Research Tool

Self-Administered Questionnaire
Purbanchal University
Koshi health and science campus
Biratnagar ,Nepal

Serial No ……. Date:

knowledge regarding pap smear test among
Research Title:
bachelor nurses at koshi zonal hospital, biratnagar.

QUESTIONNAIRE FOR DATA COLLECTION

Direction: Please tick ( √ ) the appropriate answer and you may tick more than one
answer in multiple response questions

Part I: Socio-demographic Data of Respondent

1. Age (in years) ……………….
2. Marital status
a) Single
b) Married
3. Working area (ward) …………………..
4. work experience
a) less than 5 yrs
b) 5-10 yrs
c) More than 10 yrs
5. Family history of cervical cancer
a) Yes
b) No
6. Training / In-service education received on cervical screening
a) Yes
b) No

Part II: knowledge of cervical cancer and Pap smear test

7. What is the meaning of the cervical cancer?

a) Wound of the cervix
b) Abnormal cell proliferation in the cervix
c) Dilatation of cervix
d) Atrophy of cervix

8. Which of the following is true about cervical cancer in Nepal?

a. Cervical cancer is most common cancer in Nepal.
b. Cervical cancer is 2nd most common cancer in Nepal.
c. Cervical cancer is 3rd most common cancer in Nepal.
d. Cervical cancer is 4th most common cancer in Nepal.

9. What are the risk factors of cervical cancer?(*multiple response)

a) Early age of coitus
b) Multiple sexual partners
c) Genital infection (HPV)
d) Smoking habit
e) Family history of cervical cancer
10. What may be the symptoms of cervical cancer?(*multiple response)
a) Post coital bleeding
b) abnormal vaginal discharge
c) Post menopausal bleeding
d) Painful coitus

11. What are the recommended preventive measures for cervical cancer?(*multiple
response)
a) Regular screening with pap smear test
b) Avoid smoking
c) Avoid contact from Human Papilloma virus (HPV)
d) Get vaccinated against HPV

12. Do you think cervical cancer can be treated if detected early?

a) Yes
b) No

13. What is the meaning of cervical cancer screening (Pap test)?

a) It is one type of the test which detects pelvic inflammatory disease.
b) It is one type of the test which detects pre cancerous lesion of the cervix.
c) It is a type of test which is used to treat the cervical cancer.
d) It is a type of test which is used to detect sexually transmitted disease.

14. What is the purpose of doing Pap smear test?

a) Detection of pre cancerous state of cervical cancer
b) Detection of sexually transmitted disease
 c) Cure of cervical cancer
d) Detection of pelvic inflammatory disease

15. When is the best time to take a specimen for Pap smear test?
a) During menstrual cycle
b) 3 days after menstrual cycle
c) 5 days after menstrual cycle
d) 7 days after menstrual cycle

16. When should the Pap smear test be started?

a) Anytime after onset of menstruation
b) after menopause
c) after 18 yrs of age
d) after 20 yrs of age

17. At what interval, the Pap smear test should be repeated?

a) 1 year
b) 2 years
c) 3 years
d) 4 years

18. For whom pap smear test is necessary?(*multiple response)

a) All married women
b) Women at age 21 yrs and above
c) Sexually active women
d) Women with weak immune system

19. Which conditions require more frequent pap smear test?(*multiple response)
a) Long term corticosteroid use
 b) Exposure to diethylstilbestrol (DES) before birth
c) HIV infection
d) Those in a polygamous relationship

20. How many days prior to the Pap test, coitus should be avoided?
a) 1 day
b) 2 days
c) 3 days
d) 4 days

21. Is Pap smear test necessary after total hysterectomy?

a) Yes
b) No

22. Would you want to know more about Pap smear test?
a) Yes
b) No

**Thank you for your valuable time**