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A.1. Sociodemographic Details

This document introduces a questionnaire about cervical cancer aimed at assessing understanding and preventative practices, assuring confidentiality and voluntary participation, and noting that responses will help research on prevention and control of this common female condition. Participants are asked to provide demographic details and answer questions about their knowledge, perceptions, and behaviors related to cervical cancer causes, screening, vaccination, and prevention. A research assistant is available to help complete the questionnaire.

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Raihana Zahra Ichsani
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56 views4 pages

A.1. Sociodemographic Details

This document introduces a questionnaire about cervical cancer aimed at assessing understanding and preventative practices, assuring confidentiality and voluntary participation, and noting that responses will help research on prevention and control of this common female condition. Participants are asked to provide demographic details and answer questions about their knowledge, perceptions, and behaviors related to cervical cancer causes, screening, vaccination, and prevention. A research assistant is available to help complete the questionnaire.

Uploaded by

Raihana Zahra Ichsani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Dear Respondent,

Cervical cancer is a common female condition throughout the world. This questionnaire is
aimed at assessing your understanding and preventive practices regarding cervical cancer.
Please be assured that all your responses will be kept strictly confidential. This is an anonymous
questionnaire which does not require your name or identity. Participation in this study is
voluntary, and a refusal to participate will not attract any sanctions. Please answer the entire
questions to the best of your ability and as truthfully as possible. Your responses will assist the
researchers in the prevention and control of this condition. A research assistant is available to
help you in filling the questionnaire.
◻ By checking this box I agree that I have read the above
and agree to participate in this study.
Thank you for participating.

A.1. Sociodemographic Details


(1) Age: (in years)
(2) Marital status:
Single ◻
Married ◻
Divorced ◻
Widowed ◻
Separated ◻
Others (please specify)
(3) Educational status:
No formal ◻
Primary ◻
Secondary ◻
Tertiary ◻

(4) Gender:
Male ◻
Female ◻
(5) Employment status:
Student ◻
Employed ◻
Self-employed ◻
Home maker ◻
Retired ◻
Applicant ◻

A.2. Perception and Preventive Practices on Cervical Cancer


(6) Have you ever heard of cervical cancer?
Yes ◻
No ◻
I do not know ◻
If yes,
(7) Cervical cancer is caused by
Human immunodeficiency virus (HIV) ◻
Humanpapillomavirus (HPV) ◻
Bacteria ◻
Do not know ◻
(8)Where did you learn about cervical cancer (tick all that apply)
TV ◻
Radio ◻
Magazine ◻
News ◻
Health talk ◻
Others (pls specify)
(9) Do you know anyone with a history of cervical cancer?
Yes ◻
No ◻
Do not know ◻
(10) Do you think it is helpful to detect Cervical Cancer early?
Yes ◻
No ◻
Do not know ◻
(11) Has anyone ever recommended that you should get tested or screened for cervical
cancer?
Yes ◻
No ◻
I do not know ◻
(12) Will you be willing to attend a cancer health education program on women’s
health?
Yes ◻
No ◻
I do not know ◻
(13) If yes, why?
More knowledge ◻
Better support to partner ◻
Others (Please specify)
(14) If No, why?
Embarrassing ◻
Women affair ◻
Do not know ◻
(15) If you are male, would you allow your partner to be screened/tested by a male
health care provider?
Yes ◻
No ◻
I do not know ◻
(16) Have you heard of ways to prevent cervicalcancer?
Yes ◻
No ◻
I do not know ◻
(17) Which preventive measures do you know for cervical cancer? (check all that
apply)
Pap smear ◻
Vaccination ◻
HPV testing ◻
Drugs ◻
Others (please specify)
(18) Have you heard of the humanpapillomavirus (HPV) vaccine?
Yes ◻
No ◻
I do not know ◻
(19) If yes, who are those who should receive this vaccine?
<10 years ◻
10–25 years ◻
>25 years ◻
(20) If you have a daughter, would you consider vaccinating her with the HPV vaccine?
Yes ◻
No ◻
I do not know ◻
(21) If you are female, have you been vaccinated with the HPV vaccine?
Yes ◻
No ◻
I do not know ◻
(22) Have you had a Pap smear done before?
Yes ◻
No ◻
I do not know ◻
(23) If no, why?
Not at risk ◻
Cost ◻
Partner will not allow ◻
Never heard of it ◻
No time ◻
Afraid ◻
Not sexually active ◻
Poor health worker attitude ◻

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