Items:

Sub-scale: Dignity and Respect
1. How did you feel about the amount of time you waited? Would you say it was very short, just a little long, somewhat long, or very long?
2. During your time in the health facility did the doctors, nurses, or other health care providers introduce themselves to you when they first came to see you?
3. Did the doctors, nurses, or other health care providers call you by your name?
4. Did the doctors, nurses, or other staff at the facility treat you with respect?
5. Did the doctors, nurses, and other staff at the facility treat you in a friendly manner?
6. Did you feel the doctors, nurses, or other health providers shouted at you, scolded, insulted, threatened, or talked to you rudely?
7. Did you feel like you were treated roughly like pushed, beaten, slapped, pinched, physically restrained, or gagged?
8. During examinations in the labor room, were you covered up with a cloth or blanket or screened with a curtain so that you did not feel exposed?
9. Do you feel like your health information was or will be kept confidential at this facility?

Sub-scale: Communication and Autonomy
10. Did you feel like the doctors, nurses or other staff at the facility involved you in decisions about your care?
11. Did the doctors, nurses or other staff at the facility ask your permissionconsent before doing procedures and examinations on you?
12. During the delivery, do you feel like you were able to be in the position of your choice?
13. Did the doctors, nurses or other staff at the facility speak to you in a language you could understand?
14. Did the doctors and nurses explain to you why they were doing examinations or procedures on you?
15. Did the doctors and nurses explain to you why they were giving you any medicine?
16. Did you feel you could ask the doctors, nurses or other staff at the facility any questions you had?

Sub-scale: Supportive Care
17. Were you allowed to have someone you wanted (outside of staff at the facility, such as family or friends) to stay with you during labor?
18. Were you allowed to have someone you wanted to stay with you during delivery?
19. Did the doctors and nurses at the facility talk to you about how you were feeling?
20. Did the doctors, nurses or other staff at the facility support your anxieties and fears?
21. Do you feel the doctors or nurses did everything they could to help control your pain?
22. When you needed help, did you feel the doctors, nurses or other staff at the facility paid attention?
23. Did you feel the doctors, nurses or other staff at the facility took the best care of you?
24. Did you feel you could completely trust the doctors, nurses or other staff at the facility with regards to your care?
25. Do you think there was enough health staff in the facility to care for you?
26. Thinking about the labor and postnatal wards, did you feel the health facility was crowded?
27. Thinking about the wards, washrooms and the general environment of the health facility, will you say the facility was very clean, clean, dirty, or very dirty?
28. Was there water in the facility?
29. Was there electricity in the facility?
30. In general, did you feel safe in the health facility?

Response Options:
For Item 6 and 7 under DignityRespect:
4-point response scale:
No, never
Yes, once
Yes, a few times
Yes, many times

For all other items:
4-point response scale:
No, never
Yes, a few times
Yes, most of the time
Yes, all the time
Not applicable