grop project

6001.docx

1. What is your gender?

[ ] Male [ ] Female

2. How old are you? ………………..

3. What is your highest level of education?

[ ]High school

[ ]College graduate

[ ]Post-graduate

4.What is your nationality?

[ ] Australian

[ ] Non-Australian

5. What is your relationship status?

[ ] Single

[ ] Married

[ ] Divorced

[ ] Widowed

6. Which of the following qualification suits the number of time you have participated in blood donations?

[ ] Never

[ ] First-time donor

[ ] Repeated donor

[ ] Multigallon donor

[ ]fear of pin

[ ]fear of impact of health condition

[ ]fear of epidemic

[ ]never asked to donate

[ ]Apathy

other factors:

8. To what degree does/do the following factor/factors encourage you to donate blood.

self-esteem

potential needs in the future (for one’s own and family memebers)

physical rewards

demand from people who need blood

9. In what kinds of channels did you learn the knowledge of blood donation?

(1) TV (2) ARCBS website (3) Radio (4) Poster (5) hearsay (6)Nonofficial website (7) __________

10. do you think the knowledge you learn help you eliminate the concerns for donating blood? 0-------10

11. Despite of the negative factors, are you willing to donate blood if you knew someone can be saved by your blood?　　［］ yes [ ]no [ ] not sure

12. Do you think regular presentation held in communities can help to encourage people to donate blood? [ ] yes [ ] no [ ] maybe

13. is there anything you want to comment regard of blood donation, ARCBS, etc.