DATA COLLECTION INSTRUMENT
Structured Self-Administered Questionnaire
Section A: Demographic Information
Instructions: Please tick the appropriate box or write your answer in the space provided.
1. Age:
☐ 18–25 years
☐ 26–35 years
☐ 36–45 years
☐ 46–55 years
☐ 56 years and above
2. Gender:
☐ Male
☐ Female
☐ Prefer not to say
3. Professional Cadre:
☐ Medical Doctor
☐ Nurse
☐ Clinical Officer
☐ Mental Health Practitioner
☐ Other (please specify): _____________
4. Type of Facility:
☐ Public
☐ Private
5. Years of Work Experience in Current Role:
☐ 1–3 years
☐ 4–6 years
☐ 7–10 years
☐ More than 10 years
Section B: Career Alignment Scale
Instructions: Please indicate the extent to which you agree or disagree with each statement
about your work by ticking the appropriate box.
Scale:
1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree
# Statement 1 2 3 4 5
Job Role Fit
1 My current job matches the professional ☐ ☐ ☐ ☐ ☐
training I received.
2 I feel my assigned tasks correspond to ☐ ☐ ☐ ☐ ☐
my career goals.
3 The responsibilities I hold are suitable ☐ ☐ ☐ ☐ ☐
for my skill level.
Skill Utilization
4 I fully utilize my professional skills in ☐ ☐ ☐ ☐ ☐
my current role.
5 My role allows me to demonstrate my ☐ ☐ ☐ ☐ ☐
competence.
6 My talents are effectively used in my ☐ ☐ ☐ ☐ ☐
work.
Personal Interest
7 I am interested in the work I do every ☐ ☐ ☐ ☐ ☐
day.
8 I find my job personally fulfilling. ☐ ☐ ☐ ☐ ☐
9 My work is aligned with my personal ☐ ☐ ☐ ☐ ☐
passions.
Value Alignment
10 My personal values match the values of ☐ ☐ ☐ ☐ ☐
my organization.
11 I feel my work is meaningful within my ☐ ☐ ☐ ☐ ☐
value system.
12 There is a strong fit between my beliefs ☐ ☐ ☐ ☐ ☐
and the mission of my workplace.
Section C: Mental Wellbeing (DASS-21)
Instructions: Over the past week, how much did each statement apply to you? Circle the number
that best describes your experience.
Scale:
0 = Did not apply to me at all
1 = Applied to me to some degree
2 = Applied to me to a considerable degree
3 = Applied to me very much
# Statement 0 1 2 3
Depression
1 I couldn't seem to experience any positive feeling 0 1 2 3
at all.
2 I found it difficult to work up the initiative to do 0 1 2 3
things.
3 I felt that I had nothing to look forward to. 0 1 2 3
4 I felt down-hearted and blue. 0 1 2 3
5 I was unable to become enthusiastic about 0 1 2 3
anything.
6 I felt I wasn’t worth much as a person. 0 1 2 3
7 I felt that life was meaningless. 0 1 2 3
Anxiety
8 I felt scared without any good reason. 0 1 2 3
9 I was aware of dryness of my mouth. 0 1 2 3
10 I experienced breathing difficulty (e.g., excessively 0 1 2 3
rapid breathing, breathlessness in the absence of
physical exertion).
11 I experienced trembling (e.g., in the hands). 0 1 2 3
12 I was worried about situations in which I might 0 1 2 3
panic and make a fool of myself.
13 I felt I was close to panic. 0 1 2 3
14 I was aware of the beating of my heart in the 0 1 2 3
absence of physical exertion (e.g., sense of heart
rate increase, heart missing a beat).
Stress
15 I found it hard to wind down. 0 1 2 3
16 I tended to over-react to situations. 0 1 2 3
17 I felt that I was using a lot of nervous energy. 0 1 2 3
18 I found myself getting agitated. 0 1 2 3
19 I found it difficult to relax. 0 1 2 3
20 I was intolerant of anything that kept me from 0 1 2 3
getting on with what I was doing.
21 I felt that I was rather touchy. 0 1 2 3
Section D: Additional Work Context
Optional: To help us better understand your work environment, please respond to the following
items.
1. Do you feel you have adequate opportunities for career development?
☐ Yes
☐ No
2. Do you feel supported by your supervisors in your professional growth?
☐ Yes
☐ No
3. Please indicate any other comments or concerns you would like to share:
End of Questionnaire
Thank you for your participation! Your responses will be kept strictly confidential.