Appendix h STUDY NUMBER: COST OF UNSAFE ABORTION FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES T be administered abut 2-3 weeks after leaving the health facility 1. IDENTIFICATION 101. Patient identificatin number (WRITE IN FROM Q101 IN WOMEN S QUESTIONNAIRE): 102. Date when patient was discharged frm health facility: / / / (WRITE IN FROM Q211 IN PROVIDER S QNNAIRE) Day Mnth Year 998 = Permissin nt given 103. Date f fllw-up IDI: / / / Day Mnth Year 104. Days r weeks patient waited befre arriving at health facility: (WRITE IN FROM Q601 IN WOMEN S QUESTIONNAIRE) days OR weeks 105. Interviewer's name 106. Language f fllw-up interview 107. Number f cntacts made fr fllw-up interview 1 st cntact attempt / / / Day Mnth Year 2 nd cntact attempt / / / Day Mnth Year 3 rd cntact attempt / / / Day Mnth Year 108. Final result f fllw-up IDI: 1. Cmpleted 2. Partly Cmpleted (explain) 3. Refused 4. Respndent incapacitated 5. Respndent nt at hme r did nt shw fr appintment 6. Respndent pstpned 7. Respndent died 8. Other (specify) 109. Time fllw-up interview: Started: Ended: Guttmacher Institute - Assessing the public health, 1scial and ecnmic csts f unsafe abrtin (#RHB5R121)
STUDY NUMBER: 2. INTRODUCTION AND CONSENT Hell Madam. My name is and I am wrking with the [NAME OF ORGANIZATION]. As yu may recall, sme weeks ag we had the pprtunity t talk at [NAME OF HEALTH FACILITY] when yu were receiving medical treatment. At that time yu kindly agreed t meet again t cntinue that cnversatin. I wuld like t request yur cllabratin again in this study by answering sme questins abut hw yur health has been since yu left [NAME OF FACILITY], the expenses yu may have had and in general hw was yur experience there. If yu agree, yu will be interviewed fr abut ne hur Yur participatin is entirely vluntary and yu will nt receive a direct benefit fr participating. We want t audi tape recrd the interview s that we are able t g back and review the respnses later thus, nt missing any details. Participatin in this study is nly pssible if yu are willing t have the discussin recrded. If yu decide t take part, yu may stp at any time if yu d nt want t cntinue, and yu may refuse t answer any questin if it makes yu uncmfrtable. N infrmatin which culd identify yu will ever be released. D yu have any questins abut this study tday that yu want t ask me? If yu have any questins later abut the study, yu can cntact [PRINCIPAL INVESTIGATOR] f [NAME OF ORGANIZATION] at [TELEPHONE NUMBER]. 2
If yu agree t be interviewed and t have the interview audi tape recrded, please sign r write yur initials in the space belw prvided fr bth agreements t shw that yu understand the infrmatin abve and that yur cnsent is given vluntarily. I agree t be interviewed and t have the interview audi tape recrded (Respndent) (Date) IF PERSON IS UNWILLING TO INITIAL OR SIGN OR UNABLE TO READ OR SIGN BUT AGREES TO BE A PARTICIPANT: I [the interviewer] will sign here indicating that the infrmatin abve was read t yu, that yu agree t participate in this interview and that yur cnsent is given vluntarily. (Interviewer) (Date) 3
3. INTERVIEW GUIDELINES INTERVIEWER: PLEASE REMIND THE RESPONDENT AT ALL TIMES, IN ALL QUESTIONS THAT WE ARE REFERRING TO THE TIME SINCE SHE WAS DISCHARGED FROM THE HEALTH FACILITY FOR POST-ABORTION TREATMENT (QUESTION 102) AND TODAY S DATE (QUESTION 103). A. Please tell me abut hw yur health has been since yu left (NAME OF HEALTH FACILITY)? What kind f health prblems have yu experienced, if any? IF NO HEALTH PROBLEMS, GO TO B. Hw have these health prblems prevented yu frm ding yur nrmal activities (schl, wrk, husehld chres), if at all? What specific activities were yu unable t perfrm? Hw lng were yu unable t perfrm these activities? Did yu lse any incme during this time? If s, hw much incme did yu lse? [PROBE FOR ESTIMATE] Did anyne else in yur husehld lse incme during this time because f yur illness? If s, hw much incme did he/she lse? [PROBE FOR ESTIMATE] Did yur health prblems cause yu t seek treatment? B. Let us talk in mre detail abut the expenses yu, a family member r smene else may have incurred since yu left the health facility (date in 102). [IF RESPONDENT SAYS SHE WENT TO HEALTH FACILITY ONE OR MORE TIMES AFTER BEING DISCHARGED, SAY YOU ARE ASKING ABOUT EXPENSES FOR ALL VISITS. PROBE FOR ESTIMATE] Did yu r smene else pay fr transprtatin when yu left the health facility? If s, abut hw much was it? Did yu r smene else pay fees fr health facility visits since then? If s, abut hw much (fr all visits since discharge)? Did yu r smene else pay fr any fr tests since then? If s, abut hw much (fr all tests since discharge)? Did yu r smene else pay fr medicines r supplies prescribed after being discharged? If s, abut hw much? 4
Were there any ther csts yu r smene else had t cver? What were thse csts? Abut hw much were these additinal csts in ttal? C. Nw let s talk abut yur life and feelings after returning frm the health facility. In what ways have yur usual scial activities changed r nt? What were the reasns why yur usual scial activities have (r have nt) changed? Are there any things yu wanted t d but have nt been able t? What things have yu been unable t d? Any reasn(s) that made yu nt been able t d them? As far as yu knw, did anyne find ut that yu had an abrtin r that yu were in the hspital because yu needed pst-abrtin care? (If yes) Wh fund ut? What was (his/her/their) reactin? Culd yu describe it (give an example)? Hw did yu feel because f his/her/their reactin? Did it bther yu r make yu feel relieved? Has anyne been supprtive? If s, wh has been supprtive and in what ways? In yur pinin, hw were peple s attitudes r behavirs tward yu because f yur abrtin? Any change in (his/her/their) behavirs that yu bserved? Culd yu give me an example hw his/her attitude r behavir changed? Hw des this attitude r behavir change make yu feel? When yu started having health prblems as a result f the abrtin, yu waited sme time (SEE QUESTION 104) befre ging t the health facility. Culd yu tell me what that prevented yu frm ging sner? Were yu afraid f smene r smething? Culd yu tell me wh r what yu were afraid f and why yu felt afraid? Culd yu tell me hw yur experience at the health facility was when yu were treated fr the abrtin cmplicatins f yur last pregnancy? Hw many hurs did yu wait befre receiving treatment? Hw did the staff treat yu? THANK YOU VERY MUCH FOR YOUR TIME INTERVIEWER: RECORD ENDING TIME IN Q109 ON FIRST PAGE. 5