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Survey
Marino De Raes
2024-04-03T10:51:50+02:00
Population survey questionnaire
1
Consent
2
Personal info
3
Breast cancer survey
4
Survey colon cancer
Before you begin the questionnaire, I want to inform you of some important points:
(Required)
1. Participation in this questionnaire is completely voluntary. You are not required to participate and if you decide not to participate, it will not have any negative consequences for you
2. You have the right to stop at any time during the questionnaire without any consequences. If you decide to stop, you do not have to give a reason and your information will not be used
3. All information you provide will be treated confidentially and anonymously. Your personal data will not be linked to your answers in the analysis of my research.
By proceeding with the questionnaire, you agree to the above points and consent to the use of your answers for my master's thesis.
Thank you for your time and contribution to my research!
Best regards,
Laura Heyndrickx
Persoonlijke info
Age
(Required)
Birthplace
(Required)
Place of residence
(Required)
Means of transport
(Required)
(Allow multiple answers)
Driver's license and own car
Driver's license and shared car (cambio, poppy)
I can be brought by a partner, family member or friend
Bicycle
Public transport
Other
What other means of transportation?
(Required)
Family situation
(Required)
Single person without children
Single person with children
Cohabiting with partner
Living with partner and children
Living situation
(Required)
Renting a house
Property owner
Free living with family/friends
Staying in an institution
What is your monthly net household income?
(Required)
€ 1500
€ 1500 - € 2000
€ 2000- € 2500
€ 2500- € 3000
€ 3000- € 3500
€ 3500- € 4000
> € 4000
Survey population-based breast cancer screening
Were you invited for breast cancer screening less than 2 years ago?
(Required)
Yes
No
Why not?
(Required)
I don't belong to the age category of 50-69 years old (anymore)
I have already undergone a screening outside the health screening programme
Unfortunately, I have already experienced the disease
I don't know why I'm not invited
I have not yet received an invitation
Other
Would you accept the invitation if you received it?
(Required)
Yes
No
Specify why not
(Required)
Hidden
OPGELET!
Onderstaande vragen worden dus enkel getoond wanneer bij vraag 2.1 met "ja" werd geantwoord, of wanneer bij vraag 2.1(2) de 5de optie "Ik heb nog geen uitnodiging ontvangen" NIET werd geselecteerd.
Have you already participated in the breast cancer screening?
(Required)
Yes
No
Did you accept the invitation for a mammogram each time?
(Required)
Yes
No
If you participated in the study, where did you have your screening performed?
(Required)
In a local radiology unit
At the nearest hospital
In the mammobile (Provinces of Antwerp and Flemish Brabant)
If you did not or did not always participate in the screening despite being invited, what was the reason for your non-participation
(Required)
[Allow multiple answers)
Transport to the mammogram was not possible or too difficult
My doctor advised me not to participate in this study
I wanted to reschedule the appointment, but I didn't know how
The appointment took too much time
I do not wish to participate in this study
I'm afraid of the possible result
I don't want 'unnecessary' radiation
I know acquaintances who, despite a negative screening, turned out to have breast cancer, which makes me doubt the correctness of the study
forgot the appointment
I felt sick on the day of the appointment
Other
What other reason did you have?
(Required)
Bevraging bevolkingsonderzoek Darmkanker
Were you invited for colon cancer screening less than 2 years ago?
(Required)
Yes
No
Why not?
(Required)
I don't belong to the age category of 50-74 years old (anymore)
I have already undergone a screening outside the health screening programme
Unfortunately, I have already experienced the disease
I don't know why I'm not invited
I have not yet received an invitation
Other
Would you accept the invitation if you received it?
(Required)
Yes
No
Specify why not
(Required)
Hidden
OPGELET!
Onderstaande vragen worden dus enkel getoond wanneer bij vraag 3.1 met "ja" werd geantwoord, of wanneer bij vraag 3.1(2) de 5de optie "Ik heb nog geen uitnodiging ontvangen" NIET werd geselecteerd.
Have you already participated in the bowel cancer screening programme?
(Required)
Yes
No
Have you always accepted the invitation for colorectal cancer screening?
(Required)
Yes
No
If you did not participate in the screening despite being invited, what was the reason for your non-participation?
(Required)
[Allow multiple answers)
I'm not sure how to take the sample
I do not wish to participate in this study
I'm afraid of the possible result
I don't feel anything, so I don't want any 'unnecessary' research
I know acquaintances who, despite a negative screening, turned out to have colon cancer, which makes me doubt the correctness of the research
I find it unpleasant to poke my own bowel movements.
My doctor advised me not to participate in this study
I forgot the appointment
I felt sick on the day of the appointment
Other
What other reason did you have?
(Required)
Name
This field is for validation purposes and should be left unchanged.
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