CONSENT FORM Kap Dengue Latest

7/27/2019 CONSENT FORM Kap Dengue Latest

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NPD6014

RESEARCH METHODOLOGOY AND STATISTIC

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INFORM CONSENT

FOR PARTICIPANTS IN RESEARCH SURVEYKNOWLEDGE, ATTITUDE AND PRACTICE (KAP) TOWARD DENGUE FEVER AMONG UKM

UNIVERSITY STUDENT

Instructions: Before filling out the survey questionnaire please first read carefully and sign this InformedConsent Form. This form must be returned with the questionnaire in order for us to include your comments inour study. All information will be kept confidential and no names will be used.

Title of Research Project: Knowledge, Attitude and Practive (KAP) toward Dengue Fever

1. You are invited to participate in a research study conducted by UKM postgraduate student. Thisresearch is a part of project for group assessment in NPD 6014 class. Your participation is strictly

voluntary. Before agreeing to participate, you should know enough about it to make an informeddecision. You can ask for any inquiry before participating.

2. The purpose of the study is to determine the knowledge, attitude, and practices toward dengue fever among UKM university students.

3. The questionnaire including the following parts: Part 1: Socio-demographic data Part 2: Source of Information about dengue fever Part 3: Knowledge about dengue fever Part 4: Attitude toward dengue fever

Part 5: Practice regarding dengue fever

4. The participation is voluntary. You may choose not to participate, and you may withdraw at anytime duringthe research project. You will NOT be penalized in any way should you choose not to participate or towithdraw.

5. As part of this effort, your identity will not be revealed in any publications that result from this study. Theinformation in the study records will be kept strictly confidential. Individual data will be stored securely andwill be made available only to persons conducting the study. No reference will be made in oral or written reportsthat could link you to the study.

If you have questions or concerns at any time about the study or the procedures, you may contact theresearchers:,Researcher name : FAIRUS FARIZA ZAINUDINPhone : [email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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INDIVIDUAL CONSENT

I have read read the information of this study and have also been given the explanation by a

researcher about the purpose of this document. I understand the aims of the study includingits risks and benefits.I _____________________________________ (name), IC no: ____________________,*agree/disagree to participate in the study as stated above.

I *would like to know/dont want to know the result of this study (*delete whereunnecessary)

Signature: ______________________ Date: _______________________

Witness Researcher

Name: _________________________ Name: _______________________ IC No: _________________________ IC No: _______________________

Signature: ______________________ Signature: ____________________ Date: __________________________ Date : _______________________


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KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) TOWARD DENGUE FEVER AMONG UKMUNIVERSITY STUDENT

QUESTIONNAIRE

I nstructions: Please answer all questions in Part 1, Part 2, Par t 3, Part 4 and Part 5. Please choose one and tick ( ) that was most closely to your choice.

Part 1: Socio-demographic Characteristic

1. Serial No :

2. Age :

3. Gender : ( ) Male ( ) Female

4. Race : ( ) Malay ( ) Chinese ( ) Indian ( ) Other

5. Faculty : ( ) Medical ( ) Health Science ( ) Others specify:_______

6. Year of Study : ( ) One ( ) Two ( ) Three ( ) Four

7. Hostel : ( ) KTSN1 ( ) KTSN4 ( ) KTSN5 & Plaza RAH

( ) Other Specify :____________

Part 2: Source of Information about Dengue Fever

8. Have you ever received any information about dengue?

( ) Yes ( ) No

9. Select the sources from which you got the information

( ) Television ( ) Radio ( ) Newspaper ( ) Magazines

( ) Leaflets ( ) Friend ( ) Family

( ) Others. Specify: _____________.............


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Part 3: Knowledge about Dengue Fever

CODES ITEMS YES NO

K1 The principal mosquito vector for dengue fever is Aedes Aegypti.

K2 Dengue fever is a severe, flu-like illness that affects infants, young children and

adults.

K3 A dengue patient has chills, headache, pain upon moving the eyes and low

backache.

K4 Rainy season is the only epidemic season for dengue infection.

K5 Mosquitoes transmitting dengue infection bites only during day time.

K6 The mosquitos that transmit dengue infection lay in eggs in dirty sewage water.

K7 Empty stagnant water from old tires, trash cans, and flower pots can be breeding

places for mosquitoes.

K8 Dengue viruses are transmitted to human through bites of infective female Aedes

mosquitoes.

K9 Only method of controlling dengue infection is to combat the vector mosquitoes.

K10 There is no specific treatment for dengue infection and the drug choice is

paracetamol.

K11 Abate sand can be beneficial in killing the mosquitoes larvae.

K12 Abate sand, if put in standing water, can help to prevent the mosquito breeding for 3

months.

K13 Stored water container/tanks for drinking water without being covered should be

cleaned every 7 days.

K14 I am afraid of getting it dengue fever if one of my family members has dengue

fever.


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Part 4: Attitude towards Dengue Fever

Scale Indicator

STRONGLY AGREE AGREE NEITHER AGREE NOR DISAGREE

DISAGREE STRONGLYDISAGREE

1 2 3 4 5

CODES ITEMS

SCALES

(Please tick one only)

1 2 3 4 5

A1 Dengue fever is a disease that cannot be prevented*

A2 Eliminating the breeding places is the responsibility of the public health staff

and health volunteer*

A3 Only method of controlling or preventing dengue and dengue haemorrhage fever is to combat the vector mosquitoes.

A4 Only smogging is enough to prevent mosquito and no need other ways*

A5 Everybody has a chance to be infected with dengue virus.

A6 Person who once got dengue infection cannot get dengue infection again.

A7 It is possible to recover completely from dengue infection.

A8 Elimination of larvae breeding sources is a waste of time and very complicated.*

A9 Restricting and checking the availability of potential breeding habits should be

conducted every 1 to 2 times / year.

A10 Strong and healthy person will not get dengue infection.*

A11 Sleeping in mosquito net can prevent dengue infection.

A12 You are one of the important people in preventing dengue fever.


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Part 5: Practice Regarding Dengue Fever

CODES ITEMS YES NO DONT

HAVE

P1 Do you cover water jars after using immediately?

P2 Do you have a cover in your water tanks?

P3 If there is a mosquito larva in your water tank, do you ever do anything to

get rid of it?

P4 Do you ever examine the mosquito larva in the flower pots?

P5 Do you change the water of the indoor plants every week?

P6 Do you ever drain off the water in the plates of the flower pot?

P7 Do you examine any discarded thing that can hold water around your

house?

P8 If yes, do you ever put them in the garbage or dispose them?

P9 Do you use mosquito net/ mosquito coils in your house?

P10 Do you participate when your community has been sprayed fog?

P11 Do you participate in any campaigns of dengue infection in your

community?

P12 Do you ever examine the mosquito larva in water container in the toilet?

P13 Do you check and clean your roof gutters in the rainy season?

END OF QUESTIONNAIRE

THANK YOU

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CONSENT FORM Kap Dengue Latest