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Cup Usage Survey 2.0
The Cova Project -
Cup Usage Survey
1.
Name
2.
Age
Under 18
18-24
25-34
35-44
45-54+
3.
How long have you had your cup for?
1 month
2 months
3 months
4+ months
Other (please specify)
4.
Are you using your cup?
Always
Most of the time
Sometimes
Never
Other (please specify)
5.
Are you washing your cup correctly?
Yes
No
6.
Have you had any problems related to your cup?
No
Leakage
Smell
Problems inserting or removing
Pain
Infection
Lost/stolen cup
Other (please specify)
7.
Would you recommend the cup to others?
Yes
No
8.
How many days of school/work would you usually miss during your period?
0
1-2
2-4
5+
Don't attend school/work
9.
Number of days of school or work you have missed since receiving your cup?
0
1-2
2-4
5+
Don't attend school/work
10.
What is the highest level of education do you think you will achieve?
Primary education
Secondary Education (High school)
Diploma
University (degree)
No schooling
Other (please specify)
11.
How do you feel using your cup?
Confident
Nervous
Judged by others
In control
Free
Clean
New opportunities
Excluded from my community
Other (please specify)
12.
Have you been excluded from anything because of your period since receiving your cup?
13.
Would you recommend the cup to family/friends?
Yes
No
Why?
14.
Any additional comments that we can share with our donors? (This will help us provide more cups to more girls.)
