CT Barriers to Care Survey

Cooperative Re-Engagement Controlled Trial (CoRECT)

Att 6_Conn Barriers to Care Survey

Barriers to Care Survey

OMB: 0920-1133

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OMB No. 0920-New

Expiration Date: XX/XX/XXXX









Cooperative Re-Engagement Controlled Trial (CoRECT)





Attachment #6

Connecticut Barriers to Care Survey













Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)
















Attachment 6. Connecticut Barriers to Care Survey

Project CoRECT__________________________________

Barriers to Care

Interview Script: People can have many different types of problems getting their HIV medical care. Think of reasons why you have not received the medical care you needed or care that was recommend to you. Please indicate “AGREE” or “DISAGREE” for all of the following reaons for why you may not have gotten the needed medical care in the past month. In the past month”


*Interviewer note: DO NOT READ the response option REFUSED to the participant. Only mark this response if a person chooses to skip a questions.


Attitudes/Perceptions about HIV and Health

1. You didn’t really care about your health

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

2. You didn’t feel sick

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

3. You were too sick

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

4. You didn’t want to go

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)


Challenges with the Medical Facility

5. The clinic’s hours of operation didn’t match your hours

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

6. You were treated poorly at a clinic in the past

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)



Challenges with the Medical Provider

7. You couldn’t find a provider that could speak with you in your native language

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

8. You don’t trust doctors

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)


Time Management and Organization

9. You couldn’t take time off of work or school

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

10. You forgot

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

11. You do not like to make appointments too far in advance

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)


Health Insurance and Access to Medical Care

12. You didn’t have health insurance

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

13. You weren’t sure where to go to get medical care

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)



Social and Supportive Services

CHILDCARE

14. You didn’t have child care

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

TRANSPORTATION

15. You didn’t have transportation to medical care

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

FINANCIAL CHALLENGES

16. You couldn’t pay for medical care

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

STIGMA

17. You didn’t want to be seen at a clinic

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

MEDICATION ADHERENCE

18. You didn’t want your health care provider to be mad at you for not taking your meds

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

MENTAL HEALTH

19. You were too depressed

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

SUBSTANCE USE

20. You were too drunk or high

Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)

OTHER REASON

21. Any other reasons you have not received HIV medical care?

Specify:


Agree(1)

Disagree(2)

Don’t Know(7)

Decline(8)

Missing(9)



Notes

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorNeblett Fanfair, Robyn C. (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2021-01-24

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