Staff Attitude Survey
Thank you for agreeing to complete this survey. This survey is anonymous. Your name will not appear anywhere on the survey. Please answer the following questions about medication abortion. As you may know, in a medication abortion a woman is given pills to end her pregnancy, rather than having a procedure that involves instruments. A medication abortion is only done very early in pregnancy (within the first 9 weeks of pregnancy) and the woman passes the pregnancy tissue at home after using the pills.
- What is your current position at this facility? Are you a physician, nurse practitioner or physician assistant, nursing staff, clerical staff, or administrator?
Physician 1
NP, Midwife, PA,or social worker 2
Nursing staff 3
Clerical staff 4
Administrator 5
2. How long have you been working at this facility in any position?
______weeks ______months ______years
3. Tell us whether or not you think medication abortion pills should be available at the following places. Circle Yes or No.
Yes NoIn abortion clinics
Yes No In hospitals
Yes NoIn primary care settings
- In the next year, how would you feel working in a primary care setting that offered medication abortion to women as part of their general medical care?
Very comfortable …………………..1
Somewhat comfortable …………...2
Somewhat uncomfortable ……..….3
Very uncomfortable ………………..4
IF YOU SAID “VERY COMFORTABLE” OR “SOMEWHAT COMFORTABLE” TO THE LAST QUESTION, SKIP TO QUESTION #6.
5. If you might feel uncomfortable working in a primary care setting that offers medication abortion to women as part of their general medical care, then please look at the list below and tell us whether each item is or is not a reason you would feel uncomfortable.
YES,NO,
One of my reasonsNot a reason
I’m personally opposed to abortion
I’m not opposed to abortion, but I don’t want to be involved in providing early abortion services
I’m concerned about the safety of medication abortion
I’m concerned about how well medication abortion works
I’m concerned there might be a threat of violence
OTHER REASON
______(fill-in)
- iven the necessary training and backup, how interested are you personally in participating in providing medication abortions in a primary care setting at some point in the next year? If you are an administrator or clerical staff member please circle “not applicable.”
Very interested …………………………….1
Somewhat interested ………………………2
Somewhat uninterested…………………….3
Very uninterested ………………………….4
Not applicable……………………………...7
- Given the necessary training and backup, how interested are you personally in providing early surgical (suction) abortions in a primary care setting at some point in the next year? If you are an administrator or clerical staff member please circle “not applicable.”
Very interested …………………………….…1’
Somewhat interested …………………………2
Somewhat uninterested ………………………3
Very uninterested …………………………….4
Not applicable…………………..………….…7
- About what percent of your patients here at this facility are women between the ages of
15 yrs old and 44 yrs old?
______%
- Have you ever performed a medication or aspiration abortion?
Yes …………………………………1
No ………………………………….2
Not applicable …………………...7
- Have you ever assisted in an aspiration abortion procedure?
Yes …………………………………1
No ………………………………….2
Not applicable …………………...7
- Have you ever assisted in a medication abortion ?
Yes …………………………………1
No ………………………………….2
Not applicable …………………...7
- Have you ever referred a woman for an abortion?
Yes …………………………………1
No …………………………………..2
Not applicable ………………………7
- The medication abortion pill is fairly new. How much do you know about it?
A lot ………………………………...1
Some ………………………………..2
A little ………………………………3
Nothing ……………………………..4
- Are you male or female?
Male …………………………………0
Female …………………………….…1
- What is your age?
Less than 20 …...…………………….1
20 to 29 ………………………………2
30 to 39 ………………………………3
40 to 49 ………………………………4
50 to 59 ………………………………5
60 or over …………………………….6
THANK YOU!
1