(Updated) Sample Questionnaire

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Unang Bahagi: Propayl ng mga Respondents Check the appropriate answer.

Lagyan ng tsek ang angkop na sagot.

DEMOGRAPHIC PROFILE
DEMOGRAPIKONG PROPAYL

AGE: ____ years old

EDUCATIONAL ATTAINMENT:

Elementary Technical vocational


Elementary undergraduate College graduate
Highschool graduate College undergraduate
Highschool undergraduate

MARITAL STATUS: EMPLOYMENT STATUS/SOURCE OF


Single INCOME:
Married Unemployed
Widower Employed
Separated Self-employed

Ikalawang Bahagi: Kaalaman sa Operasyon, Moderno, at mga Tradisyonal na Kontraseptibo

SURGICAL MALE CONTRACEPTION (VASECTOMY)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B1 I am knowledgeable about Vasectomy procedures and its effectiveness. (May kaalaman ako
tungkol sa mga pamamaraan ng basektomi at sa bisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B2 I know about the drawbacks and benefits of Vasectomy. (Batid ko ang mga disbentahe at
bentahe ng basektomi.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)
TRADITIONAL MALE CONTRACEPTION (Non-vaginal Intercourse, Abstinence,
Withdrawal, and Artificial Cryptorchidism)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

TRADITIONAL MALE CONTRACEPTION: NON-VAGINAL INTERCOURSE


B3 I am informed about Non-vaginal intercourse and its effectiveness. (May alam tungkol sa
pakikipagtalik na walang penetrasyon at sa pagiging mabisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

TRADITIONAL MALE CONTRACEPTION: ABSTINENCE


B4 I understand what Abstinence is and its effectiveness. (Naiintindihan ko kung ano ang pag-iwas
sa pakikipagtalik at ang pagiging mabisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

TRADITIONAL MALE CONTRACEPTION: WITHDRAWAL


B5 I am aware of Withdrawal and its effectiveness. (May kamalayan ako sa withdrawal at sa
pagiging mabisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

TRADITIONAL MALE CONTRACEPTION- ARTIFICIAL CRYPTORCHIDISM


B6 I know about Artificial Cryptorchidism and its effectiveness.(Alam ko ang tungkol sa artipisyal
na luslos (cryptorchidism) at ang pagiging mabisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B7 I know about its drawbacks and benefits of traditional male contraception.(Alam ko ang tungkol
sa disbentahe atbentahe ng tradisyonal na kontrasepsiyon sa mga lalaki.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)
MODERN MALE CONTRACEPTION (CONDOM)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B8 I understand the correct usage of male condoms and its effectiveness. (Naiintindihan ko ang
tamang paggamit ng mga kondom na panlalaki at ang pagiging mabisa nito.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B9 I believe that condoms are the most common, convenient, and cheapest contraceptive method.
(Naniniwala ako na ang kondom ang pinakakaraniwan, maginhawa, at pinakamurang paraan ng
kontrasepsyon.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B10 I know that a change of condoms is required every 30 minutes of the session. (Alam kong ang
pagpapalit ng kondom pagkaka-30 minuto ng sesyon ay kailangan.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

B11 I know about the drawbacks and benefits of condoms. (Alam ko ang tungkol sa mga disbentahe
at bentahe ng kondom.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)
PERCEPTION IN MALE CONTRACEPTION (SUSCEPTIBILITY, SEVERITY,
BENEFITS AND, BARRIERS)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

PERCEPTION IN MALE CONTRACEPTION: SUSCEPTIBILITY

C1 I believe using male contraceptives has an impact on my health. (Naniniwala akong may epekto
sa aking kalusugan ang paggamit ng mga panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C2 I believe diseases might be acquired while using male contraceptives. (Maaaring makakuha ng
sakit sa paggamit ng panlalaking kontrasepsiyon.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

PERCEPTION IN MALE CONTRACEPTION: SEVERITY

C3 I believe that using male contraceptives has drawbacks. (Naniniwala akong may epekto sa aking
kalusugan ang paggamit ng mga panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C4 I believe that males are also responsible for using contraception. (Naniniwala akong may
pananagutan din ang mga lalaki ay sa paggamit ng kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

PERCEPTION IN MALE CONTRACEPTION: BENEFITS

C5 I believe using male contraceptives prepares me financially before having a child. (Naniniwala
akong inihahanda ako ng paggamit ng mga panlalaking kontraseptibo sa gastusin bago magkaroon
ng anak.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)
C6 I believe that engaging in male contraception regulates my desired number of children.
(Naniniwala akong kinokontrol ng paggamit ng konrasepsyon ang gusto kong bilang ng mga anak.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C7 I believe that there are different kinds of male contraceptives methods. (Naniniwala akong may
iba't ibang pamamaraan ng panlalaking kontrasepsyon.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C8 I believe that using male contraceptives will prevent pregnancy. (Naniniwala akong makakapigil
sa pagbubuntis ang paggamit ng panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C9 I believe that using contraceptives during intercourse also prevents sexually transmitted diseases.
(Naniniwala akong napipigilan din ng paggamit ng mga kontraseptibo ang pagkakaroon ng mga
sakit na nakukuha sa panahon ng pakikipagtalik.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

PERCEPTION IN MALE CONTRACEPTION: BARRIERS

C10 I believe male contraceptives are expensive. (Naniniwala akong mahal ang mga panlalaking
kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)
C11 I believe male contraceptives are hard to access. (Naniniwala akong mahirap makakuha ng mga
panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C12 I believe it is embarrassing for me to buy male contraceptives.(Naniniwala akong nakahihiya


ang bumili ng mga panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

C13 I am not fully comfortable when using male birth controls. (Hindi ako ganap na kumportable
kapag gumagamit ng mga panlalaking kontraseptibo.)

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree


( Lubos na Sumasang-ayon) (Sumasang-ayon) (Di-sumasang-ayon) ( Lubos na di-sumasang-ayon)

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