Antenatal Consultation Questionnaire
Questionnaire Instructions
Please fill out this questionnaire in word document form and save as > Questionnaire- Antenatal Consultationcompleted.doc
When selecting from multiple choice please highlight the selection then ‘right-click’ and choose ‘U’ – this will
indicate your answer by underlining the selection.
eg: in this example Agree is the selection
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Carer Details
Hospital - Enter Hospitial Here
Country - Enter County Here
Consultation provided by
Neonatologist
Neonatal fellow
Neonatal nurse practitioner
Pediatrician
Other _________________
Length of consultation
The Neonatal Specialist:
1. Gave me information about medical problems that my baby might have
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
2. Gave me information about treatments my baby might need
Strongly disagree
Disagree
Neither agree nor disagree
3. Gave me information about the chances of survival for my baby
Strongly disagree
Disagree
Neither agree nor disagree
4. Gave me information about the risk of mental or physical disability for my baby
Strongly disagree
Disagree
Neither agree nor disagree
5. Gave me information about breastfeeding my premature baby
Agree
Strongly agree
Antenatal Consultation Questionnaire
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
6. Explained the difference between level II and level III care
Strongly disagree
Disagree
Neither agree nor disagree
7. Gave me information about how long my baby could be in hospital
Strongly disagree
Disagree
Neither agree nor disagree
8. Gave me information about when we could visit my baby in the neonatal intensive care unit
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
9. Gave me information about who could visit my baby in the neonatal intensive care unit
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
10. Gave me a chance to ask questions
Strongly disagree
Disagree
11. Answered my questions in words that were easy to understand
Strongly disagree
Disagree
Neither agree nor disagree
12. Asked if I understood the information discussed
Strongly disagree
Disagree
Neither agree nor disagree
13. Took time to explain information that I did not understand
Strongly disagree
Disagree
Neither agree nor disagree
14. Asked if I had questions about information that had not been discussed
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
15. Gave me a chance to talk about my pregnancy
Strongly disagree
Disagree
Neither agree nor disagree
16. Gave me a chance to talk about how I was feeling
Strongly disagree
Disagree
Neither agree nor disagree
17. Gave me a chance to talk about what I was worried about
Strongly disagree
Disagree
Neither agree nor disagree
18. Gave me a chance to talk about my knowledge of premature babies
Strongly disagree
Disagree
Neither agree nor disagree
19. Gave me a chance to talk about my baby
2
Copyright preemiehelp.com 2012 - The details of this study were published in Paediatric Child Health;
Antenatal Consultation Questionnaire
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
20. Explained his/her role in the care of my baby
Strongly disagree
Disagree
Neither agree nor disagree
21. Explained that the neonatal intensive care unit team would begin care in the delivery room
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
22. Told me that my baby would be admitted to the neonatal intensive care unit
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
23. Explained that the neonatal intensive care unit team would be available at all times for
attendance at the delivery
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
Agree
Strongly agree
24. Explained that I was not responsible for my premature labour
Strongly disagree
Disagree
Neither agree nor disagree
25. Made it easy for me to talk about what I was worried about
Strongly disagree
Disagree
Neither agree nor disagree
26. Told me another meeting could be arranged for further questions
Strongly disagree
Disagree
Neither agree nor disagree
27. Offered me a tour of the neonatal intensive care unit to help me understand my baby’s care
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Agree
Strongly agree
28. I found it easy to talk to the neonatal specialist
Strongly disagree
Disagree
Neither agree nor disagree
Additional Questions
29. Is there any other information you felt you should have received but didn’t?
30. What could have been done to improve your overall satisfaction with the consultation?
3
Copyright preemiehelp.com 2012 - The details of this study were published in Paediatric Child Health;