Oral Cancer KAP Survey Form
Please complete this short survey to help us understand knowledge, attitudes, and practices related to oral cancer. Your responses are anonymous.
Age Group
*
Please Select
18–24
25–34
35–44
45–54
55–64
65 or older
Gender
*
Male
Female
Other
Prefer not to say
Which of the following do you think are risk factors for oral cancer? (Select all that apply)
*
Tobacco use (smoking or chewing)
Alcohol consumption
Chewing betel nut/paan
HPV infection
Poor oral hygiene
Family history of oral cancer
None of the above
How confident are you in recognizing early signs or symptoms of oral cancer?
*
Not at all confident
1
2
3
4
Very confident
5
1 is Not at all confident, 5 is Very confident
Have you ever been screened for oral cancer by a healthcare professional?
*
Yes
No
Not sure
How often do you use any of the following substances?
*
Rows
Never
Occasionally
Frequently
Daily
Tobacco (smoking)
1
2
3
4
Tobacco (chewing)
5
6
7
8
Alcohol
9
10
11
12
Betel nut/paan
13
14
15
16
How serious do you think oral cancer is as a health problem?
*
Not serious
Somewhat serious
Very serious
Not sure
Would you be willing to undergo oral cancer screening if recommended by a healthcare provider?
*
Yes
No
Maybe
Where do you usually get information about oral cancer?
*
Healthcare professionals
Internet/websites
Television/radio
Friends/family
Newspapers/magazines
Social media
Other
What additional information would you like to have about oral cancer?
Submit Survey
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