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Pre and Post Questionnaire
Pre and Post Questionnaire
Name: _________________________
The purpose of this survey is to study the knowledge, attitude, and practice of consent and safe
sex practices. By filling out the questionnaire, you are voluntarily agreeing to participate. Be
aware that this survey requests the discussion of personal sexual practices and may be
uncomfortable. If for any reason you feel uncomfortable, please let the survey administrator
know and you will be excused without penalty.
INSTRUCTIONS:
Please read each question or statement carefully, circle and print responses legibly.
1
2. Fairly confident
3. Confident
4. Slightly confident
5. Not confident
11. Is the way a person dresses, smiles, looks, or acts an indication of the desire to have
sex?
1. Yes
2. No
12. How important is it for both parties to understand sexual consent before any
sexual activity?
1. Very important
2. Fairly important
3. Important
4. Slightly important
5. Not important
2
3. Agree
4. Slightly agree
5. Do not agree
15. You do not need a condom if you do not have a lot of sexual partners.
1. True
2. False
17. Do you always check the expiration date of a condom prior to usage?
1. Yes
2. No
3. Not applicable
20. Have you ever been tested for a sexually transmitted infection?
1. Yes
2. No
3
INSTRUCTIONS:
Please read each question or statement carefully, circle and print responses legibly.
1. After viewing the PSA, how confident are you in your ability to define sexual consent?
1. Very confident
2. Fairly confident
3. Confident
4. Slightly confident
5. Not confident
3. After watching the PSA, I understand the emotional distress that results from
stealthing.
1. Yes
2. No
4. After watching the PSA, how important is it for both parties to understand
sexual consent before any sexual activity?
1. Very important
2. Fairly important
3. Important
4. Slightly important
5. Not important
5. After watching the PSA, I am fully confident on how to properly use a condom.
1. Very confident
2. Fairly confident
3. Confident
4. Slightly confident
5. Not confident