Cervical Screening KAP Survey Form
A knowledge, attitude, and practice survey about cervical screening. Please answer the questions based on your experience and understanding.
Respondent Profile
Age group
*
18–24
25–34
35–44
45–54
55–64
65+
Gender
*
Female
Male
Non-binary
Prefer not to say
Other
Education level
*
Please Select
No formal schooling
Primary
Secondary
Diploma/Certificate
Bachelor’s degree
Postgraduate
Other
Residence area
*
Urban
Rural
Suburban
Clinic-based
Community-based
Other
Knowledge About Cervical Screening
Where have you learned about cervical screening?
*
Doctor or nurse
Clinic or hospital
School or college
Family or friends
Social media
News or internet
Community health campaign
Other
How much do you agree with the following statements?
*
Rows
True
False
Cervical screening is done to help find changes early before they become serious.
1
2
Cervical screening should be done only when a person has symptoms.
3
4
People who are at risk or eligible should consider regular screening as recommended by a health professional.
5
6
When should cervical screening be done?
*
Only when there are symptoms
At regular intervals as advised by a health professional
Only after age 50
I am not sure
Attitudes and Practices
Attitudes toward Cervical Screening
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel comfortable discussing cervical screening with a healthcare provider.
7
8
9
10
11
I believe cervical screening is important for women's health.
12
13
14
15
16
I am confident I can arrange a cervical screening when needed.
17
18
19
20
21
I have concerns that may make it difficult for me to get screened.
22
23
24
25
26
Screening history or intention
*
Have been screened before
Intend to screen in the next 12 months
Not sure
Do not intend to screen
Prefer not to say
Submit
Should be Empty: