Women's Health Needs STUDY_SCREENER

Attachment G2. Women’s Health Needs Study Eligibility Screener (Somali translations)

Section	Question	English Items	Qayb	Su'aal	Maadooyinka Ingiriiska
Screener Cover Page	OMB notice	Form Approved	Jaldigga Bogga Baaraha	Ogaysiiska OMB	Foomka La ansixiyay
		OMB Number:			Nambarka OMB:
		Expiration Date:			Taariikha Dhicitaanka:
Screener	Survey Title	Women's Health Needs Study	Baaraha	Ciwaanka Sahanka	Daraasada Baahiyaha Caafimaad Haweenka
Screener	OMB Burden Statement	Public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).	Baaraha	Ogaysiiska Masuuliyada e OMB	Wargalinta dadwaynaha ee aruurinta macluumaadkaan waxaa lagu qiyaasay celcelis ahaan 1 daqiiqo jawaabtiiba, ayna kujiraan waqtiga dib u eegista lagu samaynaayo tilmaamaha, raadinta ilaha macluumaadka ee horay ujiray, aruurinta iyo ilaalinta macluumaadka loobaahanyahay, iyo dhamaystirka iyo dib umuraajacaynta aruurinta macluumaadka. Waxaa suuragal ah inaan wakaalad fulin ama maalgalin, qofkana lagama doonaayo inuu jawaab kabixiyo su'aalaha macluumaad aruurinta ilaa inay muujinayso maahee nambarka saxda ah ee an wali dhicin ee maaraynta OMB. Udir fikradaha laxariira qiyaasta cadayntaan ama waxkasta oo laxariira mawduucaan ayna kujiraan soojedinada laxariira yaraynta culayskaan una gudbi Madaxa Kalahufida Warbixinada ee CDC/ATSDR; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).
Screener	Screener Start Time Hour Minutes	N/A	Baaraha	Waqtiga Bilowga Baaraha Saac Daqiiqado	N/A
Screener	Intro	The following questions will ask you general information about the languages you speak, where you were born, and your age. Please answer these questions to tell if you are a good fit for this study.	Baaraha		Su'aalaha soo socdaa waxay ku weydiin doonaan macluumaad guud oo ku saabsan luuqadaha aad ku hadasho, halka aad ku dhalatay iyo da'daada. Fadlan ka jawaab su'aalahan si aad u sheegto haddii aad ku habboon tahay daraasaddan.
SECTION A. SCREENER			QAYBTA A. BAARAHA
A	Screener 1	Have you previously participated in the Women’s Health Needs Study (WHNS)? Yes [END SURVEY] No	A	Baaraha 1	Horay ma uga qaybgashay Daraasada Cilmi Baarista Baahiyaha Caafimaadka ee Haweenka (WHNS)? Haa [DHAMAADKA SAHANKA] Maya
	Screener 2	Which of the following languages do you speak? [SELECT ALL THAT APPLY]		Baaraha 2	Midee ayaad kud=hadashaa luuqadaha soosocda?
		Amharic Arabic English Somali French Tigrinya Other, please specify			Amhaara Carabi Ingiriis Soomaali Faransiis Tigrey Midkale, fadlan sheeg
	Screener 3	Which language would you prefer to use for this interview? [INTERVIEWER NOTE: IF YOU DO NOT SPEAK THE LANGUAGE PREFERRED, MAKE NOTE AND END INTERVIEW].		Baaraha 3	Luuqadee ayaad jeceshahay in waraysigaan aad kugasho? [OGAYSIISKA WARAYSTAHA: HADAADAN KUHADLIN LUUQADA QOFKA AAD WARAYSANAYSO UU DOORTO, QORO DALABKA OO SOOGABAGABEE WARAYSIGA].
	Screener 4	In which country were you born?		Baaraha 4	Wadankee ayaad kudhalatay?
		Don’t Know Prefer not to answer			Ma aqaano Madoonaayo inaan kajawaabo
	Screener 5	In which country was your mother born?		Baaraha 5	Wadankee ayay hooyadaa kudhalatay?
		Don’t Know Prefer not to answer			Ma aqaano Madoonaayo inaan kajawaabo
	Screener 6	How old are you?		Baaraha 6	Meeqa sano ayaad jirtaa?
		Under 18 years [END SURVEY] 18-24 25-29 30-34 35-39 40-49 Over 49 years [END SURVEY] Prefer not to answer			Ka yar 18 sanno 18 illaa 24 25 illaa 29 30 illaa 34 35 illaa 39 40 illaa 49 Ka badan 49 sanno Madoonaayo inaan kajawaabo
	N/A	ELIGIBILITY CHECK LIST EACH BOX SHOULD BE CHECKED BEFORE MOVING FORWARD WITH SURVEY. Respondent did not previously participate in WHNS. Respondent between 18-49 years old. Respondent OR respondent's mother born in one of the following countries: Burkina Faso Egypt Eritrea Ethiopia Gambia Guinea Mali Mauritania Sierra Leone Somalia Sudan Interviewer is available to conduct interview in respondent's preferred language (Question 3). If respondent meets all 4 criteria above, please check the eligible box below. Respondent is eligible Respondent is NOT eligible [END SURVEY] If respondent is eligible, then review consent material and proceed to interview.		N/A	LIISKA HUBINTA U-QALMITAANKA SANDUUQ KASTA WAA IN LA SAXAA KAHOR INTA AADAN U SII GUDBIN XOG-URUURINTA. Jawaab celiyahu hore ugama qayb qaadan WHNS. Jawaab celiyaha inta u dhaxaysa 18-49 sano jir. Jawaab celiyaha AMA jawaab celiyaha hooyadii waxay ku dhalatay mid ka mid ah wadamada soo socda: Burkina Faaso Masar Eretereeya Itoobiya Gaambiya Gini Maali Moriteniyaa Siira leyon Soomaaliya Sudaan Wareystaha waxaa uu diyaar u yahay inuu jawab-bixiyaha ku wareysto luuqada uu doorbido (Su'aasha 3). Haddii jawaab bixiyuhu buuxiyo dhamaan afarta(4) shuruudood ee sare, fadlan calaamadee sanduuqa uqalmidda ee hoose. Jawaab celiyaha wuu u-qalmaa Jawaab celiyaha uma qalmo [DHAMAADKA XOG-URUURINTA] Haddii jawaab bixiyuhu uuu qalmo, markaa dib u eeg ashyaaada foomka ogolaanshaha ka dibna sii wad wareysiga.
	N/A	Screener End Time Hour Minute		N/A	Dhamaadka waqtiga baaraha Saac Daqiiqad