Nursing Research Questionnaire
Title: Knowledge on Prevention and Management of Leptospirosis Among Residents
of Barangay 408, Sampaloc, Manila
We are conducting a study to assess the knowledge and practices regarding leptospirosis
prevention and management in Barangay 408, Sampaloc, Manila. Your participation is
voluntary, and all responses will remain confidential. Please respond honestly to the
following questions.
Section 1: Demographic Information
Please fill in or select the appropriate response.
Age: _____________________
Gender:
● Male
● Female
● Other (Please specify): _____________________
Educational Background:
● Primary
● Secondary
● College
● Others (Please specify): _____________________
Socioeconomic Status:
● Low-income
● Middle-income
● High-income
Years of Residency in Barangay 408:
● Less than 1 year
● 1-5 years
● More than 5 years
Primary Source of Health Information:
● Television
● Radio
● Internet
● Community Health Programs
● Others (Please specify): _____________________
Section 2: Knowledge of Leptospirosis
Please indicate your level of agreement with the following statements by checking the
appropriate box.
Statement Strongly Disagree Neutral Agree Strongly
Disagree Agree
1. I am
aware that
leptospiros
is is
caused by
a
bacterium
transmitte
d through
contamina
ted water
or soil.
2. I know the
modes of
transmission
for
leptospirosis.
3. I can
identify the
symptoms of
leptospirosis.
4. I
understand
the
importance
of avoiding
contact with
floodwaters
to prevent
leptospirosis.
5. I am
aware of first
aid
treatments
for
leptospirosis.
6. I know
that early
detection
and
treatment
are crucial in
managing
leptospirosis.
Section 3: Preventive Practices
Please indicate how often you engage in the following behaviors.
Statement Never Rarely Sometimes Often Always
1. I avoid
contact with
floodwater.
2. I use
protective
gear (e.g.,
boots) when
exposed to
contaminate
d water.
3. I regularly
clean
wounds and
ensure they
are covered
if exposed to
floodwater.
4. I seek
medical
attention if I
suspect
exposure to
leptospirosis.
5. I
participate in
community
health
programs
about
disease
prevention.
Section 4: Attitudes Toward Leptospirosis Prevention and Management
Please indicate your level of agreement with the following statements.
Statement Strongly Disagree Neutral Agree Strongly
Disagree Agree
1. I believe
that
leptospirosis
is a serious
health threat
in my
community.
2. I feel
confident
that I know
how to
protect
myself from
leptospirosis.
3. I think
participating
in health
campaigns
can help
prevent
leptospirosis.
4. I am
willing to
participate in
community
health
initiatives for
leptospirosis
prevention.
5. I trust the
information I
receive from
community
health
workers
about
leptospirosis.
Section 5: Role of Information Sources
Please indicate your level of agreement with the following statements regarding how you
receive information about leptospirosis.
Statement Strongly Disagree Neutral Agree Strongly
Disagree Agree
1. The
information I
get from
television or
any source
of
information
helps me
understand
leptospirosis
better.
2. Radio
programs
have
increased
my
awareness
of
leptospirosis
prevention.
3. The
internet
provides
useful
information
about
leptospirosis.
4.
Communit
y health
workers
are a
reliable
source of
informatio
n about
leptospiros
is.
5. I find
health
information
from social
media
helpful in
preventing
leptospirosis.
Thank you for your participation! Your responses are valuable to our research and to
improving community health.