Items:

Interviewer: The next questions ask about care or support that you need or have needed in the previous 12 months, and care you received from individuals, for your own health and well-being. This could include financial and emotional support, health and personal care, or physical assistance. It may or may not be related to your role as caregiver.

1. Have you needed support or care in the last 12 months?
2. The last time you needed supportcare, did you get it?

Response Options:
Yes - 1
No - 2

3. For what reason(s) did you not get care?

Response Options:
_______

4. Are there childrenadults in your householdcompound, or living outside the household and visit regularly, that provide support or care that you need?

Response Options:
Yes - 1
No - 2

5. Let’s start with the person who provides you with the most supportcare. Then I will ask about other people who support and care for you. Is this person a household member or from outside your householdcompound?

Response Options:
Household - 1
Outside household - 2

6. What is your relationship to this person?

Response Options:
Spousepartner - 2
DaughterSon - 3
Daughter- or Son-in-law - 4
Grandchild - 5
Parent - 6
Parent-in-law - 7
BrotherSister - 8
Other relative, adult (e.g. cousin) - 11
Not related, Adult - 12

7. Approximately how old is this person?

Response Options:
In years: ____

8. Please tell the types of support and care you receive from this person. Do you get help with

Response Options:
Finances (cash, help to pay billsservicesdebts or for savings, or help with economic related activities outside the home – wage labor) - 1
Emotional support and care - 2
Physical assistance such as household chores, errands and outside activities, transportation, agriculture-related - 3
Health or medical care (providing the person with health care, assistance with medicinestreatments or arranging medical care) - 4
Personal care (for example, dressing, eating, toileting, getting around your house) (choose all that apply) - 5

9. How often is this?
(for each activity previously identified)

Response Options
Daily - 1
Several days per week - 2
Once per week - 3
Once per month - 4
Occasionally - 5