Appendix A
The questionnaire used in this study. Modified from The Massachusetts Eye and Ear Infirmary, the Harvard School of Public Health, and Cogent Research, Inc. [
16].
A Questionnaire for Evaluating Noise Induced Hearing Loss and People Awareness about the Effects of Loud Sounds on Hearing and Health:
Participant no: ____________ Date: ___________________
(Please write X in front of the proper answer)
Age: ________________ Gender: __Male __ Female
Educational status: __________________
Country of residence: __________________
1- These are two problems facing young people these days? Please determine how big do you feel these problems, even if they do not affect you personally?
| A very Big Problem | A Big Problem | Not that Big | Not at All |
Hearing loss or hearing problems | | | | |
Depression | | | | |
2- Now, could you please imagine yourself affected by one of these issues, how will you evaluate these problems
| A very Big Problem | A Big Problem | Not that Big | Not at All |
Hearing loss or hearing problems | | | | |
Depression | | | | |
● In this part of questions, we will point to the hearing problems:
3- Have you ever faced, read, heard or seen anything which is related to hearing loss problems?
__ a. Yes
__ b. No (if no go to question 5)
4- How/Where have you faced, heard, read or seen something about hearing Loss?
_______________________________________________
_______________________________________________
5- Have you ever experienced or ever been affected by any type of hearing Problems, such as:
__ a. Ear pain (Ex. due noise exposure)
__ b. Temporary Hearing Loss/Noise Sensitivity
__ c. Already use/used hearing aids
__ d. Tinnitus or Ringing in Ear (is a condition in which there is a sense of sound within the ear without the existence of any external sound)
__ e. Any other problems that are not listed: ___________________
__ f. None of the a above
6- In the following schedule there are some activities that may cause hearing related problems; do you frequently attend such activities?
| Yes | No | How many times in a week/year? |
Listening to loud music on a stereo/headset, others | | | |
A club, rave and discos | | | |
Concerts | | | |
weddings and parties (with loud music) | | | |
7- After or during which one of these activities have you experienced a hearing related problem?
| Very often | Often | Not often | Never |
Listening to loud music on a stereo/headset | | | | |
During or after going to a disco, club, … | | | | |
During or after going to a concert | | | | |
During or after going to weddings and parties (with loud music) | | | | |
Please read the following paragraph:
An earplug is a device that is inserted in the ear canal to protect the wearer’s ears from loud sounds and noise
8- What do you feel, when you see someone wearing an ear plug during a party, wedding, disco, …? (Funny, cool, ugly, healthy, …………)
___________________________________________________________________
9- Have you ever worn earplugs at a rave, club, concerts, weddings or any other places where loud music was being played?
__ a. Yes (If yes, go to question 11)
__ b. No (If No, go to question 10)
10- Could you please justify, why you did not follow ear protection devices consideration?
__________________________________________________________________
__________________________________________________________________
11- Why you have planned to wear Earplugs?
__ a. Since loud music cause hearing problems (I wear to protect my hearing system)
__ b. Since loud music is simply annoying (make me nervous)
__ c. Since I have already hearing problems
__ d. After hearing loud music I have problems in sleeping
__ e. Others________________________________________________________
* Please read the following paragraph:
Loud sounds affect the hearing sense and hearing loud music for a long time will increase the probability of hearing loss and hearing related problems such as (sleeplessness). Using earplugs (Hearing protection system devises) can reduce 75% of related sound. And that protect your hearing and it is already recommended to be used.
* Now could you please answer the following questions.
12- Have you ever met any person or seen any program that suggested wearing earplugs in such parties before reading this paragraph?
__ a. Yes
__ b. No
13- Where have you got this information?
__ a. Parents
__ b. Friends
__ c. Doctors, Nurses
__ d. From media (TV, Internet, Radio, … etc.)
__ e. since I experienced a problem (It is my first time to experience that)
__ f. Heard about it at a disco, weddings, parties, … etc.
__ g. Others ________________________
14- Before reading the previous Have you ever known that loud music and noise could damage the hearing system?
__ a. Yes
__ b. No
15- After this information, how likely you are to use the Earplugs next time that you go to a party, rave, concert or wedding?
__ a. Very likely
__ b. Somewhat likely
__ c. Not too likely
__ d. Not at all, why? (____________________________________________________)
16- Do you have any idea, from where can you get an earplug (Hearing protection devise)?
__ a. Yes
__ b. No
(If no, read the following suggestions: in a pharmacy, health clinic, at your doctor office, at a hearing aid store or at an audiologist’s office)
17- In a typical week, how much time do you spend on hearing music?
__ a. 1–5 h
__ b. 6–10 h
__ c. 11–15 h
__ d. 16–20 h
__ e. More than 20 h
18- To hear music what do you use Mostly?
__ a. Mainly Headset
__ b. Mainly from Loudspeakers or TV
__ c. Both (Almost equivalent)
19- To the best of your knowledge, how much was your family income in the last year?
__ a. above the average
__ b. below the average
__ c. around the average
__ d. Have no idea
__ e. Prefer not to answer
Thank you for your help