We are conducting a research on usage of adult diapers and we request 10 minutes

of your valuable time in seeking your opinion about Adult diapers. Kindly provide us
your responses and oblige.
Assurance of Confidentiality of your personal data: We assure you the
strictest of confidentiality of your personal data and this research is for academic
interest only.
Date:
Name:
Mobile:
Gender:
Are you using adult diapers Yes/No

(terminate asking further if reply is Yes)

Age:
Place:
Are you aware of adult diapers: Yes/No
Are you having any of the following conditions?
Options: Diabetes; Urinary infections; Prostate Problems; Surgical issues; Any other
reasons; No issues like the above
How strong would be your intention to use adult diaper to serve the above reasons
(ask this question if the person is having any health problems as mentioned above)
Options: Extremely Unlikely; Quite Unlikely; Slightly Unlikely; Neither Likely nor
Unlikely; Slightly Likely; Quite Likely; Extremely Likely

1. Using adult diapers would enable me to accomplish my daily tasks more

quickly.4
Options: as above and same for the rest
2.
3.
4.
5.
6.
7.
8.
9.

Using adult diaper would improve my performance in daily life.

Using adult diapers would enable me to be more productive in my daily life.
Using adult diapers would enable me to be more effective in my daily life.
Using adult diapers would make it easier for me to have a daily life.
I would find adult diapers useful in my daily life.
Learning to use adult diapers would be easy for me.
I would find it easy to do what I want to do with adult diapers.
I would find it easy to wear and use adult diapers without anyones assistance

10.I would find it easy to understand the instructions given on the packaging of
adult diapers.
11.I would find adult diapers flexible enough to be used for different occasions.
12.It is easy for me getting used to adult diapers.
13.I would find adult diapers easy to use.
14.Using adult diapers would not result in side effects such as infections and
allergies.
15.If significant barriers are overcome I intend to use adult diapers.
16.Persons who influence my behavior think I should use adult diapers.
17.Persons who are important to me think I should use adult diapers.
18.Using adult diapers enables me to comfortably manage my social
engagements.
19.Using adult diapers enables me to carry out my daily activities effectively.
20.Do you think adult diapers are expensive?
Yes
No