Research Questionnaire
This questionnaire aims to assess knowledge and barriers regarding
cervical cancers and cervical cancer screening among women in the
gynecological ward and gynecological clinic in the German Sri Lanka
Friendship Hospital for women. Your participation is voluntary and
anonymous. Please answer honestly.
Section 01 - Socio-Demographic Factors
01. Age. .......................................
02. Marital status. .......................................
03. Religion. .......................................
04. Place of residence .......................................
05. Educational level. .......................................
06. Occupation. .......................................
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Section 02 - Knowledge of Cervical Cancers, Risk Factors and
Cervical Cancer Screening
1. Cervical cancer is the most common disease among women.
Yes ( ) No ( )
2. Cervical cancer is the main cause of cancer-related death among
women. Yes ( ) No( )
3. Cervical cancer is most common for women in their 20s.
Yes ( ) No ( )
4. It is possible to prevent cervical cancer. Yes ( ) No ( )
5. You can get cervical cancer from unprotected sexual intercourse.
Yes ( ) No ( )
6. You can get cervical cancer if you have a family history of cervical
cancer. Yes ( ) No ( )
7. Vaginal bleeding is the most common sign of cervical cancer.
Yes ( ) No ( )
8. A virus called Human Papillomavirus (HPV) causes cervical cancer.
Yes ( ) No ( )
9. HIV positive women have a high risk of developing cervical cancer.
Yes ( ) No ( )
10. Screening can detect cervical infection so they do not develop
into cancer. Yes ( ) No( )
11. Knew about screening for cervical cancer.
Yes ( ) No ( )
12. Knew recommended age for start of screening. Yes ( ) No ( )
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Section 03 - Barriers of Cervical Cancer Screening
1. Have you been screened for cervical cancer? Yes ( ) No ( )
2. There are no screening sites in the community. Yes ( ) No ( )
3. There is limited information on cervical cancer in the community.
Yes ( ) No ( )
4. The screening sites are too far from where I live. Yes ( ) No ( )
5. There are no health education programs to promote screening.
Yes ( ) No ( )
6. I am scared of a cancer diagnosis & treatment. Yes ( ) No ( )
7. I cannot afford the cost of screening. Yes ( ) No ( )
8. My partner would not allow me to go for screening. Yes ( ) No ( )
9. Pap smear test is painful. Yes ( ) No ( )
10. Pap smear test is embarrassing. Yes ( ) No ( )
11. It is against my religious beliefs and cultural values to go for
screening. Yes ( ) No ( )
12. I am not sexually active so do not need to go for a pap smear.
Yes ( ) No ( )
