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Questionnaire

The document is a questionnaire designed to collect demographic data, medication adherence, dietary practices, physical activity, and knowledge about diabetes from patients. It includes multiple-choice questions regarding age, education, employment, medication habits, dietary habits, exercise frequency, and understanding of diabetes. The aim is to assess various factors that may influence diabetes management and patient education.

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3 views5 pages

Questionnaire

The document is a questionnaire designed to collect demographic data, medication adherence, dietary practices, physical activity, and knowledge about diabetes from patients. It includes multiple-choice questions regarding age, education, employment, medication habits, dietary habits, exercise frequency, and understanding of diabetes. The aim is to assess various factors that may influence diabetes management and patient education.

Uploaded by

theseustaurus
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

QUESTIONNAIRE

SECTION A: DEMOGRAPHIC DATA

1. Age group of the patient

☐ Below 20 years

☐ 20–29 years

☐ 30–39 years

☐ 40–49 years

☐ 50 years and above

2. Level of education

☐ Primary

☐ Secondary

☐ Tertiary

☐ No formal education

3. Employment status

☐ Employed

☐ Self-employed

☐ Unemployed

☐ Retired

4. Duration since diagnosis

☐ Less than 1 year

☐ 1–5 years
☐ 6–10 years

☐ More than 10 years

SECTION B: MEDICATION ADHERENCE

5. Do you take your medication as prescribed?

☐ Yes

☐ No

6. Do you ever forget to take your medication?

☐ Yes

☐ No

7. Do you stop taking medication when you feel better?

☐ Yes

☐ No

8. Can you afford your medication consistently?

☐ Yes

☐ No

9. Have you ever missed medication due to drug shortages at the hospital?

☐ Yes

☐ No
---

SECTION C: DIETARY PRACTICES

10. Do you follow a recommended diabetic diet?

☐ Yes

☐ Sometimes

☐ No

11. How often do you consume sugary foods or drinks?

☐ Often

☐ Sometimes

☐ Rarely

12. Do you eat fruits and vegetables regularly?

☐ Yes

☐ No

☐ Sometimes

13. Can you afford a balanced diet?

☐ Yes

☐ No

SECTION D: PHYSICAL ACTIVITY


14. Do you engage in regular physical activity?

☐ Yes

☐ No

☐ Sometimes

15. How often do you exercise?

☐ Daily

☐ Weekly

☐ Rarely

16. What limits your physical activity?

☐ Lack of time

☐ Illness

☐ Lack of knowledge

☐ No safe environment

SECTION E: KNOWLEDGE ON DIABETES

17. Do you understand what diabetes is?

☐ Yes

☐ No

☐ Barely

18. Do you know the importance of controlling blood sugar?

☐ Yes

☐ No
☐ Barely

19. Do you know the complications of uncontrolled diabetes?

☐ Yes

☐ No

☐ A little

20. Have you received health education about diabetes?

☐ Yes

☐ No

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