Contoh Kuosioner PDF
Contoh Kuosioner PDF
KUESIONER PENELITIAN
Hubungan Akses KB Dengan Pemilihan Alat Kontrasepsi Hormonal dan
Non Hormonal Pada Akseptor KB Aktif Di Wilayah Kerja Puskesmas
Kec.Siabu Kabupaten Mandailing Natal Tahun 2016
A. Identitas Responden
Mohon di isi sesuai jawaban anda:
No. Responden
1. Nama Responden :
2. Alamat Responden :
3. Pendidikan Responden :
g. Sumber pelayanan
1. Waktu pemasangan alat kontrasepsi hormonal (pil, suntik, implan) ibu
mendapatkan pelayanan dimana? Sebutkan..........
2. Berapa kali ibu melakukan kunjungan ke Pelayanan KB dalam sebulan?
Sebutkan.....
3. Berapa jam dari rumah ibu ke pelayanan KB?.....
4. Apa yang menjadi kendala bagi ibu waktu menuju ke pelayanan KB/
Puskesmas?......
5. Hambatan yang bagaimana ibu dapatkan waktu menuju ke pelayanan
KB?......
6. Pernahkah ibu mendapatkan kendala sewaktu pemasangan alat
kontrasepsi? Sebutkan......
7. Waktu ibu mau memakai alat kontrasepsi pernahkah ibu menjumpai
bahwa alat untuk pemasangan ada kekurangan?....
8. Jenis transportasi yang bagaimana ibu pakai waktu pergi ke pelayanan
KB? Sebutkan.....
9. Pernakah ibu tidak mendapatkan pelayanan KB saat di puskesmas?.......
10. Pernahkah keluarga (suami) ibu melarang menggunakan KB?......
11. Menurut ibu apakah di dalam agama memasang KB itu dilarang?
Sebutkan........
12. Bagaimana pendapat ibu tentang pelayanan KB di Puskesmas?........
Cumulative
Frequency Percent Valid Percent Percent
Valid Salah 57 55.3 55.3 55.3
Benar 46 44.7 44.7 100.0
Total 103 100.0 100.0
jarak
Cumulative
Frequency Percent Valid Percent Percent
Valid sulit 53 51.5 51.5 51.5
mudah 50 48.5 48.5 100.0
Total 103 100.0 100.0
biaya
Cumulative
Frequency Percent Valid Percent Percent
Valid Gratis 48 46.6 46.6 46.6
biaya sendiri 55 53.4 53.4 100.0
Total 103 100.0 100.0
pilihan alkon
Cumulati
ve
Frequency Percent Valid Percent Percent
Valid non hormonal 36 35.0 35.0 35.0
Hormonal 67 65.0 65.0 100.0
Total 103 100.0 100.0
sumber pelayanan
Cumulative
Frequency Percent Valid Percent Percent
Valid puskesmas 27 26.2 26.2 26.2
bkkbn 76 73.8 73.8 100.0
Total 103 100.0 100.0
Crosstabs
Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
jarak * pilihan alkon 103 100.0% 0 .0% 103 100.0%
sumber pelayanan *
pilihan alkon 103 100.0% 0 .0% 103 100.0%
Pengetahuan * pilihan
103 100.0% 0 .0% 103 100.0%
alkon
Chi-Square Tests
Asymp. Sig. Exact Sig. Exact Sig.
Value df (2-sided) (2-sided) (1-sided)
a
Pearson Chi-Square 3.977 1 .046
Continuity
3.196 1 .074
Correctionb
Likelihood Ratio 4.018 1 .045
Fisher's Exact Test .063 .037
Linear-by-Linear
3.939 1 .047
Association
N of Valid Casesb 103
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is
17,83.
PChi-Square Tests
Asymp. Sig. Exact Sig. Exact Sig.
Value df (2-sided) (2-sided) (1-sided)
a
Pearson Chi-Square 6.526 1 .011
Continuity
5.381 1 .020
Correctionb
Likelihood Ratio 7.204 1 .007
Fisher's Exact Test .011 .008
Linear-by-Linear
6.463 1 .011
Association
N of Valid Casesb 103
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is
9,44.
Crosstab
pilihan alkon
non hormonal hormonal Total
Jarak sulit Count 9 44 53
% within jarak 17.0% 83.0% 100.0%
% within pilihan
25.0% 65.7% 51.5%
alkon
% of Total 8.7% 42.7% 51.5%
mudah Count 27 23 50
% within jarak 54.0% 46.0% 100.0%
% within pilihan
75.0% 34.3% 48.5%
alkon
% of Total 26.2% 22.3% 48.5%
Total Count 36 67 103
% within jarak 35.0% 65.0% 100.0%
% within pilihan
100.0% 100.0% 100.0%
alkon
% of Total 35.0% 65.0% 100.0%
Chi-Square Tests
Asymp. Sig. Exact Sig. Exact Sig.
Value df (2-sided) (2-sided) (1-sided)
a
Pearson Chi-Square 6.526 1 .011
Continuity
5.381 1 .020
Correctionb
Likelihood Ratio 7.204 1 .007
Fisher's Exact Test .011 .008
Linear-by-Linear
6.463 1 .011
Association
N of Valid Casesb 103
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is
9,44.
Chi-Square Tests
Asymp. Sig. Exact Sig. Exact Sig.
Value df (2-sided) (2-sided) (1-sided)
a
Pearson Chi-Square 20.613 1 .000
Continuity
18.769 1 .000
Correctionb
Likelihood Ratio 21.218 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear
20.412 1 .000
Association
N of Valid Casesb 103
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is
16,08.
b. Computed only for a 2x2
table