Appendix 3: Questionnaire

A Questionnaire to collect data on utilization of dental services and associated factors among
adults aged 18-45 years in Lira district.
Please choose the right alternatives
Section A: ngec akwako kwnen ame dano bedo iye
Section A: Socio demographics
1 Scio 1 Mwaka ……………
2 Scio 2 Ibedo icoo onyo dako 1. Icoo
2. Dako
3 Scio 2 Rwom me kwan 1. Primary
2. Secondary
3. Kwan me rwom amalo
4. Pe akwano
4 Scio 2 kabedo 1. Caalo
2. itawun
5 Scio 2 Inyomere onoy pe? 1. anyomere
2. pe anyomere
6 Scio 2 Itio onoy pe itio? 1. Atiu
2. Pe atiu
7 Scio 2 Inwongo cente adi dwe idwe …………………….
8 Scio 2 Iworo I ot yat moro keken me nwongo 1. Eyo
kony akwako two me lak 2. Pe
9 Scio 2 Ka tenyi, iworo kunu awene I (cabit/dwete )………
okato angec

10 Scio 2 Ka eyo, inwongo kony mene me lak 1. Pwony akwako yot kom
2. Yenyo two moro keken
me lak
3. Putu lak
4. Culu wang lak ame
opiru
5. Lwoko lak
6. Lwoko lak me dok dwog
atar
7. Golo lak
8. Keto lak okene
9. Dwoko lak I lain
10. Mwono lak otur

Section B: Kop akwako dano

11 Indiv 1 Two me lak mene ame dwong aloo? 1. Two ame mako otinyo
onoy lak opiru
2. Cwak ame otur
3. Lak ame omuk
 4. Pe angeo
12 Indiv 2 Kwene ame kony me two lak romo 1 HCIV
nwongere iye? 2 HCIII
3 HCII
4 Pe angeo
13 Imaro limo dakatal me lak iyonge kare 1 Dwete 6
aromene 2 Mwaka 1
3 Ka komi lit
4 Pe angeo

14 Indiv 3 Dano myero jwa lake tyelo adi alubere 1 Iryo dikidik
kede tami? 2 Icel keken
3 Iyonge cem
4 Pe angeo
15 Indiv 4 Yin itimo ngo ka laki ocako rem? 1 Awoto bot dakatal me
lak
2 Atio kede yat lango
3 Anwongo yat ame gweo
arem
4 Pe atimo ginoro keken
16 Indiv 5 Inwongo ngecoro keken akwako kop 1.Eyo
ikom kony me two lak?
2.Pe
17 Indiv 6 Ka eyo, inwogo ngec no ikwene? 1 Radio
2 TV
3 Papara akwana
4 Social media
5 Owote
6 Jo pacu
7 Otic me yot kom
18 Indiv 7 Peko mene ame inwongo ikin men ame 1. Lak ame opir onyo two
ocoye ping kan? amako otinyo
2. Arem me lak
3. Cwak ame otur
4. Lak ame omuk
5. Lak ame omale
6. Lak ame pe tar
7. Bur ame tye I dog dano
8. Dok angwee
9. Dog ame otwo
10. Lak ame dongo ataa.
19 Indiv 8 Onyo inwongo peko moro keken ikare 1. Pe
ame itye inwongo kon me two lak I 2. Eyo
dakatal?
Section C: Kop akwako oy yat
20 HSF 1 Dakatal me lak bor aromene? ……………i KM
21 HSF 2 Dakatal no obedo me anga 1. Gamente
2. Me adaano
3. Me adaano ento me
nono (NGO)
22 HSF 3 Kony tye iwel atek onyo iwel ayot 1. Pe
2. Eyo
23 HSF 4 Nyony me tic ikom lak bedo atye onyo 1. Eyo
bedo ape? 2. Pe
24 HSF 5 Onyo kony ame omio tye aber bot otwo? 1. Eyo
2. Pe
25 HSF 6 Otic me yot kom bedo atye gini icawa 1. Eyo
ducu? 2. Pe
26 HSF 7 Alubuere kede tam ni, jonu opwoneyre 1. Eyo
gini? 2. Pe

Apwoyo pi akam ni