Sociodemographic Information

1. Name of the participants.

2. Age of the participants.

3. What is your education?

4. What is your current marital status?

5. How many members are there in your family?

6. What is your occupation?

7. What is the type of your family.

Chronic Disease Information

1. Is there anyone suffering from cancer in your family?

2. Do you have anyone in your family suffering from diabetes/hypertension/kidney disease/heart disease?

3. Is there anyone in your family who is bed ridden?

4. If yes, how old is he/she?

5. What is the reason of illness?

6. Is there anyone in your family who is more than 70 years old?

7. Do you have anyone in your family who has dementia?

Breast Cancer Related Information

1. Are you currently pregnant?

2. Have you ever experienced abortion?

3. Have you ever experienced miscarriage?

4. Did you breast feed your children.

5. Have you ever used contraceptive.

6. How old were you when your menstrual periods have stopped?

7. Have you ever heard of breast cancer?

8. Is there anyone in your family suffering from breast cancer?

9. Do you know how to do self-examination for breast cancer?

10. Have you ever felt any lump in your breast?

Lung Cancer Related Information

1. Do you smoke?

2. If yes, how many in a day?

3. When did you start smoking?

4. Have you ever stopped smoking for more than 6 months?

5. Have you ever heard of lung cancer?

6. Have you ever diagnosed with bronchitis/asthma/tuberculosis?

7. Are you taking any medicine currently?

Cervical Cancer Related Information

1. Have you heard of cervical cancer?

2. Did a health provider talk to you about cervical cancer?

3. Do you use sanitary napkins?

4. Have you ever heard of a vaccine to prevent cervical cancer?

5. Have you ever heard of a vaccine to prevent cervical cancer?

6. Have you ever undergone any of the examinations? -Pap smear, VIA.

7. If yes what was the result?

8. Have you ever heard about HPV?

Oral and Facial Maxillary Cancer related Information

1. Do you have a sharp tooth?

2. Have you ever felt pain or burning sensation inside mouth?

3. Have you ever experienced pain or swelling on neck?

4. Have you ever visited a dentist?

5. Do you chew betel nut/tobacco leaf/pan/masala?

6. Do you use any other kind of smoke?

7. Have you ever suffered from discharging pus/sinus/oozing from mouth?