Items:

Perceived susceptibility
1. I am at risk of unwanted pregnancy if I don't use contraceptive?
2. I am at risk of practicing abortion if I don't use contraceptive?
3. I am at risk of developing HIV/AIDS during unsafe abortion due to unclean materials?
4. There is risk of maternal death if wanted pregnancy happens?
5. I am at risk of having extended family if I don't use contraceptive?

Perceived severity
6. Unwanted severity can result in unsafe abortion.
7. Unsafe abortion can lead to maternal death.
8. Unwanted pregnancy can affect a family financially.
9. Births with close gap can affect the health of a women.
10. Births with close gap can affect the health children.

Perceived benefit
11. Modern contraceptives can prevent pregnancy effectively.
12. Modern contraceptives prevent abortion related consequences.
13. Modern contraceptives help in birth spacing.
14. Modern contraceptives help in permanently stopping fertility if wanted.
15. Some modern contraceptives can prevent HIV/AIDS transmission.
16. Other benefit (specify)*

Perceived barrier
17. It is too far to get contraceptives to me. 18. I fear side effects to use modern contraceptives.
19. Cost is not affordable to me to use modern contraceptives.
20. It is inconvenient for me to use modern contraceptives.
21. Other barrier (specify)*

Subjective norms
22. It is against my religious norm to use modern contraceptives.
23. It is against my cultural norm to use modern contraceptives.
24. My husband will not accept to use modern contraceptives.
25. My peers will discriminate me if they know I am using modern contraceptives.

Perceived self efficacy
26. I feel confident that modern contraceptives will prevent unwanted pregnancy.
27. I would have confidence to suggest my partner to use modern contraceptives.
28. I am confident to ask for modern contraceptive methods in health institution.
29. I feel the cost for modern contraceptives is easy to overcome.

Response Options:
Strongly disagree - 1
Disagree - 2
I don't know - 3
Agree - 4
Strongly agree - 5