Test Instrument For Research

TRIVUVAN INSTITUTE OF MEDICINE

LALITPUR NURSING CAMPUS, SANEPA Research Topic: A study on knowledge regarding sexual transmitted infection among the workers of carpet factory Objectives: To assess the knowledge regarding sexual transmitted infection among the workers of carpet factory

Survey Questionnaires:

PART-I A-Demographic Characteristics 1- Age ----------------------2-Sex ----------------------3-Address: • Permanent address: -----------------------• Temporary address: ----------------------4-Marital status a) Married

b) Unmarried

If married, No of alive children

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4- Ethnic group:

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5- Religion:

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6-Educational Status:

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7-Duration of working in carpet factory-----------------

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PART-II B- Knowledge related to sexually transmitted infection 9- Have you heard about STI a) Yes

b) No

If yes, Sources a) Radio/FM/TV

b) Friends/Neighbors/family

c) News paper, books

d)Others

11- In your opinion, what is sexually transmitted infection? a) Communicable disease of genital tract

b) disease of genital tract

c) Others

d) don't know

12- In your opinion, which is the STI in the following? a) Syphilis c)HIV/AIDs

b) Gonorrhea d) Others

13- How can transmitted sexually transmitted infection? a) Unsafe sexual contact c) Both of them

b) From mother to child/blood to blood d) don't know

14-In your opinion, STI patient having excessive white vaginal discharge? a) Yes b) No 15- In your opinion, STI patient having sore in private part? a) Yes b) No 16- In your opinion, STI patient having lower abdomen pain? a) Yes b) No 17- In your opinion, STI patient having swelling in groin? a) Yes b) No 17-Inyour opinion, STI can be transmitted by vaginal discharge, semen? a) Yes b) No

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18- In your opinion, how STI could not transmit from one to another? a) Sharing of toilet and bathroom b) Cough and sneezing c) Sharing of food and utensil

d) others

19- In your opinion, how STI can be treated? a) Yes 20- If yes, where have to go to treat STI ? a) Health Post

b) No

b) Hospital

c) Private Clinic

d) Others

21- Which is the vulnerable group for STI? a) Female sex workers

b) Multiple partner

c) Mother to child

d) others

22- In your opinion, STI can be prevented? a) Yes b) No 23-In your opinion how can be prevented from STI? a) Avoid multiple sex partner b) Use of condom during sexual intercourse c) Screening blood transfusion / Avoid pregnancy (mother to child transmission)

d) Don't know

24- Have you sexual relation with multiple sex partners? a) Yes b) No 25- If yes, did you use condom? a) Yes

b) No

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