Form to be filled by sexually active / married WOMEN(aged 25-60 yrs)
Perceptions and Opinions on cancer and general health
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watsapp number (will be used to send information about health)
Name(not mandatory)
Total(annual) income of the family members pooled together - approximate *
Civil status *
Sexually active (engaged in sexual intercourse) *
1.Age (in years) *
2.Education (highest level of education attained) *
3.Kannada language proficiency *
4.Religion
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5.Employment (job) *
6.Are you trained in any health care profession? *
(hold a health care degree example Registered nurse, doctor, physiotherapist, microbiologist etc )
7.How easy/ difficult it is for you to undergo general health check up   *
(How easy is it for you to spend 1000-3000 Rs per year for general health check up )
8.Is your general health expenditure covered under any health insurance? *
9.Who makes decisions for your expenditure on General health check-ups *
b.Able to use google/ other search engines on the phone to find information *
10.Do you do regular blood tests and health check-ups even when you are healthy *
11. Did you have any of the problems before?     (Tick the ones that you had) *
Required
12. Have you done a test of your uterine cervix to check-up for cervical cancer? *
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