College of St.

John-Roxas De La Salle Supervised Banica, Roxas City College of Nursing LISTAHAN SANG MGA PAMANGKOT Palihog tsek sang imo sabat sa kada pamangkot : Una nga parte. DEMOGRAPHIC PROFILE 1.Edad: __________

2. Pagtansya/ pagmana-mana nga kita sang pamilya kada bulan: ______________

3. Tinaposan: Elementarya Hayskul Kolehiyo ( ) ( ) ( )

Wala pormal nga edukasyon ( ) Others ( ) (palihog butang) _____________

Pangaduha nga parte.

4. Gagamit ka bala sang maskin ano nga pamaagi sang family planning? Hou ( )

Hindi ( )

5. Kung imo sabat hou, palihog tsek sang pamaagi nga imo nagamit na nakabutang sa listahan sa idalum: a.) Pills b.) Intrauterine devices (IUDs) ( ) ( )

c.) Condoms d.) Injections e.) use of calendar

( ) ( ) ( )

f.) Iban pa ( ) (palihog butang) ________________

6. Paano mo nahibalo-an ang mga pamaagi sa family planning nga napili mo na nakabutang sa ibabaw? Palihog tsekan ang nagaka-angay nga sabat: a.) Sa laygay sang doctor b.) Sa Medya ( ) ( )

c.) Kaugalingon nga desisyon sang pamilya ( ) d.) Iban pa ( ) (Palihog butang) ________________________

College of St. John-Roxas De La Salle Supervised Banica, Roxas City College of Nursing QUESTIONAIRE Fill the blank or check the appropriate box of your corresponding answer: Part I. DEMOGRAPHIC PROFILE 1.Age:_________

2. Estimated Monthly Family Income: _____________

3. Educational Attainment: Elementary Level ( ) High School Level ( ) College Level ( ) No formal education ( ) Others: ________________ (pls. indicate)

Part II. 4. Have you used any family planning methods? YES ( ) NO ( )

5. If your answer to the above question is yes, please check the method(s) you have used or are using the list below: a.) Pills b.) Intrauterine devices (IUDs) c.) Condoms ( ) ( ) ( )

d.) Injections e.) use of calendar

( ) ( )

f.) Others ( ) (pls.specify) ________________

6. How did you learn about family planning methods you have selected above? Please check the appropriate given options: a.) By doctors advice b.) From the media c.) Own family decision ( ) ( ) ( )

d.) Others ( ) (pls. specify) ________________