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(b) How many brothers and sisters do you have /None …………………………………………………………………………………………………………………………………………………………………?
7.(a)in few words, summarize some of your…
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Questionnaire al Affiliation Questionnaire Please answer all the questions. Personal information and background What is …………………………………………………....?
2. Please state your D.O.B………………………………………………….?
3 (a) What is your occupation ………………………………………………….?
If you are employed, please answer part b of the question.
(b) What kind of job is it …………………………………………………………………….?
(Please state whether it is a manual job or white collar job)
4 (a) State your marital status………………………………………………………………….? (Single, Married or Engaged)
(b) Do you have any children? (Y/N)……………………………………………………..?
(c) If yes, how many………………………………………………………………….?
5 (a) To which state were you born and brought up at………………………………………..?
(b) How many brothers and sisters do you have /None …………………………………………………………………………………………………………………………………………………………………?
Religion, Traditions and Culture
6 (a) State your religion……………………………………………………………………………?
(b)Do you follow up with your religion……………………………………………………..?
(The values, beliefs and some of the restrictions set up by your religion)
(c) If there are any restrictions, what are your views towards them…………………………?
7.(a)in few words, summarize some of your cultural beliefs practiced by your tribe…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………?
(Include rituals and rites of passage and that are practiced and how they are performed and adhered to today)
(b)Dou you adhere to these cultural practices or have you practiced some of them……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….?
(If yes, state what kind and describe them)
8(a) what are your traditional ways of tending to the sick………………………………………………………………..?
(b) What are some of the traditional ways that you apply in treating the sick………………………………………………………………………………….?
(c) In a few words, state your traditional views and how your culture views and embraces the modern healthcare.
(d) Do your traditions in any way conflict with the modern day healthcare ……………………………………………………………………………………)
(In this question, you should state if some people in your culture refuse to embrace the scientific medicine modern type of healthcare and continue administering traditional herbs and type of treatment if any exists)
Eating and Living Habits
9 (a) How many meals do you have in a day…………………………………………………….?
(b) Would you say that you eat a balanced diet………………………………………………..?
(c) Do have have any allergic reactions towards any type of foods or drinks………………
……………………………………….?
(If there are any, please list them and the type of allergic reactions that they bring to you)
10. Do you exercise………………………………………………………………….?
(If yes, how often)
11 (a) Do you smoke (Y/N) ……………………………………………………………….?
(If yes, how regularly)
(b) Do you consume alcohol and energy beverages …………………………………………………?
(If you do take alcohol, how regularly)
Health
12. How regular do you visit the doctor for regular checkups…………………………………?
13. Have you ever been admitted in a hospital (Y/N) …………………………………………………..?
(If yes, state for what reasons)
14 (a) Have you ever been involved in an accident…………………………………………..?
(If yes, when and state the degree of your injuries)
(b) Have you ever had a blood transfusion…………………………………………………….?
15 (a).Do you have any terminal diseases(s) or illnesses(s) (Y/N) …………………………………..?
(If yes continue to part b of the question, if no, proceed to the next question)
(b) Please state the disease …………………………………………………………………………………………………………….
(c) When were you diagnosed with the disease(s)……………………………………………?
(d) What are the implications that the disease(s) have in your life ………………………………………………………………….……………………………..?
(e) How do you cope with the disease and how is life like living with the disease ……………………………………………………………………………….……………..?
(State how people relate to you after learning that you have the disease, and if any experiences of stigmatization)
(f) Are you receiving any treatment? …………………………………………………………. ……………….…………………………………………………………………………………..?
(g) How do you finance for the treatment. …………………………………………………… …………………………………………………………………………………………………..?
16 (a) Do you know of any close related person diagnosed with a terminal disease (Y/N)…………………………………………………………………………………………….?
(If yes, state the relationship that you have with the person)
(b) What are your views on the way this person leads his/her life after they are diagnosed with the disease(s)……………………………………..?
17 (a) Describe and state the advantages, disadvantages and implications of the modern design healthcare and wellness………………………………………………………………………………..?
(b) In a few words, compare the traditional ways of treatment and the modern ways of treatment………………………………………………………………………………………………………………………………………………………………………..according to you and the statistics, which is more effective…………………………………………………………..?
18. If there were to be changes in the modern day HealthCare, suggest any areas that you would propose……………………………………….?
References
Eldo, F. (2005) Survival in the Current Healthcare Environment How Close Are We to socialized medicine? Journal of Social Sciences Vol.1,No .4.
Pallone, Thomas, L., & John, C.(2000) Case Records of the VA Maryland Healthcare system/University of Maryland Medicine. The American journal of the medicinal sciences Vol.320, No.3.The American Journal of the Medical Sciences.
Nikolas, R. (2013) Personalized Medicine: Promises, problems and perils of a new paradigm for Healthcare. Procedia-Social and Behavioral Sciences Vol. 77.procedia-social and Behavioral Sciences. Read More
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