2-No____
5 Which contraceptive method you use for 1-Condom____
your first sexual behavior? 2-Oral contraception pills____
3-Rhythm method____
4-Intrauterine device____
5-Norplant____
6-No method____
6 Why don’t you use contraception? 1-Thought the occasional sex could not to pregnancy____
2-Thought contraception methods were too expensive to
buy____
3-Worried about the side effects____
4-Didn’t prepare the pills or tools for the unplanned sex____
5-Partner didn’t want to use a method____
6-Thought contraceptive method were inconvenient to
buy____
7-Thought the delight would be affected by methods____
8-Didn’t know how to use____
7 Which way do you obtain the sex and 1-Popular science readings____
contraception knowledge? 2-NewsPaper and periodicals____
3-Network____
4-Radio and TV____
5-Classmates and friends____
6-Course education____
7-Family____
8-The family planning professional____
9-Lecture____
10-Medical staff____
11-Exhibition____
12-Informal publication____
8 Is it okay to use family planning method 1-Yes____
in your culture? 2-No____
9 Have you avoided using family planning 1-Yes____
method due to side effect? 2-No____
10 How is the clients handling in the family 1-Poor ____
planning clinic by the professional? 2-Well_____
3-Very well____
11 Have you discussed with your partner 1-Yes____
about which method to use? 2-No____
12 What was your partner/husband opinion 1-My own choice____
on family planning method you are using? 2-Forced me into his method of choice____
3-Decide the method together____
4-Health care provider chose for us____
13 Have you heard myths and beliefs in the 1-Yes____
community about family planning? 2-No____
14 Does your culture influence the family 1-yes____
planning choice? 2-No____
15 Does your religion influence the family 1-Yes____
planning method choice? 2-No____
12 Using both condom and pill is considered to be very effective contraceptive. Yes___
No___
Dont’know___
13 Using the pill increases the risk of ovarian, endometrial or cervical cancer. Yes___
No___
Dont’know___
14 Spacing between the child make healthier Yes___ don’t
know___
No___
15 Kindly specify other family planning method that you have known of:
B. Determine the Behaviours regarding family planning among residents of Urgello, Sambag II through the questionnaire of the researchers.
Questions Responses
1 Have you ever heard of contraceptive methods? 1-Yes ___
2-No ___
3-Don’t know____
2 Do you know how to prevent pregnancy? 1-Yes ____
2-No ____
3-Don’t know____
3 Which contraceptive method prevents ovulation 1Barrier____
2Hormonal____
3Natural____
4Surgical____
4 This contraceptive method "blocks" also serves as a protection from STD's 1diaphragm____
2IUD(Intrauterine
device)____
3Condom_____
4Vasectomy____
5 Available for both males and females 1Condoms____
2 IUD(Intrauterine
device)____
6 What do you think is the most effective methods? 1Condom____
2Natural family
planning___
3Birth control
pills_____
7 All contraceptives protect against STD's 1True____
2False____
8 How must you take the pill? 1Daily at the same
time of day_____
2Whenever you
remember to_____
3once or twice a
week____
4once a month_____
9 The only effective method where the male assumes responsibility for 1condom_____
preventing pregnancy 2withdrawal_____
3cervical cap_____
10 How much time do you have to take emergency contraception? 1within 24 hrs____
2within 48 hrs____
3within 72 hrs____
4anytime you
want_____
C. Determine the Practices regarding family planning among residents of Urgello, Sambag II through the questionnaire of the researchers.
Questions Responses
1 How often do you use contraceptive 1-Always____
method? 2-Occasionally____
3-Never____
2 If never, what are the reasons? 1-Lack of availability ____
2-Contraceptive are expensive____
3-Contraceptive can have side effect____
4-May partner doesn’t like to use contraception____
3 Have you attended any family planning 1-Yes____
seminar? 2-No____
4 Do you agree to family planning method? 1-Yes____
RESEARCH QUESTIONNAIRE
The following consists of the Profile of the Respondents and the Survey questionnaire. Please pick any one of the option by placing a
check mark beside the appropriate choice after reading each statement carefully. Make sure to call our attention when needed.
RESPONDENT'S PROFILE
1. AGE ______
2.SEX ______MALE
______FEMALE
3. RELIGION ______CHRISTIAN
______MUSLIM
______HINDU
______OTHERS, PLEASE SPECIFY: ________________
4. CIVIL STATUS ______SINGLE
______MARRIED
______SEPARATED
______COMMON LAW
5. MONTHLY INCOME
_______LESS THAN 5000 PESOS
_______5000 TO 10000 PESOS
_______10000 TO 20000 PESOS
_______OTHERS, PLEASE SPECIFY:______________
6. EDUCATIONAL QUALIFICATION
________ELEMENTARY LEVEL
________MIDDLE SCHOOL LEVEL
________HIGH SCHOOL LEVEL
________COLLEGE LEVEL
________UNDERGRADUATE.
7. OCCUPATION
_______HOME MAKER
_______SELF-EMPLOYED
_______STUDENT
_______EMPLOYED, PLEASE SPECIFY:__________
_______UNEMPLOYED
8. NATIONALITY
_______ FILIPINO
_______ OTHER : ____________________
A. Determine the level knowledge regarding family planning among residents of Urgello, Sambag II through the questionnaire of the
researchers.
Questions Responses
1 Have you ever heard about contraceptives? Yes___
No___
Don’t know___
2 Have you ever used contraceptives in your past? Yes___
No___
3 Birth control pills are effective even if a woman misses taking them for two or Yes___
three days in a row. No___
Don’t know___
4 Female sterilization is one way to avoid pregnancy. Yes___
No___
Don’t know___
5 Health education is important for man and woman who want to use Yes___
contraception. No___
Dont’know___
6 Contraceptive pills do not guarantee 100% protection. Yes___
No___
Dont’know___
7 Condoms prevent STIs. Yes___
No___
Dont’know___
8 Common side effects of contraceptive pills include mood swings and weight Yes___
gain No___
Dont’know___
9 There is increased risk for breast cancer in woman taking oestrogen- containing Yes___
contraceptives No___
Dont’know___
10 Woman control birth control shot (depo provera) must get an injection every Yes___
three months. No___
Dont’know___
11 If woman is having side effects of one kind of pill, switching to another type Yes___
might help. No___
Dont’know___
