CHUUKESE
MCH Jurisdictional Survey Eligibility and Consent Scripts
Eligibility
Ranallim, itei __________. Ngang seni ewe pekin kuta ika study ei angangen kuta poraus fan iten ekkewe inelap me semirit ren ach sipwe weweiti tumunun pochokulen inisin ekkewe inelap me nour kewe [American Samoa/Federated States of Micronesia/Marshall Islands/Northern Mariana Islands/Palau]. Om fiti kich lon ei kaio ika study mi pachelong polueni ekkoch kapas eis usun en me noum we/kewe.
[If respondent is Female got to 1, if respondent is Male or you are unsure, go to question 4]
Imwom we a pusin chok kefilata ren ei kaio. Kose mochen upwe eisinuk ekkoch kapas eis ika pwe en tongeni nom lon ei kaio ika study?
Uii
[Go to 2]
Apw [Thank individual for their time and leave]
Use Mochen Polueni [Thank individual for their time and leave]
Ka fen tori 18 ier ika lap seni?
Uii
[Go to 3]
Apw [Go to 4]
Use Mochen Polueni [Thank individual for their time and leave]
En ewe inelap ika ewe a kefil fan itan tumunun ewe semirit 0 ngeni 17 ierin ika emon chok pwal/aramasom ei e wisan tumun?
Uii
[Go to informed consent]
Apw [Go to 4]
Use mochen polueni [Thank individual for their time and leave]
Mi wor fefin lon imwom na 18 ierin ika lap seni ewe inelap ika emon fefin a wesen kefil an tumunu ewe semirit/ika emon chok aramasom a kan wisan tumunu ewe semirit 0 ngeni 17 ierin pun uwa mochen fos ngeni?
Uii [Go to beginning]
Uii
nge ese mo tawe [Go to 5]
Apw [Thank individual for their time
and leave]
Use Mochen Polueni [Thank individual for their time and leave]
5. Mi wor fansoun epwe murine ngeni ai upwe liwin sefal le poraus ngeni?
Uii [Write down time]
Apw [Thank individual for their time and leave]
Use Mochen Polueni [Thank individual for their time and leave]
Consent
[INFORMED CONSENT OBTAINED AFTER DETERMINING ELIGIBLE CHILD(REN) IN THE HOUSEHOLD]
Usun met uwa fen apasa pwe iei am uwa fori ei kaio ika study [American Samoa/Federated States of Micronesia/Marshall Islands/Northern Mariana Islands/Palau] ren am aupwe kaio nonomun tumunun pochokulen inisin ekkewe inelap me nour kewe. Ei angangen kaio pekin ewe programen Title V MCH Block Grant, monien a kauor seni ewe Health Resources me Services Administration (HRSA).
Om polueni epwe alisi ekkewe pekin ra kan tumuni ekkewe mi noukis me nour kewe (Maternal and Child Health programs) ren ar repwe weweiti pochokulen ekkewe in me nour kewe lon ach ei kinikin nge a pwal awora ekkewe alilis fan iten ekkewe famili. Ei kaio ukkukun chok 50 minich nge ekkewe kapas eis usun pochokulen inisum me noum we/kewe.
Letipom chok ika kose mochen pach lon ei kaio. Ika ke mochen poputani iei nge ka ekesiwili om mochen iwe en mi pwal tufich siwili om ekiek. Ika pwe kose mochen polueni ekkoch kapas eis letipom chok.
Eli pwe kopwe oput ekkoch kapas eis, nge me lukun met kopwe mefi lon ena fansoun, upwe erenuk pwe om pach ika om polueni ekkei kapas eis esap efeiengaweok.
Ika ka filata pwe kopwe fiti ewe kaio ren polueni ekkewe kapas eis, iwe pokiten om fansoun mi auchea am upwe ngonuk lifangom ren am kilisou ngonuk ren om fansoun, nge ese wor alilis mi weneituk ren polueni ekkei kapas eis ren ei kaio.
Om polueni mi monomonolo. Ekkewe chok aramas mi mumuta ar repwe kuna poluen ekkewe kapas eis chon chok angang won ewe kaio pwal ekkewe chon angang mi ra kan apochokula allukun ei kaio. Itom esap nom won ewe taropwen kaio fengen me om kewe poluen kapas eis. Am upwe eaea nampa code ren am upwe kuta om kewe poluen kapas eis, nge esap itom.
Ei kaio ese eis usun tumunungawan ekkewe inelap ika ar efeiengawa nour kewe. Nge ika pwe am auwa silei usun tumunungawan ika feiengawan ekkewe semirit lon eu imw, epwe auchea am aupwe repotini ngeni ekkewe chon nemenem.
Kokori X lon (XXX) XXX-XXXX ika [email protected] ren kapas eis, ren met kose tipeni me mi aosukosukok ren ei kaio. Ika pwe mi wor om kapas eis ika lolilen mi wor om pwung pokiten en chon nom lon ei kaio, kopwe kokori ewe Manager’in NORC Institutional Review Board esap kamo ei nampa iei (866) 309-0542.
Upwe likiti ngonuk ei taropwe pwe kopwe makei met uwa keran chok apasa ngonuk. [Provide the paper copy of the informed consent language]
Mi wor om kapas eis?
Uii [Answer questions, then go to B]
Apw
[Go to B]
Use Mochen Polueni [Thank individual for their time and leave]
En mi tipeu ngeni polueni ekkei kapas eis lon ei kaio?
Uii [Thank individual and begin the
questionnaire]
Apw [Thank individual for their time and leave]
Use Mochen Polueni [Thank individual for their time and leave]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Clare Davidson |
| File Modified | 0000-00-00 |
| File Created | 2021-04-06 |