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Q1. Demographic Details
Name of MDA
Mobile No. of MDA
Name of Cluster Manager
Cluster Office
Name of Mentor
Cluster Centre
 
 
Q2. Are you aware that a training session was held for MDAs and did you attend it?
Yes No
Aware that a training session was held for MDAs
Attended the training session held for MDAs
 
 
 
Q3. Are you using the mobile application while forming groups?
 
Yes
 
No
 
 
ASK Q4 ONLY IF "YES" MENTIONED IN Q3 ELSE SKIP TO Q9
Q4. How Frequently do you use the mobile application?
 
Daily
 
4-6 times in the week
 
2-3 times in the week
 
Everytime I go to a new village
 
Everytime I form a new group
 
Other
 

 
 
Q5. Which of these features have you used in the mobile application? For those features which you have not used please mention reasons for not using it so far.
Yes/No (Type "Y" for Yes and "N" for No) Reasons for not using feature
Village Contact List
Village Survey Form
Potential Member Information
Family Survey Forms
Others (Please specify)
Others (Please specify)
Others (Please specify)
 
 
Q6. Have you faced any problems with any of these features? For those features where you had some problems please provide details on the problem faced.
Yes/No (Type "Y" for Yes and "N" for No) Details of the problem
Village Contact List
Village Survey Form
Potential Member Information
Family Survey Forms
Others (Please specify)
Others (Please specify)
Others (Please specify)
 
 
 
Q7. When you faced a problem with the mobile application what did you do?
 
Spoke to Mentor to solve the problem
 
Spoke to CLM to solve the problem
 
Spoke to IT team to solve the problem
 
Spoke to other MDAs to solve the problem
 
Tried to solve the problem myself
 
Stopped using the application
 
Other (Please specify)

 
 
Q8. How would you rate the application on these parameters?
Very Easy Not very easy nor very difficult Very difficult N/A
Usage of application
Flow of the various sections
Ability to read the contents on the screen
Scrolling for responses
Saving responses
Sending responses
Makings changes to responses
Structure of the information
 
 
 
ASK ONLY THOSE WHO SAID "NO" IN Q3
Q9. Why have you not used the mobile application so far?
 
Don't know how to use
 
Find it difficult to use
 
Have some problem with my phone
 
Using the paper format so don't see use of mobile application
 
Have not yet started forming groups
 
Have not yet visited a new village
 
Other
 

 
 
ASK ONLY THOSE WHO SAID "NO" IN Q3
Q10. What support do you need in order to help you start using the mobile application?
 
More training
 
Support on the phone
 
Help from Mentor
 
Help from CLM
 
Other
 

 
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