CRC Knowledge:

1) Have you ever heard of colorectal cancer?

2) Have you ever heard about early screening for colorectal cancer?

3) Do you know if any of the following increases the possibility of colorectal cancer?

Age

Family history

Tension

Smoking

Alcohol

Obesity

Not doing sport activities

Gastro-system diseases

Diabetes

4) Do you know if any of the following is a symptom of colorectal cancer?

Tummy inflation

Blood in stool

Change in bowel habit

Gases

5) What is your source for the information you have about colorectal cancer?

Physician

Nurse

Friend

Family members

Newspaper

Periodical

Media

Internet

Others, please specify ____________

6) If your completed years of age are below 40 years, please omit this question.

After reading the following statements, please choose the only one that expresses your opinion about colorectal cancer.

a) I never thought about having an early screening test to detect colon cancer.

b) I don’t think I need to do any screening test for early detection of colon cancer.

c) May be I need to do an early detection test, and I am thinking of what to do.

d) I am ready to do the early screen test for colon cancer but I haven’t done it yet.

e) I have been screened for early detection of colon cancer.

7) Do you plan to get an early screening test for colon cancer even in the absence of symptoms, knowing that early screening can stop this disease?

8) Do you think that you can reduce the possibility of getting colorectal cancer?

9) Have you ever done any of the following tests?

a) FIT b) Colonoscopy

If your answer is no, please indicate which of the following tests you are planning to have:

a) FIT b) Colonoscopy c) None

10) Do you have any relatives that got colon cancer?

If your answer is yes, please indicate the ages of the infected persons___________.

Respondent Demographics:

1) Completed years of age at last birthday

2) Gender

3) Marital status

4) Residence

5) Working status

6) To whom you recur when you feel of any health related problem?