|Learning to Live - Monitoring and Evaluating HIV/AIDS Programmes for Young People - Practice Handbook (DFID - UNAIDS - Save the Children, 2000, 220 p.)|
Questionnaire for adolescent users: ask adolescents as they leave the clinic (ask patients only, not visitors).
2. Clinic name/town:
5. Clinic attended: [ ] OPD [ ] MCH [ ] ANC
6. Waiting time:
7. Did the nurse/doctor ask you any questions about your condition?
[ ] yes [ ] no
8. Did the nurse/doctor give you any information regarding your condition?
9. Were you able to ask all the questions that you wanted to?
10. Were you given or prescribed any medicines/treatments?
[a] medicines/treatments not needed
[b] medicines were given at the clinic
[c] medicines were prescribed
10. If treatments were given, were they explained to you? (what it does, when to take, any side-effects) give details:
11. How did you find the clinic staff who saw you? Were they friendly, not so friendly, or unpleasant to you?
12. Did the nurse call you by your name?
13. Did you feel that you had enough privacy while with the nurse?
[a] yes [b] no
if no, explain:
14. How much money did you have to pay?
[a] for consultation
[b] for a prescription
[c] travelling costs to and from the clinic
15. In general, do you feel satisfied with the service you have just received?
[a] very satisfied
[c] neither satisfied nor unsatisfied
16. Would you come back here again if you had a similar need?
[a] yes [b] no
17. What did you like best about the service?
18. What did you like least about the service?
19. Any other comments:
Source: adapted from Webb 1997c.