55. In the last 12 months, how often did you get 58. In the last 12 months, did you feel that a the prescription medicine you needed health professional you saw judged you through your [NAME OF PROVIDER] unfairly or treated you with disrespect clinic? because of your tribal affiliation? 1 Never 1 Yes 2 Sometimes 2 No 3 Usually 4 Always 59. Blood quantum level refers to the level of tribal blood required for membership in an Indian tribe. In the last 12 months, did you Overall Rating Of Clinic feel that a health professional you saw judged you unfairly or treated you with 56. For this next question, please think about disrespect because of your blood quantum level? the [NAME OF PROVIDER] clinic you visited most often in the last 12 months. 1 Yes Using any number from 0 to 10 where 0 is 2 No the worst clinic possible and 10 is the best 3 I’m not sure clinic possible, what number would you use to rate the clinic? 0 Worst possible clinic 1 Look for Information 2 3 60. In the last 12 months, did you look for 4 information in written materials or on the Internet about how to get care from a 5 [NAME OF PROVIDER] clinic or 6 hospital? 7 8 1 Yes 9 2 No If No, go to #62 10 Best possible clinic 61. In the last 12 months, how did the written materials or the Internet provide the information you wanted on how to get care Discrimination from a [NAME OF PROVIDER] clinic or hospital? In the last 12 months, have you ever felt 57. 1 Never that a health professional you saw judged you unfairly or treated you with disrespect 2 Sometimes for any reason? 3 Usually 4 Always 1 Yes 2 No If No, go to #60
55. In the last 12 months, how often did you get the prescription medicine you needed through your [NAME OF PROVIDER] clinic? 1 Never 2 Sometimes 3 Usually 4 Always Overall Rating Of Clinic 56. For this next question, please think about the [NAME OF PROVIDER] clinic you visited most often in the last 12 months. Using any number from 0 to 10 where 0 is the worst clinic possible and 10 is the best clinic possible, what number would you use to rate the clinic? 0 Worst possible clinic 1 2 3 4 5 6 7 8 9 10 Best possible clinic Discrimination 57. In the last 12 months, have you ever felt that a health professional you saw judged you unfairly or treated you with disrespect for any reason? 1 Yes 2 No If No, go to #60 58. In the last 12 months, did you feel that a health professional you saw judged you unfairly or treated you with disrespect because of your tribal affiliation? 1 Yes 2 No 59. Blood quantum level refers to the level of tribal blood required for membership in an Indian tribe. In the last 12 months, did you feel that a health professional you saw judged you unfairly or treated you with disrespect because of your blood quantum level? 1 Yes 2 No 3 I’m not sure Look for Information 60. In the last 12 months, did you look for information in written materials or on the Internet about how to get care from a [NAME OF PROVIDER] clinic or hospital? 1 Yes 2 No If No, go to #62 61. In the last 12 months, how did the written materials or the Internet provide the information you wanted on how to get care from a [NAME OF PROVIDER] clinic or hospital? 1 Never 2 Sometimes 3 Usually 4 Always
american-indian-eng-851.docx