Zambia Post-Intervention Mystery Client Form Information to be completed in the office from sampling list: Mystery Client ID (circle one): 1 | 2 | 3 | 4 Mystery Client Sex (circle one): Male | Female Pharmacy name: ___________________________________ Pharmacy code: __ __ __ Was this pharmacy part of the OR study intervention? (circle one) Yes | No Information below is part of a TRAINED SIMULATED CLIENT FOLLOW-UP FORM: COMPLETE after interaction (CONFIDENTIAL: DATA USED FOR RESEARCH PURPOSES ONLY) Mystery client should say she/his girlfriend is 7 weeks pregnant and has had a positive pregnancy test. Section 1. General information about the pharmacy and pharmacy worker Age of pharmacist 1 Less than 20 2 20 to 30 101 3 31 to 40 4 41 or older Sex of pharmacist 1 Male 102 2 Female What was the position of the pharmacist? 1 Pharmacist 2 Pharmacy attendant 103 3 Couldn’t tell 4 Other (specify): _____________________ How many other customers were in the shop 104 when you started the interview? ________________ Customers Section 2. Did the pharmacist offer anything to help you? Did the pharmacist recommend any medication 0 No 201 to complete the abortion? 1 Yes Go to question 203
Zambia Post-Intervention Mystery Client Form Information to be completed in the office from sampling list: Mystery Client ID (circle one): 1 | 2 | 3 | 4 Mystery Client Sex (circle one): Male | Female Pharmacy name: ___________________________________ Pharmacy code: __ __ __ Was this pharmacy part of the OR study intervention? (circle one) Yes | No Information below is part of a TRAINED SIMULATED CLIENT FOLLOW-UP FORM: COMPLETE after interaction (CONFIDENTIAL: DATA USED FOR RESEARCH PURPOSES ONLY) Mystery client should say she/his girlfriend is 7 weeks pregnant and has had a positive pregnancy test. Section 1. General information about the pharmacy and pharmacy worker 101 Age of pharmacist 1 Less than 20 2 20 to 30 3 31 to 40 4 41 or older 102 Sex of pharmacist 1 Male 2 Female 103 What was the position of the pharmacist? 1 Pharmacist 2 Pharmacy attendant 3 Couldn’t tell 4 Other (specify): _____________________ 104 How many other customers were in the shop when you started the interview? ________________ Customers Section 2. Did the pharmacist offer anything to help you? 201 Did the pharmacist recommend any medication to complete the abortion? 0 No 1 Yes Go to question 203
Mystery-Client-Survey-Endline.docx