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Questionaire
Questionaire
B. Determine the Behaviours regarding family planning among residents of Urgello, Sambag II through the questionnaire of the researchers.
Questions Responses
1 Have you ever heard of contraceptive methods? 1-Yes ___
2-No ___
3-Don’t know____
2 Do you know how to prevent pregnancy? 1-Yes ____
2-No ____
3-Don’t know____
3 Which contraceptive method prevents ovulation 1Barrier____
2Hormonal____
3Natural____
4Surgical____
4 This contraceptive method "blocks" also serves as a protection from STD's 1diaphragm____
2IUD(Intrauterine
device)____
3Condom_____
4Vasectomy____
5 Available for both males and females 1Condoms____
2 IUD(Intrauterine
device)____
6 What do you think is the most effective methods? 1Condom____
2Natural family
planning___
3Birth control
pills_____
7 All contraceptives protect against STD's 1True____
2False____
10 How much time do you have to take emergency contraception? 1within 24 hrs____
2within 48 hrs____
3within 72 hrs____
4anytime you
want_____
C. Determine the Practices regarding family planning among residents of Urgello, Sambag II through the questionnaire of the researchers.
Questions Responses
1 How often do you use contraceptive 1-Always____
method? 2-Occasionally____
3-Never____
2 If never, what are the reasons? 1-Lack of availability ____
2-Contraceptive are expensive____
3-Contraceptive can have side effect____
4-May partner doesn’t like to use contraception____
3 Have you attended any family planning 1-Yes____
seminar? 2-No____
RESPONDENT'S PROFILE
1. AGE ______
2.SEX ______MALE
______FEMALE
3. RELIGION ______CHRISTIAN
______MUSLIM
______HINDU
______OTHERS, PLEASE SPECIFY: ________________
4. CIVIL STATUS ______SINGLE
______MARRIED
______SEPARATED
______COMMON LAW
5. MONTHLY INCOME
_______LESS THAN 5000 PESOS
_______5000 TO 10000 PESOS
_______10000 TO 20000 PESOS
_______OTHERS, PLEASE SPECIFY:______________
6. EDUCATIONAL QUALIFICATION
________ELEMENTARY LEVEL
________MIDDLE SCHOOL LEVEL
________HIGH SCHOOL LEVEL
________COLLEGE LEVEL
________UNDERGRADUATE.
7. OCCUPATION
_______HOME MAKER
_______SELF-EMPLOYED
_______STUDENT
_______EMPLOYED, PLEASE SPECIFY:__________
_______UNEMPLOYED
8. NATIONALITY
_______ FILIPINO
_______ OTHER : ____________________
A. Determine the level knowledge regarding family planning among residents of Urgello, Sambag II through the questionnaire of the
researchers.
Questions Responses
1 Have you ever heard about contraceptives? Yes___
No___
Don’t know___
2 Have you ever used contraceptives in your past? Yes___
No___
3 Birth control pills are effective even if a woman misses taking them for two or Yes___
three days in a row. No___
Don’t know___
4 Female sterilization is one way to avoid pregnancy. Yes___
No___
Don’t know___
5 Health education is important for man and woman who want to use Yes___
contraception. No___
Dont’know___
6 Contraceptive pills do not guarantee 100% protection. Yes___
No___
Dont’know___
7 Condoms prevent STIs. Yes___
No___
Dont’know___
8 Common side effects of contraceptive pills include mood swings and weight Yes___
gain No___
Dont’know___
9 There is increased risk for breast cancer in woman taking oestrogen- containing Yes___
contraceptives No___
Dont’know___
10 Woman control birth control shot (depo provera) must get an injection every Yes___
three months. No___
Dont’know___
11 If woman is having side effects of one kind of pill, switching to another type Yes___
might help. No___
Dont’know___