QUESTIONNAIRE FOR ASSESSING THE INFLUENCE OF SOCIAL
FACTORS ON THE ACCEPTANCE OF BREAST CANCER
SCREENING AMONG MARKET WOMEN
Questionnaire no.: ……….…
Date: ………………………..
Instructions
Please tick () the box that matches your answer or fill the space provide
PART A: General Information
1. Age
a. 18-25 ( )
b. 26-30 ( )
c. 31- 40 ( )
d. 40 and above ( )
2. Academic qualification
a. Certificate ( )
b. Diploma ( )
c. Undergraduate degree ( )
d. Others (please specify) .……………………………………………………
3. How long have you been working in your present job?
a. Less than 5 years ( )
b. 6 to 10 years ( )
c. Over 11 years ( )
PART B:
This part contains four sections relating to the influence of social factors; breast cancer
awareness, accessibility to cancer screening services, perception towards breast cancer
and attitude towards breast cancer on the uptake of breast cancer screening among
women at the Nairobi City Park Market.
SECTION 1: Influence of breast cancer awareness on the uptake of breast cancer
screening
4. Have you ever heard about breast cancer?
a. Yes (please answer question 5) ( )
b. No (please skip question 5 and go directly to question 6) ( )
5. Where did you hear about it?
a. Social media (Television, internet, Newspaper or Radio) ( )
b. School/college ( )
c. Seminars and Conferences ( )
d. Local community Programs ( )
c. Other (please specify) …………………………………................
…………………………………………........................................
6. Are there any training programs on breast cancer that you know?
a. Yes ( ) (please answer question 7 and 8)
b. No ( ) (please skip question 7 and 8, go directly to question 9)
7. Where are the training programs held?
a. At the Market place ( )
b. Church ( )
c. Estate ( )
d. Other (please specify) …………………………………………………….
…………………………………………………………………………….
8. Do you attend the training programs?
a. Yes ( )
b. No ( )
9. Name any two methods of breast cancer screening,
………………………………………………….
………………………………………………….
10. Name the Hospitals or other health centers where breast cancer screening is done,
…………………………………………………….
…………………………………………………….
…………………………………………………….
SECTION 2: Influence of accessibility to cancer screening services on the uptake of
breast cancer screening
11. What is your income per month?
a. Less than Ksh. 10,000 ( )
b. Ksh. 10,000-20,000 ( )
c. Ksh. 21,000-30,000 ( )
d. Ksh. 31,000 and above ( )
12. Do you have any kind of health care cover, including health insurance such as
NHIF? a.Yes ( )
b.No ( )
13. When was the last time you visited hospital for normal check-up? ........................
…………………………………………………………………………………….
14. How do you normally travel to go to Hospital?
…………………………………………………………………………………….
15. Have you ever been screened for breast cancer?
a. Yes ( ) (answer question 16)
b.. No ( ) (skip question 16 and go directly to question 17)
16. How much did you pay for breast cancer screening?
……………………………………………………………
17. How frequent do you go for breast cancer screening?
a. Monthly ( )
b. Twice/ year ( )
c. Once/ year ( )
d. Other (specify) ……………………………………………
e. I don’t ( )
18. What is your experience in accessing breast cancer screening services?
………………………………………………………………………………………
………………………………………………………………………………………
……………………………………………………………………………………....
SECTION 3: Influence of perception towards breast cancer on the uptake of breast
cancer screening.
19. Using the Likert 1-5 scale, with
1. = Strongly agree
2. = Agree
3. = Neutral
4. = Disagree
5. = Strongly disagree
How do you agree with the statements below? Please tick () in the spaces provided for
all the questions as appropriate
12345
A. Breast cancer only affects old
women aged 40 years and above
B. Breast cancer is more common in
women with a positive family
history of breast cancer
C. Breast cancer can only develops in
women with formal employment
D. Breast cancer treatment is painful
SECTION 4: Influence of attitude towards breast cancer on the acceptance of breast
cancer screening
20. If you develop breast lamb how first will you go to see a doctor?
a. Within one Week ( )
b. Within one Month ( )
c. Within one to three Months ( )
d. Not bother at all ( )
21. Will you allow a male doctor to examine your breast?
a. Yes ( )
b. No ( )
22. Using the Likert 1-5 scale, with
1. = Strongly agree
2. = Agree
3. = Neutral
4. = Disagree
5. = Strongly disagree
How do you agree with the statements below? Please tick () once in the spaces
provided for all the questions as appropriate.
1 2 3 4 5
A. Breast cancer screening is a stress free process
B. You will be treated well if you go for breast
cancer screening for the first time
C. Breast cancer can be cured once it has been
detected early
D. It is a waste of money to go for breast cancer
screening
