Variable / Field Name,Form Name,Section Header,Field Type,Field Label,"Choices, Calculations, OR Slider Labels",Field Note,Text Validation Type OR Show Slider Number,Text Validation Min,Text Validation Max,Identifier?,Branching Logic (Show field only if...),Required Field?,Custom Alignment,Question Number (surveys only),Matrix Group Name,Matrix Ranking?,Field Annotation record_id,my_first_instrument,,text,Record ID,,,,,,,,,,,,, heart_intro,heart,,descriptive,"READ: I would like to ask you some questions about you and about your relationship with your partner(s) and your readiness to use an HIV prevention product. These questions will help determine what kind of counseling and support you might need from us. Before we begin, I would like you to take a moment to think about the partner or partners you have been involved with sexually during the last year. ",,,,,,,,,,,,, heart_disclose,heart,,radio,"I would like to ask you some questions about what you have told your partner about your PrEP use and his reaction. Does your primary partner know that you are taking tablets for HIV prevention? If you don't have a primary relationship, think about your partner who has the most ""say"" or more influence over your ability to use HIV prevention products. ","1, Yes | 2, No",,,,,,,y,,,,, heart_reactpp,heart,,radio,"What was his reaction when he first found out? ","1, Supportive | 2, Neutral | 3, Opposed | 4, Don't know",,,,,,[heart_disclose] = '1',y,,,,, heart_refusesex,heart,"TRADITIONAL VALUES READ: With the first set of statements, I would like to understand how you feel about the kind of roles that men and women should have in their everyday lives. Please answer as honestly as you can. If the statement is not clear, I can repeat it. These questions will help us to consider how much or how little support you might receive from this partner.",radio,1. I think that a woman cannot refuse to have sex with her husband.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_own,heart,,radio,"2. I think that if a man has paid lobola for his wife, he owns her.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_abide,heart,,radio,3. A woman should always listen and abide by the word of her husband without questions.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_final,heart,,radio,4. A man should have the final word about decisions in his home.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_male,heart,,radio,5. A real man produces a male child.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_lobola,heart,,radio,"6. I think that if a man has paid lobola for his wife, she must have sex when he wants it.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_fam,heart,,radio,7. I think that a man should have the final say in all family matters.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_accept,heart,,radio,8. A woman should accept her partner's wishes - even when she disagrees - to keep the family together.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_attr,heart,,radio,9. I only think I am attractive if other people think I am.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_trad,, heart_commit,heart,"PARTNER SUPPORT READ: With the first set of statements, I would like to get a better sense about your relationship in general with the partner we have just identified. Do you have that partner in mind? Please answer as honestly as you can. If the statement is not clear, I can repeat it. These questions will help us to consider how much or how little support you might receive from this partner. ",radio,1. My partner is as committed as I am to our relationship.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtsup_a,, heart_tens,heart,,radio,"2. In general, my relationship has a lot of tension.","6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prtsup_b,, heart_stuck,heart,,radio,3. I feel trapped or stuck in our relationship.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prtsup_b,, heart_down,heart,,radio,4. Arguments with my partner result in me feeling down or bad about myself.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prtsup_b,, heart_wants,heart,,radio,"5. My partner does what he wants, even if I do not want him to.","6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prtsup_b,, heart_safe,heart,,radio,6. I feel safe in my current relationship.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtsup_c,, heart_slap,heart,"PARTNER ABUSE & CONTROL READ: In this next section, I would like to ask you some questions about how your partner treats you. Some of these questions might be difficult to answer. Please respond as honestly as you can. ",radio,"1. My partner slaps, hits, kicks, or pushes me.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_a,, heart_scare,heart,,radio,2. My partner does things to scare or intimidate me on purpose.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_a,, heart_humil,heart,,radio,3. My partner makes fun of me or humiliates me.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_a,, heart_finance,heart,,radio,4. My partner makes most of the decisions about how the household finances are used.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_a,, heart_fright,heart,,radio,5. I feel frightened by what my partner says or does.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_a,, heart_good,heart,READ: The next two questions ask how you feel in general about decisions you make. ,radio,6. I can't seem to make good decisions about my life.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_b,, heart_trust,heart,,radio,7. I do not trust myself to make good decisions about my life.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_abuse_b,, heart_cndmang,heart,"PARTNER RESISTANCE to HIV PREVENTION READ: These next items will help assess whether you might face any risks from asking your partner about using HIV prevention products.",radio,"1. If I asked my partner to use a condom, he would get angry.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtres,, heart_othrsex,heart,,radio,"2. If I asked my partner to use a condom, he would think I'm having sex with other people.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtres,, heart_cndmvio,heart,,radio,"3. If I asked my partner to use a condom, he would get violent.","1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtres,, heart_prevang,heart,,radio,4. I cannot tell my partner about PrEP use because he will become angry.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtres,, heart_prevvio,heart,,radio,5. If I asked my partner to use PrEP he would get violent.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prtres,, heart_prtcomm,heart,"HIV PREVENTION READINESS READ: The last set of items are about your readiness to use an HIV prevention product - in this case, oral PrEP. Are you ready? ",radio,1. Using PrEP with my partner will help us communicate better.,"1, Disagree a lot | 2, Disagree some | 3, Disagree a little | 4, Agree a little | 5, Agree some | 6, Agree a lot",,,,,,,y,,,heart_prevread_a,, heart_nerv,heart,,radio,2. I am nervous to learn my HIV status.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prevread_b,, heart_afctsex,heart,,radio,3. I worry that PrEP will affect my sex life.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prevread_b,, heart_prmscs,heart,,radio,4. I worry that others will think I am promiscuous if they know I am using PrEP.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prevread_b,, heart_prttrust,heart,,radio,5. I worry that my partner will think I do not trust him because I am using PrEP.,"6, Disagree a lot | 5, Disagree some | 4, Disagree a little | 3, Agree a little | 2, Agree some | 1, Agree a lot",,,,,,,y,,,heart_prevread_b,, heart_tradvalue_score,heart,Calculated Scores,calc,"Traditional Values - Score (range 9-54)",[heart_refusesex] + [heart_own] + [heart_abide] + [heart_final] + [heart_male] + [heart_lobola] + [heart_fam] + [heart_accept] + [heart_attr],Calculated field,,,,,,,,,,, heart_partsupp_score,heart,,calc,"Partner Support - Score (range 6-36)",[heart_commit] + [heart_tens] + [heart_stuck] + [heart_down] + [heart_wants] + [heart_safe],Calculated field,,,,,,,,,,, heart_abusecntrl_score,heart,,calc,"Partner Abuse & Control - Score (range 7-42)",[heart_slap] + [heart_scare] + [heart_humil] + [heart_finance] + [heart_fright] + [heart_good] + [heart_trust],Calculated field,,,,,,,,,,, heart_partprep_score,heart,,calc,"Partner Resistance to HIV Prevention - Score (range 5-30)",[heart_cndmang] + [heart_othrsex] + [heart_cndmvio] + [heart_prevang] + [heart_prevvio],Calculated field,,,,,,,,,,, heart_prepready_score,heart,,calc,"HIV Prevention Readiness - Score (range 5-30)",[heart_prtcomm] + [heart_nerv] + [heart_afctsex] + [heart_prmscs] + [heart_prttrust],Calculated field,,,,,,,,,,, heart_mod,heart,,descriptive,"NOTE: All questions must be answered to recommend counseling modules. ",,,,,,,,,,,,, heart_partcommod,heart,"RECOMMENDED COUNSELING MODULE Based on the participant's HEART scores, the following module(s) is/are suggested: ",descriptive,