QUESTIONNAIRE

FACTORS ASSOCIATED WITH INTENTION TO REPORT CHILD ABUSE AMONG HOSPITAL NURSES IN
ILIGAN CITY, PHILIPPINES

Date:

Section 1: Demographics Directions: Check appropriate box

1 Gender □ Male □ Female
2 What is your age? years old.
3 What is your civil status? □ married □ single □ separated □widowed
4 In what type of health care facility are you currently working?
□ Hospital □ Health care center □ Clinic
5 What is the name of the health care facility you are currently working?
.
6 In what department are you currently working?
□ Pediatric □ EENT □ Gynecology
□ Neurology □ Nutrition and dietetics □ Oncology
□ Opthalmology □ Orthopedics □ Physiotherapy
□ Emergency Room □ Cardiology □ Gastroenterology
□ Others:
(Please specify) .

7 How many years have you been in service as a nurse? years.

8 Have you participated in any trainings/education on Child Abuse BEFORE you were in service?
□ Yes □ No
If yes, what type of training/education? .
9 Have you participated in any trainings/education on Child Abuse WHILE you are in service?
□ Yes □ No
If yes, what type of training/education? .
Direction:
Questions in this survey use rating scales with 7 places; please circle the number that best describes your opinion.
Please be sure to answer all questions, not omitting any. Be sure to circle one number only per question. Thank you.
Section 2: Attitude
10 For me, being able to detect and report a suspected victim of child abuse is
not worth it :___1__:___2__:___3__:___4__:___5__:___6__:___7___: extremely worth it
11 For me, reporting child abuse cases is of high importance.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7___: strongly agree
12 For me, as a nurse, being able to detect and report a victim of child abuse is
not part of my job :___1__:___2__:___3__:___4__:___5__:___6__:___7___: a part of my job
13 For me, it is necessary for nurses to be highly knowledgeable and skillful in the detection and reporting of
suspected child abuse.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7___: strongly agree
14 For me, failure to report a case of child abuse could have long term effects and consequences to the victim.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7___: strongly agree
Section 3: Subjective Norm
15 Most people whose opinions I value would expect me to report suspected cases of child abuse immediately.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
16 It is expected for nurses to be knowledgeable and skillful enough in the detection and reporting of child abuse.
 strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
17 My superiors would approve if I report a suspected case of child abuse.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
18 Most people that are important to me thinks that I
should not :___1__:___2__:___3__:___4__:___5__:___6__:___7__: should
report a suspected child abuse.
19 It is mandated by law that child abuse cases should be reported immediately to authorities.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
Section 4: Perceived Behavioral Control
20 The detection and reporting of child abuse cases is
extremely difficult :___1__:___2__:___3__:___4__:___5__:___6__:___7__: extremely easy
21 I have enough knowledge and skills in the detection of child abuse cases when I meet one.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
22 I am confident that I can accurately detect a possible case of child abuse among my patients.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree
23 There is enough time for me to detect signs of possible abuse among my patients during assessments.
strongly disagree :___1__:___2__:___3__:___4__:___5__:___6__:___7__: strongly agree

Section 5: Intention