APPENDIX A: RESEARCH QUESTIONNAIRE

Dear respondents, we are graduating students of Health Science at Salaam University. This is
a questionnaire prepared for data collection concerning effects of stroke among adult people
at Aden Ade Hospital The purpose of this questionnaire is for academic reason. Your
information will be kept confidentially. Therefore, we kindly request you to answer these
questions to the best of your knowledge.
Instruction
 Do not write your name on this questionnaire
 The research is for academic purpose not money
 Your information will be private
Please circle your answer to the provided answers to the best of your knowledge.
SECTION ONE: BACKGROUND AND SOCIODEMOGRAPHIC CHARACTERISTICS
Number Question Answer
1 What is your age? A. 15-25
B. 25-35
C. 35-45
D. 45 above

2 What is your sex? A. Male

B. Female

3 What is your marital status? A. Single

B. Married
C. Divorced
D. Widowed

4 What is your education level? A. Primary level

B. Secondary level
C. University level
D. Non formal education

5 What is your occupation? A. Employee

B. Unemployed
C. Student
D. Housewife

6 Have you ever told by a physician that you A. Yes

had mild stroke or stroke? B. No

7 Have you a family member with stroke? A. Yes

B. No

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SECTION TWO: SOCIAL EFFECTS OF STROKE

Number Question Answer

8 Stroke causes social isolation A. Agree
B. Disagree
C. Strongly agree
D. Strongly disagree

9 I experienced myself with social isolation A. Agree

B. Disagree

10 Stroke patients disrupt family members A. Agree

B. Disagree
C. Strongly agree
D. Strongly disagree

11 Most families with stroke patients suffer from A. Stress

B. Anxiety
C. Fatigue
D. All of them

12 Patients with stroke disrupt family member’s job A. Agree

B. Disagree
C. Strongly agree
D. Strongly agree

13 Some members of the family with a stroke A. Agree

patient may quit their jobs. B. disagree

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SECTION THREE: PHYSICAL EFFECTS OF STROKE

Number Question Answer

14 Most patients with stroke become paralyzed A. Agree
B. Disagree
C. Strongly agree
D. Strongly disagree

15 Have you ever had a sudden painless weakness A. Yes

on one side of your body? B. No

16 Have you ever had a sudden numbness or dead A. Yes

feeling on one side of your body? B. No

17 Have you ever suddenly lost of vision in one or A. Yes

both eyes? B. No

18 Aphasia typically occurs suddenly after stroke or A. Agree

head injury B. Disagree
C. Not sure

19 Have you ever suddenly lost the ability to A. Usually

understand what people are saying? B. Sometimes
C. Never

20 Have you ever suddenly lost the ability to A. Usually

express yourself verbally or in writng? B. Sometimes
C. Never

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SECTION FOUR: MENTAL EFFECTS

Number Question Answer

21 Stroke patients may face cognitive problems A. Agree
B. Disagree
C. Strongly agree
D. Strongly disagree

22 Do you find you confuse right and left when A. Very often
giving direction? B. Quite often
C. Occasionally
D. Very rarely
E. never

23 Do you find you forget why you went from one A. Usually
part of the house to the other B. Sometimes
C. Rarely
D. Never

24 Do you find forget whether you have turned off A. Usually

the light or locked the door? B. Sometimes
C. Rarely
D. Never

25 Stroke patients may also face impaired brain A. Agree

control B. Disagree
C. Strongly agree
D. Strongly disagree

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