FACTORS HINDERING PROSTATE CANCER SCREENING AMONG MEN AGED [40 –

65 YEARS] ATTENDING CONSOLATA HOSPITAL NKUBU.

You are requested to participate in the above mentioned study .the interview will take
approximately 15- 20 mins to complete and everything discussed with you will remain
confidential and will help to determine factors hindering prostate cancer screening

Do you consent to the study? Yes ….. No ……….

INSTRUCTIONS
Do not indicate your name on the questionnaire

Answer only what is asked.

Answer the entire question.

Tick the answer in the space provided

SECTION ONE: INDIVIDUAL DATA

1. How old are you?

a) 40 years _45 years [ ]

b) 46 years -50 years[ ]
c) 51 years -55yers [ ]
d) 56 years -60 years [ ]
e) 61 years – 65 years [ ]

2. Which is your religion?

a) Christian [ ]
b) Muslim [ ]
c) Hindu [ ]
d) Others {specify}…

3. What is your level of education?

a) Tertiary [ ]
b) Secondary [ ]
c) Primary [ ]
d) None [ ]

4. How far is your residing area from the hospital?

a) Less than 1km [ ]

b) 1km – 2 km [ ]
c) 2km -3 km [ ]
 d) Above 3 km [ ]

SECTION TWO: SOCIO – ECONOMIC FACTOR

1. What is your monthly level of income?

a) Less than 5000ksh [ ]

b) 5000k to 10,000ksh [ ]
c) 10,000 ksh to 20,000ksh [ ]
d) Above 20,000 ksh [ ]

2. Which form of payment do you use for prostate screening?

a) Cash [ ]
b) Insurance cover [ ]
c) Free [ ]
d) I don ‘t know [ ]

3. Which believes hinder you from utilization of prostate cancer screening services?

a) That prostate cancer is a death sentence [ ]

b) Prostate cancer is inevitable [ ]
c) All of the above [ ]
d) None [ ]

4. Does lack of insurance cover hinder prostate cancer screening?

a) Yes [ ]
b) No [ ]
c) I don’t know [ ]

SECTION THREE: HOSPITAL- RELATED FACTORS

1. Where did you hear of prostate cancer screening?

a) Media [ ]
b) Health workers [ ]
c) Family [ ]
d) Never heard about it [ ]
e) Others {specify} …

2. How many times have you had prostate screening?

a) Once [ ]
b) Twice [ ]
c) More than two times [ ]
d) None [ ]
3. Have you ever come across health workers in the community educating on prostate
cancer screening?

a) Never [ ]
b) Once [ ]
c) Twice [ ]
d) More than twice [ ]