Professional Documents
Culture Documents
Pilot Questionnaire
Pilot Questionnaire
Pilot Questionnaire
Serial #: _____
Dear Respondent,
Good day!
This set of questionnaires has been developed to assess how knowledgeable are you in the disease and
treatment regimen given in your health center under TB-DOTS Program.
We are asking for your cooperation through answering the questionnaires with sincerity and truthfulness. It
will take you 15 minutes to finish the survey. Rest assured that your answers will be kept with stringent
confidentiality and will only be utilized for study purposes.
Thank you!
PATIENTS INFORMATION
Age
:___________
Sex
:___________
Actual Income per Month :___________
Occupation
:___________
Educational Attainment
:___________
Treatment Category
:___________
Direction: MODIFIED TRUE OR FALSE. Please answer the following. Put a check mark on the space provided
that corresponds to your answer.
TRUE
FALSE
1. Tuberculosis is highly infectious disease.
2. Tuberculosis is a curable disease.
3. Tuberculosis is caused by a virus.
4. Tuberculosis can infect anyone regardless of age.
5. All people with tuberculosis infection will show symptoms
6. Tuberculosis can spread from one person to another through coughing,
speaking, sneezing, and singing.
7. Tuberculosis can spread from one person to another through kissing, sharing of
cigarettes, and sharing toothbrushes.
8. Some people can get tuberculosis disease easier than others.
9. Tuberculosis spread from one person to another through sharing drinking
containers, eating utensils, or food.
10. Tuberculosis bacteria are killed during the first 8 weeks of treatment.
11. Regimens for the treatment of tuberculosis disease need to only contain one
drug to which bacteria are susceptible.
12. Treatment with a single drug cannot lead to the development of a bacterial
population resistant to drug
13. When two or more drugs are given together, each helps prevent the
emergence of tubercle bacilli resistant to the other drugs.
14. Given adequate treatment, patients will recover and be cured.
15. Initial phase of treatment consists of 2 months of treatment.
16. Initial phase of treatment is not crucial for preventing the emergence of drug
resistance.
17. Initial phase of treatment regimen usually consists of 6 drugs.
18. Continuation phase of treatment consists of either 4 or 7 months of treatment.
19. Liver injury can be caused by three of the first - line tuberculosis drugs
including Isoniazid, Rifampicin, and Pyrazinamide.
20. There is a recurrence of fever in a patient who has been receiving therapy for
several weeks.
21. Gastrointestinal problem is common particularly in the first few weeks of
therapy.
22. All drugs used in treating tuberculosis disease can cause a rash.
23. Any symptoms of suggestive hepatitis like nausea, vomiting, persistently dark
urine, yellowish skin or eyes, malaise, unexplained elevated temperature for
more than 3 days, or abnormal tenderness are normal when taking first line
drugs.
24. First line drugs are to be stopped immediately without adequate justification.
25. Blurred or changed color vision caused by Ethambutol is not a serious drug
reaction.
26. Easy bruising caused by Rifampicin is a normal drug reaction.
27. Dizziness, tingling or numbness around the mouth caused by Isoniazid are
serious drug reactions.
28. Joint aches caused by Pyrazinamide are not a serious drug reaction.
RESEARCH INSTRUMENT (VISAYAN VERSION)
Serial #: _______
Mahal Namong Partisipante,
Maayong adlaw!
Kini nga mga pangutana gihimu para mukuha sa inyung mga opinyon mahitungod sa inyung kahibalo ug
pagtuman sa dihang anaa ka sa programa sa TB-DOTS sa health center.
Kami nangayo sa inyong kooperasyon sa pagtubag sa mga pangutana nga adunay sinseridad ug matinudanon. Kani matubag sulod sa 15 minutos. Gipasalig namo nga tanan nimung tubag kay itago ug gamitun
lang kini para sa pagtulun-an.
Daghang salamat!
IMPORMASYON SA PASYENTE
Edad
:___________
Kasarian
:___________
Sweldo sa matag-buwan: :___________
Trabaho
:___________
Edukasyon
:___________
Direksyon: TINUOD O DILI TINUOD: Palihug sa pagtubag pinaagi sa pagbutang ug tsek mark sa kahon nga
gihatag kilid sa pangutana.
TINUOD
DILI
TINUOD
1. Ang tuberkulosis usa ka makatakod na sakit.
2. Ang tuberculosis kay matambalan.
3. Ang hinungdan sa tuberkulosis kay usa ka virus.
4. Makatakod ang tuberkulosis bisan unsang edara.
5. Ang tao nga adunay tuberculosis mopakita ug simtomas.
6. Ang tuberkulosis kay mabalhin sa ubang tao pinaagi sap ag-ubo, pagistorya,paghatsing ug pagkanta.
7. Ang tuberkulosis kay mabalhin sa ubang tao pinaagi sa paghalok,
pagtabako sa laing sigarilyo, ug paggamit sa toothbrush sa laing tao.
8. Ang ubang tao kay daling makakuha ug sakit na tuberkulosis.
9. Ang tuberkulosis kay mabalhin sa ubang tao pinaagi sa pagkaon ug paginom ug laing baso, kutsara ug uban pa.
10. Kasagarang bakterya sa tuberkulosis kay mamatay sulod sa walo ka
simana nga pagtambal.
11. Ang tulumanon sa pag-inom sa tambal sa tuberculosis kinahanglan nga
kausa lang imnon para madutlan ang bakterya.