Group:  Doer
 Non-Doer
Barrier Analysis Questionnaire:
Care Seeking during pregnancy for use with
Mothers with Children 0 – 6 Months
Behavior Statement
Pregnant women seek care from a trained health care provider within 24 hours of seeing any of
the following danger signs: fever, bleeding, cramps, swollen face, dizziness.
Demographic Data
Interviewer’s Name: ___________________
Date: ____/____/____
Questionnaire No.: ______
Community : ___________________
Scripted Introduction:
Hi, my name is_________; and I am part of a study team looking into what women do
when they are pregnant. The study includes a discussion of this issue and will take about 20
minutes. I would like to hear your views on this topic. Would you be willing to talk with me?
You are not obliged to participate in the study and no services will be withheld if you decide
not to. Everything we discuss will be held in strict confidence and will not be shared with
anyone else.
Would you like to participate in the study? [If not, thank them for their time.]
Section A - Doer/Non-doer Screening Questions
1. How old is your youngest child? (write the age in months here) _________
 A. 6 months or less
 B. 7 months or older  end interview and find another respondent
 C. Not sure/ No reply end interview and find another respondent
2. Now, thinking about your last pregnancy, did you experience any signs of danger
such as bleeding, fever, dizziness, swollen face, cramps?
 A. Yes
 B. No end interview and find another respondent
 C. Can’t remember/No reply end interview and find another respondent
3. What did you do when you noticed any of these danger signs?
 A. Sought health care
 B. any other response  mark as Non-doer and continue with Section B
 Can’t recall  end interview
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4. Where did you seek health care/medical care?
 A. government health facility or a private health facility
 B. a traditional healer/ a spiritual healer/family member or friend/bought
meds herself mark as Non-doer and continue with Section B
 Can’t recall/won’t say  end interview and look for another respondent
5. From the time you noticed the danger signs, how long did it take for you to see a
health care provider at a health facility?
 A. Within 48 hours (less than 2 days)
 B. Over 48 hours (more than 2 days)  mark as Non-doer
 C. Don’t remember  end interview and look for another respondent
Doers/Non Doers Classification Table
Doer
Non Doer
Don’t Interview
(all of the following)
(any of the following)
(any of the following)
Question 1=A
Question 1 = B or C
Question 2=A
Question 2 = B or C
Question 3=A
Question 3 = B
Question 3 = C
Question 4= A
Question 4 = B
Question 4 = C
Question 5 = A
Question 5 = B
Question 5 = C
Group:  Doer
 Non-doer
Explanation: In the following questions I am going to be talking about danger signs
during pregnancy. When I say “danger signs”, I am talking about bleeding, fever,
swollen face, dizziness or cramping. Note: Consider having a picture showing pregnant
women with these symptoms as a reminder to the mother.
Section B – Research Questions
(Perceived Self-efficacy)
1a. Doers: What made it easy for you to seek medical care at a health facility within
24 hours of noticing danger signs during pregnancy?
1b. Non-doers: What would make it easy for you to seek medical care at a health
facility within 24 hours of noticing danger signs during pregnancy?
(Write all responses below. Probe with “What else?”)
(Perceived Self-efficacy)
2a. Doers: What made it difficult for you to seek medical care at a health facility
within 24 hours of noticing danger signs during your pregnancy?
2b. Non-doers: What would make it difficult for you to seek medical care at a
health facility within 24 hours of noticing danger signs during your pregnancy?
(Write all responses below. Probe with “What else?”)
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(Perceived Positive Consequences)
3a. Doers: What are the advantages of seeking medical care at a health facility
within 24 hours of noticing danger signs during your pregnancy?
3b. Non-doers: What would be the advantages of seeking medical care at a health
facility within 24 hours of noticing danger signs during your pregnancy?
(Write all responses below. Probe with “What else?”)
(Perceived Negative Consequences)
4a. Doers: What are the disadvantages of seeking medical care at a health facility
within 24 hours of noticing danger signs during your pregnancy?
4b. Non-doers: What would be the disadvantages of seeking medical care at a
health facility within 24 hours of noticing danger signs during your pregnancy?
(Write all responses below. Probe with “What else?”)
(Perceived Social Norms)
5a. Doers: Who are the people that approved of you seeking medical care at a
health facility within 24 hours of noticing danger signs during your pregnancy?
5b. Non-doers: Who are the people that would approve of you seeking medical
care at a health facility within 24 hours of noticing danger signs during your
pregnancy?
(Write all responses below. Probe with “Who else?”)
(Perceived Social Norms)
6a. Doers: Who are the people that disapproved of you seeking medical care at a
health facility within 24 hours of noticing danger signs during your pregnancy?
6b. Non-doers: Who are the people that would disapprove of you seeking medical
care at a health facility within 24 hours of noticing danger signs during your
pregnancy? (Write all responses below. Probe with “Who else?”)
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(Perceived Access)
7a. Doers: How difficult is it to get to the health center within 24 hours of noticing
danger signs during your pregnancy? Very difficult, somewhat difficult or not
difficult at all?
7b. Non-doers: How difficult would it be to get to the health center within 24 hours
of noticing danger signs during your pregnancy? Very difficult, somewhat difficult
or not difficult at all?
 a. Very difficult
 b. Somewhat difficult
 c. Not difficult at all.
(Perceived Cues for Action / Reminders)
8a. Doers: How difficult is it to remember to seek medical care from a health center
within 24 hr. of noticing symptoms? Very difficult, somewhat difficult, or not
difficult at all?
8b. Non-doers: How difficult do you think it would be to seek medical care from a
health center within 24 hr. of noticing symptoms?
Very difficult, somewhat
difficult, or not difficult at all?
 a. Very difficult
 b. Somewhat difficult
 c. Not difficult at all.
(Perceived Susceptibility / Perceived Risk)
9.
Doers & Non-doers: If you become pregnant again, how likely is it that you will
have danger signs and not receive care at the health facility? Very likely,
somewhat likely, or not likely at all
 a. Very likely
 b. Somewhat likely
 c. Not likely at all.
(Perceived Severity)
10. Doers and Non-doers: If you become pregnant again, how serious would it be
if you have danger signs and did not receive the care at the health facility? How
serious would it be if you had untreated danger signs during your next
pregnancy? Very serious, somewhat serious, or not serious at all?
 a. Very serious
 b. Somewhat serious
 c. Not serious at all
(Action Efficacy)
11. Doers and Non-doers During your next pregnancy, how likely is it that you will
have a safe pregnancy if you seek care at the health facility within 24 hours if you
notice danger signs? How likely is it that you e from a health center within 24 hours
of noticing symptoms?
Very likely, somewhat likely, or not likely at all
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 a. Very likely
 b. Somewhat likely
 c. Not likely at all.
(Perception of Divine Will)
12. Doers: Do you think that God makes pregnant women sick?
 a. Yes
 b. Maybe
 c. No
(Policy)
13. Doers: Are there any community laws or rules in place that make it easier for
you to seek medical care from a health center within 24 hours when you see
danger signs during pregnancy?
13b. Non-doers: Are there any community laws or rules in place that you know of
that would make it easier for you to seek medical care from a health center
within 24 hours when you see danger signs during pregnancy?
 a. Yes
 b. Maybe
 c. No
(Culture)
14. Doers and Non-doers: Are there any cultural rules or taboos that you know of
against seeking medical care when you see danger signs during your pregnancy?
 a. Yes
 b. Maybe
 c. No
Now I am going to ask you a question totally unrelated to seeking care for a sick child.
(Universal Motivators)
15.
Doers and Non-doers: What is the one thing that you desire most in life?
THANK THE RESPONDENT FOR HER TIME!
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