Items:

Information exchange factor

1. During the contraception consultation, I was able to give my opinion about what I needed.
2. I received complete information about my options for contraceptive methods.
3. The provider knew how to explain contraception clearly.
4. I had the opportunity to participate in the selection of a method.
5. I received information about how to protect myself from sexually transmitted infections.
6. I received information about what to do if a method fails (e.g., broken condom, forget a pill, feel an IUD is poorly placed).
7. I could understand how my body might react to using contraception.
8. I could understand how to use the method(s) we talked about during the consultation.
9. I received information about what to do if I wanted to stop using a method.
10. The provider explained to me what to do if I had a reaction to a method (e.g., allergies, nausea, pains, menstrual changes).

Interpersonal relationship factor

11. I felt the information I shared with the provider was going to stay between us.
12. The provider gave me the time I needed to consider the contraceptive options we discussed.
13. The provider was friendly during the contraception consultation.
14. I felt the health care provider had sufficient knowledge about contraceptive methods.
15. The provider showed interest in my health while we talked about contraception.
16. The provider was interested in my opinions.
17. I felt listened to by the provider

Response Options:
Completely agree - 4
Agree - 3
Disagree - 2
Completely disagree - 1

Disrespect and abuse factor

18. The provider pressured me to use the method they wanted me to use.
19. I felt the provider treated me poorly because they tend to judge people.
20. I felt scolded because of my age.
21. The provider made me feel uncomfortable because of my sex life (e.g., when I started having sex, my sexual preferences, the number of partners I have, the number of children I have).
22. The provider looked at me or touched me in a way that made me feel uncomfortable.

Response Options:
Yes - 1
Yes with doubts - 2
No with doubts - 3
No - 4