SECTION: Knowledge, Perceptions, Screening History
No	Questions and Filters	Answers and codes		Skip to
Q01.	Have you ever heard of HPV or a disease called cervical cancer?	Yes…...............1 No……............2 No response…9	/___/
Q02.	Do you know anyone who has suffered from Cervical Cancer or died from Cervical Cancer?	Yes…..............1 No……...........2 No Response...9	/___/
Q03.	How can we protect ourselves against cervical cancer? INTERVIEWER, several answers are possible. Do not suggest answers, circle alphabetical letters according to respondent’s answers	a) Use the condom b) have few sexual partners c) Be faithful to an uninfected partner d) sexual abstinence e) early screening f) Vaccination g) Other h) No response
Q04.	Do you think that cervical cancer can be prevented by early detection?	Yes…………..1 No …………...2 No Response…9	/___/
Q05.	Is it possible to screen for cervical cancer in your community?	Yes……………1 No……..….......2 No Response …9	/___/
Q06.	what screening methods do you know?	VIA……………1 VILI……………2 VIA/VILI ……...3 Uterine cervical smear test…………….4 biopsy for cervical cancer test.……5 None……………6 Other (Specify)…7	/___/
Q07.	How often should we be screened for cervical cancer?	every three years……………….1 every three years bitten two normal smear tests…………2 every five years ……3 every year... ……….4 Other (Specify)……..5 Don’t Know……….. 8	/___/
Q08.	How do you think cervical cancer is transmitted?	Sexual intercourse …………………….1 Unprotected sexual intercourse………... 2 By dirty objects ……3 Other (Specify)……..4 Don’t Know………...8	/___/
Q09.	Can cervical cancer be prevented?	Yes…………………1 No ………………….2 No response………...9	/___/
Q010.	If yes enumerate the means do you know?	Vaccination…………1 Screening…………...2 Sexual abstinence…..3 condom use…………4 Don’t Know………...8	/___/
Q011.	Do you think early screening for cervical cancer facilitate the management of cervical cancer?	Yes…………………1 No…………..………2 No-response………...9	/___/
Q012.	When you discover cancer, is it always too late?	Yes………………1 No………..………2 No-response ……..9	/___/
Q013.	Perceptions of cervical cancer as chronic disease?	Cervical cancer does not last long………..1 Cervical cancer is likely to be permanent rather than temporary…2 Cervical cancer progress speedily…..3 I don’t think cervical cancer progress progresses throughout life…4	/___/
Q014.	Perceptions of the consequences of the disease	cervical cancer is severe ……………1 cervical cancer has important consequences on life………2 Cervical cancer does not have much effect on the person life……….3 Cervical cancer greatly affects how others see the sufferer…………4 cervical cancer has serious financial consequences……….5	/___/
Q015.	Emotional representation	I get depressed when I think about cervical cancer....................1 When I think to cervical cancer, I worry about it................................2 Cervical cancer doesn’t bother me.....3 Cervical cancer frightens me…………4	/___/
Q016.	Perceptions of curability of cervical cancer	effective treatment can cure cervical cancer.....................1 Negative effects of cervical cancer can be prevented (avoided) by treatment..................2 treatment can control cervical cancer........3 Nothing can help someone who starts cervical cancer .........4	/___/
Q017.	Perceptions of causes and risk factors
Q018.	Lifestyle	alcohol consumption….1 tobacco consumption…..2 personality type.........3 My overload work.....4 my behavior.............5 Chance or bad luck...6 dietary habits............7	/___/
Q019.	Biological or organic	a virus......................1 hereditary.................2 immunosuppression..3 aging..........................4	/___/
Q020. A	Physical or mental state	Injury, stress or trouble........................1 Aging.........................2 Solitude......................3 Abatement.................4 Anxiety.....................5 Having a negative view of oneself..........6	/___/
Q021.	Environmental pollution	Yes…………........1 No …….................2 No-response………9	/___/
Q022.	I don’t want to know the result, but have you ever been tested for cervical cancer?	Yes…………………1 No ………................2 No -response …….....9	/___/
Q023.	Specify the Method used	VIA …………..1 VILI……………2 VIA/VILI ……...3 Uterine cervical smear test…………….4 biopsy for cervical cancer test.……5 None…………6 Other (Specify)…7 Don’t know.…….…. 8	/___/
Q024.	Who made this or these tests?	gynecologist ………1 generalist physicians…............2 midwives ……........3 Anatomo pathologist ................................4 lab technicians ……5 Others (specify)…...6 Does not remember anymore …………...0	/___/
Q025.	Where did you do the screening?	Specify.....................................................................
Q026.	When did you screen for the cervical cancer, the last time? INTERVIEWER, circle the correct answer.	a) last 3 months b) last 6 months c) last 12 months d) 1 to 3 years e) More than 3 years f) Cannot remember
Q027.	In the last 3 years, how many times have you tested for cervical cancer?	a) None……….....1 b) Once……….....2 c) Twice ………......3 d) Tree times……....4 e) Four times and more …................5 f) Don’t know ….....8 g) No response ….....9 h) Does not remember ………..................0	/___/
Q028.	With regard to cervical cancer screening, what were the circumstances under which you performed the test? INTERVIEWER, circle the correct answer	a) voluntary b) by obligation c) by medical prescription d) other (specify) e) No response
Q029.	Why did you screen for Cervical Cancer? INTERVIEWER, circle the correct answer	a) Know my status b) A health worker proposed it to me c) Medical prescription d) Advice from a peer educator e) Advice from the treating physician f) Others (specify)------------------------------- g) No response
Q030.	So tell me if your test result was positive or negative	Positive..……………1 Negative ……………2 Don’t know …….......8 No response ..............9	/___/
Q031.	if not, what are the reasons why you did not screen?	Never thought to do..1 Embarrassed to be examined by a man...2 not informed..............3 Others (Specify).......................................4	/___/