Items:

Subscale: Autonomy, Respectful Care and Communication
1. Did the doctors, nurses, or other staff at the facility treat you with respect?
2. Did you feel the doctors, nurses or other staff at the facility wanted the best for you?
3. Were you given enough information about your care in order for you to feel like you understood what happened?
4. Did you feel like you understood the purpose of medicines and tests given?
5. Did you feel like the doctors, nurses or other staff at the facility involved you in decisions about your care?
6. Did you feel the doctors, nurses or other staff at the facility clearly explained things to you?
7. When you had questions, did the doctor or nurse answer in a way you could understand?
8. Did you feel you could ask the providers any questions you had?
9. Did the doctors, nurses or other staff at the facility support your anxieties and fears about your family planning procedure or your choice?
10. Did you feel like the doctor or nurse asked how much pain you were in?
11. Did you feel you were given pain medication when you felt you needed it?
12. When you needed help, did you feel the doctors, nurses or other staff at the facility paid attention?
13. Did you feel you were allowed to have someone you wanted to stay with you during your visit?
14. Did you feel the doctors, nurses, or other health staff at the facility take the best care of you?
15. Did you feel the doctors, nurses or other staff at the facility care about you as a person?
16. Did you feel you had complete trust in the doctors, nurses or other staff at the facility with regards to your care?
17. Did the doctors, nurses or other staff at the facility ask you or your family for money other than the official cost?

Subscale: Health Facility Environment
18. Did you think there was enough health staff in the facility to care for you?
19. Did you feel the facility was clean?
20. Did you think the toilets and washroom are clean?
21. Did you feel safe in the health facility?
22. Was the counseling room too crowded?

Response options:
Not specified.