Appendix: Survey Questionnaire

Contraception Booklet Survey

Please complete the following:

1. Today’s Date: / /

2. Age:

3. Gender: Female / Male

4. Your Postcode

5. Are you currently attending school or enrolled in a course?

Yes No

6. Which is the highest level of education you have completed? (please tick one)
Year 8 or below
Year 9
Year 10
Year 11
Year 12
Certificate course (I, II, III, IV) / Advanced diploma / diploma
Bachelor degree or higher (graduate certificate / graduate diploma /
postgraduate degree)

7. Is English the main language you speak at home?

Yes No

8. Are you of Aboriginal or Torres Strait Islander descent?

Yes No

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Are the following statements true or false?

Using a condom can help prevent sexually transmissible

9. Don’t
infections (STIs) True False know

10. It is okay to use the same condom more than once Don’t
True False know

11. Condoms have an expiry date Don’t

True False know

It is okay to use an oil-based lubricant (such as Vaseline

12. Don’t
or baby oil) when using latex condoms True False know

Side effects from the Pill, such as nausea, usually go

13. Don’t
away a few months after a woman starts using it True False know

The combined pill (The Pill) makes women’s

14. Don’t
menstruation more regular True False know

The combined pill (The Pill) decreases blood loss during

15. Don’t
menstruation True False know

Women using the contraceptive injection (Depo, DPMA)

16. Don’t
must get an injection every three months True False know

Women can have a small rod placed in their upper arm

17. by a doctor or nurse which can prevent pregnancy for 3 Don’t
True False know
years

Women using the vaginal ring (Nuvaring) must have it

18. Don’t
inserted by a doctor or nurse every month True False know

A hormonal IUD can change a woman’s menstrual

19. Don’t
bleeding pattern True False know

A young woman can use a copper IUD, even if she has

20. Don’t
never had a child True False know

A woman who is breastfeeding a baby cannot get

21. Don’t
pregnant True False know

22. During a woman’s monthly menstrual cycle, there are

2
 certain days when she is more likely to become pregnant True False Don’t
know
if she has sex

None of the common methods of contraception are

23. Don’t
100% effective True False know

Most contraceptives protect against sexually

24. Don’t
transmissible infections (STIs) True False know

During sex, if the man ‘pulls out’ before he ejaculates

(‘cums’), and ejaculation occurs outside of the woman’s
25. Don’t
body, it is still possible for the woman to become True False know
pregnant

The Emergency Contraceptive Pill only works if taken the

26. Don’t
morning after having unprotected sex True False know

A person needs to see a doctor to get the Emergency

27. Don’t
Contraceptive Pill True False know

We are interested in your personal opinion about the following statements. Please
show your agreement with each statement below by ticking either: strongly disagree,
disagree, undecided, agree or strongly agree.
Strongly Strongly
Disagree Undecided Agree
Disagree Agree
28. I believe that contraceptives
actually prevent pregnancy

29. I would feel embarrassed

discussing contraception with
my friends.

30. Contraceptives are difficult to get

31. Contraceptives are simple to use

32. Couples should talk about

contraception before having
sexual intercourse

33. If my partner or I experienced

unwanted side effects from a
contraceptive, we would use a
different method

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34. Contraceptives make sex seem
less romantic

35. I encourage my friends to use

contraceptives

36. I know how to find contraception

information that I trust

37. Using contraceptives is a way of

showing that you care about
your partner

38. I feel that contraception would

be solely my partner’s
responsibly

39. Contraception is worth using

even if the financial cost is high

Strongly Strongly
Disagree Undecided Agree
Disagree Agree

This is the end of the survey. Thank you!