QES2: Zambia Client Exit interviews for MA follow-up visit only

Instructions: (Study staff) Use this form to interview the woman after she has seen the health care provider and before she leaves the clinic on the same day that she was consented/enrolled into the study. For open responses, write the response in space provided. For Yes/No questions, tick the appropriate box. All instructions for the interviewer are written in italics.

Name of Facility: ______Today’s Date: __ __ / __ __ / ______

Participant Identification Number: MA2- ______(Must be entered)

INTERVIEWER, PLEASE READ:

“Hello, my name is ______, and I am working with a team monitoring service quality. I would like to ask you questions about your experiences with the staff here and the procedure that you have just undergone. We are collecting this information in order to improve the facility’s services. I will not write down your name on the data collection form. Everything you tell me will be kept strictly confidential. No one will be able to identify you from the information we collect. Your participation is voluntary, and you do not have to answer questions that you do not want to answer. Any answers you give will not change or affect the care or services you receive. Do I have your permission to continue?”

Participant Consent:

I have understood the information. I have had the opportunity to ask questions about this interview.

______I agree to participate

______I do not wish to be interviewed

Signature or mark of the respondent: ______Date: __ __ / __ __ / __ __

Signature or mark of respondent's parent/guardian: ______

(If respondent is younger than 18 years of age)

This form should be signed by both the client and her parent/guardian if respondent is younger than 18 years of age. If the woman declines to participate, stop the interview now and record the reason for declining here:______.

This research has been reviewed and approved by the Allendale Ethical Review Committee in the United States and the University of Zambia ethics committee. If you have any questions or concerns about this study you may contact the study investigator Dr. Stephen Mupeta at Tel: 0977809134.

A copy of the first page (the informed consent page) should be given to the respondent.

Ensure that the location of your interview area has auditory privacy.

Section 8: Additional care-seeking by MA clients
801 / Did the doctors or nurses tell you to be looking for the following warning signs at home that mean you should go to the nearest health center or hospital right away? (These are sometimes called “complications”).
Interviewer read list and mark all that apply. / More than two weeks of bleeding
Bleeding more than normal menstrual bleeding
Severe or increased pain
Fever
Chills
Other (Specify) ______
802 / Have you telephoned a health provider anywhere since you took the misoprostol (or the second) tablets? / Yes
No
Don't Know/Refused
803 / Have you gone to see a health provider anywhere since you took the misoprostol (or the second) tablets? / Yes
No(Skip to question 901)
Don't Know/Refused
804 / If YES, Where did you go? / I came back to this facility
Public hospital
Public health Center
Pharmacy
Other private health facility
Traditional birth attendant
Community health worker
Other (Specify) ______
 Not Applicable
805 / If YES, Why did you go to see the health provider? / More than two weeks of bleeding
Bleeding more than normal menstrual bleeding
Severe or increased pain
Fever
Chills
Other (Specify) ______
 Not Applicable
806 / If YES, Can you tell me what happened there?
Probe: Did they do a surgical abortion with MVA or D&C? Did you have to go into the theater? Did you stay overnight? /  Not Applicable
807 / If YES, did the doctor or nurse tell you if you were still pregnant? / Yes
No(Skip to question 901)
Don't Know/Refused
 Not Applicable
808 / If YES, What was the status of your pregnancy? / Abortion completed
Ongoing pregnancy
 Not Applicable
Section 9: Today’s visit and the abortion experience
901 / How many days has it been since you took your first tablet here at this facility? / Number of days: ____
902 / How many days has it been since you took your misoprostol (the second tablets)? / Number of days: ____
903 / Did you have pain after you took the misoprostol tablets? / Yes
No(Skip to question 905)
Don't Know/Refused
904 / If YES, would you describe the pain as mild, moderate, or severe? / Mild
Moderate
Severe
 Not Applicable
905 / Did you have bleeding after taking the pills? / Yes
No(Skip to question 907)
Don't Know/Refused
906 / If YES, for how many days did you bleed? / Days of Bleeding: ______
Don't Know/Refused
 Not Applicable
907 / Did you see any tissue come out of your vagina between the time you took the pills and now? / Yes
No
Don't Know/Refused
908 / Were you satisfied with your abortion procedure? / Yes
No
Don't Know/Refused
909 / In total, how many times did you come to this health facility to have your abortion from the time you first knew you were pregnant until now? / ______times
910 / How long did you wait today from the time you came to this facility until now? / ______minutes
911 / How do you feel about the amount of time that you waited? / It was acceptable
 It was too long
 Don't know/Refused
912 / How prepared were you for what happened during this abortion? /  Very prepared(Skip to question 914)
 Somewhat prepared
 Not at all prepared
 Don’t know/Refused
913 / If somewhat or not at all prepared:
For what aspects of the procedure were you not prepared? /  Not Applicable
914 / Did you take any pain medication during your abortion? / Yes
No
Don't Know/Refused
915 / Did you receive the pain medication from this facility or purchase it from a pharmacist? / This facility
A pharmacist
Other (Specify) ______
916 / Was the pain medication you took enough to reduce your pain to a comfortable level? / Yes
No
Don’t Know/Refused
917 / If you ever needed an abortion again would you choose this method? / Yes
No
Don't Know/Refused
918 / Would you recommend this abortion method to a friend? / Yes
No
Don't Know/Refused
919 / Did you purchase any medications or sanitary products since you took the first pills here in this facility? / Yes
No
Don't Know/Refused
920 / Did the provider talk to you about family planning the first time you took your pills? / Yes
No (Skip to question 922)
Don't Know/Refused
921 / If yes, did you take a method home with you the last time you were seen in this facility to take your pills? / Yes
No
Don't Know/Refused
922 / Did the provider talk to you about family planning today? / Yes
No
Don't Know/Refused
923 / Did you accept a method today or get an appointment to return for a method? / Yes
No(Skip to question 925)
Don't Know/Refused
924 / If yes, which method did you accept? / Condoms
Pills
Injection/Depo Provera
IUCD
Implant
Female Sterilization/Male Sterilization
Periodic Abstinence/Withdrawal
Other (specify) ______
 Not Applicable
925 / Did you want a family planning method today? / Yes
No
Don't Know/Refused
926 / Why did you not get a family planning method today? / Did not want a method
Not offered a method
Facility did not have any supplies
Facility did not have supply of the method I wanted
I could not afford a method
Other (specify) ______
Don't know/Refused
 Not Applicable
927 / Did the provider ask you if you had any questions today? / Yes
No
Don't Know/Refused
928 / How much did you have to pay at this facility for your care today? / Kwacha ______
929 / Were you ever asked to pay or give something in addition to your fee for the services you received here today? / Yes
No
Don't Know/Refused
930 / How do you feel about the amount that you had to pay in total for your procedure? / It was affordable
It was too much
Don't Know/Refused
Not Applicable
931 / Do you have any unanswered questions now about your procedure or your care? / Yes
No
Don't Know/Refused
Section 10: Stigma and your community
Since getting your abortion, how many times have you….
1001 / Talked openly about your abortion? / Never
Once
More than once
1002 / Asked someone to keep your abortion a secret? / Never
Once
More than once
1003 / Wished you could talk to more people about your abortion? / Never
Once
More than once
1004 / Talked to someone who understands your decision? / Never
Once
More than once
1005 / Known that someone found out about your abortion, even though you didn’t want them to find out? / Never
Once
More than once
1006 / Lied about your abortion? / Never
Once
More than once
While you were deciding what to do about this pregnancy and abortion…..
1007 / Did you tell the man involved about your abortion / Yes(Skip to question 1009)
No
Don't Know/Refused
1008 / If you did not tell him, can you tell me why?
(Skip to question 1010) / He is no longer in my life
I didn’t feel like he needed to know
I was afraid it would break us up (he would leave me)
I was afraid he would disagree with the abortion
Other (specify) ______
 Not Applicable
1009 / The following situations pertain to you and the man involved with you when you became pregnant. Did any of the following things happen to you while you were deciding about your abortion?
(Interviewer read all and select all that apply) / He told me he supported my abortion decision
He told me he wanted to have the baby
He denied responsibility for the pregnancy
He threatened to hurt me because of my abortion decision
He struck, hit or pushed me because of my abortion decision
He threatened to leave me because of my abortion decision
He insulted me or called me names because of my abortion decision
He has told me he doesn’t agree with abortion
Other (specify) ______
 Not Applicable
1010 / Did you tell your mother about your abortion? / Yes(Skip to question 1012)
No
Don't Know/Refused
1011 / If no, can you tell us why you did not tell your mother?
(Read all and select all that apply)
(Skip to question 1013) / I don’t have a relationship with her right now
I didn’t feel like she needed to know
I knew she would disapprove
I didn’t tell my mother but she found out anyway
Other (specify) ______
 Not Applicable
1012 / The following situations pertain to you and your mother. Did any of the following things happen to you while you were deciding about your abortion?
Interviewer read all and select all that apply) / Told me she supported my abortion decision
Pressured me to have the baby
Struck, hit or pushed me because of my abortion decision
Threatened to kick me out because of my abortion decision
Insulted me or called me names because of my abortion decision
Has told me she doesn’t agree with abortion
Other (specify) ______
Since/Because of your abortion:
1013 / Have you been gossiped about? / Yes
No
Don't Know/Refused
1014 / Haveyou lost an important relationship? / Yes
No
Don't Know/Refused
1015 / Have you been insulted? / Yes
No
Don't Know/Refused
What do you think would happen if other people found out about your abortion?
1016 / I would lose my job. / Not likely
Possibly
Definitely
1017 / I would lose an important relationship. / Not likely
Possibly
Definitely
1018 / I would disappoint someone I love? / Not likely
Possibly
Definitely
1019 / I would be humiliated / Not likely
Possibly
Definitely
1020 / I would be physically harmed / Not likely
Possibly
Definitely
1021 / People would gossip about me / Not likely
Possibly
Definitely
1022 / I would be kicked out of my house / Not likely
Possibly
Definitely
I would now like to ask you some questions about your feelings since your abortion, since your abortion have you……
1023 / Felt like a bad mother? / Never
Some of the time
Most of the time
1024 / Felt confident that you made the right decision? / Never
Some of the time
Most of the time
1025 / Felt ashamed about your abortion? / Never
Some of the time
Most of the time
1026 / Felt alone? / Never
Some of the time
Most of the time
1027 / Felt like you brought trouble to your family? / Never
Some of the time
Most of the time
1028 / Felt that you have control of your life? / Never
Some of the time
Most of the time
1029 / Felt like you brought trouble to your relationship? / Never
Some of the time
Most of the time
1030 / Women who have abortions are:
(Interviewer read all and select all that apply) / Seen as sinners
Rejected by boyfriends/partners/husbands
No longer welcome at church
Given less respect than single mothers
Considered selfish
Other (specify) ______
1031 / How did answering these questions make you feel? / It was good to have a chance to talk about this
It was OK and I feel fine
It made me feel worse
1032 / Do you have any unanswered questions or concerns? / Yes
No
Don't Know/Refused

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