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* Age Years:
* Level of Education of your husband:
1- Does not read or write
2- Primary
3- Preparatory
4- Secondary
5- University or equivalent
* Total Duration of marriage:
1) 1-5 years
2) 6-10 years
3) 11-15 years
4) 15-20 years
5) < 20 years
(1) Have you ever heard about pap smear
(taking a sample from the cervix).
1- Yes
2- No
(2) If Yes, from where or whom did you get to know about this cancer?
1- Family / Friends
2- Your Family physician Dr.
3- You're Gynecology Dr.
4- Nurse
5- News paper, Television. & Internet
6- Others (
)
(3) Have you ever had a pap smear?
1- Yes
2- No
(4) Have you ever heard of cervical cancer?
1-Yes
2-No
(5) What do you think the risk factors which can lead to cervical
cancer?
1- Early age of marriage (>18)
2- Multiple partners
3- Smoking
4- STDS
5- Diet
6- Others (
)
(6) Is it possible to cure this cancer?
1- Yes
2- No
(7) Is it possible to detect cervical cancer before symptoms appear by
pap smear?
1- Yes
2- No
(8) Is early detection of cervical cancer good for treatment outcome?
(9) If you were told that pap smear test is simple, painless procedure
& good for early detection & treatment of cervical cancer, would
you like to have one?
1- Yes (go to question # 11)
2- No (go to question # 10)
(10) If No, Why?
1- It may be painful.
2- I feel shy
3- I am healthy
4- My husband would not agree
5- Others (
)
(11) If Yes, where do you like to have your pap smear taken?
1- Primary health care center.
2- Well women clinic in the hospital
3- Obstetric and Gynecology clinic in the Hospital.
(12) Who do you prefer to perform this test for you?
1- Family physician / GP.
2- Gynecologic Dr.
3- Maternal & child health Dr.
4- Private Dr.
5- Nurse

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