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A Study on Psycho-social problem faced by who are

diagnosed with breast cancer


Questions
Respondent No:
Demographic Details:
1, Age of the respondents.
a, 22 29

b, 30 39

c, 40 49

d, 50 59

2, Sex of the respondent.


a, Male
b, Female

3, Religion of the Respondent.


a, Hindu

b, Muslim

c, Christian

d, Others

4, Marital Status of the respondent.


a, Single

b, Married

c, Widowed

d, Separated

5, Educational qualification of the respondent.


a, Illiterate

b, Primary

c, High School

d, Higher Secondary

e, Under Graduate

f, Post Graduate

6, Occupation of the respondent.


a, Public Sector

b, Private Sector

c, Business

d, Retired

7, Income of the respondent.


a, Below ` 1000

b, ` 1001 ` 2000

c, ` 2001 ` 3000

d, ` 3001 ` 4000

e, ` 4001 ` 5000

f, ` 5000 and above.

8, Family type of the respondent.


a, Nuclear Family

b, Joint Family

c, Broken Family

9, Type of House.
a, Thatched

b, Tiled

c, Concrete

10, Mother tongue of the respondent.


a, Tamil

b, Telugu

c, Kannada

d, Hindi

c, Others
11, Family consultation.
No.

Name of Family
Members

Sex

Age

Marital
Status

Education

SOCIAL PROBLEM
12, Locality in which the family lives?
a, Urban

b, Sub Urban

c, Slum

d, Village

13, No of Family members in your family?


a, 2

b, 3

c, 4

14, Any Support from other family members/ Friends.


a, Yes
b, No

15, How does the society view your disease?


a, Stigmatized

b, Contagious

c, Infectious

d, Hereditary

e, Normal

16, Does your family members, friends or relatives support or help in


overcome the problem.
a, Yes
b, No

If Yes in What way?


1, Sympathetic
2, Encouraging
3, Help Physically
4, Help Financially
5, Help Emotionally

17, Does your family members, friends or relatives look down upon you
because of your problem.
a, Yes
b, No

18, Do you like others to know about your problem?


a, Yes
b, No
i, If No, Why?
1, Social Stigma

2, Look down upon you

3, Hate attention seeking behavior

4, others specify ______

________________________________________________________________________
19, What are the social factors that prevented you have this problem?

20, Are you able to adjust your family with this problem?
a, Yes
b, No

21, Do you get any aid or support from NGO?

a, Yes
b, No

ECONOMICAL PROBLEMS
22, No. of earning members in your family?
a, 1

b, 2

c, 3

d, 4

23, Annual Income of your Family?


a, Below ` 20000

b, ` 20001 ` 30000

c, ` 30001 ` 40000

d, ` 40001 above

24, Minimum cost of treatment availability at present?

25, Any Concession from hospital?


a, Yes
b, No
26, How much money do you spent for your treatment per month.
a, Below ` 1000

b, ` 1001 ` 2000

c, ` 2001 ` 3000

d, ` 3001 ` 4000

e, ` 4001 above

27, Are you able to meet the medical expenditure?


a, Yes
b, No

PSYCHOLOGICAL PROBLEMS
28, What is your emotional reaction after diagnosed with the disease?

a, anxiety

b, Emotional withdraw

c, Guilt feeling

d, depressive mood

e, fear

f, no reaction

29, Is your condition known to your family members


a, Yes
b, No

30, If you are married has you husband or wife accepted your
conditions?
a, Yes
b, No

31, Are you worried about your condition?


a, Yes
b, No

32, Do you have awareness about the disease?


a, Yes
b, No
33, Do you have any problem in your marital life because of your
disease?
a, Yes
b, No

TREATMENT AVAILABLE FOR BREAST CANCER


34, Place of treatment?
a, Private Hospital

b, Govt. Hospital

c, Aided Hospital

d, Through NGO

35, Availability of Medicine?


a, From Private Hospital

b, From NGO

c, From Govt. Hospital

36, How did you come to know about the disease?

37, What the other types of cancer you aware of it?

38, Do you know about treatment available for breast cancer?


a, Yes
b, No

39, What types of treatments given to you?


a, Chemotherapy

b, Radiotherapy

c, Biological treatment

40, You have any physical problems after taking of medicine?


a, Fever
c, tired

b, Vomiting

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