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Research Questionnaire translation

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5 views8 pages

Research Questionnaire translation

Uploaded by

dumindu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Permission Request

• The questionnaire provided to you has been prepared by a group of fourth year
students of the Karapitiya Medical Faculty for a survey on teenage pregnancy.

• We invite you to contribute to the success of this survey.

• Please note that the medical services provided to you will not change
depending on whether you participate in this survey or not.

• Your identity will be protected to the fullest extent and therefore we kindly
request that you provide only truthful information.

• The privacy of the information you provide will be protected and the information
will be published only in scientific papers.

Signature of willingness to participate in this survey Agree/Disagree


……………..………………….

Signature of the Participant


A survey to study the risk factors and social influences affecting teenage
pregnancy

Questionnaire

Instructions:

• Please answer the questions provided here.

• For some questions, please mark the answer that is closest to yours.

• If you have a problem with a particular question, please ask our students

• if any questions do not apply to you, please leave them blank.


1.1 Resident's district: ……………………………………

1.2 Your Municipal council / Local council:…………………………………………..

1.3 Date of birth Age Approximate years of birth: ………………………………….

1.4 Are you married? Yes/ No

If you are married,


Age at the time of marriage: …………………….

Spouse's age: ……………….


Spouse's occupation: …………………………..

If you are unmarried,

Occupation of the head of the household:………………………

2.1 Grade you completed in school when you left school:……………………..

3.1 Gross monthly income of your family: Rs………………………

3.2 Is that income sufficient to cover the family's expenses: Yes/No

3.3 Were you employed during pregnancy: Yes/No

If yes, employment: …………………………………….

4.1 Have your sisters gotten pregnant at a young age? Yes/No

4.2 Have your friends gotten pregnant at a young age? Yes/ No

4.3 Have your relatives gotten pregnant at a young age? Yes/ No

5.1 Age at which you reached puberty:……………..

5.2 Have you had sexual relations before puberty? Yes/ No


5.3 Have you had romantic relationships? Yes/ No

If yes,

They started over the phone


Tuition classes
On the bus
Dhamma school

Other……………………….

5.4 Did those relationships go as far as sexual relations? Yes/No

5.5 Did your friends at your school have romantic relationships? Yes/No

5.6 Did you know that pregnancy could occur after sexual intercourse? Yes/No

If yes how did you learn about it?

Newspapers, Magazine, Television


Friends
School Health Education

Other………………………………………….

5.7 Have you been pregnant before? Yes/No

If yes,

How many times have you been pregnant? ……..

How many miscarriages have you had?..........


6.1 Do you know about other birth control methods? Yes/No.

6.2 If Yes, how did you learn about it?

Newspapers, magazines, television


Friends
From school health education
From the family health officer

Other……………………………………..

6.3 What birth control methods do you know?

Calendar method
Male and Female condoms
Oral contraceptives
Intrauterine Device
Permanent sterilization

Other…………………………………………………

6.4.1 Do you know about natural birth control methods? Yes/No

6.4.2 To avoid pregnancy when using the calendar method, when you should abstain
from intercourse in your menstrual cycle?

From the start of menstruation to the seventh day


From the seventh to the fourteenth day
From the 14th to the 28th day

6.4.3 Did you know that the effectiveness of natural birth control methods is low?
Yes /No
6.5.1 Do you know about birth control pills? Yes/No

If Yes, When you learned about birth control pills?

Before you got pregnant


After you get pregnant

6.5.2 Do you know how to use birth control pills? Yes/No

6.5.3 Have you used them? Yes/No

6.5.4 In which of the following ways you used or you expect to use them?

Daily
On and off
Once a week
Once a month
On the days you have sex with your partner
On your period days

Other…………………………………….

6.5.5 How do you expect or already started using the birth control pill new card?

Any day after the old card finished


The day after the old card finished
First day of periods
Last day of periods
When you do not have periods

other ………………………………….

6.5.6 Are you aware of the side effects of birth control pills? Yes/No

6.6.1 Are you aware of emergency contraception? Yes /No


6.6.2 Are you aware of the treatments to prevent pregnancy after sex? Yes/ No

6.6.3 If yes, what are the methods you know?

Prostino two tablets


High dose birth control pills

Other……………………………………………..

6.6.4 Irrespective of treatment, do you know that two pills need to be taken? Yes/No.

6.6.5 The first pill should be taken,

After sexual intercourse, within 72 hours


After sexual intercourse, after 72 hours

6.6.6 The second pill should be taken after having the first pill,

Within 12 hours of the first pill


Exactly Twelve hours after the first pill
Twelve hours after the first pill

7.1 Do you have any knowledge about taking care of children? Yes/No.

7.2 Do you expect to raise the child yourself? Yes/No

7.3 If the answer to the above question is no, what do you expect to do for the child's
future?

Hand over legal custody to someone


Hand over the child to a childcare home
Ask parents to take care of the child

Other…………………………………………………..
7.4 After the child's birth what do you plan to do for your future?

To resume school education


To engage in employment
If unmarried to get married Other

Other……………………………………………………

7.5 If you expect to resume school education, to whom will you give custody of the
child?..............................................................

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