Section 1

This section is about your health habits.

Statement 1: I always make sure I exercise regularly at least once a week.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 2: I always make sure to eat a nutritious and balanced meal.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 3: I go for periodic health checks even if I do not have any specific health concern.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 4: I have to be really ill to go to the doctor.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

Section 2

This section is about your experience and exposure to dengue.

1. Have you or a family member been infected with dengue?
Yes
No
2. How would you rate the risk level of getting dengue in your household?
No Risk
Low Risk
Medium Risk
High Risk
3. How would you rate your knowledge about dengue?
None: I have no knowledge about dengue
Low: I have some basic knowledge about dengue but may not be able to answer questions about dengue accurately
Moderate: I have a good understanding of dengue, including the symptoms, transmission, prevention, and management
Good: I have a deep understanding about dengue, including the latest research
4. How concerned are you about dengue?
Not concerned at all
Slightly concerned
Concerned
Extremely concerned
5. Do you take any preventative measures against dengue?
Yes
No
6. Beyond a doctor, where do you get information about dengue? You may select more than one.
Social media platforms such as Facebook, Instagram, etc.
Chat groups such as WhatsApp, Telegram, etc.
Friends and family
Government portals or approved websites such as the MySejahtera app or iDengue official portal*
General health or medical websites such as Healthline, Medical News Today, Cleveland Clinic, etc.
International medical authorities such as World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC)
Search engines
Online forums such as Lowyat.net, Positive Parenting, etc.
Television programmes
Pharmacists
Articles in general media
Magazines
Leaflets or posters
Others:

*By the Malaysian Space Agency (MYSA), Disease Control Division (BKP) and Ministry of Health Malaysia (MOH)

7. In your opinion, which area has a risk of dengue?
Indoors
Outdoors
Both indoors and outdoors
Not sure

Section 3

This section is to understand your perception towards immunisation against infectious diseases in general.

Statement 1: It is important for people to be immunised against infectious diseases.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 2: The benefits of vaccination outweigh the risks.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 3: I only follow my doctor’s recommendation when it comes to immunization.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Statement 4: I believe immunization is important, whether the vaccines are free or not.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree

Section 4

This section covers your personal details.

I agree to future communications from DoctorOnCall only. Personal information will not be shared with Takeda Malaysia Sdn. Bhd [company Registration No. 200901025887 (868989-K). I have read the DoctorOnCall Privacy Policy and expressly consent to the processing of my personal data as detailed in the Privacy Policy
1. Name:
2. Age
Below 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 60
61 and above
3. Phone number:
4. Email address:
5. Please select your monthly household income.
Below RM3,000
RM3,000 - RM3,999
RM4,000 - RM5,999
RM6,000 - RM7,999
RM8,000 or more
6. What is your current employment status?
Employed
Unemployed
Self-employed
Student
Retired
Others:
7. Which of the following, if any, best describes your highest level of education?
Primary school
Lower secondary (Form 1, 2 and 3)
Upper secondary (Form 4 and 5)
Pre-university (Form 6, GCE A Level, Matriculation, etc.)
Certificate programmes in specific trades or technical skills
Tertiary certificate or diploma
Tertiary degree or advanced diploma
I don’t know
None
Others:
8. Please select your marital status:
Single
Married
Divorced
Widowed
9. Please select your family status:
No children
With children
C-ANPROM/MY/DENV/0238 DEC 2023