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The Updated, Adapted&modified Questionnaire
The Updated, Adapted&modified Questionnaire
The Updated, Adapted&modified Questionnaire
Confidentiality
All information collected on forms will be entered into computers with only the study
identification number. All information that will be collected from you will be protected. The
study will not include details that directly identify you, such as your name. Only a participant
identification number will be used in the survey. Only a small number of researchers/ Research
Assistants will have direct access to the survey. the results of the current study will be
published or presented in a scientific meeting, names and other information that might identify
you will not be used.
Risks -As the study will be conducted through self-administered questionnaire, the individual
student will not be subjected to any harm.
Taking part in this study is completely your choice. You are free to skip any question if you
feel uncomfortable to disclose information.
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You can stop participating in this study at any time, even if you have already given your
consent. Refusal to participate, or withdrawal from the study, will not involve penalty or loss of
any benefits to which you are otherwise entitled.
Benefits- There are no direct benefits to you; But we hope that the results of the study will
provide valuable information on blood donation.
B) NO ________:
I have read the participant information sheet. I have clearly understood the purpose of the
research, the procedure the risk and benefits, issue of confidentiality the right of participants. I
have been given the opportunity to ask questions for things that may have been un clear. I was
informed that participants have the right to withdraw from the study at any time or not to
answer any questions that I do not want.
Signature…………
Date ……………
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HARAMAYA UNIVERSITY
COLLEGE OF HEALTH AND MEDICAL SCIENCE
SCHOOL OF PUBLIC HEALTH
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202 If your answer to Q. # 201 is “yes”, from 1.Health professionals/facility
where did you hear or see those messages? 2.Print media (Newspaper, leaflet, brusher,
billboard)
(More than one answer is possible.) 3. Electronic media (TV, Radio)
4.School/University
5. Friends/ Family, relatives
6. Religious worship place
7 others (specify)………..
203 The place where blood is donated( more 1. Hospital 3. Mobile blood donation
than one answer is possible ) centers
5. Others, specify___________
207 Minimum weight of a donor to donate 1.<45 Kg 2.45Kg 3.>45Kg 4. I Don’t know
blood
209 At what minimum interval a person donate 1. Every 3 months 3. Once in a year
blood? 2. Every 6 months 4. Don’t know
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212 If “ No” for #210 skip ,Which blood 1. A 2. B 3. AB 4. O
group type is the commonest one?
216 What is the duration of a donation process? 1.20 min 2.20-60min 3.don’t know
221 Can a person with high blood pressure 1. Yes 2. No 3. Don’t know
donate?
222 Is donated blood screened for HIV/AIDS 1 Yes 2 .No 3 .Don’t know
and blood born disease
223 Can HIV infected person donate blood? 1. Yes 2. No 3. Don’t know
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Part III: Attitude question
301 What do you think about blood donation? 1.good 2. bad 3. no idea
305 Blood donation makes you sick and weak 1. Yes 2. No 3. No idea
306 What happen to blood donors during and 1.Contact infection 2. Temporary weakness
after donation?
3. Nothing will happen 4 I don’t know
309 Would you like to donate blood to only family 1.Yes 2.No
members and friend?
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402 If your answer to Q.#401 is “Yes”, how 1. Once 2. Twice 3.3 times 4. >3 times
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Name of data collector---------------signature ---------- Date-----------