Please put a circle 'Ο' to select the appropriate answer in the
following questions.
| 1. |
How do you know the date and place of
this exhibition? |
| |
| a. |
Pass through while on my way |
|
b. |
Posters |
|
c. |
Internet |
|
d. |
Newspapers |
|
e. |
Others |
 |
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| |
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| 2. |
How do you feel about the overall content
of this exhibition? |
| |
| a. |
Very useful |
|
b. |
Useful |
|
c. |
Quite general |
|
d. |
Not useful |
|
e. |
Others |
 |
|
|
| |
|
| 3. |
How do you feel about the design of this
exhibition |
| |
| a. |
Very attractive |
|
b. |
Attractive |
|
c. |
Quite general |
|
d. |
Not attractive |
|
e. |
Others |
 |
|
|
| |
|
| 4. |
Have you ever had a cervical smear before?
|
| |
|
| |
|
| 5. |
After having visited the exhibition, would
you like to have cervical smear? |
| |
| a. |
Yes, the reason is (can choose more
than one answer) |
| |
| i. |
After having visited the exhibition |
| ii. |
Have regular cervical smears
already |
| iii. |
Others, please specify, |
 |
|
|
| |
|
| b. |
No, the reason is (can choose more
than one answer) |
| |
| i. |
Not yet sexually active |
|
vi. |
Don¡¦t know where to have cervical
smear |
| ii. |
Not feel the need |
|
vii. |
Feel embarrassed |
| iii. |
Not useful |
|
viii. |
Fear of pain |
| iv. |
Expensive |
|
ix. |
Had total hysterectomy |
| v. |
No time |
|
x. |
Others, please specify |
 |
|
|
| |
|
| c. |
Not yet decided |
|
| |
|
| 6. |
Would you encourage your relatives or friends
to have cervical smear? |
| |
| a. |
Yes, the reason is (can choose more
than one answer) |
| |
| i. |
After having visited the exhibition |
| ii. |
Have regular cervical smears
already |
| iii. |
Others, please specify, |
 |
|
|
| |
|
| b. |
No, the reason is (can choose more
than one answer) |
| |
| i. |
No relative or friend need cervical
smear |
| ii. |
Others, please specify, |
 |
|
|
| |
|
| c. |
Not yet decided |
|
| |
|
| 7. |
Have you registered with the Cervical Screening
Information System? |
| |
| a. |
Yes (please go to 9.) |
b. |
No |
|
|
c. |
Not sure |
|
|
| |
|
| 8. |
Having visited the exhibition, would you
like to register with the Cervical Screening Information System? |
| |
| a. |
Yes, the reason is (can choose more
than one answer) |
| |
| i. |
After having visited the exhibition |
| ii. |
Can receive a reminder letter
to remind of the next screening date |
| iii. |
Can view smear results using
the Internet |
| iv. |
Can help doctors trace previous
smear results |
| v. |
Others |
 |
|
|
| |
|
| b. |
No, the reason is (can choose more
than one answer) |
| |
| i. |
Not have cervical smear |
| ii. |
Not need reminder letter |
| iii. |
Not need to view smear results
using the Internet |
| iv. |
Not need doctors trace previous
smear results |
| v. |
Not/ seldom use the Internet |
| vi. |
Troublesome |
| vii. |
Others |
 |
|
|
| |
|
| c. |
Not yet decided |
|
| |
|
| 9. |
Having visited the exhibition, would you
encourage your relatives or friends to register with the Cervical
Screening Information System? |
| |
| a. |
Yes, the reason is (can choose more
than one answer) |
| |
| i. |
Having visited the exhibition |
| ii. |
Can receive a reminder letter
to remind of the next test |
| iii. |
Can view smear results using
the Internet |
| iv. |
Can help doctors trace previous
smear results |
| v. |
Others |
 |
|
|
| |
|
| b. |
No, the reason is (can choose more
than one answer) |
| |
| i. |
Relatives or friends do not
have cervical smear |
| ii. |
Relatives or friends do not/
seldom use the Internet |
| iii. |
Relatives or friends do not
need reminder letter |
| iv. |
Relatives or friends do not
need to view smear results using the Internet |
| v. |
Relatives or friends do not
need doctors trace previous smear results |
| vi. |
Troublesome |
| vii. |
Others |
 |
|
|
| |
|
| c. |
Not yet decided |
|
| |
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| 10. |
Your age is: a. below 25
b. 25-64 c.
Above 64 |
| |
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| 11. |
Your occupation is: |
| |
| a. |
Clerk/sales/service worker |
|
d. |
Employer/ business |
| b. |
Skilled/non-skilled worker |
|
e. |
Professional/manager/administrator |
| c. |
Housewife |
|
f. |
Others (e.g. student/ retired/unemployed) |
|
| |
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| 12. |
What other opinion do you have in this
exhibition? |
| |
|