula milk [] 2 evaporated milk [] 3 animal milk [] 4 plants / soy milk
[] 5 plain water [] 6 tea /coffee [] 7 fruit juice [] 8 honey [] 9 other ______
5 Are you continuing / will breastfeeding to your child until 12 – 23 months ?
[] 0 yes [] 1 no
6 What is your difficulties to give exclusive breastfeeding ? Multiple choices
[] 1 painful breast by anycause [] 2 insufficient breastmilk production
[] 3 lack of support [] 4 short maternity leave periods [] 5 emotional stress
[] 6 lack of knowledge [] 7 cultural influence [] 8 mother unable to breastfeeding
[] 9 other, specify________________
B. Complementary Food
NO Questions Code
1 At what time you give complementary food ? 1[] < 6 months 2[] > 6 months
Questionnaire for Parents/guardians
2 How many times did (name of the baby) eat foods, that is meals and snacks other than
liquids yesterday? [] _______ number of times [] 88 don’t know
For researcher : WHO recommended for age <8 month is 2-3 times. For age 9-23 months is 3-4 times
[] 0 inappropriate frequency of meals [] 1 appropriate frequency of meals
C Minimum Dietary Diversity (24 hr-recall)
Warning ! SKIP group 1. Breast milk, for parents of children and adolescent.
Yesterday during the day or at night, did (name of the child) have:
Group Food lists code
Group 1 : Breast Breast Milk (direct to mother breast or bottle feeding)
Milk [] 0 yes [] 1 no
Ripe mangoes, papaya, banana, star fruit, langsat, watermelon (rich vit A
fruits) [] 0 yes [] 1 no
Group 8: Other Any other fruits or vegetables [] 0 yes [] 1 no
fruits and vegetable
Others (not counted Any oil, fats, or butter or foods made with any of these (rempeyek,
in the dietary gorengan, karupuak) [] 0 yes [] 1 no
diversity score) Any sugary foods, such as chocolates, sweets, candies, pastries, cakes or
biscuits (martabak, donat, brownis, bolu) [] 0 yes [] 1 no
Condiments for flavour, such as chillies, spices, herbs or fish powder
[] 0 yes [] 1 no
Instant drinks (®popice, ®marimas, ®nutrisari) and Soft drinks
(®cocacola, ®sprite, ®fanta) [] 0 yes [] 1 no
For researcher : []0 inappropriate food diversity []1 appropriate food diversity ( ≥five groups per day)
No Questions code
4 What is your difficulties to give divers food ? Multiple choices
[] 1 financial difficulties [] 2 child is picky eater
[] 3 lack of knowledge about nutritious food [] 4 have no time / busy
[] 5 lack of child appetite [] 6 unhealthy food preference
[] 7 other ________
D Food Frequency Questionnaire (FFQ)
Over the past 1 year, how often did your child have ?
Warning ! SKIP group 1. Breast milk, for parents of children and adolescent.
Times/month Times/week Times/day
Group 1: Breast milk Never
1-3 times 1-3 times >3 times 1-3 times >3 times
1 Breast milk
Group 2 : Grains, roots and Never Times/month Times/week Times/day
tubers 1-3 times 1-3 times >3 times 1-3 times >3 times
1 White rice
2 bread
3 Porridge
4 lontong
5 Instant noodles (mie or bihun)
6 Boiled corn
Questionnaire for Parents/guardians
7 Cassava
8 Potatoes
9 Sweet potatoes
10 Biscuit
Never Times/month Times/week Times/day
Group 3 : Legumes and nuts
1-3 times 1-3 times >3 times 1-3 times >3 times
1 beans
2 long beans
3 gadang beans
4 soybeans
5 peanuts
8 Parrot fish
9 Seafood (shrimp, squid)
10 snails
Group 6: Eggs Never Times/month Times/week Times/day
1-3 times 1-3 times >3 times 1-3 times >3 times
1 Eggs
Group 7: Vitamin A fruits and Never Times/month Times/week Times/day
vegetables 1-3 times 1-3 times >3 times 1-3 times >3 times
1 Pumpkin
2 carrots
3 squash
4 Kangkong
5 Spinach
6 Cassava leaves
7 Broccoli
8 mustard
9 cabbage
10 Ripe mangoes,
11 Papaya
12 Banana
13 starfruit
14 langsat
15 Watermelon
Group 8: Other fruits and Never Times/month Times/week Times/day
vegetables 1-3 times 1-3 times >3 times 1-3 times >3 times
1 Snakefruit
2 Orange
3 Duku
4 Guava
5 jicama
6 Dates
7 avocado
8 Melon
Questionnaire for Parents/guardians
9 Longan
10 Cucumber
Other foods and drinks Never Times/month Times/week Times/day
1-3 times 1-3 times >3 times 1-3 times >3 times
1 Any oil, fats, or butter or foods
(rempeyek, bakwan, risol,
karupuak)
2 Any sugary foods, (permen,
martabak, donat, brownis, bolu)
3 Condiments for flavour, such as
chillies, spices, herbs or fish
powder (seblak, bakso bakar,
telur gulung)
4 Instant drinks (®popice,
®marimas, ®nutrisari) and Soft
drinks (®cocacola, ®sprite,
®fanta)
KNOWLEDGE
A. Breastfeeding
No Questions Code
1 Have you ever heard about exclusive breast feeding? [] 0 yes [] 1 no
2 Colostrum is important for baby [] 0 yes [] 1 no [] 88 don’t know
3 A neonate should start breastfeeding within 1 h of birth [] 0 yes [] 1 no [] 88 don’t know
4 An infant should exclusively breastfeed for the first 6 months
[] 0 yes [] 1 no [] 88 don’t know
5 Benefit of breastfeeding for baby
[] 1 baby will grow healthy [] 2 protects from diseases [] 3 other [] 88 don’t know
6 Benefit of breastfeeding for mother
[] 1 Delays fertility [] 2 Helps her lose the weight [] 3 Lowers risk of breast cancer
[] 4 Improves mother and baby relationship [] 5 Other [] 88 Don’t know
7 How long is it recommended that a woman breastfeeds her child?
1[] Six months or less 2[] 6–11 months 3[] 12–23 months
4[] 24 months and more 5[] Other 88[] Don’t know
B. Complementary Food
NO Questions Code
1 An infants should start complementary food at 6 months [] 0 yes [] 1 no [] 88 don’t know
2 Reason for giving complementary foods
[] 1 Breastmilk alone is not sufficient (enough)/cannot supply all the nutrients needed for
growth
[] 2 baby needs to know different flavour of foods [] 88 Don’t know
3 Which foods or types of food can be added to rice porridge make it more nutritious?
multiple choices
[] 1 protein-rich foods (meat, poultry, fish, liver/organ meat, eggs, etc.)
[] 2 Pulses and nuts: flours of groundnut and other legumes (peas, beans, lentils, etc.),
[] 3 Vitamin-A-rich fruits and vegetables (carrot, orange- yellow pumpkin, mango, etc.)
[] 4 Green leafy vegetables (e.g. kangkung, bayam, etc)
[] 5 rich sugary and strong flavor food
[] 6 Other, specify_________ [] 88 Don’t know
4 Why is it bad to eat too many sweets and candies?
Questionnaire for Parents/guardians
[]1 Because they can cause tooth decay []2 Because they are not nutritious
[]3 Because they interfere with appetite []4 Other [] 88 Don’t know
C. Knowledge about malnutrition
No Questions Code
1 How can you recognize that your child is not having enough food/nutrition ?
Multiple choices
[] 1 Lack of energy/weakness: cannot work, study or play as normal (disability)
[] 2 Weakness of the immune system (becomes ill easily or becomes seriously ill)
[] 3 Loss of weight/thinness
[] 4 Children do not grow as they should (growth faltering)
[] 5 Other [] 88 Don’t know
2 What are the reasons why children are undernourished? Multiple choices
[] 1 Not getting enough food [] 2 Food is watery, not enough nutrients
[] 3 Disease/ill and not eating food [] 4 Other, [] 88 Don’t know
3 How can you (caregiver) find out if the baby is growing well or not?
̈ [] 1 Go to the health centre/ask a doctor or nurse (health professional)(seeking health-care
services for growth monitoring)
[] 2 measure yourself [] 3 never find out [] 4 Other [] 88 Don’t know
4 If the baby is not gaining weight, What could be the causes?
[] 1 The baby is not eating well/the baby does not want to eat
[] 2 The baby may be sick often [] 3 genetic [] 4 Other [] 88 Don’t know
5 What should you do to prevent your child from malnutrition?
[] 1 Breastfeed exclusively/give only breastmilk under 6 month
[] 2 Go to the health centre/hospital and check that the child is growing (growth monitoring
services)
[] 3 give a lot of food [] 4 Other [] 88 don’t know