SURVEY QUESTIONNAIRE ON DENGUE PREVENTION AND CONTROL

NUMBER CODE OF PARTICIPANT______________

PART I. SOCIODEMOGRAPHIC INFORMATION

Instruction: Please put a check mark [ ] on the selected option based on the following
sociodemographic information.

Sex: ___ Male ___ Female

Age: ___ 18-23 ___ 30-35 ___ 42-47 ___ 54-59

___ 24-29 ___ 36-41 ___ 48-53

Civil status:
___ Single ___ Separated
___ Married ___ Widowed

Education level:
___ Post-graduate (Masters or PhD)
___ College graduate (4-year course)
___ College undergraduate
___ Graduate of any 2-year course
___ High school graduate
___ High school undergraduate
___ Elementary graduate
___ Elementary undergraduate

Employment status:
___ Employed (private) ___ Self-employed
___ Employed (public) ___ Unemployed

Number of family members living in the household:

___ 1 ___ 3 ___ 5
___ 2 ___ 4 ___ 6 or more
Monthly average family income (Albert et al., 2020):
___ PhP10,957 or below
___ Between PhP10,958 to PhP21,914
___ Between PhP21,915 to PhP43,828
___ Between PhP43,829 to PhP76,699
___ Between PhP76,700 to PhP131,484
___ Between PhP131,485 to PhP219,140
___ More than PhP219,140

Type of residence:
___ Bungalow/residential house
___ Condominium/apartment
___ Town house

Residing in a flood-prone area:

___ Yes ___ No ___ Not sure

Abundance of plants/trees/vegetation (surrounding your place of residence):

___ High ___ Moderate ___ Low ___ None

Abundance of mosquitoes (in your place of residence):

___ High ___ Moderate ___ Low ___ None

Frequency of fogging activities (in your neighborhood):

___ Regularly ___ At times ___ Rarely ___ Never
PART II. SURVEY QUESTIONNAIRE

A. Knowledge on Dengue
Instruction: Please indicate your level of awareness and understanding on the
following statements.

STATEMENTS YES NO
Knowledge on the cause
1. Dengue is caused by a virus.
2. Dengue is caused by a mosquito bite.
3. Dengue mosquitoes are likely to feed/bite in the
afternoon.
Knowledge on susceptibility and severity
4. Dengue is an infectious disease.
5. Anyone can be infected by dengue.
6. A person can be infected by dengue more than once.
7. Dengue is curable.
8. Dengue can cause death if left untreated.
Knowledge of symptoms
9. Fever is a symptom of dengue.
10. Headache is a symptom of dengue.
11. Rashes are symptoms of dengue.
12. Joint and muscle pains are symptoms of dengue.
13. Abdominal pain is a symptom of dengue.
Knowledge of transmission
14. Flies transmit dengue fever.
15. Ticks transmit dengue fever.
16. All types of mosquitoes transmit dengue fever.
17. Person to person contact transmits dengue fever.
18. Dengue fever can be transmitted through blood
transfusion.
 19. Dengue can be transmitted through sexual intercourse.
Knowledge on treatment
20. When I get infected with dengue, I can self-medicate at
home instead of going to a hospital for treatment.
21. Once I experience having dengue, I will develop
immunity from it and not be infected again.
22. There is a dengue vaccine available to the general
public.
Knowledge on prevention
23. Removal of stagnant water prevents mosquito breeding.
24. Pouring chemicals in stagnant water can kill mosquito
larvae.
25. Covering water containers reduce mosquitoes.
26. Window screens and bed nets reduce mosquitoes.
27. Insecticide sprays reduce mosquitoes and prevent
dengue.
28. Mosquito repellents prevent mosquitoes.
29. Cutting down bushes and tall plants can reduce
mosquitoes and prevent dengue.

B. Attitude Towards Dengue

Instruction: Please indicate your level of agreement or disagreement on the following
statements.

STRONGLY STRONGLY
STATEMENTS DISAGREE UNCERTAIN AGREE
DISAGREE AGREE

1. I want to help to reduce

the number of dengue
cases in my area.
2. I regularly check the
dengue situation or
hotspots around my area.
3. I will take extra action
to prevent dengue
infection if I know the risk
of being infected with
dengue is increasing in
my area.
4. Removal of mosquito
breeding sites at my
premises will reduce the
chance of dengue
infection among my
family members.
5. Chemical fogging by
health authority is good
enough to prevent dengue
infection.
6. I am satisfied with the
dengue prevention and
control programs
implemented by our local
government.
7. It is not my
responsibility to remove
mosquito breeding sites in
and around our house.
8. It is necessary to
continue the removal of
mosquito breeding sites at
home even during the
period when there is no
outbreak.
9. Dengue outbreak in my
community can be
controlled if every
household is committed
to remove mosquito
 breeding sites.
10. I will take part in a
public activity for dengue
control or removal of
mosquito breeding sites.

C. Dengue Prevention Practices

Instruction: Please indicate your level of compliance on the following statements
regarding dengue prevention practices.

STATEMENTS ALWAYS USUALLY SOMETIMES SELDOM NEVER

1. Use of insecticide
sprays to reduce
mosquitoes.
2. Use of professional pest
control to reduce
mosquitoes.
3. Use of screen windows
to reduce mosquitoes.
4. Use of fans to reduce
mosquitoes.
5. Use of bed nets to
reduce mosquitoes.
6. Eliminates stagnant
water around the house to
reduce mosquitoes.
7. Cuts down bushes and
tall plants in the yard to
reduce mosquitoes.
8. Use of mosquito coils to
reduce mosquitoes.
9. Covers water
containers at home.
 10. Cleans water-filled
containers and ditches
around the house.

D. Source of Dengue Information

Instruction: Please choose your source/s of dengue information from the list below. You
may choose more than one option.

[ ] Newspaper
[ ] Magazine
[ ] Radio
[ ] Television
[ ] Online news articles
[ ] Social media (Facebook, Twitter, Instagram, etc.)
[ ] School
[ ] Community or barangay health centers
[ ] Healthcare professionals (doctors, nurses, et al.)
[ ] Posters, pamphlets, or banners (including infographics)
[ ] Family, friends, or relatives
[ ] Seminars, webinars, etc.
[ ] Others (Please specify: _______________________)
[ ] None