03.10.2017 Views

Food Consumption Patterns Part 2

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160<br />

Boutik (neighborhood store) Questionnaire<br />

Enumerators initials*<br />

Location-<br />

PAP<br />

Gonaives<br />

Okap<br />

other<br />

Neighborhood*Number of Sample Cluster*<br />

Hi. My name is_______. We are conducting a survey about foods, particularly snack foods and<br />

fortified foods. The information you share with us is confidential. We will not share your name<br />

with anyone. Do you consent to respond to the questions?* Required<br />

refuse<br />

accept<br />

absent<br />

Respondent's name*Sex*<br />

female<br />

male<br />

Does the boutique have a name?*<br />

yes<br />

no<br />

do you own the business?*<br />

yes<br />

no<br />

Telephone numbers<br />

*What kind of drink to they most buy?*<br />

Regarding snacks that you sell, do clients more often buy something to drink or a snack?*<br />

Snack<br />

Drink<br />

Same<br />

Tell me 5 non staple foods that you sell most frequently?*<br />

(PRODUCT LIST)<br />

Now I would like to ask you some questions about snacks that are good for people, that have<br />

vitamins, that are good for the health*<br />

Ok<br />

Tell me three things that you sell that are most fortifying for babies*<br />

(PRODUCT LIST)<br />

Tell me three things that you sell that are most fortifying for children?*<br />

(PRODUCT LIST)<br />

Tell me three things that you sell that are most fortifying for adults?*<br />

(PRODUCT LIST)

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