Table 8 Questionnaire on Awareness of Cataract and Glaucoma
Tilganga Institute of Ophthalmology | |||||||||||||||
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Bhaktapur Glaucoma Study | |||||||||||||||
Questionnaire: Awareness of Cataract and Glaucoma | |||||||||||||||
Date of Interview | |||||||||||||||
Please write the English Date (dd/mm/yr): | |||||||||||||||
Name of Interviewer: | Â | Â | Â | Code | Â | Â | Â | Â | Ward: | Â | |||||
House No. | S N | How many years have you been living here? * | Do you have people aged 40 or more in your family? | (If the answer is yes in the last 2 questions then take the interview of the people aged 40 or more in that family) | Sex | Caste | Â | Education | Have you had your eyes examined by a doctor? | If yes, where? | Do you know about these eye diseases? | If yes, what do you know about them? | What is your source of information? | ||
| Â | Â | Â | Â | Â | M = 1 F = 2 | Brahmin/Chhetri = 1 Newar = 2 Tamang = 3 Muslim = 4 Dalit = 5 Others (specify)= 6 | Age | Illiterate = 0 < 6 grade = 1 6-10 = 2 > 10 = 3 Others = 4 | Â | Tilganga Hospital = 1 Community Eye Centre Bhaktapur = 2 Other Hospital = 3 Private Clinic/Nursing home = 4 Heath camps = 5 Others (specify) = 6 | Yes = 1 No = 0 | Blurred Vision = 1 Blindness = 2 Pearl like opacity = 3 Rainbow haloes = 4 Raised eye pressure = 5 Unmatched answers = 6 | Family members = 1 Hospital = 2 Doctor = 3 Friends/neighbors = 4 Radio/TV/Newspapers = 5 Others(specify) = 6 Don't know = 9 | ||
| Â | Â | < 1 year = 0 > 1 year = 1 | Yes = 1 No = 0 | Write the name serially. | Â | Â | Â | Â | Yes = 1 No = 0 | Â | Glaucoma | Cataract | Glaucoma | Cataract | Â |