Print Version Email page to a Friend
   
   
 

Appendix 2 — 

Survey Questionnaire for Roving Exhibition of the Cervical Screening Programme


Date: Day Month Year   Time: : am/pm   Ref. No.:  

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  
   
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?
 
a. Yes   b. No   c. Not sure  
   
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
   
10. Your age is: a. below 25 b. 25-64 c. Above 64
   
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)
   
12. What other opinion do you have in this exhibition?
   

~ End of questionnaire, thank you ~

   
Back to Top
Previous
   
 
 

Last revision date: 30 June 2008