Table 8.
Questionnaire on Awareness of Cataract and Glaucoma
| Tilganga Institute of Ophthalmology | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bhaktapur Glaucoma Study | |||||||||||||||
| Questionnaire: Awareness of Cataract and Glaucoma | |||||||||||||||
| Date of Interview | |||||||||||||||
| Please write the English Date (dd/mm/yr): | |||||||||||||||
| Name of Interviewer: | Code | Ward: | |||||||||||||
| 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 | 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? | |||
| 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 |
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 |
||||||||
| < 1 year = 0 > 1 year = 1 |
Yes = 1 No = 0 |
Write the name serially. | Yes = 1 No = 0 |
Glaucoma | Cataract | Glaucoma | Cataract | ||||||||
* If the time of stay is less than 1 year/there is no one in the family of 40 or above age - do not interview.