ANNEX 1 QUESTIONARY

Fekede Egzi college of health science department of Nurse

My name is ----------------------------------------------- (Interviewer)

I am an undergraduate BSc candidate in Nurse Fekede Egzi college of health science, Department of
nurse. Iam collecting data from reproductive age group women living in Debre Tabor town to write my
graduation paper.

This study is to be conducted with the objective of assessing knowledge, attitude, and practice and
associated factors towards implant utilization among currently married reproductive age group women.
Therefore, you are kindly requested to participate in this study and provide some information I required
from you. Your responses will be kept confidential. If you don’t want to participate you may end up the
interview at any time.

I would like to inform you that the response that you provide to the questions are very essential for
producing relevant information which will be helpful in differentiating the gap, planning,
implementation of utilizing implant contraceptives.

Code

Are you voluntary to respond for the questions? 1. Yes 2. No

If yes, proceed with the interview

If No, thank the respondent and end the interview.

ANNEX –II QUESTIONARY

PART I: Socio Demographic Characteristics

S. No QUESTION ANSWER

1 Respondent Age --------(in years)

2 What is your ethnicity? A. Amhara

B. Oromo

C.SNNP

Others/Specify

3 What is your educational status? A. Not able to read and write

B. Able to read and write

C. Primary school (1-8 grade)

 D. Secondary/prep school

E. College/university

4 What is your husband’s educational A. Not able to read and write

status?
B. Able to read and write

C. Primary school (1-8 grade)

D. Secondary/ prep school

E. College/university

5 What is your main occupation? A. House wife

B. Farmer

C. Government employee

D. Student

E. Merchant

F. Others specify

6 What is your religion? A. Orthodox

B. Muslim

C.Protestant

D. Others/specify

7 What is your family monthly income in

Ethiopian Birr?

8 Is there any mass media in your house A. Yes

(Radio/TV)
B. No

PART II Reproductive health history

S. No QUESTION ANSWER

1 Age at marriage? ------(in year)

2 No of pregnancy

3 No of child birth

4 If history of child birth, Age at first

child birth?

5 How many children do you have

currently?
No of male-----------

No of female--------

6 Have your history of abortion? A. Yes

B.NO

7 If yes, question No 6. how many --------(in No)

times?

8 Have your history of new born A. Yes

death?
B.NO

9 If yes, how many times? ------(in no)

10 Where did you give birth your last A. Health facility

child? (hospital, health center,
health post, clinic)

B. Home

11 Have you faced complications A. Yes

during your last child birth?
B.NO

12 Who are responsible for deciding A. Yourself

to have children?
B. Your Husband

C. Both of you in joint

discussion
PART III: KNOWLEDGE ABOUT CONTRACEPTIVE METHODES

1. Have you ever heard about modern A. Yes

prevention of pregnancy methods?

B.no

2. Have you ever heard about long A. yes

acting prevention of pregnancy
B .no
methods?

3. Which types of prevention of A. pills

pregnancy methods do you heard
B. injectable
or know it (grater thanone answer
is possible but do not read the C.implants
following for them)
D.IUCD

E. other (specify

4. From where do you heared about A. from health personnel

prevention of pregnancy methods?
B. from media

C. from friend

D. from schools

E. other(specify)

5. What is the importance of using A. for spacing

 prevention of pregnancy method B .to limit pregnancy
(more than one answer is possible)
C .to prevent STI

D.Other (specify)

6. What is the side effect of using A. headache

prevention of pregnancy method?
B. increase weight
(more than one answer is possible)
C. twin pregnancy

D. irregularity of period

E. other (specifies)

7. Do you know implants as a A. Yes

prevention of pregnancy method?
B.no

7.1 If yes where is the site of implant --------------------

insertion

7.2 If No which type of prevention of A. pills

pregnancy methods used in the
B. injectable
last?
C.implants

D.IUCD

E. other (specify

8 Do you know where implant service A. Health center

given?
B. Hospital

C.Health post

D.Private clinic

9 By whom implant given? A. Midwifery

B. Health extension worker

C.Other

10 For how many years implant use as A .3

a prevention of pregnancy
B .2
methods?
C .5

D .12
 11 What is the dis advantage of using A. Spontaneous abortion
implant contraceptive methods
B. Congenital anomalies
after removal?
C.Delay fertility time

D. Infertility

E. other (specifies)

Part IV: Questions to assess the attitude of women toward Implanon contraceptive utilization

5. Strongly agree 4. Agree 3. Neutral 2. Disagree 1. Strongly disagree

S. N Questions 5 4 3 2 1

1 Hormonal implants cause sterility

2 Hormonal implants cause spontaneous abortion

3 The hormonal implants are not effective to prevent pregnancy

4 Hormonal implants cause low birth weight babies in the future

pregnancy

5 Hormonal implants make the users thin

6 Hormonal implants negatively affect breast milk

7 Hormonal Implants cause irregular Uterine bleeding

8 Hormonal implants don’t help the mother to regain strength

before her next baby

9 Hormonal Implants cause the users arm loss

PART V: Practice of Contraceptive

S. No QUESTION

ANSWER

1 Have you ever used any modern A. Yes

contraception?
B. No

2 If yes, what type of contraceptive A. short acting contraceptive

methods? methods (Injectable, Pills, condom)

Belongs acting contraceptive

methods (IUCD, implant, jeddel)

3 If you are currently using short acting
contraceptive methods (oral pills or
injectable), why you are not using long
acting contraceptive methods?
A. Want pregnancy in a short period
B. Because, it causes infertility
C.Has more side effects

D.Oher methods are not available

E. Other/specify

4 If you are currently using long acting A. Implant

contraceptive methods, what types?
B. Jeddel

C.IUCD

5 If used Implant contraceptive methods, for A One years

how many years?
B. Two years

C.Three years
 D.Greater than three years

6 If ever used implant what was the main A. Its expiry time
reason that you stopped using the
B. Desire to have more children
method?
C.Fear of fertility

D.Irregular uterine bleeding

E. Rumors as not good

F. Others/specify

7 If ever not used implant what was the A. Fear of procedure during
reason? insertion and removal

B. It cause users arm loss

C.Unavalibility in the nearby

D.Negatively affects breast milk

E. It causes user thin

F. Others/specify

8 If you are using Implants currently who is A. Health workers

your source of information to use it?
B. Media

C.Husband/family

D.Friends

E. Others/specify

9 If you are using Implants currently, are you A. Yes

satisfied with this method?
B. No

10 What is the side effect of using implant A. irregularity menstrual period

currently?
B. Increasing body weight

C.Headache

THE END OF THE INTERVIEW

THANK YOU!

Name of Data Collector _____ Date: ______ Sign: __________