The development of a standardized global questionnaire was led by CDC scientists with extensive external consultation. A broad range of academic background and subject-matter expertise is represented in the team at CDC and among the external consultants who developed this tool. The questionnaire draws questions and definitions from a number of well-respected survey tools which has the benefit of (a) being able to compare data on various measures with other studies as a useful validation and an interesting comparison and (b) using measures that have already been field tested in other studies. In addition, the questionnaire has been previously implemented in five other countries (i.e. Swaziland, Tanzania, Kenya, Zimbabwe and Haiti) after being adapted based on vital country-level review by stakeholders.
The following international and violence surveys helped to inform the questionnaire:
- Cambodia Demographic and Health Survey (CDHS)
- National Intimate Partner and Sexual Violence Surveillance System (NISVSS)
- The Child Sexual Assault Survey (CSA)
- Longitudinal Studies of Child Abuse and Neglect (LONGSCAN)
- ISPCAN Child Abuse Screening Tool (ICAST)
- HIV/AIDS/STD Behavioral Surveillance Surveys (BSS)
- Youth Risk Behavior Survey (YRBS)
- National Longitudinal Study of Adolescent Health (Add Health)
- World Health Organization (WHO) Multi-country Study on Women's Health and Domestic Violence against Women
- Behavioral Risk Fact Surveillance System (BRFSS)
- Hopkins Symptoms Checklist
- ISPCAN Child Abuse Screening Tool (ICAST)
The questionnaire has been further adapted for Cambodia (Appendices W/AA, X/BB, Y/CC). Consultation with key informants from Cambodia and input from stakeholders participating in the Technical Working Group on Questionnaire Development (part of the Steering Committee), who are familiar with the problem of violence against children, child protection, and the cultural context, helped to further adapt the questionnaire and survey protocol for Cambodia.
The questionnaire includes the following topics: demographics; parental relations, family, friends and community support, school experiences, sexual behavior and practices; physical, emotional, and sexual violence; perpetration of sexual violence, health outcomes associated with exposure to violence; and utilization and barriers to health services. The background characteristics of the study respondents and the head of household survey include questions that assess age, socio-economic status, marital status, work status, education, and living situation. The sexual behavior and HIV/AIDS component utilizes questions from the CDHS, BSS, and WHO Multi-country study. Sexual behavior questions are divided among the following topics: sexual behavior, including sex in exchange for money or goods, pregnancy, and HIV/AIDS testing. The sexual violence module, the primary focus of the study, includes questions on the types of sexual violence experienced and important information on the circumstances of these incidents, such as the settings where sexual violence occurred and the relationship between the victim and perpetrator. This information will be collected on the first and most recent incidents of sexual violence, which will include a question on whether sexual violence occurred within the past 12-months. In addition, we developed several questions assessing potential risk and protective factors, including attitudes around sexual violence. Some of these questions were based on DHS, YRBS, and Add Health. We also ask questions regarding the negative health and social consequences as well as health-seeking behaviors related to these events.
The questionnaire was administered in Khmer and has already been translated into Khmer (Appendices AA, BB, CC). The Technical Working Group on Questionnaire Development made up of representatives from the ministries of women's affairs, justice, social affairs, planning (National Institute of Statistics), tourism, and education, as well as UNICEF Cambodia, Save the Children and a local NGO, Social Services of Cambodia, have reviewed the Khmer questionnaire to ensure definitions and question context have remained comprehensive and intact. The pilot was aimed to provide an opportunity to test the questionnaire to ensure that the intent of questions is consistent after translation and appropriate for the Cambodian context.