Provider Pre-Intervention Participant ID

Interview

Facility ID Today’s Date

Instructions: (STUDY STAFF) Use this form with the health care provider at baseline (i.e. pre-intervention). DP refers to “data processing” and does not need to be filled out at time of interview.

COMPLETE BEFORE STARTING INTERVIEW:

PARTICIPANT GENDER:

1-Male

2-Female

I. INTRODUCTION AND BACKGROUND INFORMATION

Good morning/afternoon. My name is [NAME]. How are you today? Thank you for agreeing to speak with me today for the research study we’re conducting regarding abortion services.

I’d like begin with a few questions about your background and individual practice.

  1. Can you tell me, what is your profession?

1- Physician
2-Nurse

3-Midwife
4-Clinical officer
5-Other, specify ______

  1. What is your official job title? ______
  1. What are your duties/responsibilities here generally?
  1. Do you also work in the private sector or at other facilities?

0-no

1-yes

  1. Where else do you work?
    1-other public facility Name: ______
    2-private facility Name: ______
  2. a. Are you a specialist of any kind? If yes, what is your specialty?
    0-not a specialist

1-OB/GYN
2-Surgery
3-Internal medicine

4-Pediatrics

  1. The following questions refer your medical training?
    a. At what universities did you study?
    1-UNZA
    2-Chainama College (for clinical officers)
    3-Nursing School, specify ______
    4-Midwifery School, specify ______
    5-Foreign, specify______

6-Other, specify ______

  1. In what year did you complete your studies? ______
  2. What degree did you earn?

1-MBChB
2-Diploma in Clinical Medicine
3-Nursing certificate (RN or enrolled)
4-Midwifery Certificate (Registered or enrolled)
5-Other, specify ______

  1. a. Have you been trained in TOP or PAC service provision?
  1. What kind of training was it?
    1-PAC with MVA
    2-MPAC
    3-EMONC
    4-CAC using MVA
    5-CAC using medical abortion
    6-CAC using MVA and medical abortion
    99-Not applicable
  2. Where was this training conducted?

1-hospital, specify ______

2-hotel

3-other, specify______
99-Not applicable

  1. Was your training PAC only or did you receive TOP training, too?
    1-PAC only
    2-TOP and PAC
    99-Not applicable
  1. a. Have you ever performed PAC services?
    0-no
    1-yes
    b. How often do you currently perform PAC services?
    ______DP: Convert to times per month: ______
  1. What methods do you use to perform PAC [Multiple responses possible]?
    1-MVA

2-Sharp Curettage/D&C
3-Misoprostol
4-Other, specify ______
99-Not applicable

  1. Do you perform PAC at this facility or elsewhere?

1-at this facility
2-elsewhere
3-both at this facility and elsewhere
99-Not applicable

  1. Have you ever performed TOP procedures?
    0-no
    1-yes
  2. How often do you currently perform TOP services?
    ______DP: Convert to times per month: ______
    99-Not applicable
  3. What methods do you use to perform TOP?

1-MVA

2-Sharp Curretage/D&C
3-Misoprostol
4-Mifepristone and misoprostol

5-Other, specify ______
99-Not applicable

  1. Do you perform TOP at this facility or elsewhere?

1-at this facility
2-elsewhere
3-both at this facility and elsewhere
4-Neither

  1. a. For how long have you been involved inPAC servicesgenerally?

____years ____months
[Enter months only if total time is less than one year; otherwise round to nearest year]

b. And for how long have you been involved in the PAC services at this facility?
____years ____months
[Enter months only if total time is less than one year; otherwise round to nearest year]

  1. a. For how long have you been involved in TOP services generally? ____years
    ____years ____months
    [Enter months only if total time is less than one year; otherwise round to nearest year]
  1. And for how long have you been involved in the TOP services at this facility?
    ____years ____months
    [Enter months only if total time is less than one year; otherwise round to nearest year]

ii. CURRENT PRACTICE and impressions of service

Now I’d like to ask about the PAC/TOP services at this facility and your role in those services.

  1. Are PAC/TOP performed at this site currently?
    1-PAC only
    2-TOP and PAC
    3-Neither PAC nor TOP are performed here currently
  2. How many women come to this facility each week in need of PAC services?
  1. What techniques are used at this facility for first trimester PAC?
    1-MVA

2-Sharp Curretage/D&C
3-Misoprostol
4-Other, specify ______
5-PAC not offered

  1. What techniques are used at this facility for first trimester TOPs?
    1-MVA

2-Sharp Curretage/D&C
3-Misoprostol
4-Mifepristone and misoprostol
5-Other, specify ______

99-Not applicable

  1. What is the protocol for preparation of the cervix before a uterine evacuation?
    1-Administer misoprostol
    2-Dilators
    3-Other, specify ______
    99-N/a
  2. What is the protocol for pain management?
    1-general anesthesia (light)
    2-Ibuprofen
    3-Diclophenac
    4-other, specify ______
    99-N/a
  3. Is provision of antibiotic prophylaxis standard?

0-no
1-yes
99-N/a

  1. Are second trimester TOPs also done at this facility?
    0-no
    1-yes
  1. Where are second trimester TOPs done at this facility?
    1-MVA room
    2-theatre
    3-Other, specify ______

99-N/a

  1. What is your general impression of the first trimester TOP/PAC services at this facility?
    ______

______

  1. The following questions refer to the space where the first trimester TOP/PAC services are provided.

a. Is the space sufficient to meet the needs of the service?
0-no
1-yes
99-N/a

b.Are first trimester TOP and PAC services provided in the same space?
0-no
1-yes
99-N/a

c.Is there adequate privacy for clients?
0-no
1-yes
99-N/a

d.What dostaff think about the space?
______

  1. What is your role in the first trimester PAC/TOP services that are provided here? [TICK ALL THAT APPLY]
    1-Participate in supporting role in procedureDP: q29_1 0 no 1 yes

2-Principal provider of procedureDP: q29_2 0 no 1 yes
3-reception/intakeDP: q29_3 0 no 1 yes
4-counselingDP: q29_4 0 no 1 yes

III. Need for PAC services

In the next sections I have some questions about the possibility of expanding services at this facility to include PAC and TOPs and possibly medical abortion and what you think some of the challenges might be for that.

  1. How comfortable are you personally providing PAC services?
  1. Extremely uncomfortable
  2. Somewhat uncomfortable
  3. Comfortable
  4. Extremely comfortable
  1. Do you think women should have access to PAC services in general?

0-no
1-yes

  1. Do you think women should have access to PAC services at this facility?

0-no
1-yes

[IF PAC SERVICES ARE PROVIDED AT THIS FACILITY:]

  1. How many PAC procedures are done at this facility in:
    a. an average week? ______
    b. an average month? ______
  2. Of the total PAC procedures performed here in one month, how many of those are first trimester PAC procedures? ______
  1. Do you feel that the number of PAC procedures done here in an average week or month is appropriate for this facility, or should there be fewer or more?
    a. Appropriate
    b. should be fewer
    c. should be more
    Explain ______
  1. Do you think that this facility is one of the major providers of PAC procedures in the district?
    0-no
    1-yes
    98-don’t know

[IF PAC SERVICES ARE NOT PROVIDED AT THIS FACILITY:]

  1. Why are PAC procedures not provided at this facility? ______
    ______
  2. a. Do you think PAC procedures could be provided at this facility?
    0-no
    1-yes
    b. Why or why not? ______
    ______
  3. a. Do you think staff at this facility would be interested in receiving training on the provision of PAC services?

0-no

1-yes

b. Why or why not? ______
______

  1. a .If PAC services were to be provided at this facility and you received proper training, would you be willing to provide PAC services here?
    0-no

1-yes

b. Why or why not? ______
______

  1. What do you think are the barriers for implementation of PAC services in this facility? [Read possible responses aloud; allow multiple responses/tick all that apply]
  1. Work overload because there is not enough staff to run the clinic
  2. Lack of training on provision of PAC
  3. Lack of skill in counseling
  4. Lack of time for counseling
  5. There is no willingness/ commitment among staff to provide abortion services
  6. There are negative attitudes among staff towards abortion
  7. Lack of confidence in handling side effects among staff
  8. No proper referral mechanism between this facility and the hospital
  9. Other, explain ______
  1. a. What kind of clinic would be best suited for the provision of PAC services?
    1. tertiary facility

2. secondary facility

3. primary facility
b. Why? ______

IV. Need for FIRST trimester TOP services

Now I have some questions about demand for and access to TOPs.

  1. How comfortable are you personally providing TOP services?

1-Extremely uncomfortable

2-Somewhat uncomfortable

3-Comfortable

4-Extremely comfortable

  1. Do you think women should have access to TOP services in general?

0-no
1-yes

  1. Do you think women should have access to TOP services at this facility?

0-no
1-yes

[IF TOP SERVICES ARE PROVIDED AT THIS FACILITY, answer Q46-49. If not, skip to Q50]:

  1. How many TOPs are done at this facility in:
    a. an average week? ______
    b. an average month? ______
  2. Of the total TOPs performed here in one month, how many of those are first trimester TOPs? ______
  1. Do you feel that the number of first trimester TOP services done here in an average week or month is appropriate for this facility, or should there be fewer or more?
    a. Appropriate
    b. should be fewer
    c. should be more
    Explain ______
  1. Do you think that this facility is one of the major providers of this service in the province?
    0-no
    1-yes

[IF TOP SERVICES ARE NOT PROVIDED AT THIS FACILITY, answer Q50-Q55; otherwise skip to Q56]

  1. Why are TOPs not provided at this facility? ______
    ______
  2. a. Do you think TOP services could be provided at this facility?
    0-no
    1-yes
    b. Why or why not? ______
    ______
  3. a. Do you think staff at this facility would be interested in receiving training on the provision of TOP services?

0-no

1-yes

b. Why or why not? ______
______

  1. a. If TOP services were to be provided at this facility and you received proper training, would you be willing to provide TOP services here?
    0-no

1-yes

b. Why or why not? ______
______

  1. What do you think are the barriers for implementation of TOP services in this facility?
  1. Work overload because there is not enough staff to run the clinic
  2. Lack of training on provision of TOP
  3. Lack of skill in counseling
  4. Lack of time for counseling
  5. There is no willingness/ commitment among staff to provide abortion services
  6. There are negative attitudes among staff towards abortion
  7. Lack of confidence in handling side effects among staff
  8. No proper referral mechanism between this facility and the hospital
  9. Other, explain ______
  1. What kind of clinic would be best suitable for the provision of abortion services?
    1. Tertiary facility

2. secondary facility

3. primary facility
a. Why? ______

V. Barriers to changing/expandingfirst trimester services to include MA

  1. a. In some settings, medication is used for first trimester abortions. Have you ever heard of “medical abortion?”

0-no

1-yes

  1. What have you heard? ______
    ______
  1. a. Have you ever been involved in provision of medical abortion?
    0-no
    1-yes

[IF NO] EXPLAIN: With “medical abortion” a woman takes one pill (mifepristone) at the clinic and then takes another medicine (misoprostol) at home. She should then come back to the clinic for a follow-up visit 10-14 days later.

  1. [If YES] in what way?______
  1. How comfortable are you personally providing MA services?

1-Extremely uncomfortable

2-Somewhat uncomfortable

3-Comfortable

4-Extremely comfortable

  1. Do you think women should have access to MA services in general?

0-no
1-yes

  1. Do you think women should have access to MA services at this facility?

0-no
1-yes

  1. a. Do you think it might be possible to add medical abortionservices at this facility?

0-no

1-yes

  1. Why or why not? ______
    ______
  1. a. Do you think staff at this facility would be interested in receiving training on medical abortion?

0-no

1-yes

b. Why or why not? ______
______

  1. a. If medical abortion were to be provided at this facility and you received proper training, would you be willing to provide medical abortion services here?
    0-no

1-yes

b. Why or why not? ______
______

  1. What do you think are the barriers for implementation of medical abortion in this facility? [Allow multiple responses; tick all that apply]

a.Work overload because there is not enough staff to run the clinic

b.Lack of training on medical abortion

c.Lack of skill in counseling

d.Lack of time for counseling

e.Lack of time for handling follow-up visit

f.The clinic has not enough space for counseling medication abortion clients

g.There is no willingness/ commitment among staff to provide medical abortion

h.There are negative attitudes among staff towards medical abortion

i.Lack of confidence in handling side effect among staff

j.No proper referral mechanism between this facility and the hospital

k.Women won’t want this type of service

l.Lack of drugs

m.Too costly

n.Other, explain ______

  1. a. What kind of clinic would be best suitable for the provision of medical abortion?

1. Tertiary facility

2. secondary facility

3. primary facility
b. Why? ______

  1. Based on your experiences, what are the requirements that a clinic will need to implement medical abortion services?

Thank you very much for your time!

Interviewer’s initials and date:

Instrument6.Provider Interview - Pre-5-27-09 Page 1 of 11

Approved by UNZAREC IRB:xxx

Approved by AIRB:xxxVersion 1.0 English