Questionnaire

The University of Lahore

Lahore School of Nursing

Asalam-e-alikum my name is farhat shaheen I am the student of Lahore school of nursing
University of Lahore. I am conducting research report writing with the title, “.Knowledge, attitude,
and practice about anemia among adolescent girls in urban” For this purpose, I improve the
knowledge, attitude and practice in the community girls regarding anemia I would appreciate if
you can respond to this questionnaire. It will take approximately 15 minutes of your time. I assure
you that all the information gathered will kept confidential, and solely used for educational
purpose. I thank you for your cooperation

Name ………………………. Age…………………………

Gender ………………………………….. Occupation………………………….

Education………………………………… Region………………………………..

Salary…………………………………….. Date……………………………………

Signature………………………………

Family

Knowledge toward anemia among adolescent girls

1 What is your source of School teacher Doctor/health Family Friends/
information personal members neighbors
2 You know anemia is health Yes No
problem
3 In anemia there is? Increased red Decreased Increased Don’t
blood cells hemoglobin hemoglobin know
4 You know what are the Iodine Iron Calcium Don’t
Nutrient deficient in anemia know
5 What are the causes of anemia Worm Poor diet Excessive All
infestation bleeding three are
correct
6 What are signs and symptoms Tiredness/body Irregular Impact Don’t
of anemia weakness menstrual learning know
cycle process
7 What are the effects of anemia Impact on Impact on Decreased Don’t
growth and learning wok know
development capacity
8 You know what are preventive Consuming Personal Taking IFA Don’t
measures of anemia iron-rich food hygiene tablet know