This interview form is provided to guide structured interviews amongst households as part of a study on polio immunisation in Nigeria that is being conducted by Public Health Services and Solutions (PHSS) and The Communication Initiative with the United States Agency for International Development (USAID). The purpose of this study is to identify, quantify, and analyse the combined effects of social and material factors, at the micro-level, that appear to associate with incidence of missed children by household in a given community. The research proposed aims to strengthen understanding of how factors operate in a composite manner to determine the prevailing level at which households with eligible children drop out of, or are missed in the process of, supplementary immunisation activities (SIAs). This research aims to generate more in-depth, localised analysis of factors leading to missed children and to produce that analysis in a way that is easily converted back into locally relevant programme knowledge and practice.

The interview for which this form has been created is structured and includes questions such as "Do you participate in community meetings to discuss ways to improve living conditions?", "Do you feel that your opinions about community development can influence your government (local, state)?", and "Do you approve or disapprove of the polio eradication programme?"

Click here for the 11-page form in Word format. This form is also available in Hausa. To request a copy in that language, contact Chris Morry