Form to be filled by Sexually active / married MEN(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
Total(annual) income of the family members pooled together - approximate *
Civil status *
Sexually active (engaged in sexual intercourse) *
1. Age (in years) *
1b. Partner's (wife/ sexual partner) age(in yrs)
2. Education (highest level of education attained) *
3. Kannada language proficiency *
4. Religion
Clear selection
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 expenditure on general health check-ups for your partner/women in your family? *
10. Do you do regular blood tests and health check-ups even when you are healthy *
b. Able to use google/ other search engines on the phone to find information *
11. Did your wife/ sexual partner/ woman have any of the problems before?     (Tick the ones that she had) *
Required
12. Did your wife/partner/woman get cervical or vaginal examination done *
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