Family member questionnaire - SHQ 2 U - Sexual Health Quarters

This questionnaire is designed to gather valuable feedback from family members of individuals with disabilities to help shape an in-home cervical screening service. The goal of this project is to ensure that people with disabilities have access to cervical screening in the comfort and privacy of their own homes, with the support of trained SHQ nurses.

We value your perspective as a family member because you play a key role in the well-being of your family member you care for. Your input will help us better understand the specific needs, concerns, and preferences of people with disabilities when it comes to cervical screening.

"*" indicates required fields

Name *

Email (optional)

Enables you to receive a copy of your responses.

Relationship to the individual receiving support *

How long have you been supporting the individual with a disability? *

1. How familiar are you with cervical screening and its importance for people with disabilities? *

Very familiar

Somewhat familiar

Not familiar at all

2. Have you been involved in helping the person you care for access cervical screening in the past? *

Yes

3. What do you think would make in-home cervical screening more comfortable for the individual? *

4. Are there specific considerations or needs related to the person that should be taken into consideration when planning in-home cervical screening? *

5. How do you think the screening process could be adapted to make it more accessible for the individual? *

6. How involved would you like to be in the cervical screening process for the person you care for? *

7. How comfortable do you feel with a health care provider conducting cervical screening in the home setting? *

8. What would make you feel more comfortable with the cervical screening process at home? *

9. Do you have any additional concerns or suggestions about delivering cervical screening at home for people with disabilities? *

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Family member questionnaire – SHQ 2 U