Questionnaire
(Check in the corresponding box ☐ and fill in the blanks ________)
Section 1: Demographic Characteristics
1. Age:
☐ 18-24
☐ 25-34
☐ 35-44
☐ 45-54
☐ 55+
2. Gender:
☐ Male
☐ Female
☐ Other
3. Religion:
☐ Hindu
☐ Muslim
☐ Christian
☐ Buddhist
☐ Other: ___________
4. Ethnicity:
☐ Brahmin
☐ Chhetri
☐ Newar
☐ Magar
☐ Muslim
☐ Other: ___________
5. Nationality:
☐ Nepalese
☐ Indian
☐ Other: ___________
6. Marital Status:
☐ Single
☐ Married
☐ Divorced
☐ Widowed
☐ Other: ___________
7. Educational Level:
☐ No formal education
☐ Primary education
☐ Secondary education
☐ Bachelor’s degree
☐ Master’s degree
☐ Doctorate
8. Family Type:
☐ Nuclear family
☐ Joint family
☐ Extended family
☐ Other: ___________
9. How many years have you been working in this healthcare facility?
☐ Less than 1 year
☐ 1-5 years
☐ 6-10 years
☐ More than 10 years
10. Socioeconomic Level: (Based on Kuppuswamy Scale)
☐ Lower class
☐ Lower middle class
☐ Middle class
☐ Upper middle class
☐ Upper class
Section 2: Assessment of Knowledge
11. What does Mental Health mean to you? (Select all that apply)
☐ Same as Happiness
☐ Simply absence of mental illness
☐ Loss of interest in nearly all activities
☐ Change in sleep, appetite, or other difficulties for 2 weeks
If other, please specify: ___________
12. What does Seeking for Mental Health Care mean to you? (Select all that apply)
☐ Support
☐ Guidance
☐ Healing
☐ Treatment
If other, please specify: ___________
13. What are different types of mental illness known to you? (Select all that apply)
☐ Depression
☐ Panic disorder
☐ Mood disorder
☐ Substance use disorder
☐ Post-traumatic stress disorder
If other, please specify: ___________
14. What do you think mental illness is caused by? (Select all that apply)
☐ Evil eye
☐ Ageing
☐ Genetics/Heredity
☐ Substance Abuse
☐ Stress – Life
If other, please specify: ___________
15. Are you aware of mental health services available in your community?
☐ Yes
☐ No
16. Have you ever received information about mental health services through any of the
following? (Select all that apply)
☐ Social media
☐ Friends and family
☐ Internet search
☐ TV/Radio
☐ School/University
☐ Health care providers
If other, please specify: ___________
17. Have you heard of the following mental health care services? (Select all that apply)
☐ Counseling
☐ Behavioral Therapy
☐ Music Therapy
☐ Teletherapy (Online Therapy)
☐ Psychotherapy
☐ In-patient psychiatric services
☐ Out-patient psychiatric services
☐ Don’t Know
If other, please specify: ___________
18. Which of the following professionals can provide mental health care services? (Select all
that apply)
☐ Psychologists
☐ Psychiatrists
☐ Counselors
☐ Social workers
☐ General practitioners (doctors)
If other, please specify: ___________
19. Is mental health different from physical health?
☐ Yes
☐ No
☐ Unsure
20. Do you think a person can recover from mental illness and lead a normal life with the
right treatment?
☐ Yes
☐ No
☐ Unsure
21. Do you believe that early intervention in mental health issues can prevent more serious
problems later on?
☐ Yes
☐ No
☐ Unsure
Section 3: Assessment of Attitude
22. Do you believe seeking mental health care is important?
☐ Yes
☐ No
☐ Unsure
23. Do you believe mental health problems are common in society?
☐ Yes
☐ No
☐ Unsure
24. In your opinion, how important is mental health care compared to physical health care?
☐ More important
☐ Equally important
☐ Less important
☐ Unsure
25. Do you think people with mental illness should be treated differently than those with
physical illnesses?
☐ Yes
☐ No
☐ Unsure
26. Do you believe that mental health care can significantly improve the quality of life?
☐ Disagree Completely
☐ Strongly Disagree
☐ Somewhat Disagree
☐ Somewhat Agree
☐ Strongly Agree
☐ Agree Completely
27. What could be the main reason for seeking mental health care? (Select all that apply)
☐ Depression
☐ Anxiety
☐ Stress
☐ Trauma/PTSD
☐ Grief or loss
☐ Relationship issues
☐ Addiction
☐ Other (Please specify): __________
28. Do you think people who seek mental health care are viewed negatively by society?
☐ Yes
☐ No
☐ Don’t Know
29. How would you rate the availability of emotional support from the following sources
affect mental health?
(Rate each from 1 – Very Poor to 5 – Excellent)
Family: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
Friends/Peers: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
Social networks (community/religious groups, etc.): ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
Workplace colleagues/Seniors: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
30. How comfortable are you with the idea of seeking mental health care for yourself?
☐ Very comfortable
☐ Somewhat comfortable
☐ Neutral
☐ Somewhat uncomfortable
☐ Very uncomfortable
31. Do you feel comfortable discussing mental health concerns with family or friends?
☐ Yes
☐ No
☐ Unsure
32. If you needed mental health care, would you feel embarrassed to tell others?
☐ Yes
☐ No
☐ Unsure
33. How likely would you be to recommend mental health care services to a friend or family
member in need?
☐ Very likely
☐ Somewhat likely
☐ Neutral
☐ Somewhat unlikely
☐ Very unlikely
34. Do you believe that seeking mental health care is a sign of weakness?
☐ Strongly agree
☐ Agree
☐ Neutral
☐ Disagree
☐ Strongly disagree
35. Would you be concerned about the cost of mental health care services when deciding
whether or not to seek help?
☐ Yes
☐ No
☐ Unsure
36. Would you prefer to manage mental health issues on your own rather than seeking
professional help?
☐ Yes
☐ No
☐ Unsure
37. Who would you prefer seeking mental health care from:
☐ A mental health specialist (therapist, counselor)
☐ A religious leader
☐ Friends or family
☐ Online resources
☐ I wouldn’t seek mental health care
☐ Other (please specify): ___________
38. Do you feel that mental health services are accessible in your community?
☐ Yes
☐ No
☐ Unsure
39. What, if any, would be your primary reason for not seeking mental health care? (Check
all that apply)
☐ Stigma or embarrassment
☐ High cost of services
☐ Lack of time
☐ Cultural or religious beliefs
☐ Lack of knowledge on where to seek help
☐ Belief that the issue isn’t serious enough
☐ Fear of being judged or misunderstood
☐ Other (please specify): ___________
40. Would fear of being judged by others prevent you from seeking mental health care?
☐ Yes
☐ No
☐ Unsure
41. How do you cope with feelings of fear?
☐ Avoid the situation
☐ Seek support from others
☐ Use relaxation techniques (e.g., Breathing exercises)
☐ Try to face the fear head-on
☐ Other: _______________
42. Do you believe that mental health issues are influenced by sleep habits?
☐ Yes
☐ No
☐ Unsure
43. Do you believe that mental health issues are influenced by workplace environment?
☐ Yes
☐ No
☐ Unsure
44. Do you believe mental health services within your healthcare facility (COMS-TH) are
accessible when needed?
☐ Strongly agree
☐ Agree
☐ Neutral
☐ Disagree
☐ Strongly disagree
45. Do you feel comfortable discussing your mental health issues with your supervisor or HR
personnel?
☐ Yes
☐ No
☐ Unsure
46. Do you believe that mental health issues are influenced by conflicts or disagreements
with family members/workplace colleagues?
☐ Yes
☐ No
☐ Unsure
47. Do you believe that mental health issues are influenced by Substance Abuse?
☐ Yes
☐ No
☐ Unsure
48. Do you believe that mental health issues are influenced by spiritual or religious beliefs?
☐ Yes
☐ No
☐ Unsure
Section 4: Assessment of Practice
49. Have you ever sought mental health care for yourself?
☐ Yes
☐ No
☐ Unsure
50. If yes, what type of mental health care did you seek? (Select all that apply)
☐ Counseling
☐ Psychotherapy
☐ Psychiatric services (medication management)
☐ Group therapy
☐ Teletherapy (Online therapy)
☐ Support groups
☐ Other (Please specify): ___________
51. How frequently have you accessed mental health care services in the past?
☐ Once
☐ 2-3 times
☐ 4-6 times
☐ Regularly (more than 6 times)
52. If you have received mental health care, do you follow the treatment or therapy plan as
recommended?
☐ Always
☐ Sometimes
☐ Rarely
☐ Never
53. Do you know where to access mental health services within your healthcare center
(COMS-TH)?
☐ Yes
☐ No
☐ Unsure
54. How long did you wait before seeking help after recognizing a mental health issue?
☐ Immediately
☐ Within a week
☐ After a month
☐ Did not seek help
55. Have you referred anyone (colleague, friend, or family) to mental health care services in
the past?
☐ Yes
☐ No
☐ Unsure
56. If you have never sought mental health care, what are the reasons? (Select all that apply)
☐ Lack of knowledge about services
☐ Didn’t know where to go
☐ Concerns about stigma or judgment
☐ Preferred to handle it myself
☐ Financial barriers
☐ Lack of time
☐ No perceived need
☐ Other: ___________
57. Do you take any self-care actions to manage your mental health (e.g., exercise,
meditation, talking to a friend)?
☐ Yes
☐ No
☐ Unsure
58. When you experience mental health challenges, what is the first step you usually take?
☐ Speak to friends or family
☐ Seek professional help (therapist, counselor)
☐ Look for online resources or self-help
☐ I don’t do anything
☐ Other (please specify): ___________
59. Have you ever used alternative methods to cope with mental health concerns instead of
professional mental health care?
☐ Yes
☐ No
☐ Unsure
60. If yes, which of the following alternative methods have you used? (Select all that apply)
☐ Meditation or mindfulness practices
☐ Exercise (e.g., yoga, running)
☐ Religious or spiritual guidance
☐ Herbal remedies or supplements
☐ Self-help books or online resources
☐ Talking with friends or family
☐ Other (please specify): ___________
61. How often do you experience barriers (e.g., time constraints, workload) that prevent you
from seeking mental health care?
☐ Frequently
☐ Occasionally
☐ Rarely
☐ Never
62. Do you participate in any mental health awareness programs or workshops offered by
your workplace (COMS-TH)?
☐ Yes
☐ No
☐ Not aware of any programs
63. Have you participated in any mental health awareness programs (Other than COMS-TH)?
☐ Yes
☐ No
☐ Unsure
Section 5: Open ended Feedback
Any suggestions?
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Thank you for sharing your time and insights through this questionnaire. Your contribution is
invaluable to our research.
