IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Outpatient Survey Regarding Laboratory Experience

Instructions: Use this tool when interviewing outpatients about their experience with laboratory
and/or diagnostic services.

Sections

A – Background Information (all respondents)

B – Laboratory Script Information (all respondents)

C – Patient information (all respondents)

D – Intention to pursue lab tests (all respondents)

E – Experience at PPP Facility lab (only those respondents who seek tests within the facility)

F – Follow-up survey on patient laboratory experience and changes to clinical management for
patients who used PPP facility lab (1-2 weeks later, only those respondents who use facility lab AND
completed module E)

G – Follow up survey on patient laboratory experience and changes to clinical management for
patients who seek diagnostic services outside of facility lab (1-2 weeks later, respondents who seek
care outside facility lab)

H – Follow up survey on patient laboratory experience and changes to clinical management for
patients who used the PPP facility lab (1-2 weeks later, only those respondents who use facility lab
and did NOT complete module E)

Section A: Background Information

Applies to: All respondents
Instructions: Interviewers meet respondent as the patient exist providers’ office. Interviewer asks
for respondent’s consent to participate in the study. If respondent agrees, ask them to see their
lab script (or electronic medical record) and complete Sections A and B. To be filled by
interviewer in advance of asking further questions of the patient.
A01 Respondent ID

A02 Country Ethiopia…………………………………...1

Kenya……………………………………....2
Ghana……………………………...........3

A03 District/County *add list based on final sample*

A04 Date (day/month/year) GC

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1
A05 Facility ID code (site of recruitment)
A06 Interviewer name and code
Section B: Laboratory Script Information
Applies to: All respondents
Instructions: Information to be obtained from the laboratory script or electronic medical record
and filled in by the interviewer looking at the record provided by clinician
B01 Does the patient have a
paper prescription script for
diagnostics?
B02 If this facility has a system
of electronic medical records,
then please note down the
Patient Medical Record ID
B03 Symptoms/Health
condition that patient is being
evaluated for as recorded on
prescription script
(Circle all that apply)
(List of facilities)
Yes……………………………………………………1 If yes, go to B03
No…………………………………………………….2
Questions B03-B04 will
___________________ be filled from the EMR.
Go to C01
Prevention/Screening…………………………………………………………..1
Prenatal care………………………………………………………………………..2
Fatigue………………………………………………………………………………….3
Weight loss…………………………………………………………………………..4
Edema…………………………………………………………………………………..5
Chronic pain………………………………………………………………………….6
Rhinitis………………………………………………………………………………….7
Chest pain…………………………………………………………………………….8
Syncope………………………………………………………………………………..9
Rash…………………………………………………………………………………….10
Insomnia……………………………………………………………………………..11
Acute abdominal pain………………………………………………………….12
Chronic abdominal pain……………………………………………………….13
Nausea/Vomiting…………………………………………………………………14
Jaundice……………………………………………………………………………….15
GI bleeding…………………………………………………………………………..16
Acute diarrhea……………………………………………………………………..17
Chronic diarrhea…………………………………………………………………..18
Mass (tumor).……………………………………………………………………….19
Cough/dyspnea…………………………………………………………………….20
Hemoptysis…………………………………………………………………………..21
Fever…………………………………………………………………………………….22
Vaginal discharge (Sexually transmitted disease)…………………23
Hematuria……………………………………………………………………………24
Headache…………………………………………………………………………….25
Neurological dysfunction (stroke) ……………………………………….26
Seizure…………………………………………………………………………………27
Dizziness………………………………………………………………………………28
Tremor…………………………………………………………………………………29
Behavior change…………………………………………………………………..30
Muskuloskeletal pain……………………………………………………………31
Incontinence…………………………………………………………………………32
Amenorrhea………………………………………………………………………….33
Infertility……………………………………………………………………………….34
Sexual dysfunction………………………………………………………………..35
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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1
B04 List of tests ordered
(Circle all that apply)
Vaginal bleeding……………………………………………………………………36
Malaria ……………………………………………………………………………….37
Hypertension……………………………………………………………………….38
Diabetes……………………………………………………………………………….39
Other (specify)………………..…………………………………………………….96
Health condition is illegible/unreadable…………………………..98
Health condition is missing……………………………………………….99
General Haematology
Hb……………………………………………………….……………………………….01
Full Blood Count…………………………………………………………………..02
ESR……………………………………………………………………………………….03
Reticulocytes………………………………………………………………………..04
Sickling Test………………………………………………………………………….05
Bf For Malaria Parasite………………………………………………………….06
RDT for Malaria Parasite……………………………………………………….07
Widal Test…………………………………………………………………………….08
Special Haematology
Hb A2 & F…………………………………………………………………………….09
G6PD……………………………………………………………………………………10
Osmotic Fragility………………………………………………………………….11
Bone Marrow Trephine Biopsy…………………………………………….12
Bone Marrow Aspirate…………………………………………………………13
LE Cell Test…………………………………………………………………………..14
Blood Film Comment……………………………………………………………15
Hb Electrophoresis……………………………………………………………….16
Coagulation
Clotting profile……………………………………………………………………17
Prothrombin Time………………………………………………………………18
INR……………………………………………………………………………………..19
APTT……………………………………………………………………………………20
Clotting Time………………………………………………………………………21
Bleeding Time……………………………………………………………………..22
Thrombin Time……………………………………………………………………23
Fibrinogen…………………………………………………………………………..24
D-Diners………………………………………………………………………………25
Factor VIII Assay………………………………………………………………….26
Factor IX Assay……………………………………………………………………27
Serology
Blood Group………………………………………………………………………28
VDRL………………………………………………………………………………….29
HIV (1 & 2) ………………………………………………………………………..30
CD4……………………………………………………………………………………31
PCR – DBS (infant under 6 months)……………………………………32
PCR – Tuberculosis…………………………………………………………….33
HBsAg………………………………………………………………………………..34
Viral Load…………………………………………………………………………..35
HCV Antibodies…………………………………………………………………36
Hepatitis B profile……………………………………………………………..37
Rheumatoid Factor……………………………………………………………38
Other (specify)………………………………………………………………….96
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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Prescribed lab tests are missing………………………………………….99

Section C: Patient information

Applies to: All respondents
Instructions: Information collected from the patient or their caretaker/guardian at the point of
enrollment as the patient exits the provider’s office, prior to visiting the laboratory.

C01 Is the patient the respondent? Yes………………………………….1 If C01 is

No………………………………….2 1, go to
C03.

If C01 is
2, go to
C02.

C02 Relationship of respondent to Parent……………………………………………….1

patient Spouse………………………………………………2
Caretaker………………………………………….3
Friend……………………………………………….4
Other (specify)
…………………………………….96

C03 Patient gender Male…………………………………………….…..1

Female……………………………………………..2
Do not wish to identify………………….….3
C04 Patient age Years |__|__|
(If less than a year old, enter Months |__|__| (Only if <1 year old)
months)
C05 What is the highest level of (0) No schooling
education you (the patient) has (1) Primary
completed? Primary, Secondary 1 (2) Secondary 1 (1st cycle)
(1st cycle), Secondary 2 (2nd cycle) (3) Secondary 2 (2nd cycle)
or Superior? (4) Superior/Upper

C06 How long did you (the patient)

travel to reach this facility today? __________ hours

C07 Do you (does the patient) have Yes………………………..1

coverage from the national health No…………………………2
insurance scheme? Don’t know…………….9

C08 Do you (does the patient) have a Yes…………………………………………….……..1

below poverty line card or No…………………………………………………….2
identification? (Adapted for each
country)
*remove for Ghana*

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

C09 I would like to ask you a few (Insert asset index list)
questions about your household. *For Ghana add DDHA Checklist**
Which of the following items do you
(does the patient) have in your
(their) household?

Section D: Intention to pursue lab tests

Applies to: All respondents
Instructions: Information collected at the point of enrollment as the patient exits the provider’s
office, prior to visiting the laboratory.

Introduce this section by saying “I will now be asking you some questions regarding your
experience with the laboratory referral process from the doctor’s office today”
D01 What brought Prevention/Screening…………………………………..1
you to the Prenatal care………………………………………………………..2
health facility Fatigue………………………………………………………….3
today? Weight loss…………………………………………………………………4
Edema/swelling of legs / face ………………..5
Chronic pain……………………………………………………………….6
Runny nose/congestion……………………………………………7
Chest pain……………………………………………………………….8
Feeling faint/losing consciousness………………………………………..9
Rash…………………………………………………………………………………….10
Difficulty sleeping………………………………………………………………..11
New stomach pain………………………………………………………….12
Long-standing stomach pain……………………………………………….13
Nausea/Vomiting…………………………………………………………………14
Jaundice/yellow skin or eyes ……………………………………………….15
Blood in stool …..………………………………………………………………..16
New diarrhea……………………………………………………………………..17
Long-standing diarrhea………………………………………………………..18
Mass (tumor).……………………………………………………………………….19
Cough/difficulty breathing…………………………………………………….20
Bloody sputum……………………………………………………………………..21
Fever…………………………………………………………………………………….22
Vaginal discharge (Sexually transmitted disease)………………….23
Blood in urine………………………………………………………………………….24
Headache……………………………………………………………………………..25
Neurological dysfunction (stroke) ………………………………………..26
Seizure………………………………………………………………………………….27
Dizziness……………………………………………………………………………….28
Tremor………………………………………………………………………………….29
Behavior change (i.e., confusions/loss of orientation)…………..30
Muscle or bone pain…………………………………………………………….31
Incontinence………………………………………………………………………….32
Loss/change of menstruation……………………………………………….33
Infertility……………………………………………………………………………….34
Sexual dysfunction………………………………………………………………..35
Vaginal bleeding……………………………………………………………………36

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Other (specify)………………..…………………………………………………….96

D02 What None ………………………………………………………………01

condition does None (antenatal screening) …………………....02
the provider Malaria………………………………………………………………………………..03
suspect you Urinary tract infection…………………………………………………………04
(the patient) Intestinal tract infection……………………………………………………..05
may have? Covid-19……………………………………………………………………………..06
Pneumonia………………………………………………………………………….07
Tuberculosis………………………………………………………………………..08
Cancer………………………………………………………………………………..09
Autoimmune disease…………………………………………………………10
Liver dysfunction ………………………………………………………………..11
Hepatitis C……………………………………………………………………………12
Sickle Cell anaemia………………………………………………………………13
Thyroid dysfunction……………………………………………………………14
Anaemia………………………………………………………………………………15
Hypertension…………………………………………………………………………16
Diabetes Mellitus…………………………………………………………………17
Neurological dysfunction………………………………………………………18
Psychological/psychiatric disorder……………………………………………19
Renal disease…………………………………………………………………………20
Cardiovascular disease……………………………………………………………21
Menstrual dysfunction……………………………………………………………22
Sexually transmitted infection…………………………………………………23
Other infectious disease…………………………………………………………24
Other (specify) ………………………………………………………………………96
Don’t know…………………………………………………………….9
D03 What samples Blood……………………………………………….1
does the Urine………………………………………………..2
doctor want Stool…………………………………………………3
you (the Throat swab……………………………………..4
patient) to Nasal swab……………………………………….5
submit for lab Sputum…………………………………………….6
testing? Genital swab…………………………………….7
(Circle all that X ray…………………………………………………8
apply) Other (specify)……………………………………………….96

Don’t know…………………………………………………………………………9

D04 Did the doctor Yes…………………………………………….……..1 If 2 go to

explain the No…………………………………………………….2 D06
reason for Don’t Know……………………………………….9
performing
the laboratory
tests for you
(the patient)?
D05 Are you Yes…………………………………………….……..1
satisfied with No…………………………………………………….2
the Don’t Know……………………………………….9

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

explanation
provided by
the doctor
about reason
for performing
the tests /
diagnostics?
D06 Did the doctor No ………………………………………………..1
provide you Yes, the doctor indicated that the tests are urgent and
an indication should be done today
for when you ………………………………………………………..2
(the patient) Yes, the doctor indicated that the tests should be done
should get the within the next week
laboratory ………………………………………………………….3
tests done by? Yes, the doctor indicated that the tests should be done
within the next two weeks
………………………………………………….4
Yes, the doctor indicated that the tests should be done
within the next month
………………………………………………………..5
Don’t know
…………………………………………………………………………..9

D07 Which Lab within health facility………….………1 If 1 go to

laboratory are Private lab outside the facility………....2 D12-D14
you (the Public lab outside the facility……….…..3
patient) Don’t know / Haven’t decided………….4 If 2 or 3 go
planning to go Not planning to get the test……………….5 to D08-
to? Other (specify)………………………………96 D09, then
D12 and
D14

If 4 go to
D10, then
D12 and
D14.

If 5 go to
D11.

D08 Which outside Laboratory name:___________________

laboratory
(public or
private) are
you planning
to visit?
D09 Why have you Doctor advice…………………………….1 Any
chosen this Suggested by friend………………….……2 answer,
lab? Good service…………………………….……3 Skip to D12
(Circle all that Affordability……………………………….….4
apply) Easy to reach…………………………...……5

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Quick results……………………….………..6
Have had tests done here before….7
Reliable results……………………………….8
Other (specify)…………………………………………….96

D10 Why are you Cannot afford the tests……………………..….1

uncertain Difficulties to travel to the lab……………….2
about I do not want laboratory tests done………3
whether you Unsure which lab can provide the test….4
will go to the Unsure how much the test will cost………5
lab or which Unsure whether the test is needed……….6
one to go to? Doctor indicated that it is not urgent to do tests today
(circle all that ………………………….7
apply) I do not have time…………………..8
Other (specify)……………………………………………………96
___________________________________
D11 Why are you Cannot afford the tests…………………….1 End
not planning Unable to travel to the lab……………….2 interview
to go to the I do not think it is necessary…………….3 and thank
lab? (circle all I do not trust the health provider’s recommendation………… for their
that apply) 4 time.
I have a sensitivity to needles……………5
Other (specify)……………………………………………….96
__________________________________
D12 When do you Right now …………………………..……………1
expect to go Later today ………………………………………2
to the In the next week ………………………………3
laboratory? In the next 2 weeks ………………………..…4
Don’t know …………………………………….…9
D13 Do you Yes…………………………………………….……..1 If 1 thank
consent for us No…………………………………………………….2 for time
to meet you and
after your indicate
laboratory that a
visit today to researcher
collect will meet
information them at
about your the lab.
experience? Then go to
The interview D14.
will take about
20 minutes. If 2, go to
Do you D14.
consent to
this? Note to
skip for
respondent
where D07
was
anything

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

but 1
D14 Do we (also) Yes…………………………………………….……..1 If 2, end
have your No…………………………………………………….2 interview
permission to and thank
contact you 1- for time.
2 weeks later
by phone to
collect
information
about your
follow up
experience?
The follow-up
interview will
take about 30
min.

D15 Please provide First and Last Name ____________

me your Primary phone number _________________
contact Alternate phone number _________________
details.

Section E: Experience at the PPP facility lab

Applies to: Only those respondents who seek tests within the facility
Instructions: Please ask these questions when the patient completes testing in the laboratory.

Please say “I would like to ask some questions about your experience with the lab now that you
have provided samples and finished your visit.”
E01 What test samples Blood……………………………………………….1 If E01
did you submit in the Urine………………………………………………..2 equal to 2
laboratory? Stool…………………………………………………3 or 3 go to
(Circle all that apply) Throat swab……………………………………..4 E02 else
Nasal swab……………………………………….5 skip to E09
Sputum…………………………………………….6
Genital swab…………………………………….7
X ray…………………………………………………8
Other (specify)……………………………………………….96

E02 Did you have access Yes…………………………………………….……..1 If 2 go to

to a toilet on the No…………………………………………………….2 E05
premises to collect
the urine sample?
E03 Did you have access Yes…………………………………………….……..1
to a toilet reserved No…………………………………………………….2
for your gender?
E04 How would you rate Good…………………………………………..…….1

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1
the cleanliness of the
toilet facilities?
E05 Did the technician
provide you with a
sterile collection
cup?
E06 From the time you
arrived at the lab,
approximately how
long did it take for
laboratory personnel
to take your sample?
E07 After collecting the
specimens, did the
lab personnel inform
you when the results
will be available?
E08 Were you given an
option to receive the
results electronically
or by mobile phone?
E09 Did you pay for any
of the tests today
E10 How much money
did you pay in total
for all the tests
today?
E11 How did you pay for
the lab tests? (Circle
all that apply)
E12 Do you have an
itemized invoice for
the tests you have
done today?
E13 Do I have your
permission to take a
picture of it or
record the costs
listed on it? (Please
take a picture of the
invoice if available)
Average……………………………….……………2
Poor………………………………………………….3
Yes…………………………………………….……..1
No…………………………………………………….2
<1 hour………………………...............………1
1 to 2 hours………………………............…..2
Over 2 hours…………………………………….3
Don’t know / Don’t remember …………9
Yes…………………………………………….……..1
No…………………………………………………….2
Don’t know / Don’t remember …………9
Yes…………………………………………….……..1
No…………………………………………………….2
Don’t know / Don’t remember …………9
Yes…………………………………………….……..1 If 2 or 9 go
No…………………………………………………….2 to E14
Don’t know / Don’t remember …………9
Ethiopian birr/ Ghanaian cedi/ Kenyan shilling/
(Circle the correct option)
Own savings/ income……………………….1
Borrowed from friends/ relatives……..2
Borrowed from money lender/ bank..3
Sold assets………………………………4
Self-help groups……………………………….5
Paid using insurance…………………………6
Other (specify)………………………………..96
Don’t Know……………………………………….9
Yes…………………………………………….……..1 If 1, go to
No…………………………………………………….2 E13
Did not receive an invoice……………….3
If 2 or 9 go
to E15
Yes…………………………………………….……..1 If 2 go to
No…………………………………………………….2 E15
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E14 This section should be filled by the interviewer looking at the itemized costs to patient (after
insurance) from the invoice or receipt, if available. If test was conducted but fee was waived, or
test was free, then please enter zero.
Test name Cost to patient
General Haematology
Hb
Full Blood Count
ESR
Reticulocytes
Sickling Test
Bf for Malaria
Parasite
RDT for Malaria
Parasite
Widal Test
Special Haematology
Hb A2 & F
G6PD
Osmotic Fragility
Bone Marrow
Trephine Biopsy
Bone Marrow
Aspirate
LE Cell Test
Blood Film Comment
Hb Electrophoresis
Coagulation
Clotting profile
Prothrombin Time
INR
APTT
Clotting Time
Bleeding Time
Thrombin Time
Fibrinogen
D-Diners
Factor VIII Assay
Factor IX Assay
Serology
Blood Group
VDRL
HIV (1&2)
CD4
PCR – DBS (infant
under 6 months)
PCR – Tuberculosis
HBsAg
Viral Load
HCV Antibodies
Hepatitis B profile

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Rhemuatoid Factor
Other (specify)
E15 Will the laboratory
be able to perform
all your tests today?
E16 What were the
reason(s) all the
tests were not
performed on your
first visit to the lab?
(Circle all correct
options)
Yes…………………………………………….……..1 If 1 or 9 go
No…………………………………………………….2 to E18
Don’t know…………………………………...…9
Some tests or collection equipment were not
available at the lab…………………………………………1
I could not afford some of the tests
ordered……………………………………….2
Would take too long to receive the
results…………………………………………….3
Would take too long to collect the specimen in
the lab………………………..4
I do not think it is necessary…………….5
I do not trust the health provider’s
recommendation…………6
I have a sensitivity to needles……………7
Other (specify) …………………………………..96

E17 What will you do to Come back to the same lab on a different
complete the day……...…1
remaining tests? Visit another lab today …………………………….…..2
Visit another lab on a different day …......……..3
I will not do the tests………………….……...........…4
I will seek a second opinion…...........................5
Don’t know………….………………….............…………9
Other (specify)…………………………………............96

E18 I would like to ask you to rate your experiences using this lab. Please rate the lab
facility for the following questions from (1) Very Poor to (5) Excellent
(1) (2) (3) (4) (5) (9) Don’t
Very Poor Fair Good Excellent know
poor
Attitude of the
laboratory staff
Cleanliness of the lab
facility
The time you waited
from your arrival to
the lab to when you
finished providing all
necessary samples
Affordability (cost of
services, cost of
transport, other
costs related to
accessing services)
Accessibility (in
terms of distance,

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

availability of
transport)
Opening hours of the
facility
Overall satisfaction
E19 How will your doctor Patient will pick up results from lab and take
receive the test them to the doctor at the next visit…..1
results? Laboratory will send the test results directly to
the doctor’s office…..2
Other (please specify)….96
E20 When do you Within the next week/7 days ………………..1
anticipate seeing Within 1-2 weeks ………………………………….2
your doctor or Within the next 4 weeks ……………………….3
another specialist Don’t know ……………………………………………9
next to discuss test
results and/or to
follow-up with
treatment
E21 We would like to Yes…………………………………………….……..1 If 2 then
contact you by No…………………………………………………….2 thank
phone in 1-2 weeks respondent
time to discuss your for time
experience around and close
receiving your test the
results from the interview.
laboratory. The
interview will take
30 minutes. Do we
have your
permission to follow
up with you?

Section F: Follow-up survey on patient laboratory experience and changes to clinical

management for patients who used PPP facility lab
Applies to: Patients who used PPP facility lab AND completed module E of the survey following the
laboratory visit
Instructions: Follow-up phone survey delivered 1-2 weeks after the laboratory visit at the PPP
facility

(If last interview was with patient themselves, please introduce this section as: “We spoke outside
the [name of the facility] about 1-2 weeks ago. Do you remember our conversation? At that time,
you agreed to participate in a 30-minute-long follow-up phone survey. Do you still agree to
proceed? I would like to ask you questions about your experience with the laboratory you visited
about 1 to 2 weeks ago.”

If last interview was with patient representative, please introduce this section as: “We spoke to
you about [patient name] outside the [name of the facility] about 1-2 weeks ago. Do you
remember our conversation? At that time, you agreed to participate in a 30-minute-long follow-
up phone survey. Do you still agree to proceed? I would like to ask you questions about [patient
name]’s experience with the laboratory you visited about 1 to 2 weeks ago.”

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F01 First, could First name_______

you please Last name_______
confirm your
(the patient’s)
name
F02 Have you Yes, I have obtained the results…..1 If 3,
obtained the Yes, I have obtained some but not all of the results….2 go to
results of the No, I have not received results….3 F08.
tests
performed in
the
laboratory
about 1-2
weeks ago?

F03 How did you Picked up in person from the lab If 1,

obtain the …………………………………1 go to
results of the Results sent to my mobile phone……..2 F04
tests you Results sent only to doctor /
performed in provider……………………………………………3 If 2,
the laboratory Other (specify)………………………………………………..96 got
about 1-2 to
week(s) ago? F05

If 3
go to
F07
F04 How did the Lab scheduled pick-up appointment on the same
laboratory let day samples were collected
you know Lab called and informed me when results were
that the test available
results were Went to the lab multiple times in person to check
ready to be whether the results were available
picked up? Other (specify)………………………………………………..96
F05 When did you Same day of testing……………………….1
get most of 1-2 days later…………………………………2
the results > 2 days – one week later ………………3
from your More than a week later…………………..4
tests?
F06 How did your Patient/representative picked up results from lab
doctor and took them to the doctor at the next visit….1
receive the Laboratory sent the test results directly to the
test results? doctor’s office….2
Don’t know….9
Other (specify)…..96

F07 When did Same day of testing……………………….1

your doctor 1-2 days later…………………………………2
receive the > 2 days – one week later ………………3

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

test results? More than a week later…………………..4

Don’t know………9

F08 Were you Yes, asked by lab……………………………...1 If 3

asked to redo Yes, asked by provider……………………….2 skip
any test by No…………………………………………………….3 to
the lab or F10
your health
care
provider?
F09 If you were Provided sample not adequate / good……1
asked to redo Strange or unexpected results (outlier values)
any tests, ………….2
what was the Other (specify)………………………………………………..96
reason?

F10 I would like to ask you to rate your experiences using this lab. Please rate
the lab facility on a scale of (1) to (5) where (1) is very poor and (5) is
excellent, for the following questions
(1)V (2)Poor (3)Fair (4)Good (5)Excelle (9)
ery nt Don’t
poo Know
r
F10a How quickly
the results
were made
available to
patient by the
lab
F10b Trust in the
quality of
results
provided by
the lab
F10c Overall
satisfaction
F11 Would you Yes…………………………………………….……..1
visit this No…………………………………………………….2
laboratory Don’t Know………………………………………9
again if you
needed more
tests
Now I would like to ask you a few questions about follow-up treatment you have received based
on the tests. Last time we spoke, you had seen the doctor for (insert condition here, from the first
part of the survey).
F12 Have you Yes…………………………………………….……..1 If 1,
seen the No…………………………………………………….2 skip
doctor to to
discuss the F14.
results from
the laboratory

Page 15 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

tests?
F13 Are you Yes………………………………………………….1 Than
planning to No………………………………………………….2 k
visit a Don’t know………………………………..…9 resp
provider? onde
nt
for
time
and
end
surv
ey.
F14 Did the Yes………………………………………………….1
doctor No………………………………………………….2
provide you Don’t know………………………………..…9
with a
diagnosis?

F15 Did the Yes…………………………………………….……..1 If 2

doctor No…………………………………………………….2 or 9,
prescribe new Don’t know………………………………..…9 skip
medication, to
change your F19
medication,
or provide
some new
order (e.g.,
dietary or
behavioral
change)
based on your
results?
F16 Did you begin Yes……………………………………………………….1 If 2
this No…………………………………………………………2 or 9
treatment? Don’t Know……………………………………………9 skip
to
F19
F17 Did you face Yes……………………………………………………….1
any barriers No…………………………………………………………2
to starting Don’t Know……………………………………………9
treatment?
F18 If yes, what Treatment not available at local pharmacy………….1
barriers did Facility opening hours not convenient……….…..…2
you face to Transport not available……………..…….….……3
start Friend / Family advised not to proceed…..……….4
treatment? Too expensive / can’t afford…………….……..5
Did not trust the health provider’s
recommendation…6
Did not think the treatment was necessary…7
Seeking a second opinion ………………………8
Other (specify)……………………………………………….96

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

_______________________________________

F19 Did the Yes…………………………………………….……..1 If 2

doctor refer No…………………………………………………….2 or 9
you to a Don’t know………………………………..…9 skip
specialist or to
other F22
provider
based on your
results?
F20 Did you Yes…………………………………………………….1 If 1
follow-up No………………………………………………………2 skip
with the Don’t Know………………………………………….9 to
specialist or F22
other
provider
already?
F21 Do you intend Yes……………………………………………………….1
to follow-up No…………………………………………………………2
with the Maybe…………………………………………………..3
specialist or Don’t Know……………………………………………9
other
provider?
F22 Did the Yes……………………………………………………….1
doctor say No…………………………………………………………2
that you will Maybe…………………………………………………..3
you need to Don’t Know……………………………………………9
be tested
again to
monitor your
condition?
F23 Have the Yes, it got resolved …………………………………………..1
symptoms for It improved, but treatment is needed to manage
which you condition……………………………………………………..2
sought care It did not get resolved/stayed the
changed since same………………….3
you visited Don’t know ……………………………………………….9
the doctor on
…..[insert
date of first
interview]

Thank you for answering our questions and supporting our research study.

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Section G:
Applies to: Patients who visited a public or private laboratory outside the PPP health facility
Instructions: Follow-up phone survey delivered 1-2 weeks after the laboratory visit at the PPP
facility

(Please introduce by saying: “I would like to ask you questions about your visit to the laboratory
about 1 to 2 weeks ago to perform tests advised by the provider in the (specify name) health care
facility. This survey will take around 30 minutes to complete.)

G01 Could you First name____

please confirm Last name_____
your first and
last name?
G02 Did you visit a Yes…………………………………………….……..1 If 1, go to
laboratory to No…………………………………………………….2 G04
perform the
tests
recommended
by the health
care provider
you visited
when we met
you 1-2 weeks
ago?
G03 Why did you Lab was closed……………………..…….…….1 Thank the
decide not to Open hours not convenient…….….….…2 respondent
get tested? Transport not available………….….…..…3 and close
Friend / Family advised not to go…..….4 the
Too expensive / can’t afford……………..5 interview
I do not think it is necessary…………….5 here
I do not trust the health provider’s
recommendation…………………………….6
I have a sensitivity to needles …………..7
Other (specify)………………………………………96

G04 What is the Laboratory name __________ If G04 is

name of the same as
laboratory D09 skip to
facility you G07
visited?
G05 Was this a Public
public or a Private
private lab? Don’t know
G06 Why did you Doctor advice…………………………….1
choose the lab Suggested by friend………………….……2
%name from Good service…………………………….……3
G03% instead Affordability……………………………….….4
of %name from Easy to reach…………………………...……5

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

D09%? (Circle Quick results……………………….………..6

all correct Have had tests done here before….7
options) Reliable results……………………………….8
Only location the test or collection equipment were
available………………9
Other (specify)…………………………………………….96

G07 I would like to ask you to rate your experience using this lab on a scale of 1 to 5 where (1)
is Very Poor and (5) is Excellent. Please rate the lab facility for the following questions
(1)Very (2)Poor (3)Fair (4)Good (5)Excellent (9)Don’t
poor know
G07a Attitude of the
laboratory staff
G07b Cleanliness of
the lab
G07c Waiting time to
get the tests
done once you
arrived at the
lab
G07d Affordability
G07e Accessibility (in
terms of
distance,
availability/cos
t of transport)
G07f Opening hours
G07g How quickly
the results
were made
available by the
lab
G07h Trust in the
quality of
results
provided by
the lab
G07j Overall
satisfaction
G08 Did you pay for Yes…………………………………………….……..1 If 2 go to
any of the tests No…………………………………………………….2 G13
done in that
lab?
G09 How much
money did you Ethiopian birr/ Ghanaian cedi/ Kenyan shilling/ (Circle the
pay in total for correct option)
all the tests
you did in that
lab?

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

G10 Did you have Yes…1 If 2 go to

travel costs No…2 G12
associated with Don’t know…9
the test as
well?
G11 If yes, how Ethiopian birr/ Ghanaian cedi/ Kenyan shilling/
much did you
pay to travel to
this lab
G12 How did you Own savings/ income……………………….1
pay for the lab Borrowed from friends/ relatives……..2
tests and Borrowed from money lender/ bank..3
associated Sold assets………………………………4
travel? Self-help groups……………………………….5
Paid using insurance…………………………6
Don’t know……………………………………….9
Other (specify)………………………………………………..96

G13 Were you able Yes…………………………………………….……..1 If 1 or 9 go

to perform all No…………………………………………………….2 to G16
the tests Don’t know…………………………………...…9
ordered by the
doctor upon
one visit to the
lab?
G14 What were the Some tests or collection equipment were not available at
reason(s) all the lab…………………………………………1
the tests were I could not afford some of the tests
not performed ordered……………………………………….2
on your first Would take too long to receive the
visit to the lab? results…………………………………………….3
(Circle all Would take too long to collect the specimen in the
correct lab………………………..4
options) I do not think it is necessary…………….5
I do not trust the health provider’s
recommendation…………6
I have a sensitivity to needles……………7
Other (specify) …………………………………..96
G15 What did you Came back to the same lab on a different
do to complete day……………………………………………..…..…1
the remaining Visited another lab on the same day………2
tests? Visited another lab on a different day………..3
I did not do the tests………………….………4
I sought a second opinion…...........................5
Don’t know………….………………….............…………9

Other (specify)……………………………………………………96

G16 Have you Yes, I have obtained the results…..1 If 3, go to

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

obtained the Yes, I have obtained some but not all of the results….2 G22
results of the No, I have not received results….3
tests
performed in
the laboratory
about 1-2
weeks ago?

G17 How did you Picked up in person from the lab ………………………………… If 1, go to
obtain the 1 G18
results of the Results sent to my mobile phone……..2
tests you Results sent only to doctor / If 2, got to
performed in provider……………………………………………3 G19
the lab about Other (specify)………………………………………………..96
1-2 week(s) If 3 go to
ago? F21
(Circle all that
apply)
G18 How did the Lab scheduled pick-up appointment on the same day
laboratory let samples were collected
you know that Lab called and informed me when results were available
the test results Went to the lab multiple times in person to check
were ready to whether the results were available
be picked up? Other (specify)………………………………………………..96
G19 When did you Same day of testing……………………….1
get most of the 1-2 days later…………………………………2
results of your > 2 days – one week later ………………3
tests? More than a week later…………………..4

G20 How did your Patient/representative picked up results from lab and
doctor receive took them to the doctor at the next visit….1
the test Laboratory sent the test results directly to the doctor’s
results? office….2
Don’t know….9
Other (specify)…..96

G21 When did your Same day of testing……………………….1

doctor receive 1-2 days later…………………………………2
the test > 2 days – one week later ………………3
results? More than a week later…………………..4
Don’t know………9

G22 Were you Yes, asked by lab……………………………...1 If 3, go to

asked to redo Yes, asked by provider……………………….2 G24.
any test by the No…………………………………………………….3
lab or your
health care
provider?
G23 If you were Provided sample not adequate / good.................1
asked to redo Strange results (outlier values)…………..................2

Page 21 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

any tests, what Other (specify)………………………………………………..96

was the
reason?
G24 Would you visit Yes…………………………………………….……..1 If G16=3,
this laboratory No…………………………………………………….2 thank the
again if you Maybe…………………………………………………..3 respondent
needed more Don’t Know……………………………………………9 and end
tests the
interview
after G24.

Now I would like to ask you a few questions about follow-up treatment you have received based
on the tests.
G25 Have you seen Yes…………………………………………….……..1 If 1, skip to
the doctor with No…………………………………………………….2 G27.
the results
from the
laboratory
tests?
G26 Are you Yes…………………………………………….……..1 Thank
planning to No…………………………………………………….2 respondent
visit a Maybe…………………………………………………..3 for time
provider? Don’t Know……………………………………………9 and end
survey..
G27 Did the doctor Yes………………………………………………….1
provide you No………………………………………………….2
with a Don’t know………………………………..…9
diagnosis?
G28 Did the doctor Yes…………………………………………….……..1 If 2 or 9,
prescribe new No…………………………………………………….2 skip to G36
medication, Don’t know………………………………..…9
change your
medication, or
provide some
new order
(e.g., dietary or
behavioral
change) based
on your
results?
G29 Did you begin Yes……………………………………………………….1 If 2 or 9,
this treatment? No…………………………………………………………2 skip to G32
Don’t Know……………………………………………9
G30 Did you face Yes……………………………………………………….1 If 2 skip to
any barriers to No…………………………………………………………2 G36
starting Don’t Know……………………………………………9
treatment?
G31 If yes, what Treatment not available at locally…………….1
barriers did you Facility opening hours not convenient……….…..…2
face to start Transport not available……………..…….….……3
treatment? Friend / Family advised not to go…..……….4

Page 22 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Too expensive / can’t afford…………….……..5

Did not trust the health provider’s recommendation…6
Did not think the treatment was necessary…7
Seeking a second opinion ………………………8
Other (specify)……………………………………………….96

G32 Did the doctor Yes…………………………………………….……..1 If 2 or 9

refer you to a No…………………………………………………….2 skip to G35
specialist or Don’t know………………………………..…9
other provider
based on your
results?
G33 Did you follow- Yes…………………………………………………….1 If 1 skip to
up with the No………………………………………………………2 G35
specialist or Don’t Know………………………………………….9
other provider
already?
G34 Do you intend to Yes……………………………………………………….1
follow-up with No…………………………………………………………2
the specialist or Maybe…………………………………………………..3
other provider? Don’t Know……………………………………………9
G35 Did the doctor Yes……………………………………………………….1
say that you will No…………………………………………………………2
need to be Maybe…………………………………………………..3
tested again to Don’t Know……………………………………………9
monitor your
condition?
G36 Have the Yes, it got resolved …………………………………………..1
symptoms for It improved, but treatment is needed to manage
which you condition……………………………………………………..2
sought care It did not get resolved/stayed the same………………….3
changed since Don’t know ……………………………………………….9
you visited the
doctor on …..
[insert date of
first interview]

Thank you for answering our questions and supporting our research study.

Section H:
Applies to: Patients who visited the laboratory at the PPP facility but did NOT complete module E
Instructions: Follow-up phone survey delivered 1-2 weeks after the laboratory visit at the PPP
facility

(Please introduce by saying: “I would like to ask you questions about your visit to the laboratory

Page 23 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

about 1 to 2 weeks ago to perform tests advised by the provider in the (specify name) health care
facility. This survey will take around 30 minutes to complete.)

H01 Could you First name____

please confirm Last name_____
your first and
last name?
H02 When we Yes, I visited %lab name% the same day…………………. If 1 or 2, go
spoke 1-2 ……..1 to H07
weeks ago, you Yes, I went back to %lab name% another If 3, go to
were planning day………………….2 H04
to visit %PPP No, I visited another lab outside of %lab name%....3
facility name% No, I did not complete the tests….4
to perform the
tests
recommended
by the health
care provider.
Did you
ultimately visit
that lab?
H03 Why did you Lab was closed……………………..…….…….1 Thank the
decide not to Open hours not convenient…….….….…2 respondent
get tested? Transport not available………….….…..…3 and close
Friend / Family advised not to go…..….4 the
Too expensive / can’t afford……………..5 interview
I do not think it is necessary…………….5 here
I do not trust the health provider’s
recommendation…………………………….6
I have a sensitivity to needles …………..7
Other (specify)………………………………………96

H04 What is the Laboratory name __________ If H04 is

name of the same as
laboratory D09 skip to
facility you H07
visited?
H05 Was this a Public
public or a Private
private lab? Don’t know
H06 Why did you Doctor advice…………………………….1
choose the lab Suggested by friend………………….……2
%name from Good service…………………………….……3
G03% instead Affordability……………………………….….4
of %name from Easy to reach…………………………...……5
D09%? (Circle Quick results……………………….………..6
all correct Have had tests done here before….7
options) Reliable results……………………………….8
Only location the test or collection equipment were
available………………9

Page 24 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

Other (specify)…………………………………………….96

H07 I would like to ask you to rate your experience using this lab on a scale of 1 to 5 where (1)
is Very Poor and (5) is Excellent. Please rate the lab facility for the following questions
(1)Very (2)Poor (3)Fair (4)Good (5)Excellent (9)Don’t
poor know
H07a Attitude of the
laboratory staff
H07b Cleanliness of
the lab
H07c Waiting time to
get the tests
done once you
arrived at the
lab
H07d Affordability
H07e Accessibility (in
terms of
distance,
availability/cos
t of transport)
H07f Opening hours
H07g How quickly
the results
were made
available by the
lab
H07h Trust in the
quality of
results
provided by
the lab
H07j Overall
satisfaction
H08 Did you pay for Yes…………………………………………….……..1 If 2 go to
any of the tests No…………………………………………………….2 G13
done in that
lab?
H09 How much
money did you Ethiopian birr/ Ghanaian cedi/ Kenyan shilling/ (Circle the
pay in total for correct option)
all the tests
you did in that
lab?
H10 Did you have Yes…1 If 2 go to
travel costs No…2 H12
associated with Don’t know…9
the test as
well?

Page 25 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

H11 If yes, how Ethiopian birr/ Ghanaian cedi/ Kenyan shilling/

much did you
pay to travel to
this lab
H12 How did you Own savings/ income……………………….1
pay for the lab Borrowed from friends/ relatives……..2
tests and Borrowed from money lender/ bank..3
associated Sold assets………………………………4
travel? Self-help groups……………………………….5
Paid using insurance…………………………6
Don’t know……………………………………….9
Other (specify)………………………………………………..96

H13 Were you able Yes…………………………………………….……..1 If 1 or 9 go

to perform all No…………………………………………………….2 to H16
the tests Don’t know…………………………………...…9
ordered by the
doctor upon
one visit to the
lab?
H14 What were the Some tests or collection equipment were not available at
reason(s) all the lab…………………………………………1
the tests were I could not afford some of the tests
not performed ordered……………………………………….2
on your first Would take too long to receive the
visit to the lab? results…………………………………………….3
(Circle all Would take too long to collect the specimen in the
correct lab………………………..4
options) I do not think it is necessary…………….5
I do not trust the health provider’s
recommendation…………6
I have a sensitivity to needles……………7
Other (specify) …………………………………..96
H15 What did you Came back to the same lab on a different
do to complete day……………………………………………..…..…1
the remaining Visited another lab on the same day………2
tests? Visited another lab on a different day………..3
I did not do the tests………………….………4
I sought a second opinion…...........................5
Don’t know………….………………….............…………9

Other (specify)……………………………………………………96

H16 Have you Yes, I have obtained the results…..1 If 3, go to

obtained the Yes, I have obtained some but not all of the results….2 H22
results of the No, I have not received results….3
tests
performed in
the laboratory

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

about 1-2
weeks ago?

H17 How did you Picked up in person from the lab ………………………………… If 1, go to
obtain the 1 H18
results of the Results sent to my mobile phone……..2
tests you Results sent only to doctor / If 2, got to
performed in provider……………………………………………3 H19
the lab about Other (specify)………………………………………………..96
1-2 week(s) If 3 go to
ago? H21
(Circle all that
apply)
H18 How did the Lab scheduled pick-up appointment on the same day
laboratory let samples were collected
you know that Lab called and informed me when results were available
the test results Went to the lab multiple times in person to check
were ready to whether the results were available
be picked up? Other (specify)………………………………………………..96
H19 When did you Same day of testing……………………….1
get most of the 1-2 days later…………………………………2
results of your > 2 days – one week later ………………3
tests? More than a week later…………………..4

H20 How did your Patient/representative picked up results from lab and
doctor receive took them to the doctor at the next visit….1
the test Laboratory sent the test results directly to the doctor’s
results? office….2
Don’t know….9
Other (specify)…..96

H21 When did your Same day of testing……………………….1

doctor receive 1-2 days later…………………………………2
the test > 2 days – one week later ………………3
results? More than a week later…………………..4
Don’t know………9

H22 Were you Yes, asked by lab……………………………...1 If 3, go to

asked to redo Yes, asked by provider……………………….2 H24.
any test by the No…………………………………………………….3
lab or your
health care
provider?
H23 If you were Provided sample not adequate / good.................1
asked to redo Strange results (outlier values)…………..................2
any tests, what Other (specify)………………………………………………..96
was the
reason?
H24 Would you visit Yes…………………………………………….……..1 If H16=3,
this laboratory No…………………………………………………….2 thank the

Page 27 of 29
IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

again if you Maybe…………………………………………………..3 respondent

needed more Don’t Know……………………………………………9 and end
tests the
interview
after H24.

Now I would like to ask you a few questions about follow-up treatment you have received based
on the tests.
H25 Have you seen Yes…………………………………………….……..1 If 1, skip to
the doctor with No…………………………………………………….2 H27.
the results
from the
laboratory
tests?
H26 Are you Yes…………………………………………….……..1 Thank
planning to No…………………………………………………….2 respondent
visit a Maybe…………………………………………………..3 for time
provider? Don’t Know……………………………………………9 and end
survey..
H27 Did the doctor Yes………………………………………………….1
provide you No………………………………………………….2
with a Don’t know………………………………..…9
diagnosis?
H28 Did the doctor Yes…………………………………………….……..1 If 2 or 9,
prescribe new No…………………………………………………….2 skip to H36
medication, Don’t know………………………………..…9
change your
medication, or
provide some
new order
(e.g., dietary or
behavioral
change) based
on your
results?
H29 Did you begin Yes……………………………………………………….1 If 2 or 9,
this treatment? No…………………………………………………………2 skip to H32
Don’t Know……………………………………………9
H30 Did you face Yes……………………………………………………….1 If 2 skip to
any barriers to No…………………………………………………………2 H36
starting Don’t Know……………………………………………9
treatment?
H31 If yes, what Treatment not available at locally…………….1
barriers did you Facility opening hours not convenient……….…..…2
face to start Transport not available……………..…….….……3
treatment? Friend / Family advised not to go…..……….4
Too expensive / can’t afford…………….……..5
Did not trust the health provider’s recommendation…6
Did not think the treatment was necessary…7
Seeking a second opinion ………………………8
Other (specify)……………………………………………….96

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IRB18086-AHDP-OutpatientSurvey-V1-2022Sept1

H32 Did the doctor Yes…………………………………………….……..1 If 2 or 9

refer you to a No…………………………………………………….2 skip to H35
specialist or Don’t know………………………………..…9
other provider
based on your
results?
H33 Did you follow- Yes…………………………………………………….1 If 1 skip to
up with the No………………………………………………………2 H35
specialist or Don’t Know………………………………………….9
other provider
already?
H34 Do you intend to Yes……………………………………………………….1
follow-up with No…………………………………………………………2
the specialist or Maybe…………………………………………………..3
other provider? Don’t Know……………………………………………9
H35 Did the doctor Yes……………………………………………………….1
say that you will No…………………………………………………………2
you need to be Maybe…………………………………………………..3
tested again to Don’t Know……………………………………………9
monitor your
condition?
H36 Have the Yes, it got resolved …………………………………………..1
symptoms for It improved, but treatment is needed to manage
which you condition……………………………………………………..2
sought care It did not get resolved/stayed the same………………….3
changed since Don’t know ……………………………………………….9
you visited the
doctor on …..
[insert date of
first interview]

Thank you for answering our questions and supporting our research study.

Page 29 of 29