State Strategies for Improving Data on Women's Health

State Strategiesfor Improving Data on

Women’s Health

The Women’s and Children’s Health Policy CenterJohns Hopkins Bloomberg School of Public Health

STATE STRATEGIES FOR IMPROVING

DATA ON WOMEN’S HEALTH

Prepared by

The Women’s and Children’s Health Policy CenterJohns Hopkins Bloomberg School of Public Health

With funding from the Maternal and Child Health Bureau, HRSA

Cite as:

Grason, H, et al., 2002. State Strategies for Improving Data on Women’s Health. Baltimore, MD: Women’sand Children’s Health Policy Center, Johns Hopkins University Bloomberg School of Public Health.

Development of the Women’s Health Care Experiences Survey (WHCES) was led by Carol Weisman,PhD; substantial and substantive contributions were made by Wanda Nicholson, MD, MPH; Holly A.Grason, MA; Charlyn Cassady, PhD; Jillian Henderson, MPH; Ann M. Koontz, CNM, DrPH; Gillian B.Silver, MPH; Patricia O’Campo, PhD; and Cynthia S. Minkovitz, MD, MPP. The Battelle Center forPublic Health Research and Evaluation formatted the WHCES for CATI administration.

State Strategies for Improving Data on Women’s Health was printed by Automated Graphics Systems, 4590Graphics Drive, White Plains, MD 20695-3111. Tel: 800-678-8760, Fax: 310-843-6339.

Both State Strategies for Improving Data on Women’s Health and the Women’s Health Care ExperiencesSurvey are copyrighted. Readers may duplicate and use all or part of the information contained in thesepublications. In accordance with accepted publishing standards, the Johns Hopkins Women’s andChildren’s Health Policy Center requests acknowledgment, in print, of any information reproduced inanother publication.

The Women’s and Children’s Health Policy CenterDepartment of Population and Family Health SciencesJohns Hopkins University Bloomberg School of Public Health615 N. Wolfe StreetBaltimore, MD 21205Tel: 410/502-5443Fax: 410/502-5831Internet: http://www.jhsph.edu/wchpc

Development of this document was supported through project #U93 MC 00101 with the Maternal andChild Health Bureau, Health Resources and Services Administration, U.S. Department of Health andHuman Services. Opinions expressed in this publication are those of the authors and do not necessarilyreflect the views or policies of the Bureau, HRSA, or the Department of Health and Human Services.

State Strategies for Improving Data on Women’s Health 3

ACKNOWLEDGMENTS

Development of this document would not havebeen possible without the guidance of the StateCluster Group—a dozen state Title V programdirectors and maternal and child health expertswho graciously guide the Women’s and Children’sHealth Policy Center’s work, reviewing docu-ments to ensure their relevance and “usability” forstate maternal and child health programs. Similarinput on a near-final draft was provided by DianaCheng (Maryland), Millie Jones (Wisconsin), andMargaret Mendez (Texas).

A group of nine women at the Learning Bank inBaltimore participated in a focus group, providingvaluable feedback on the comprehensibility of thequestions and response sets in the Women’sHealth Care Experiences Survey (WHCES). TheBattelle Center for Public Health Research andEvaluation, through the leadership of DianeBurkom, prepared the WHCES for CATI admin-istration and fielded the pilot test. Interviewers at

Battelle documented the experiences of over fivehundred women in the Baltimore metropolitanarea. Their collective efforts provided informationthat led to improvements in the phrasing of ques-tions and response sets, and also a data set that hasresulted in greater understanding of the women’shealth issues addressed in this survey.

Beth Cameron Feldpush did yeoman’s worksearching through the multiple national healthsurveys, cross-referencing their questions withthose posed in the WHCES. Elizabeth Patchiaslent a hand in this regard. Dr. Melissa Hawkinshelped write sections of the text of this document.Gillian Silver assisted with writing and editing,and then helped to pull the pieces together andbring the document to press.

The authors are grateful to all of these individualsfor their contributions to this document and tothe field of women’s health.


TABLE OF CONTENTS

page

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Overview of the Women’s Health Care Experiences Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Overview of the Women’s Social Roles and Health Care Utilization Supplement . . . . . . . . . . . . . . . . . 9

Approaches for State-level Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Appendices

1. WHCES Instrument Development

2. WHCES Instrument (with information for Administering the WHCES)

3. Women’s Social Roles and Health Care Utilization Supplement

4. Tables, Related National Data Collection Efforts

Table 1: Comparison of National Surveys Related to Women’s Health

Table 2: Descriptive Overview Information of National Surveys Relevant to Women’sHealth

Table 3: WHCES Items Matched with Similar Items in National Data Collection

Table 4: WSR & HCU Items Matched with Similar Items in National Data Collection

CD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inside of Back Cover

CD Contents:

WHCES Instrument

WSR & HCU Instrument

Table 1: Comparison of National Surveys Related to Women’s Health

Table 2: Design and Administration Features of Related National Data Collection

Table 3: WHCES Items Matched with Similar Items in National Data Collection

Table 4: WSR & HCU Items Matched with Similar Items in National Data Collection

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INTRODUCTION

Attention to women’s health has gained groundnationally, especially since legislation enacted in1990 regarding women’s health research focusedon the health needs of women, particularly duringtheir reproductive years. The Maternal and ChildHealth Bureau (MCHB) has since that time beenworking with states, professional organizations,and academic partners to explore the role of theTitle V program in women’s health with the goalof strengthening their capacity to address emerg-ing health issues for women.

An example of the Bureau’s evolving commit-ment in the arena of women’s health is found inMCHB’s recent revision of its mission statementthat includes all women as part of the MCH pop-ulation. This revision is grounded in a lifespanapproach to women’s health that recognizes thecumulative nature of health and the diverse socialcircumstances of women’s lives that change overtime. This perspective further acknowledges thehealth-related implications of the multiple roles inwhich women engage (e.g., employee, mother,spouse, daughter, etc.). It gives recognition to theimportance of women’s overall wellness in itsbroadest sense to improving reproductive healthgenerally, and pregnancy outcomes specifically.This approach particularly emphasizes healthmaintenance/promotion in addition to diseaseprevention (Weisman 1997). These ideas and sup-porting research have been disseminated in anumber of Bureau-supported publications,including Charting a Course for the Future ofWomen’s and Perinatal Health (Grason, Hutchins,Silver, Eds., 1999).

State Title V Maternal and Child HealthPrograms utilize a range of functions applicable toimplementing the evolving concepts underpin-ning the field of women’s health. Data collectionand its use are key public health functions in thisregard. With expansion of the MCH populationof focus, state and local public health data needswill continue to grow.

This publication is designed to assist states ingathering, organizing, and analyzing informationabout women and their health. It presents ideasfor data collection, including the Women’s HealthCare Experiences Survey (WHCES), and discuss-es a number of alternative ways these data collec-tion instruments can be used to advance publicMCH programs’ knowledge, thereby enhancingstate capacity to better address needs amongwomen.

BACKGROUND

It has become increasingly accepted that womenhave specific health care access and utilizationneeds. A ubiquitous finding in health servicesresearch is that women consume more health careservices than men, particularly outpatient preven-tive services (NCHS 1996; Weisman and Poole1999). Women’s greater use of health care isthought to be due to a combination of greaterneed, socialization to help-seeking, and the organ-ization of the health care delivery system. There isgrowing recognition that the organization ofwomen’s primary care differs from men’s, largelybecause of the frequent separation of reproductiveand non-reproductive services (Clancy andMassion 1992). As a consequence, women use adifferent array of providers than men, and oftenconcurrent providers, in order to obtain compre-hensive routine and preventive health care(Weisman 1996). In the 1998 CommonwealthFund Survey of Women’s Health, 41% of womenages 18 to 64 reported using a generalist physician(family practitioner or internist) and an obstetri-cian-gynecologist (ObGyn) for regular health care.Most recently, the Kaiser Family Foundationdescribed in its 2001 Kaiser Women’s HealthSurvey that 52% of women ages 18 to 64 report-ed using 2 providers; 31% reported using specifi-cally a primary care provider and an ObGyn(Kaiser Women’s Health Survey, 2002, p. 29).

The environment for women’s health care isdynamic. The growth and increasing diversity ofmanaged care plans suggests that there are many

8 State Strategies for Improving Data on Women’s Health

“natural experiments” underway in the delivery ofwomen’s health care. In addition, innovative sys-tems and organizations for women’s health carehave been launched—notably, comprehensive pri-mary care women’s health centers such as the 15DHHS-designated National Centers of Excel-lence in Women’s Health, and MCHB-sponsoredsystems of Integrated Women’s Health Services.These new models of systems and primary caredelivery for women are beginning to be evaluat-ed. Simultaneously, some organizations that tradi-tionally have served as safety-net providers forwomen (such as family planning clinics) may facechallenges in surviving in an era of competitionwith Medicaid managed care and declining rev-enues from Medicaid enrollees. Little informationis available on how women are navigating thischanging health care landscape.

Because women are a majority of health care con-sumers and make most health care consumptiondecisions for their families, their experiences inthe health care delivery system could provide keyinformation for purchasers and policymakers.Current surveys are limited, however, in theircapacity to provide this information. For onething, national surveys do not always providestate-level data. For another, generic surveysmeasuring the population’s utilization of healthcare do not necessarily include questions that aresensitive to the specific needs and experiences ofwomen—either as a gender class, or reflecting thediversity of social and health experiences withinthe population of women.

As part of the Johns Hopkins Women’s andChildren’s Health Policy Center (WCHPC) proj-ect initiatives, faculty developed and pilot tested asurvey instrument—The Women’s Health CareExperience Survey (WHCES)—to measurewomen’s utilization of health services, including acomprehensive set of questions and topic areasthat are not measured in sufficient detail or fromwomen’s perspectives in existing national surveys.A companion project—the Women’s Social Rolesand Health Care Utilization (WSR & HCU)

Supplement—exploring the inter-relationships offamily and personal factors that influencewomen’s use of health care, generated additionalquestions that could be fielded in conjunctionwith the WHCES.

OVERVIEW OF THE WOMEN’S HEALTH CAREEXPERIENCES SURVEY

The Women’s Health Care Experiences Surveyinstrument was developed in five stages. First, thedomains and questions to be included in the sur-vey were generated from the literature review andcomparison of existing population-based surveyinstruments. Second, cognitive testing was con-ducted with nine women at the Learning Bank, aliteracy program for low-income women inBaltimore, Maryland; the purpose of this testingwas to address whether the questions were under-standable and clear. Third, the research teamsolicited feedback on the survey content from agroup of state maternal and child health (MCH)program directors. Fourth, the survey was pilottested in the Baltimore metropolitan area. Fifth,the survey instrument was revised based on find-ings from the pilot test and associated feedback.

The comparison of survey instruments (seeAppendix 4, Table 1) revealed that the followingquestions were not adequately addressed in exist-ing surveys:

• What types and combinations of outpa-tient health care services do adult womenuse for their health care? This includestypes of professionals, programs, organiza-tions, and alternative therapies that are usedalone or in combination. Concurrent use ofmultiple sources of care has not been wellmeasured. The policy implications of thisinformation would pertain to designinghealth care systems for comprehensive, inte-grated services for women in communities.

• What are women’s perceptions of theaccessibility, affordability, and quality of


the services they use? Women confrontspecific access problems that have not beenwell documented from women’s perspec-tives. Both financial access barriers (e.g.,inadequate health insurance benefits) andnon-financial access barriers (e.g., inabilityto make the time for multiple visits or sys-tem navigation; difficulties communicatingwith providers) need to be assessed fromwomen’s perspectives. The policy implica-tions of this information would pertain tohealth insurance reform and to designinggender-appropriate delivery systems andprocesses of care.

• What sources of health information dowomen use and which do they think aremost credible? Possible sources includehealth care providers, health plans, familyand friends, the media, medical journals,pharmaceutical ads, women’s healthnewsletters, women’s health advocacy andinterest groups, the Internet, etc. Little isknown about the combinations of sourcesthat women use and how they assess thecredibility or usefulness of these sources.The policy implications of this informationwould pertain to improving health educa-tion and information services to enablewomen to be informed decision makersabout their health.

Two conceptual frameworks guided the identifi-cation of domains and questions for the surveyinstrument. First, the expanded Behavioral Modelof Health Services Utilization (Andersen 1995;Phillips et al. 1998) directs attention to severaltypes of determinants of health services use: envi-ronmental and health system variables; provider-related variables; predisposing, enabling, andneed factors; and personal health behaviors.Second, the recently expanded definition ofwomen’s health focuses attention on the diversesocial circumstances of women’s lives, healthacross the lifespan (not only in relation to re-production), and health maintenance/promotion

in addition to disease prevention (Weisman1997). Together, these frameworks suggest thatwomen’s health care access and use should beconceptualized within a social and health care sys-tem context, with particular attention to enablingresources for women, how women interact withtheir providers, and women’s broad range ofneeds for health information and services.

The decision was made to design the surveyaround three domains: utilization patterns; accessto care (both financial and non-financial); andsources of health information used. Utilizationquestions would be structured around women’sperceived health care needs in order to capturethe range of services used as well as unmet needsfor care. Access questions would include commu-nication problems as a potential barrier to the careprocess. In addition to these domains, the surveywould include sections on individual characteris-tics that might affect use of care: health risks andhealth behaviors; perceived health status; andsociodemographics.

OVERVIEW OF THE WOMEN’S SOCIAL ROLESAND HEALTH CARE UTILIZATION SUPPLEMENT

The Women’s Social Roles and Health CareUtilization Supplement (WSR & HCU) is com-prised of a set of questions whereby the inter-relationships of family and personal factors thatinfluence women’s health care use can beexplored. Minkovitz’s and O’Campo’s analyses ofthe 1996–7 Community Tracking HouseholdSurvey (CTS) identified the need to enhancefocus on the influence of women’s social roles ontheir health and use of services. These social rolesinclude employment status and its characteristics,marital status, and caregiving responsibilities(Minkovitz et al. 2000). This section briefly out-lines the rationale for a supplemental set of ques-tions on women’s multiple roles. It should benoted that these questions were not tested as partof the WHCES.


First, there have been recent and ongoing demo-graphic shifts in women’s social roles such asmore women with very young children enteringthe labor force (US DHHS 2001), increases inchildbearing at older ages (Guyer et al. 1999), andincreases in occupying parenting and elderly care-giving roles (Dautzenberg et al. 1998). Moreover,these roles have been shown to be associated withhealth care utilization (Altman and Taylor 2001;Bernstein 2001). Specifically, married women aremore likely to have a Pap smear compared to sin-gle women, and single women are more likely thanmarried women to lack a usual source of care(Eberhardt et al. 2001). In addition, women withchildren report less difficulty in obtaining medicalcare and were more likely to have had a Pap smearthan women without children (Kandrack et al.1991). Among women ages 18–64, employedwomen are more likely than those unemployed tohave a usual source of care, and to have had anambulatory visit and a Pap smear (Eberhardt et al.2001).

While it is of interest to understand how these fac-tors are related to health care utilization, it is alsoimportant to learn more about how these demo-graphic shifts impact population health as well asthe policies that support these various roles (e.g.,child care, nursing home care, etc). Despite thefact that most studies have examined individualroles in relation to health care use, future effortsneed to assess the joint effects of occupying thesemultiple roles. While a number of studies havefound that health status is better among womenwho occupy more than one social role (e.g., mar-ried with children and employed) compared tothose who occupy fewer or one role, (Pugliesi1995; Ross and Mirkowsky 1995; Verbugge1985) it is not clear whether occupying morethan one role will lead to more appropriate healthcare utilization. For example, occupying multipleroles may leave little time to obtain appropriatepreventive health care.

Current questions in many national surveys arenot adequate for capturing important facets of

understanding the relationships among women’smultiple roles, health status, and health care uti-lization. While some surveys include detailedinformation on limited social roles (e.g., employ-ment, or caregiving), many do not adequatelyaddress the reality that women often assume mul-tiple roles, each with varying levels of social sup-ports.

Given these considerations, we developed a shortset of questions to specifically examine the socialroles of women (see Appendix 3, and Appendix 4 -Table 4). As noted in the table, these questionshave been drawn from other, previously fieldedsurveys. Questions regarding marital status, cur-rent employment, household composition, andhealth insurance already are included in the coreWHCES instrument. In order to keep the overalllength of time needed to administer the survey viatelephone reasonable, however, detailed itemswere avoided. Other WSR & HCU items arefrom national surveys that capture informationregarding workplace benefits and flexibility as wellas women’s caregiving responsibilities for childrenand other family members. To the extent thatstates choose to describe social roles for women inorder to design effective programs, this circum-scribed set of WSR & HCU questions may sup-plement the core WHCES instrument. As appro-priate, states may draw upon published resultsfrom previously fielded surveys for comparison.

APPROACHES FOR STATE-LEVEL DATACOLLECTION

States might consider a number of strategies forgathering information to enhance assessment ofwomen’s health. An intensive, but highly inform-ative approach might involve fielding a compre-hensive household survey, such as the Women’sHealth Care Experiences Survey (WHCES).Those states and/or localities interested inexploring women’s social roles in particular maywish to survey women using the WHCES in con-junction with the WSR & HCU supplement.


Because developing and conducting statewidehousehold surveys can be resource intensive, pub-lic health professionals may seek alternative strate-gies for filling knowledge gaps specific towomen’s health concerns. Potential strategiesstates might pursue in this regard include con-structing an adapted survey effort through anabbreviated WHCES, or by adding selectedWCHES or WSR & HCU items to other surveys.These options are identified for considerationwhen data collection resources are limited. Statesalso or alternatively may wish to strengthen ongo-ing broad-based state needs assessments related towomen’s health by identifying information itemswhere there is available national comparisoninformation against which to benchmark state-specific data, or by exploring additional aspects ofsystems of care (e.g., by drawing on informationprovided in facility-based data sets).

In order to assist MCH professionals in con-structing a match between their interests, needs,and capacities for enhancing data on women’shealth care in their states, discussion of eachoption is provided below. In addition, severaltables are provided in Appendix 4 where informa-tion on various surveys and data collection ques-tions is summarized. The specific features (such assurvey design and method of administration) ofother data collection efforts are outlined in Table2. Contact information is provided along withweb addresses to view the individual surveys andspecific results directly on-line. Included are sev-eral national household surveys that currentlyattend to selected issues specific to women’shealth, as well as several national provider surveys.This information may be particularly helpful tothose undertaking a broad assessment of theirhealth systems serving women.

Table 3 identifies, for each domain addressed inthe WHCES, specific survey instruments withquestion items that are the same or very similar tothose outlined by the WCHPC. This may be ofuse in designing adapted surveys at the state leveland/or in making comparisons between state and

national data where comparable questions exist inthe larger national surveys.

Table 4 outlines the question items included inthe WSR & HCU supplementary section to cap-ture information specific to women’s multipleroles (i.e., employment, caregiving and maritalstatus), that can be incorporated into assess-ment efforts to examine the influence of socialcontext in women’s health. The source of eachquestion is identified in this table, as well as com-parable question items that are found in largernational surveys.

1. Administer the WHCES

The Women’s Health Care Experiences Survey isdesigned for the collection of population-basedinformation. As such, depending on the size ofthe population, administering the survey may beexpensive. The validity of the survey was assuredthrough testing in a focus group, feedback fromState Maternal and Child Health experts, andpilot testing with 509 women in the Baltimore,Maryland metropolitan area.

The WHCES is designed for administration as atelephone survey that takes approximately 30minutes to complete. The survey has not beenformatted for self-administration. Although thewording of questions was assessed for clarity infocus groups of women in Baltimore, the read-ability of the questions was not assessed for self-administration. Self-administration through amailed survey, for example, should not beattempted without reformatting the survey, pro-viding respondent instructions, and testing of theitems for readability. For example, when referringto “osteoporosis” in a self-administered survey,the item could be reworded to “osteoporosis, orbrittle bones.” Also of note, because the instru-ment has not yet been translated to other lan-guages or tested with women from an array ofethno-cultural heritages, care will be needed topre-test and adapt the instrument if plans for useinvolve multi-culture populations.


2. Administer the WSR & HCU

The Women’s Social Roles and Health CareUtilization Supplement was not tested as part ofthe WHCES, and the items have not been testedtogether as a group. However, the preponderanceof the questions were drawn from other, validat-ed, national surveys, and some were drawn fromthe WHCES.

The set of questions as currently presented cannotbe administered on their own. Dependent on theend point data set desired, at a minimum a set ofdemographic items (as can be found in most sur-veys, including the WHCES) should be included.Additional question and response-set language, beit health-related or otherwise, can be drawn fromthe WHCES or the national surveys cited in orderto assess the associations among the social rolesand other heath concerns. Further, the questionswould need to be amended to include the appro-priate skip-pattern terminology (i.e., if respondenthas no children, then the interviewer should skipthe questions regarding number of children).

3. Adapt the WHCES/Utilize WSR & HCU

Each domain of interest in the WHCES (and theWSR & HCU supplement) is addressed as anindependent unit, and can be examined alone, orin different combinations. One may wish to fielda survey specific only to needs-based utilization,access to care, social roles, or use of health infor-mation. Any of these domains might be combinedwith the set of questions on health status and risksand/or on socio-demographic information inorder to understand predisposing and/or needsfactors influencing responses given in a particulardomain of inquiry.

Alternatively, one may wish to conserve data col-lection resources by building on other ongoingsurveys, such as the Behavior Risk FactorSurveillance System survey (the BRFSS is conduct-ed in 50 states as well as Washington D.C, Guam,Puerto Rico, and the Virgin Islands) or the

Pregnancy Risk Assessment and MonitoringSystem survey (the PRAMS is currently imple-mented by 32 states). These two survey platformsallow addition of questions to ongoing data collec-tion, thereby reducing the potentially high costs tostates of fielding a stand-alone survey assessinghealth concerns specific to women. For example,questions from the WHCES could be added to thestate-based BRFSS in order to learn about use ofhealth information specific to women as related tohealth risk behaviors (from the BRFSS). This addi-tional information could be quite valuable for plan-ning new interventions and/or improving target-ing of ongoing public health prevention efforts.

A second example of how this approach might beuseful is found in the PRAMS. In this case womengiving birth in the prior year (state-specific sam-pling is employed) are asked whether they experi-enced sexual assault, but not about resultant serv-ice access/use. Questions from Section A10 ofthe WHCES could be added to a state’s PRAMSsurvey in one or more years to develop and/orrefine public health programming related to vio-lence against women.

Under a third scenario, states (and there are quitea few) that are fielding annual or otherwise rou-tine household surveys on health insurance mayfind adding the section of questions specific towomen’s need-based health service utilization ofbenefit. In this case, a more comprehensive pic-ture of women’s health including aspects of accessto health care, as well as, the appropriateness andutilization of the services received, may be under-stood. Women typically obtain health care servic-es from a wide variety of providers, and thus theirpatterns of use are more complex.

Others may be interested in broader policy ques-tions that address issues of met and unmet needsbased on health care utilization alongside suchfactors as employment status, and/or type of jobas related to women’s caregiving responsibilitiesand supports. Furthermore, the joint effects ofseveral risk factors could be examined. For exam-


ple, the NHIS could be combined with WHCESquestions from the Employment Domain sectionof the survey to examine barriers to care.

Women today are more knowledgeable abouttheir own health and are active in taking steps andbehaviors to stay healthy (for example, participat-ing in regular exercise programs). Legislativeaction and insurer practices have also focusedgreater attention on the health needs of women,particularly during the reproductive years. Thus,increasing access to health information, andimproving communication between providers andpatients is of considerable importance. To thatextent, the WHCES (Sections A and C) would beuseful to examine how counseling differs acrosstypes of health plans.

4. Identify Information Items Where NationalComparisons Are Possible

There are several items in the WHCES and theWSR & HCU supplement that could be used inconjunction with national data to make state-spe-cific comparisons regarding access, quality, andutilization of health care services received bywomen. An important aspect of women’s healththat would be useful to compare nationally is per-ceptions regarding accessibility, affordability, andquality of services received. Data from theMedical Expenditure Panel Survey (MEPS),National Health Interview Survey (NHIS),National Health and Nutrition ExaminationSurvey (NHANES), and/or National Maternaland Infant Health Survey (NMIHS) along withthe WHCES could be used for this purpose.

Another use of the WHCES data may be to pro-vide baseline data on health care utilization (e.g.,annual mammograms, pap smears, preventivescreening) for subgroups of women (e.g., high-risk); this information could be used for projec-tions and budgeting considerations. Additionally,such information could provide baseline data indeveloping statewide, county-by-county preva-lence estimates that could be compared withnational averages.

Furthermore, a composite index could be created(for example, based on employment or participa-tion in the work force, caregiving responsibility,and income) to compare with other states for thepurpose of examining societal determinants ofhealth. Indices may all be used to examine effectson specific health conditions and/or activity limi-tations.

Access to quality health care encompasses severaldomains including both financial and non-finan-cial barriers. The three major national sources ofdata on financial access to health care (insurancestatus) are: NHIS (National Health InterviewSurvey), NMES (National Medical ExpenditureSurvey), and CPS (Current Population Survey).Statewide comparisons of risk factors for lack ofcoverage could be examined by social factors(e.g., marital status, age, education).

National surveys do not typically measure howhealth care utilization patterns change over timeor how provider services are used in combination(e.g., ObGyn as primary care physician), which isof particular relevance to women’s health carepractices. Because national surveys are oftencross-sectional in design, it is difficult to analyzechange of health care use longitudinally.However, statewide and within state comparisonsare possible and could be highly informative, par-ticularly with regard to use of preventive servicesby women by age. Access to ObGyn providers isan important issue for women’s health needs.Comparisons could be made on mammographyscreening rates, annual exams, and then disparitiesin rates could be examined by social factorsincluding, income, education, and/or ethnicity.

5. Consider Aspects of Systems of Care for aBroad-based State Needs AssessmentSpecific to Women’s Health

Information from the WCHPC question sets alsomay be used to conceptualize broad-based stateneeds related to women’s health issues. Suchinformation may be helpful to states that are plan-


ning, implementing, and evaluating women’shealth programs. For example, the use of any orall sections from the WHCES (or questions fromthe WSR & HCU supplement) may assist indetermining priorities for local health depart-ments. In addition, information may be used todocument need and monitor progress of preven-tion programs (for example, breast and cervicalcancer). Furthermore, intervention priorities maybe determined by analyzing data on health risks(Section E); for example, cardiovascular diseaseinterventions can be examined by analyzing dataon smoking, treatment and measurement of highblood pressure, and/or participation in physicalactivity. Data may also assist in evaluating the suc-cess of interventions.

Progress towards Healthy People 2010 objectivesmay be monitored in areas including: physicalactivity, Pap smear test and mammography usage,risk behaviors including smoking and alcohol use.Information also may be used to provide data topolicymakers, health care providers, and con-sumers regarding the distribution of health risksamong women in the population.

Furthermore, data provided could be used in stateannual reports to profile women’s health includ-ing social indicators (e.g., education, caregivingresponsibilities) and reported by risk categories ofwomen (e.g., income).

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State Strategies for Improving Data on Women’s Health

Appendix 1: WHCES Development

APPENDIX 1: WHCES DEVELOPMENT

The Women’s Health Care Experiences Surveyinstrument is designed for community-based sam-ples and is organized in six sections: need-basedpatterns of health services utilization; health careaccess and barriers to access; communication withproviders; health information sources; personalhealth risks and health status; and sociodemo-graphics. The instrument was developed in fivestages. First, the domains and questions to beincluded in the survey were generated from theliterature review and comparison of existing pop-ulation-based survey instruments. Second, cogni-tive testing was conducted with nine women atthe Learning Bank, a literacy program for lowincome women in Baltimore, Maryland; the pur-pose of this testing was to address whether thequestions were understandable and clear. Third,the research team solicited feedback on the surveycontent from a group of state maternal and childhealth (MCH) program directors. Fourth, thesurvey was pilot tested in the Baltimore metro-politan area. Finally, the survey instrument wasrevised based on findings from the pilot test andsubsequent feedback to yield the July 2000 ver-sion, found in Appendix 2.

Domains and Questions

Two conceptual frameworks guided the identifi-cation of domains and questions for the surveyinstrument. First, the expanded Behavioral Modelof Health Services Utilization (Andersen 1995;Phillips et al. 1998) directs attention to severaltypes of determinants of health services use: envi-ronmental and health system variables; provider-related variables; predisposing, enabling, andneed factors; and personal health behaviors.Second, the recently expanded definition ofwomen’s health focuses attention on the diversesocial circumstances of women’s lives, healthacross the lifespan (and not only in relation toreproduction), and health maintenance/promo-tion in addition to disease prevention (Weisman1997). Together, these frameworks suggest that

women’s health care access and use should beconceptualized within a social and health care sys-tem context, with particular attention to enablingresources for women, how women interact withtheir providers, and women’s broad range ofneeds for health information and services.

The decision was made to design the surveyaround three domains: utilization patterns; accessto care (both financial and non-financial); andsources of health information used. Utilizationquestions would be structured around women’sperceived health care needs in order to capturethe range of services used as well as unmet needsfor care. Access questions would include commu-nication problems as a potential barrier to the careprocess. In addition to these domains, the surveywould include sections on individual characteris-tics that might affect use of care: health risks andhealth behaviors; perceived health status; andsociodemographics.

Cognitive Testing

A draft survey instrument with 76 questions wastested in a focus group with nine women ages 20to 49 at the Learning Bank, a community-basedadult literacy program in Baltimore. The purposeof the focus group was to assess how well the sur-vey questions would be understood by womenwithout high levels of formal education. The sub-jects were predominantly African American (8 outof 9 women), Medicaid recipients (5 out of 9),and not employed (7 out of 9 were notemployed). The subjects were asked to discusseach question for its clarity of wording, what theyunderstood the question to mean, and the appro-priateness of the response set. Wording changeswere made to a number of questions as a result ofthe suggestions made in the focus group.

State MCH Directors’ Feedback

State MCH directors’ feedback on the surveycontent was obtained at a meeting convened inBaltimore in May, 1999. The directors were sup-portive of the domains identified. The survey was



revised to incorporate their specific suggestionsabout items to include.

Women’s Health Care Experiences Survey Pilot

Pilot Test Methods

Sample. The Women’s Health Care ExperiencesSurvey was pilot tested on a sample of English-speaking adult women, ages 18 to 64, residing inhouseholds in the Baltimore metropolitan area.The telephone survey was conducted betweenOctober 1999, and January 2000, using randomdigit dialing (RDD). A total of 4,635 telephonenumbers were screened, of which 39% were nothouseholds and 44% were not eligible for the sur-vey because of a variety of reasons (e.g., no age-eligible woman in the household; refused screen-ing questions). Among age-eligible women (N =776), 66% completed the interview. The finalsample consisted of 509 women. Because theWHCES was pilot tested using RDD, no infor-mation is available on non-responders.

According to the Battelle Center for PublicHealth Research and Evaluation, which conduct-ed the survey, RDD response rates range fromabout 40% to 70%, depending on eligibilityrequirements and the length of the interview (i.e.,respondents prefer shorter interviews). InBattelle’s experience with health-related surveys,RDD response rates typically are about 65%. Theresponse rate for this survey therefore is at thehigh end of RDD response rates for health-relat-ed surveys.

Interviews. The interviews were conducted by tele-phone using computer-assisted technology by

female interviewers employed and trained for thisproject by Battelle. Oral informed consent proce-dures were followed. All questions were closed-ended, but room was included to specify “other”responses for several questions in order to assessthe appropriateness of designated categories. Theaverage interview took 33 minutes, including eligi-bility screening, which is long for a telephone inter-view. Interviews were conducted in English only.

Pilot Test Results

The results presented are intended to illustratethe types of information that can be obtainedusing this survey instrument in local populations.Selected findings are presented by age group andby race/ethnicity in order to demonstrate that theitems are sensitive to subgroup differences amongwomen. While the data can be used to testhypotheses about women’s health care in a multi-variate framework, the results reported here aredescriptive only.

Respondent Characteristics. Women were catego-rized into two age groups representing broad lifestages: reproductive age (18 to 44 years) andmidlife (45 to 64 years). This was to permit com-parisons of the two age groups with other datasets, as the definition of “reproductive age” is fair-ly standard in the field (although increasingly amisnomer). Overall, the mean age of women inthe sample was 42.6 (median = 43). The socio-demographic characteristics of the pilot testrespondents are shown below.



Ages 18 to 44 Ages 45 to 64(N=281) (N=228) P-valuea

Married/living with partner (%) 70 66 .001

Employed for pay (%) 78 68 .030

Children at home (%) 68 26 .001

Caregiver for sick or disabled elderly family 8 22 .001member (%)

U.S. citizen (%) 94 93 NS

Race/ethnicity (%)

White, non-Hispanic 62 73 .011

Black, non-Hispanic 29 24 NS

Hispanic 4 2 NS

Other 5 2 NS

Education (%)

Not high school graduate 6 14 .006

High school graduate 24 28 NS

Some college 36 25 .014

College graduate 34 33 NS

Household income (%)

<= $15,000 13 14 NS

$15,001-$35,000 26 24 NS

$35,001-$50,000 22 19 NS

$50,001-$75,000 20 17 NS

$75,000+ 19 27 .036

Received food stamps, TANF or SSI (%) 5 6 NS

Perceived health status (% fair or poor) 11 20 .002

Perceived relative health status (% not as 11 18 .039healthy as most women of same age)

Number of chronic conditions (mean) 0.97 2.09 .0001

Sociodemographic and health status characteristics of respondents, by age group

TANF = Temporary Assistance for Needy FamiliesSSI = Supplemental Security Incomea P-values are based on Chi square or t-tests, as appropriate.



As expected, the younger women (ages 18 to 44)were more likely than the midlife women (ages 45to 64) to be married or living with a partner, tobe employed for pay, to have children at home,and to be college educated. Younger women wereless likely to be caring for an elderly family mem-ber, to be non-Hispanic white, to have less than ahigh school education, and to have householdincomes over $75,000. Younger women alsoreported better health status than midlife women.

Need-based Health Care Utilization. Need-basedhealth care use was measured in the survey by firstasking women what health problems and healthcare needs they had experienced in the past 12months, and then what types of care (if any) theyreceived for those needs (i.e., source of care andproviders seen) and, if appropriate, the reasons fornot obtaining care. This method of asking utiliza-tion questions is an innovation of this survey.Predominant types of outpatient care needsreported by the women participating in theWHCES pilot test were: routine and preventivecare (these needs were reported by 88% ofwomen); acute conditions such as minor illnessesand injuries (61%); chronic conditions (38%);pregnancy-related care, including family planning(28%); and mental health problems, specificallyanxiety and depression (45%).

A large majority of women reporting these needsobtained care, with the exception of mentalhealth needs: only 38% of those reporting mentalhealth needs obtained care. The reasons for notobtaining needed care varied by category ofhealth care need. For routine/preventive care,being too busy, having no health insurance, andhigh cost of care were the main reasons for notgetting care. For acute conditions and mentalhealth problems, believing that the condition wasnot serious and taking care of the condition one-self was the main reason. For chronic conditions,cost issues (being uninsured or believing the serv-ice costs too much) were the main reasons report-ed. For pregnancy-related care, having no healthinsurance was the main reason reported for not

getting care. Overall, 24% of women reportedhaving some difficulty getting needed care.

The major source of care, reported for all types ofhealth care needs, was provider offices locatedoutside of hospitals, followed by provider officesin hospitals. Community-based clinics (includingfamily planning clinics, public health departmentclinics, and women’s health centers) were thethird leading source of care for routine/preven-tive care, pregnancy-related care, and mentalhealth problems. Emergency rooms were thefourth leading source of care for acute conditions.

Family practitioners and internists were the mainproviders seen for routine/preventive care and fortreatment of acute and chronic conditions.Obstetrician-gynecologists (ObGyns) were themain providers seen for pregnancy-related careand the second most common provider seen forroutine/preventive care; ObGyns also providedsome acute and chronic condition care. Mentalhealth specialists (psychiatrists, psychologists,social workers, and mental health counselors)were the most common providers of mentalhealth care. While physicians were the most com-mon providers used overall, advanced practicenurses and physician assistants provided some carein all categories, ranging from 3% of care episodesfor chronic conditions to 8% of care episodes foracute conditions.

Receipt of Specific Services. Receipt of specific clin-ical preventive services, pregnancy-related servic-es, and counseling services in the past 12 monthswas analyzed by age and race/ethnicity. (Here,race/ethnicity comparisons are for AfricanAmericans compared with non-Hispanic whites;there were insufficient respondents in otherrace/ethnic groups for comparison purposes.)Overall, midlife women reported receiving moreclinical preventive services and counseling servic-es than younger women, and younger womenreported more pregnancy-related services thanmidlife women. African American womenreceived more pregnancy-related services than



white women, owing in part to the higher pro-portion of African Americans in the sample beingin the reproductive age category (60% of AfricanAmerican women compared with 51% of whitewomen). While we did not adjust for the numberof visits, only 7% of women (N = 36) made nohealth care visits in the past year.

In multiple linear regression analyses, we exam-ined the effects of the types of physicians used forregular care, type of health insurance, physiciangender, age, education, income, race/ethnicity,and the number of chronic conditions on twodependent variables: the number of clinical pre-ventive services received and the number of coun-seling services received. The independent vari-ables reflect enabling, predisposing, and need fac-tors. The pattern of physician use is a significantpredictor for both outcomes. For a number ofclinical preventive services received, women see-ing only a generalist physician receive significant-ly fewer services compared with all other women;seeing only an ObGyn had the strongest effect onnumber of clinical services received. Other pre-dictors of clinical services received were havinghealth insurance, being 45–64 years of age, andthe number of chronic conditions. For number ofcounseling services received, the number ofchronic conditions was the strongest predictor,followed by the pattern of physician use: womenseeing both a generalist and an ObGyn or otherspecialists received more counseling services thanwomen seeing a generalist alone. No other pre-dictors were significant.

Types of regular providers and main reasons for nothaving a regular provider. Younger women weresignificantly less likely than midlife women tohave one regular health care provider “you usual-ly go to first when you need health information, atest, or treatment for a health problem:” 76% ver-sus 83%. Among those without regular providers,the major reason reported is their use of morethan one provider and consequent inability todesignate one as the “person you usually go tofirst.” The second most prevalent reason given

was not having health insurance. AfricanAmerican women were more likely than whitewomen to report that they do not have a regularprovider due to lack of health insurance.

The majority of women in each age group report-ed using both a generalist physician (a family prac-titioner or internist) and an obstetrician-gynecol-ogist (ObGyn) for regular care. In this survey,58% of all women ages 18 to 64 reported usingtwo physicians, compared with 41% of womenages 18 to 64 in the national sample from the1998 Commonwealth Fund Survey of Women’sHealth. The higher percentage in this surveycould reflect such factors as the urban locale, inwhich the number of ObGyns per population ishigher than for the nation as a whole; local pri-mary care medical practices, including referralpatterns; or Maryland state legislation mandatingdirect access to ObGyns in health plans (i.e.,insurers are required to allow women to self-referto an ObGyn without prior approval).

Midlife women were significantly more likely thanyounger women to rely on a generalist physicianalone and significantly less likely to rely on anObGyn alone. African American women were lesslikely than white women to see both a generalistphysician and an ObGyn, and they were morelikely to see a generalist alone.

Younger women were more likely than midlifewomen to have regular non-ObGyn providerswho are female, while the two age groups ofwomen are equally likely to see female ObGyns.African American women were more likely thanwhite women to have regular non-ObGyn physi-cians who are female.

Health Insurance. Most women among the pilottest survey respondents reported having healthinsurance through an employer. These womenwere about evenly divided between those whoseinsurance is based on their own employment andthose who are dependents on a family member’semployment-based insurance. About 90% of the



women interviewed had health insurance of somekind (either private or public), but AfricanAmerican women were significantly more likelythan white women to be uninsured or to beMedicaid recipients. African American womenand younger women were significantly more like-ly than white and midlife women, respectively, tohave had a spell of being uninsured in the pastyear. The most frequently reported reason for nothaving health insurance among the uninsured wasreported as inability to afford it, followed bychanging jobs (either the woman or a familymember), and losing eligibility for Medicaid.

Health Plans. Most insured women (76%) report-ed being enrolled in a managed care plan (HMOor PPO), and 24% reported being in neither andtherefore are assumed to be in traditional fee-for-service plans. While the majority of insuredwomen had been enrolled in their current healthplans for more than two years, substantial propor-tions of women had been enrolled for less thanone year or between one and two years. Youngerwomen and African American women were signif-icantly more likely to have been in their plans lessthan two years.

Most women were in health plans that requirethem to select a primary care provider (PCP),and younger women were significantly morelikely than midlife women to be in plans requir-ing them to select two PCPs, one of whom is anObGyn. As would be expected due toMaryland’s direct access to ObGyns legislation,the majority of women reported that their plansdo not require referrals for seeing an ObGyn.However, younger women were significantlymore likely than midlife women to report thattheir plans limit the number of ObGyn visits thatmay be made without referrals. Substantial pro-portions of women (14% of younger women and19% of older women) did not know the ObGynreferral policy of their health plan. The majorityof women reported that their health plansrequire referrals for other types of specialty care.African American women were more likely than

white women to report that their health planssend reminders for preventive services.

When asked about whether or not their healthplans cover any part of the cost of specific servic-es, substantial proportions of women reportedthat they do not know. Most notably, large num-bers of women did not know if their plan coversabortion services, infertility treatments, homehealth services, long-term care, drug and alcoholabuse treatment, and medical contraception.Women were more aware of coverage for servicesthat they are likely to use: women of reproductiveage were more likely than midlife women toknow about coverage of pregnancy-related servic-es and were less likely to know about coverage ofmammograms.

Types of Health Information Sources Women Use.Only television news programs were reported bya majority of all women. Midlife women were sig-nificantly more likely than younger women toreport reading health magazines and newspapers;younger women were significantly more likely toreport using computer-based sources, includingthe internet or CD-ROM programs on healthtopics. Overall, midlife women reported usingmore sources of health information than youngerwomen. African American women were signifi-cantly less likely than white women to use com-puter-based sources and to read newspapers, butthey were more likely than white women toattend women’s health fairs.

Women also were asked to rate the usefulness ofvarious sources of health information. Overall,their own doctors were rated the most useful, fol-lowed by other health care providers used.Younger women were more likely than midlifewomen to rate computer-based sources and tele-phone information lines as very useful. Drugcompany advertisements were rated least useful(although 13% of women reported that in the past12 months they had requested a prescription for amedication they saw advertised on radio, TV, orin a magazine). An important omission from this



set of questions was information provided byhealth plans in the form of newsletters, mailings,or pamphlets; this was added to the currentrevised version of the survey.

Women’s health advocacy and interest groups canprovide access to health information as well asopportunities to participate in women’s healthissues at a local, state, or national level. This is thefirst population-based survey to measure women’sparticipation in these groups. Midlife womenwere significantly more likely than youngerwomen to subscribe to women’s health newslet-ters and to participate in women’s health groupsseeking to influence national policy (e.g., theNational Breast Cancer Coalition). Midlifewomen include members of the post-World WarII baby-boom generation, which has a history ofactivism including the women’s health movementof the 1960-70s. African American women weresignificantly less likely than white women to sub-scribe to women’s health newsletters and to par-ticipate in women’s health advocacy and interestgroups of all kinds. However, African Americanwomen were significantly more likely than whitewomen to rate television and radio programs,church and community groups, and women’shealth groups as “very useful” sources of healthinformation.

Communication with Providers. Women reportedon the quality of communication with their healthcare providers, which can be an important facilita-tor or barrier to appropriate care. While fewwomen overall reported difficulties talking totheir providers about personal health concerns,specific communication problems were identifiedby women with a regular provider. Most notably,nearly half of women who reported having a reg-ular provider indicated that their provider is only“fair” or “poor” at discussing alternative thera-pies. Smaller but noteworthy proportions ofwomen reported fair or poor provider perform-ance on spending enough time with them, bring-ing up difficult or sensitive topics that they mightnot feel comfortable bringing up themselves, giv-

ing them the results of their tests, and treatingthem like partners in their health care.

Younger women were significantly more likelythan midlife women to report that their providersdo not spend enough time with them or have dif-ficulty bringing up sensitive topics. This reflectsthe general tendency of younger women to reportmore dissatisfaction with health care. In this sur-vey, 36% of younger women, compared with 28%of midlife women, reported that they hadchanged doctors in the past 5 years due to dissat-isfaction with care received (p = .042). Whitewomen were more likely than African Americanto have changed doctors due to dissatisfaction(52% versus 31%, p = .005).

The only statistically significant difference byrace/ethnicity is for discussion of alternative ther-apies, such as herbal medications or acupuncture:white women were more likely than AfricanAmerican women to rate their provider as fair orpoor.

Pilot Test Conclusions

The WHCES was revised based on findings fromthe pilot test as well as subsequent feedback fromState maternal and child health experts, shorten-ing the time it will take to administer, streamlin-ing the section on needs-based patterns of healthservices utilization, and modifying the questionsand response sets to make the instrument morerelevant for older women.

The pilot test demonstrated the feasibility of con-ducting the Women’s Health Care ExperiencesSurvey in local communities using a RDD com-munity-based sample. This six-section survey (uti-lization, access, communication, health informa-tion sources, health risks and status, and sociode-mographics) can be used as a stand-alone instru-ment or can be used separately as optional mod-ules appended to other population-based surveys.


NOTES ON ADMINISTERING THE WHCES

The Women’s Health Care Experiences Surveywas designed to be administered as a telephonesurvey. Instructions to the interviewer are typedin CAPS.

The survey has not been formatted for self-administration. Although the wording of ques-tions was assessed for clarity in focus groups ofwomen in Baltimore, the readability of the ques-tions was not assessed for self-administration.Self-administration through a mailed survey, forexample, should not be attempted without refor-matting the survey, providing respondent instruc-tions, and testing of the items for readability. Forexample, when referring to “osteoporosis” in aself-administered survey, the item could bereworded to “osteoporosis, or brittle bones.”

Section A

Questions A4–A14 These questions are meantto be used as a set to meas-ure all of women’s need-based health care utilizationduring the past 12 months.Unlike other surveys thatask only about visits made,these questions try to cap-ture all episodes of healthcare use by starting withwomen’s perceived needs(Question A4) and thenasking about sources of care(and about reasons for notgetting care if there is anunmet need). Takentogether, these questionsprovide more detailed infor-mation about the types ofhealth professionals and set-tings used for care com-pared with standard ques-tions. The health care needscovered in Question A4 are

meant to be comprehensivefor women’s health care.We suggest using theseitems as a set and not omit-ting any of the needs listedin Question A4.

Question A15 Because the episodes of usedescribed in response toQuestions A4-A14 may beoverlapping, Question A15asks for a count of total “vis-its” in the past 12 months.This question is not redun-dant with Questions A4 -A14.

Question A25a–s These questions are meantto be used as a set to meas-ure a comprehensive set ofclinical preventive services(screening tests) and select-ed treatments that either arerecommended in currentclinical guidelines (e.g., Paptests) or are known to beneeded by a substantialnumber of women (e.g.,cholesterol tests). The setincludes some services forwhich trend data may bedesired (e.g., tests for infer-tility). We suggest usingthese items as a set and notomitting any of the serviceslisted in Question A25a-s.

Question 26 This set of items is meant toprovide an expanded list ofcounseling topics that eitherare recommended in cur-


rent clinical guidelines (e.g.,smoking cessation) or areknown to be needed by asubstantial number ofwomen (e.g., violence in thehome or workplace). Thelist of topics intentionallycovers social and behavioralissues that are relevant towomen’s health (e.g., vio-lence, work or financialproblems, family or rela-tionship problems). This isa more comprehensive listof counseling topics than isincluded in other surveys ofwomen’s health. This set ofitems could be expanded totake into account othercounseling topics relevantto a specific population.

Section B

Question B1 Because women may havemore than one type ofhealth insurance, the ques-tion is set up to code all thatapply. We suggest codingthat categorizes women bythe major types of healthinsurance. For example, anywomen who reported being“covered” by Medicare orMedigap could be coded as“Medicare;” then remainingwomen who reported beingcovered by Medicaid couldbe coded as “Medicaid;”then remaining women withother public coverage (mili-tary) could be coded as“other public;” thenremaining women could becoded as “private healthinsurance.” Dental insur-

ance should be treated as aseparate variable.

Section C

Question C3a-o This set of items is meant toprovide a list of communica-tion issues that have beenfound to be important inwomen’s health care. Thelength of this list reflects theneed for multiple items inorder to create a scale of sat-isfaction with communica-tion with the regularprovider. We have not yetconducted item analyses toidentify the best set of itemsor candidates for omission.

ID ....................................................................

DATE ................................. MM DD YY

INTERVIEWER ID ....................................

TOTAL TIME................................................................

WOMEN’S HEALTH CARE EXPERIENCES SURVEY

Prepared By

The Women’s and Children’s Health Policy Center The Johns Hopkins University Bloomberg School of Public Health

July 2000

Cite as: Women’s and Children’s Health Policy Center, 2000. Women’s Health Care Experiences Survey. Johns Hopkins University Bloomberg School of Public Health; Baltimore, MD.

Development of the Women’s Health Care Experiences Survey (WHCES) was led by Carol Weisman, PhD; substantial and substantive contributions were made by Wanda Nicholson, MD, MPH; Holly A. Grason, MA; Charlyn Cassady, PhD; Jillian Henderson, MPH; Ann M. Koontz, CNM, DrPH; Gillian B. Silver, MPH; Patricia O’Campo, PhD; and Cynthia S. Minkovitz, MD, MPP. The Battelle Center for Public Health Research and Evaluation formatted the WHCES for CATI administration.

The Women’s Health Care Experiences Survey is copyrighted. Readers may duplicate and use all or part of the information contained in these publications. In accordance with accepted publishing standards, the Johns Hopkins Women’s and Children’s Health Policy Center requests acknowledgment, in print, of any information reproduced in another publication.

The Women’s and Children’s Health Policy Center Department of Population and Family Health Sciences Johns Hopkins University Bloomberg School of Public Health 615 N. Wolfe Street Baltimore, MD 21205 Tel: 410/502-5443 Fax: 410/502-5831

Development of the Women’s Health Care Experiences Survey was supported through project #U93

MC 00101 with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Concepts incorporated in this publication are the sole responsibility of the authors and do not necessarily reflect the views or policies of the Bureau, HRSA, or the Department of Health and Human Services.

Internet: http://www.jhsph.edu/wchpc

Women’s Health Care Experiences Survey Page A-1 SECTION A: NEED-BASED UTILIZATION

START TIME.............................................. :

I would like to begin by asking you some questions about your health, in general, and the kinds of health care you receive.

A1. Would you say your health, in general, is excellent, very good, good, fair, or poor?

EXCELLENT ........................................................................1 VERY GOOD .......................................................................2 GOOD ..................................................................................3 FAIR.....................................................................................4 POOR...................................................................................5 RF ........................................................................................7 DK ........................................................................................8

A2. Compared with other women your age, would you say that you are healthier than most, as healthy as most, or not as healthy as most?

HEALTHIER THAN MOST...................................................1 AS HEALTHY AS MOST......................................................2 NOT AS HEALTHY AS MOST.............................................3 RF ........................................................................................7 DK ........................................................................................8

A3. All in all, do you think that you visit health care providers too often, not often enough, or about the right number of times each year?

TOO OFTEN ........................................................................1 NOT ENOUGH.....................................................................2 RIGHT NUMBER OF TIMES ...............................................3 RF ........................................................................................7 DK ........................................................................................8

A4. Now I am going to ask you about the specific health problems and health care needs that you may have had during the past 12 months—from (CURRENT MONTH, LAST YEAR) to (CURRENT

MONTH, THIS YEAR). At any time in the past 12 months (READ LIST):

YES NO RF DK

a. did you have a minor illness like the flu or an

infection? .......................................................... 1 2 7 8

b. did you need a regular checkup or routine

physical exam?................................................. 1 2 7 8

c. were you pregnant?.......................................... 1 2 7 8

d. did you need any screening or diagnostic tests, such as a Pap test, mammogram, or blood test? ........................................................ 1 2 7 8

e. did you need family planning or

preconceptional services? ................................ 1 2 7 8

f. were you a victim of violence or sexual

assault? ............................................................ 1 2 7 8

g. did you have an injury that you have not

already mentioned? .......................................... 1 2 7 8

h. did you need care for a chronic health problem, that is, one that goes on for a long time? ................................................................. 1 2 7 8

i. did you need surgery for a condition not


j. were you feeling depressed, anxious, or

highly stressed?................................................ 1 2 7 8

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-2 IF A4a NOT = 1, SKIP TO A6

A5. You said you had a minor illness like the flu or an infection in the past 12 months. Did you receive any health care for this?

YES................................ (SKIP TO B).................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

A. What was the main reason you did not get care for this illness? CODE ONE ANSWER.

NO HEALTH INSURANCE ................................................ 01

WOULD COST TOO MUCH.............................................. 02

HEALTH INSURANCE DOES NOT COVER..................... 03

DIDN’T KNOW WHERE TO GET CARE ........................... 04

TOO BUSY ........................................................................ 05

PROVIDER TOO FAR AWAY............................................ 06

NO CHILDCARE OR DEPENDENT CARE ....................... 07

NO TRANSPORTATION ................................................... 08

AFRAID OR EMBARRASSED........................................... 09

COULD NOT FIND A PROVIDER I LIKED........................ 10

COULD NOT FIND A SPECIALIST ................................... 11

REFERRAL FORM OR PAPERWORK GOT LOST .......... 12

NOT SERIOUS/TOOK CARE OF IT MYSELF .................. 13

OTHER REASON ........... (SPECIFY)................................ 14

RF ...................................................................................... 97

DK ...................................................................................... 98

SPECIFY: ________________________________________________________________________________

SKIP TO A6

B. At what kinds of places did you get care for the minor illness? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE....................................................... 01

AN HMO OR MANAGED CARE PLAN.............................. 02

HOSPITAL OUTPATIENT DEPARTMENT........................ 03

HOSPITAL EMERGENCY ROOM (ER) ............................ 04

HOSPITAL CLINIC ............................................................ 05

HOSPITAL INPATIENT (OVERNIGHT STAY) .................. 06

FAMILY PLANNING CLINIC.............................................. 07

WOMEN’S HEALTH CENTER/CLINIC.............................. 08

PUBLIC HEALTH DEPARTMENT CLINIC ........................ 09

OTHER COMMUNITY/NEIGHBORHOOD CLINIC ........... 10

HEALTH PROGRAM AT PLACE OF WORK..................... 11

URGENT CARE CENTER................................................. 12

DENTIST’S OFFICE .......................................................... 13

TREATED/PRESCRIBED OVER TELEPHONE................ 14

OTHER (SPECIFY)........................................................... 15

RF ...................................................................................... 97

DK ...................................................................................... 98

SPECIFY:____________________________________________________________________________

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-3 C. What kinds of health professionals did you

see for the minor illness? CODE UP TO 3 PROFESSIONALS.

FAMILY PRACTITIONER/FAMILY PHYSICIAN................01

INTERNIST (INTERNAL MEDICINE DOCTOR)................02

OBSTETRICIAN OR GYNECOLOGIST ............................03

PSYCHIATRIST.................................................................04

OTHER TYPE OF PHYSICIAN..........................................05

NURSE PRACTITIONER...................................................06

NURSE MIDWIFE / MIDWIFE ...........................................07

PHYSICIAN’S ASSISTANT................................................08

DENTIST OR DENTAL HYGIENIST..................................09

OPHTHALMOLOGIST/OPTOMETRIST (EYE DOCTOR).10

PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12

MENTAL HEALTH COUNSELOR .....................................13

PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18

MEDICAL / LAB TECHNOLOGIST....................................19

OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for minor illnesses?

NUMBER OF VISITS ..........................................

IF A4b NOT = 1, SKIP TO A7

A6. You said you needed a regular checkup or routine physical exam in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not get a regular checkup or routine physical exam? CODE ONE ANSWER.

NO HEALTH INSURANCE ................................................01

WOULD COST TOO MUCH ..............................................02

HEALTH INSURANCE DOES NOT COVER .....................03

DIDN’T KNOW WHERE TO GET CARE ...........................04

TOO BUSY.........................................................................05

PROVIDER TOO FAR AWAY............................................06

NO CHILDCARE OR DEPENDENT CARE .......................07

NO TRANSPORTATION....................................................08

AFRAID OR EMBARRASSED...........................................09

COULD NOT FIND A PROVIDER I LIKED........................10

COULD NOT FIND A SPECIALIST ...................................11

REFERRAL FORM OR PAPERWORK GOT LOST ..........12

NOT SERIOUS/TOOK CARE OF IT MYSELF ..................13

OTHER REASON ........... (SPECIFY) ................................14

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A7

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-4 B. At what kinds of places did you get a regular

checkup or routine physical exam? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01

AN HMO OR MANAGED CARE PLAN..............................02

HOSPITAL OUTPATIENT DEPARTMENT........................03

HOSPITAL EMERGENCY ROOM (ER).............................04

HOSPITAL CLINIC.............................................................05

HOSPITAL INPATIENT (OVERNIGHT STAY) ..................06

FAMILY PLANNING CLINIC..............................................07

WOMEN’S HEALTH CENTER/CLINIC..............................08

PUBLIC HEALTH DEPARTMENT CLINIC ........................09

OTHER COMMUNITY/NEIGHBORHOOD CLINIC ...........10

HEALTH PROGRAM AT PLACE OF WORK.....................11

URGENT CARE CENTER .................................................12

DENTIST’S OFFICE ..........................................................13

TREATED/PRESCRIBED OVER TELEPHONE................14

OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

C. What kinds of health professionals did you see for the regular checkup or routine physical exam? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for a regular checkup or routine physical exam?

NUMBER OF VISITS ..........................................

IF A4c NOT = 1, SKIP TO A8

A7. You said you were pregnant in the past 12 months. Did you receive any health care for this?


JHU • WCHPC

Women’s Health Care Experiences Survey Page A-5 A. What was the main reason you did not get

care for your pregnancy? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A8

B. At what kinds of places did you get care for your pregnancy? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-6

C. What kinds of health professionals did you see for your pregnancy? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for your pregnancy?

NUMBER OF VISITS ..........................................

IF A4d NOT = 1, SKIP TO A9

A8. You said you needed screening or diagnostic tests, such as a Pap test, mammogram or blood test, in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not get screening or diagnostic tests, such as a Pap test, mammogram or blood test? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A9

JHU • WCHPC


B. At what kinds of places did you get care for screening or diagnostic tests, such as a Pap test, mammogram or blood test? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

C. What kinds of health professionals did you see for screening or diagnostic tests, such as a Pap test, mammogram or blood test? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for screening or diagnostic tests, such as a Pap test, mammogram or blood test?

NUMBER OF VISITS ..........................................

IF A4e NOT = 1, SKIP TO A10

A9. You said you needed family planning or preconceptional services in the past 12 months. Did you receive any health care for this?


JHU • WCHPC


A. What was the main reason you did not get family planning or preconceptional services? CODE BEST BUT CONFIRM WITH R IF WORDS NOT EXACT.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10

B. At what kinds of places did you get family planning or preconceptional services? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC


see for family planning or preconceptional services? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for family planning or preconceptional services?

NUMBER OF VISITS ..........................................

IF A4f NOT = 1, SKIP TO A11

A10. You said you were a victim of violence or sexual assault in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not receive health care for this? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A11

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-10 B. At what kinds of places did you get care for

this? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

C. What kinds of health professionals did you see to care for this? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for injuries caused by violence or sexual assault?

NUMBER OF VISITS ..........................................

IF A4g NOT = 1, SKIP TO A12

A11. You said you had an injury in the past 12 months. Did you receive any health care for this?


JHU • WCHPC


care for this injury? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A12

B. At what kinds of places did you get care for this injury? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC


see for this injury? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for this injury?

NUMBER OF VISITS ..........................................

IF A4h NOT = 1, SKIP TO A13

A12. You said you had a chronic health problem in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not get care for this problem? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A13

JHU • WCHPC


this problem? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

C. What kinds of health professionals did you see for this problem? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for this chronic health problem?

NUMBER OF VISITS ..........................................

IF A4i NOT = 1, SKIP TO A14

A13. You said you needed surgery in the past 12 months. Did you receive any health care for this?


JHU • WCHPC


this surgery? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A14

B. At what kinds of places did you get this surgery? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC


see for this surgery? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for this surgery?

NUMBER OF VISITS ..........................................

IF A4j NOT = 1, SKIP TO A15

A14. You said you were depressed or feeling stressed in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not get care for this depression or stress? CODE ONE ANSWER.





TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A15

JHU • WCHPC


this depression or stress? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

C. What kinds of health professionals did you see for this depression or stress? CODE UP TO 3 PROVIDERS.




PSYCHIATRIST.................................................................04







PSYCHOLOGIST...............................................................11

SOCIAL WORKER.............................................................12


PODIATRIST......................................................................14

CHIROPRACTOR..............................................................15

ACUPUNCTURIST ............................................................16

HERBALIST .......................................................................17

HOMEOPATH....................................................................18


OTHER............................ (SPECIFY) ................................20

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

D. How many outpatient visits in all did you make in the past 12 months for this depression or stress?

NUMBER OF VISITS ..........................................

A15. How many times altogether did you visit a doctor or other health professional for outpatient health care in the past 12 months?

NUMBER OF VISITS ................................................

A16. Some women have a regular health care provider. A regular health care provider is a person you usually go to first when you need health information, a test, or treatment for a health problem. Is there one person that you depend on as your regular health care provider?

YES......................................................................................1 NO................................ (SKIP TO A24)...............................2 RF ................................ (SKIP TO A24)...............................7 DK ................................ (SKIP TO A24)...............................8

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-17 A17. What type of provider is the health professional

you see most often for regular care (READ LIST AND RECORD ONE ANSWER)?

Family physician or general practitioner.....................01

Internist or internal medicine doctor ............................02

Obstetrician or gynecologist .........................................03

Physician’s assistant......................................................04

Nurse practitioner ...........................................................05

Nurse Midwife .................................................................06

Chiropractor.....................................................................07

Acupuncturist...................................................................08

Herbalist ...........................................................................09

Homeopath ......................................................................10

Some other kind of health care provider (SPECIFY) .11

RF ......................................................................................97

DK ......................................................................................98

A18. Is this regular provider male or female? MALE ...................................................................................1 FEMALE...............................................................................2 RF ........................................................................................7 DK ........................................................................................8

A19. About how many years have you been seeing this health care provider?

LESS THAN A YEAR.........................................................01 ONE YEAR.........................................................................02 TWO YEARS......................................................................03 FOUR YEARS....................................................................04 FIVE OR MORE YEARS....................................................05 RF ......................................................................................97 DK ......................................................................................98

A20. In general, do you prefer to see a male or female health care provider?

MALE ...................................................................................1 FEMALE...............................................................................2 EITHER................................................................................3 RF ........................................................................................7 DK ........................................................................................8

IF A17 = 3, SKIP TO A25

A21. In addition to your regular health care provider, do you also see an obstetrician or gynecologist (OB-

GYN)?

YES......................................................................................1 NO................................ (SKIP TO A25)...............................2 RF ................................ (SKIP TO A25)...............................7 DK ................................ (SKIP TO A25)...............................8

A22. Is this obstetrician-gynecologist (OB-GYN) male or female?


A23. In general, do you prefer to see a male or female obstetrician-gynecologist?


SKIP TO A25

JHU • WCHPC

Women’s Health Care Experiences Survey Page A-18 A24. There are many reasons why some women do not

have a regular health care provider. Can you tell me the main reason you do not have a regular health care professional? CODE BEST ANSWER BUT CONFIRM WITH R IF WORDS NOT EXACT.

SEE MORE THAN ONE PROVIDER AND DON’T CONSIDER ANY AS YOUR “REGULAR” PROVIDER ..01

JUST CHANGED PROVIDERS OR HEALTH

INSURANCE PLANS ......................................................02

OLD PROVIDER IS NO LONGER AVAILABLE ................03

JUST MOVED INTO A NEW COMMUNITY ......................04

DON’T KNOW WHERE TO GO FOR REGULAR HEALTH CARE..............................................................................05

CAN’T FIND A PROVIDER THAT YOU ARE COMFORTABLE WITH..................................................06

RARELY GET SICK OR GO FOR HEALTH CARE ...........07

OTHER REASONS......... (SPECIFY) ................................08

NO INSURANCE................................................................09

RF ......................................................................................97

DK ......................................................................................98

JHU • WCHPC







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

I.

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....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

b

. T

est fo

r g

lau

co

ma

or

pre

ssu

re in

th

e e

ye

...........................................

1

2

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)..

....

....

....

....

....

....

....

01

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

..0

6

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)...

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

c.

Blo

od c

hole

ste

rol te

st.

...................

12

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)..

....

....

....

....

....

....

....

01

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

..0

6

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)...

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

Page A-19







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

Page A-20

A25

. T

here

are

man

y ty

pes

of h

ealth

car

e se

rvic

es th

at w

omen

rec

eive

. I a

m

goin

g to

rea

d a

list o

f spe

cific

ser

vice

s or

test

s, a

nd I

wou

ld li

ke y

ou to

tell

me

if yo

u ha

ve h

ad e

ach

one

in th

e pa

st 1

2 m

onth

s?

YE

S

(AS

K I)

N

O

(NE

XT

)

RF

(NE

XT

)

DK

(NE

XT

)

Wha

t was

the

mai

n re

ason

you

had

(T

ES

T)?

CO

DE

BE

ST

AN

SW

ER

BU

T

CO

NF

IRM

WIT

H R

IF W

OR

DS

NO

T E

XA

CT

.

d.

C

heck

for

high

blo

od p

ress

ure.

......

1 2

7 8

I GE

T T

HIS

TE

ST

RE

GU

LAR

LY (

E.G

. AN

NU

ALL

Y, B

IAN

NU

ALL

Y).

......

......

......

......

.....

01

FO

LLO

W-U

P O

F C

HR

ON

IC C

ON

DIT

ION

......

......

......

......

......

......

......

......

......

......

......

....0

2

HE

ALT

H C

AR

E P

RO

VID

ER

SU

GG

ES

TE

D IT

......

......

......

......

......

......

......

......

......

......

....0

3

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT...

......

......

......

......

......

......

......

......

....0

4

IT T

ES

TS

FO

R A

HE

ALT

H P

RO

BLE

M T

HA

T R

UN

S IN

TH

E F

AM

ILY

......

......

......

......

...05

HA

D S

YM

PT

OM

S...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..06

LEA

RN

ED

AB

OU

T T

HIS

TE

ST

IN T

HE

ME

DIA

(N

EW

SP

AP

ER

S, M

AG

AZ

INE

, TV

)....

.07

OT

HE

R...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.08

RF

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

97

DK

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

98

e.

T

est f

or d

iabe

tes

......

......

......

......

....

1

27

8I G

ET

TH

IS T

ES

T R

EG

ULA

RLY

(E

.G. A

NN

UA

LLY

, BIA

NN

UA

LLY

)....

......

......

......

......

..01

FO

LLO

W-U

P O

F C

HR

ON

IC C

ON

DIT

ION

......

......

......

......

......

......

......

......

......

......

......

....0

2

HE

ALT

H C

AR

E P

RO

VID

ER

SU

GG

ES

TE

D IT

......

......

......

......

......

......

......

......

......

......

....0

3

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT...

......

......

......

......

......

......

......

......

....0

4

IT T

ES

TS

FO

R A

HE

ALT

H P

RO

BLE

M T

HA

T R

UN

S IN

TH

E F

AM

ILY

......

......

......

......

...05

HA

D S

YM

PT

OM

S...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..06

LEA

RN

ED

AB

OU

T T

HIS

TE

ST

IN T

HE

ME

DIA

(N

EW

SP

AP

ER

S, M

AG

AZ

INE

, TV

)....

.07

OT

HE

R...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.08

RF

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

97

DK

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

98

f.

Bre

ast e

xam

by

a do

ctor

or

nurs

e...

......

......

......

......

......

......

......

.

1

27

8I G

ET

TH

IS T

ES

T R

EG

ULA

RLY

(E

.G. A

NN

UA

LLY

, BIA

NN

UA

LLY

)....

......

......

......

......

..01

FO

LLO

W-U

P O

F C

HR

ON

IC C

ON

DIT

ION

......

......

......

......

......

......

......

......

......

......

......

....0

2

HE

ALT

H C

AR

E P

RO

VID

ER

SU

GG

ES

TE

D IT

......

......

......

......

......

......

......

......

......

......

....0

3

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT...

......

......

......

......

......

......

......

......

....0

4

IT T

ES

TS

FO

R A

HE

ALT

H P

RO

BLE

M T

HA

T R

UN

S IN

TH

E F

AM

ILY

......

......

......

......

...05

HA

D S

YM

PT

OM

S...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..06

LEA

RN

ED

AB

OU

T T

HIS

TE

ST

IN T

HE

ME

DIA

(N

EW

SP

AP

ER

S, M

AG

AZ

INE

, TV

)....

.07

OT

HE

R...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.08

RF

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

97

DK

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

98







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

I.

A25.

There

are

many types o

f health c

are

se

rvic

es th

at w

om

en

re

ce

ive

. I a

m

go

ing

to

re

ad

a lis

t o

f sp

ecific

se

rvic

es

or

tests

, and I w

ould

lik

e y

ou to tell

me

if yo

u h

ave

ha

d e

ach

on

e in

th

e

pa

st 1

2 m

on

ths?

Y

ES

(A

SK

I)

NO

(N

EX

T)

RF

(NE

XT

)

DK

(NE

XT

)

Wh

at w

as th

e m

ain

re

aso

n y

ou

ha

d (

TE

ST)?

CO

DE

BE

ST

AN

SW

ER

BU

T

CO

NF

IRM

WIT

H R

IF

WO

RD

S N

OT

EX

AC

T.

g.

Mam

mogra

m..................................

1

2

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

h.

Pap test.

.........................................

12

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

i.

Bone d

ensity test (f

or

oste

oporo

sis

).................................

1

2

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

Page A-21







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

Page A-22p

yg

I.

A25.

There

are

many types o

f health c

are

se

rvic

es th

at w

om

en

re

ce

ive

. I a

m

go

ing

to

re

ad

a lis

t o

f sp

ecific

se

rvic

es

or

tests

, and I w

ould

lik

e y

ou to tell

me

if yo

u h

ave

ha

d e

ach

on

e in

th

e

pa

st 1

2 m

on

ths?

Y

ES

(A

SK

I)

NO

(N

EX

T)

RF

(NE

XT

)

DK

(NE

XT

)

Wh

at w

as th

e m

ain

re

aso

n y

ou

ha

d (

TE

ST)?

CO

DE

BE

ST

AN

SW

ER

BU

T

CO

NF

IRM

WIT

H R

IF

WO

RD

S N

OT

EX

AC

T.

j.

Genetic

scre

enin

g test.

..................

1

2

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

k.

Scre

enin

g for

HIV

/AID

S.................

1

2

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

l.

Scre

en

ing

fo

r o

the

r se

xu

ally

tr

ansm

itte

d d

iseases......................

1

2

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

I.

A25.

There

are

many types o

f health c

are

se

rvic

es th

at w

om

en

re

ce

ive

. I a

m

go

ing

to

re

ad

a lis

t o

f sp

ecific

se

rvic

es

or

tests

, and I w

ould

lik

e y

ou to tell

me

if yo

u h

ave

ha

d e

ach

on

e in

th

e

pa

st 1

2 m

on

ths?

Y

ES

(A

SK

I)

NO

(N

EX

T)

RF

(NE

XT

)

DK

(NE

XT

)

Wh

at w

as th

e m

ain

re

aso

n y

ou

ha

d (

TE

ST)?

CO

DE

BE

ST

AN

SW

ER

BU

T

CO

NF

IRM

WIT

H R

IF

WO

RD

S N

OT

EX

AC

T.

m.

Denta

l exam

...................................

1

2

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

n.

Shot fo

r flu o

r pneum

onia

..............

1

2

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

o.

Pre

gnancy test.

..............................

12

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

03

A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

....

....

....

....

....

....

....

....

....

....

....

....

...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

....

....

....

....

....

....

.05

HA

D S

YM

PT

OM

S..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

.06

LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

......

08

RF

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

97

DK

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

....

98

Page A-23







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

Page A-24p

yg

I.

A25.

There

are

many types o

f health c

are

se

rvic

es th

at w

om

en

re

ce

ive

. I a

m

go

ing

to

re

ad

a lis

t o

f sp

ecific

se

rvic

es

or

tests

, and I w

ould

lik

e y

ou to tell

me

if yo

u h

ave

ha

d e

ach

on

e in

th

e

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ths?

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(NE

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(NE

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at w

as th

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aso

n y

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d (

TE

ST)?

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DE

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ST

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ER

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NF

IRM

WIT

H R

IF

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S N

OT

EX

AC

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p.

Fa

mily

pla

nn

ing

se

rvic

es o

r contr

aception

.................................

1

2

7

8

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ET

TH

IS T

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T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

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AL

LY

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98

q.

Tests

for

infe

rtili

ty...........................

12

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

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1

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LL

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OF

CH

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GE

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IT

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98

r.

Abort

ion info

rmation o

r serv

ices

....

1

2

78

I G

ET

TH

IS T

ES

T R

EG

UL

AR

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.G.

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LY

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98







TOO BUSY.........................................................................05










RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

SKIP TO A10


A DOCTOR’S OFFICE.......................................................01




HOSPITAL CLINIC.............................................................05








DENTIST’S OFFICE ..........................................................13


OTHER (SPECIFY)...........................................................15

RF ......................................................................................97

DK ......................................................................................98

SPECIFY: ___________________________________________________________________________

JHU • WCHPC

I.

A25.

There

are

many types o

f health c

are

se

rvic

es th

at w

om

en

re

ce

ive

. I a

m

go

ing

to

re

ad

a lis

t o

f sp

ecific

se

rvic

es

or

tests

, and I w

ould

lik

e y

ou to tell

me

if yo

u h

ave

ha

d e

ach

on

e in

th

e

pa

st 1

2 m

on

ths?

Y

ES

(A

SK

I)

NO

(N

EX

T)

RF

(NE

XT

)

DK

(NE

XT

)

Wh

at w

as th

e m

ain

re

aso

n y

ou

ha

d (

TE

ST)?

CO

DE

BE

ST

AN

SW

ER

BU

T

CO

NF

IRM

WIT

H R

IF

WO

RD

S N

OT

EX

AC

T.

s.

Alc

oh

ol o

r d

rug

ab

use

counselin

g o

r tr

eatm

ent

................

1

2

7

8

I G

ET

TH

IS T

ES

T R

EG

UL

AR

LY

(E

.G.

AN

NU

AL

LY

, B

IAN

NU

AL

LY

)...

....

....

....

....

....

....

...0

1

FO

LL

OW

-UP

OF

CH

RO

NIC

CO

ND

ITIO

N..

....

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....

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....

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....

....

....

02

HE

AL

TH

CA

RE

PR

OV

IDE

R S

UG

GE

ST

ED

IT

....

....

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....

....

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....

....

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A F

RIE

ND

OR

FA

MIL

Y M

EM

BE

R S

UG

GE

ST

ED

IT

....

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...0

4

IT T

ES

TS

FO

R A

HE

AL

TH

PR

OB

LE

M T

HA

T R

UN

S I

N T

HE

FA

MIL

Y..

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HA

D S

YM

PT

OM

S..

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LE

AR

NE

D A

BO

UT

TH

IS T

ES

T I

N T

HE

ME

DIA

(N

EW

SP

AP

ER

S,

MA

GA

ZIN

E,

TV

)..

...0

7

OT

HE

R..

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98

Page A-25


JHU • WCHPC

A26. In the past 12 months, did any of your health care providers talk with you or give you information about (READ ITEM)?

YES NO RF DK

a. Smoking, second-hand smoke, or quitting

smoking ............................................................ 1 2 7 8

b. Nutrition or diet ................................................. 1 2 7 8

c. Alcohol or drug use........................................... 1 2 7 8

d. Physical fitness or exercise .............................. 1 2 7 8

e. Menopause or hormone replacement therapy . 1 2 7 8

f. Violence in the home or workplace................... 1 2 7 8

g. Work or financial problems ............................... 1 2 7 8

h. Family or relationship problems........................ 1 2 7 8

i. Sexual function or problems ............................. 1 2 7 8

j. Stress management ......................................... 1 2 7 8

k. Preventing unintended pregnancies................. 1 2 7 8

l. Using alternative therapies, such as herbs or

acupuncture ...................................................... 1 2 7 8

m. Preventing osteoporosis................................... 1 2 7 8

A27. I am going to read a list of other therapies that some people use. For each one, please tell me whether or not you have used it in the past 12 months. Have you used (READ ITEM)?

YES NO RF DK

a. Herbal medicines, such as St. Johnswort or

ginkgo ............................................................... 1 2 7 8

b. Dietary supplements, such as calcium ............ 1 2 7 8

c. Chiropractic care............................................... 1 2 7 8

d. Acupuncture...................................................... 1 2 7 8

e. Massage therapy .............................................. 1 2 7 8

f. Relaxation or meditation therapy...................... 1 2 7 8

Women’s Health Care Experiences Survey Page B-1

JHU • WCHPC

SECTION B: HEALTH CARE ACCESS

I would now like to ask you some questions about the kinds of health insurance you might have.

B1. As I read a list of types of health insurance, please tell me whether or not you are now covered by it. (READ LIST)

COVERED NOT

COVERED RF DK

a. Private health insurance through your own job or

union ......................................................................... 1 2 7 8

b. Private health insurance through a family

member’s job or union .............................................. 1 2 7 8

c. Private health insurance you or a family member

bought directly from an insurance company............. 1 2 7 8

d. Medicaid, MA, or Medical Assistance, a government plan that covers specific groups, including pregnant women with low income ............. 1 2 7 8

e. Medicare, a government plan that covers people

ages 65 and over and some disabled people........... 1 2 7 8

(IF E=1, ASK F)

f. Medigap or other supplemental Medicare 1 2 7 8

g. Military, TriCare Standard, or VA insurance............. 1 2 7 8

h. The Indian Health Service ........................................ 1 2 7 8

h. Dental Insurance ..................................................... 1 2 7 8

IF NO INSURANCE OF ANY KIND – ALL ANSWERS TO B1 NOT=1 – SKIP TO B3

B2. During the past 12 months, was there any time, including now, when you had no health insurance of any kind?

YES.........................................................................................1NO................................. (SKIP TO B4)...................................2RF ................................. (SKIP TO B4)...................................7DK ................................. (SKIP TO B4)...................................8

a. How many months of the last year were you without insurance?

NUMBER OF MONTHS...............................................

SKIP TO B4.

B3. There are many reasons why some people do not

have health insurance. Please tell me whether any of these reasons apply to you. (READ LIST)

YES NO RF DK

a. You or a family member lost your insurance

because of changing jobs or leaving a job. .............. 1 2 7 8

b. You lost eligibility for Medicaid or Medical

Assistance. ............................................................... 1 2 7 8

c. You didn’t think you needed health insurance.......... 1 2 7 8

d. You couldn’t afford to buy health insurance. ............ 1 2 7 8

e. An employer stopped offering health insurance. ...... 1 2 7 8

f. You became divorced, separated, or widowed. ....... 1 2 7 8

g. You couldn’t get coverage because of pregnancy. .. 1 2 7 8

h. You couldn’t get coverage because of pre-existing

condition 1 2 7 8


JHU • WCHPC

SKIP TO B14

B4. Many people today are enrolled in managed care plans of one kind or another. HMOs, or health maintenance organizations, are plans that provide a full range of health care services and usually require you to choose doctors and hospitals on the plan’s list. PPOs, or preferred provider organizations, give you a list of doctors they prefer you to use; if you use these doctors, you pay less than if you visit a doctor not on the list. Are you now enrolled in an HMO or PPO?

HMO....................................................................................... 1 PPO........................................................................................ 2 NEITHER ............................................................................... 3 RF .......................................................................................... 7 DK .......................................................................................... 8

B5. Some health plans require women to select one primary care provider, or PCP, to coordinate all of their care. Sometimes, women are asked to select two PCPs—a family or general practice physician and an obstetrician-gynecologist. What does your plan require you to do?

SELECT ONE PCP................................................................ 1 SELECT TWO PCPS, ONE OF WHOM IS AN OB-GYN........................................ (SKIP TO B7)..... 2 NOT REQUIRED TO SELECT ANY PCP.. (SKIP TO B7)..... 3 RF .............................................................. (SKIP TO B7)..... 7 DK .............................................................. (SKIP TO B7)..... 8

B6. Can this PCP be an obstetrician-gynecologist? YES.........................................................................................1NO...........................................................................................2RF ...........................................................................................7DK ...........................................................................................8

B7. Regarding your use of an obstetrician-gynecologist (OB-GYN), which of the following best describes your health plan’s rules (READ LIST):

YOU CAN SEE AN OB-GYN WITHOUT A REFERRAL FOR AS MANY VISITS AS YOU NEED ......................................1

YOU CAN SEE AN OB-GYN WITHOUT A REFERRAL FOR A LIMITED NUMBER OF VISITS PER YEAR ....................2

YOU MUST GET A REFERRAL FROM YOUR PRIMARY CARE PROVIDER EVERY TIME YOU SEE AN OB-GYN..3

RF ...........................................................................................7

DK ...........................................................................................8

B8. Does your current health plan require you to get a referral from you primary care provider, or PCP, in order to receive specialty care, such as care from heart doctors, skin doctors, psychiatrists, and others?

YES.........................................................................................1NO...........................................................................................2RF ...........................................................................................7DK ...........................................................................................8

B9. Does your current health plan send you reminders when it is time for you to get preventive health care services such as Pap tests or mammograms?

YES........................................................................................ 1 NO.......................................................................................... 2 RF .......................................................................................... 7 DK .......................................................................................... 8


JHU • WCHPC

B10. How long have you been enrolled in your current health plan? Less than one year, one to two years, or more than two years?

LESS THAN ONE YEAR........................................................ 1 ONE TO TWO YEARS........................................................... 2 MORE THAN TWO YEARS................................................... 3 RF .......................................................................................... 7 DK .......................................................................................... 8

B11. At the place where you get your regular health care, do they have any of the following? (READ

LIST)

YES NO RF DK

a. A women’s health resource center (a place where you can get information on women’s health and referrals to professional health services and community programs).................. 1 2 7 8

b. Women’s support groups, such as groups to

discuss menopause.......................................... 1 2 7 8

c. Health education programs specifically for

women .............................................................. 1 2 7 8

d. Research projects on women’s health that

you can participate in........................................ 1 2 7 8

B12. I am going to read a list of specific services. Please tell me whether your current health insurance plan covers any part of the cost of these services, even if you do not use the service yourself. (READ LIST)

COVERS DOES NOT

COVER RF DK

a. Regular checkups............................................. 1 2 7 8

b. Pap test ............................................................ 1 2 7 8

c. Mammograms................................................... 1 2 7 8

d. Prescription medications .................................. 1 2 7 8

e. Contraceptives, like birth control pills, the

“shot,” Norplant. ................................................ 1 2 7 8

f. Abortion ............................................................ 1 2 7 8

g. Infertility treatments. ......................................... 1 2 7 8

h. Mental health counseling.................................. 1 2 7 8

i. Drug or alcohol abuse treatment. ..................... 1 2 7 8

j. Home health services, like nurse visits at

home................................................................. 1 2 7 8

k. Long-term care or nursing home care. ............. 1 2 7 8

l. Chiropractic care............................................... 1 2 7 8


JHU • WCHPC

B13. During the past 12 months, was there ever a time

when your health insurance did not pay for a test or treatment that you thought you needed?

YES........................................................................................ 1 NO................................ (SKIP TO B14)................................. 2 RF ................................ (SKIP TO B14)................................. 7 DK ................................ (SKIP TO B14)................................. 8

B14. Overall, how difficult is it for you to get health care when you need it—would you say it is extremely difficult, somewhat difficult, not too difficult, or not at all difficult?

EXTREMELY DIFFICULT...................................................... 1 SOMEWHAT DIFFICULT....................................................... 2 NOT TOO DIFFICULT ........................................................... 3 NOT AT ALL DIFFICULT ....................................................... 4 RF .......................................................................................... 7 DK .......................................................................................... 8

B15. Women have different preferences for how they get health care. For each of the following options in women’s health care, please tell me whether you would like it a lot, like it a little, or you don’t really care one way or another about it. (READ

LIST)

LIKE A LOT LIKE A LITTLE

DON’T CARE (DK) RF

a. A women’s health resource center that offers

health information and a referral network......... 1 2 3 7

b. A women’s health center where you can get most of your basic health care, including gynecological care, in one place. ..................... 1 2 3 7

c. The choice of getting regular health care from a professional who is not a physician, like a nurse practitioner or nurse midwife......... 1 2 3 7

d. Women’s health support groups on specific

topics. ............................................................... 1 2 3 7

e. A directory of opportunities to participate in

women’s health research projects. ................... 1 2 3 7

Women’s Health Care Experiences Survey Page C-1

JHU • WCHPC

SECTION C: COMMUNICATION

Now I have some questions about health care communication.

C1. Over the past 12 months, how difficult was it for you to contact a health care provider over the telephone about a health problem? Was it very difficult, somewhat difficult, not too difficult, or not difficult at all?

VERY DIFFICULT................................................................1 SOMEWHAT DIFFICULT.....................................................2 NOT TOO DIFFICULT .........................................................3 NOT DIFFICULT AT ALL .....................................................4 RF ........................................................................................7 DK ........................................................................................8

C2. In general, how difficult have you found it to talk to health care providers about your personal health concerns? Have you found it very difficult, somewhat difficult, not too difficult, or not difficult at all?

VERY DIFFICULT................................................................1 SOMEWHAT DIFFICULT.....................................................2 NOT TOO DIFFICULT .........................................................3 NOT DIFFICULT AT ALL .....................................................4 RF ........................................................................................7 DK ........................................................................................8

IF A16 NOT = 1, SKIP TO C4.

C3. You told me you have one health care provider whom you think of as your regular provider. Please tell me whether this provider generally does an excellent job, a good job, a fair job or a poor job. (READ LIST)

EXCELLENT GOOD FAIR POOR RF DK

a. listening to what you have to say.............. 1 2 3 4 7 8

b. talking to you in a respectful and caring

manner...................................................... 1 2 3 4 7 8

c. answering your questions clearly ............. 1 2 3 4 7 8

d. giving you the opportunity to ask all of

your questions .......................................... 1 2 3 4 7 8

e. bringing up difficult or sensitive topics that you might not feel comfortable bringing up yourself .................................. 1 2 3 4 7 8

f. helping you to feel comfortable talking about your personal or sensitive health concerns ................................................... 1 2 3 4 7 8

g. giving you complete health information ... 1 2 3 4 7 8

h. discussing alternative therapies, like herbal medicines or acupuncture, with you ............................................................ 1 2 3 4 7 8

i. giving you complete information about

any tests or services................................. 1 2 3 4 7 8

j. giving you the results of your tests ........... 1 2 3 4 7 8

k. giving you complete information about

all your options for treatments .................. 1 2 3 4 7 8

l. giving you the opportunity to make important decisions about your health care........................................................... 1 2 3 4 7 8

m. giving you written or printed information

when you need it....................................... 1 2 3 4 7 8

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n. spending enough time with you during

your visits.................................................. 1 2 3 4 7 8

o. treating you like a partner in your health

care........................................................... 1 2 3 4 7 8

C4. Have you ever changed doctors in the past 5 years because you were dissatisfied with the care you were receiving?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

Women’s Health Care Experiences Survey Page D-1

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SECTION D: HEALTH INFORMATION SOURCES

We are interested in how women get information about their health and health care issues.

D1. Let’s begin with the news and other media. I will read a list of media sources of health information, and for each one, please tell me whether you have used it for health information at any time during the last 12 months (READ LIST):

USED NOT USED RF DK

a. Newspapers...................................................... 1 2 7 8

b. News magazines (like Newsweek, Time)......... 1 2 7 8

c. Women’s magazines (like Essence,

Glamour, Latina, Redbook, Vogue) .................. 1 2 7 8

d. Health magazines (like Heart & Soul,

Prevention) ....................................................... 1 2 7 8

e. Television news programs................................ 1 2 7 8

f. Radio talk shows............................................... 1 2 7 8

D2. In the past 12 months, have you read any health books, like Our Bodies, Ourselves or other books on women’s health?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D3. In the past 12 months, have you used any computer-based health information, like sites on the Internet or CD-ROM computer programs about health topics?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D4. Do you receive or subscribe to any women’s health newsletters, such as those from local hospitals, universities, or women’s organizations?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D5. I am now going to read a list of types of women’s self-help, awareness or advocacy groups. Please tell me whether you participate in any of these groups by contributing money, attending meetings, or volunteering in any way. Do you participate in (READ LIST):

YES NO RF DK

a. support groups for women with specific

health problems ................................................ 1 2 7 8

b. student groups focusing on women’s health

advocacy........................................................... 1 2 7 8

c. women’s groups focusing on increasing awareness of issues such as breast cancer or reproductive rights........................................ 1 2 7 8

d. groups campaigning to influence women’s

health policy at the state or national level ........ 1 2 7 8

D6. Do you belong to any on-line legislative action or information groups concerned with women’s health issues?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

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JHU • WCHPC

D7. During the past 12 months, have you visited any women’s health resource centers in your community, such as those located in hospitals, universities, churches, or community organizations?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D8. During the past 12 months, have you attended any women’s health fairs to get information or to learn about health services in your community?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D9. During the past 12 months, have you requested a prescription for a specific medication you saw advertised on radio, TV, or in a magazine?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

D10. When you make decisions about your health, what sources of health information do you find most useful? I am going to read a list, and for each source of health information, please tell me whether it is very useful, somewhat useful, or not useful to you. (READ LIST)

VERY USEFUL

SOMEWHAT USEFUL

NOT USEFUL RF DK

a. Media sources like newspapers and

magazines. ....................................................... 1 2 3 7 8

b. Books and health manuals ............................... 1 2 3 7 8

c. Health newsletters ............................................ 1 2 3 7 8

d. Television or radio programs............................ 1 2 3 7 8

e. Materials provided by your health plan 1 2 3 7 8

f. Women’s health advocacy or information

groups............................................................... 1 2 3 7 8

g. Internet/Websites.............................................. 1 2 3 7 8

h. CD-ROM computer software programs............ 1 2 3 7 8

i. Drug company advertisements......................... 1 2 3 7 8

j. Hot-lines or telephone advice services, such

as “Ask-a-Nurse”............................................... 1 2 3 7 8

k. Your doctors 1 2 3 7 8

l. Your pharmacist................................................ 1 2 3 7 8

m. Other health care providers you use ................ 1 2 3 7 8

n. Your family or friends........................................ 1 2 3 7 8

o. Church or community groups ........................... 1 2 3 7 8

p. Courses or seminars ........... 1 2 3 7 8

Women’s Health Care Experiences Survey Page E-1

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SECTION E: HEALTH RISKS AND STATUS

These next questions are about your health.

E1. In a typical week, how often do you exercise strenuously enough that you breathe heavily and your heart rate is accelerated for at least 20 minutes? Would you say (READ OPTION)?

Never ..................................................................................1

Once a week......................................................................2

Twice a week.....................................................................3

Three times a week..........................................................4

More than three times a week........................................5 RF ........................................................................................7 DK ........................................................................................8

E2. Do you currently smoke cigarettes? YES......................................................................................1 NO................................. (SKIP TO E3)................................2 RF ................................. (SKIP TO E3)................................7 DK ................................. (SKIP TO E3)................................8

A. How many cigarettes do you smoke per day? NUMBER CIGARETTES PER DAY....................

E3. In a typical week, how many alcoholic drinks—such as a beer, a glass of wine, or a mixed drink—do you usually have? Would you say (READ OPTION)?

None ...................................................................................1

1–2 drinks/week................................................................2

3–6 drinks/week................................................................3

7 drinks/week ....................................................................4

More than 7 drinks/week .................................................5 RF ........................................................................................7 DK ........................................................................................8

E4. Do you currently use (READ LIST)? YES NO RF DK

a. vitamin supplements......................................... 1 2 7 8

b. calcium supplements ........................................ 1 2 7 8

c. herbal supplements .......................................... 1 2 7 8

d. hormone replacement therapy or estrogen

therapy.............................................................. 1 2 7 8

E5. In the past 5 years, has a doctor ever told you that you have any of the following conditions? (READ

LIST)

YES NO RF DK

a. Hypertension or high blood pressure ............... 1 2 7 8

b. Heart disease.................................................... 1 2 7 8

c. High cholesterol ................................................ 1 2 7 8

d. Diabetes............................................................ 1 2 7 8

e. Depression or anxiety....................................... 1 2 7 8

f. Migraine headaches ......................................... 1 2 7 8

g. Arthritis.............................................................. 1 2 7 8

h. Osteoporosis or brittle bones............................ 1 2 7 8

i. Obesity or problems with being overweight...... 1 2 7 8

j. Urinary incontinence or leakage of urine.......... 1 2 7 8

k. Cancer .............................................................. 1 2 7 8

l. Eating disorders like anorexia or bulimia.......... 1 2 7 8

m. Thyroid problems.............................................. 1 2 7 8

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JHU • WCHPC

E6. In the past 5 years, have you ever been the victim

of a (READ LIST):

YES NO RF DK

a. Sexual assault .................................................. 1 2 7 8

b. Rape ................................................................. 1 2 7 8

c. Other type of physical assault .......................... 1 2 7 8

E7. A disability or chronic health problem, like one that goes on for a long time, may interfere with people’s daily lives. In the past year, has such a problem (READ ITEMS):

YES NO RF DK

a. kept you from participating fully in your regular major activities, like work, school, or taking care of your family ................................. 1 2 7 8

b. required you to get the help of another person for your personal care needs, such as eating, bathing, dressing, or getting around the house .......................................................... 1 2 7 8

c. required you to get the help of another person for handling routine needs, such as cooking, shopping, or running errands ............. 1 2 7 8

Women’s Health Care Experiences Survey Page F-1

JHU • WCHPC

SECTION F: SOCIODEMOGRAPHICS

Just a few more questions.

F1. Are you currently married or living with a partner, single, widowed, separated, or divorced?

MARRIED OR LIVING WITH A PARTNER .........................1 SINGLE................................................................................2 WIDOWED, SEPARATED, OR DIVORCED........................3 RF ........................................................................................7 DK ........................................................................................8

F2. Are you currently working at a job for pay, either full-time or part-time?

YES, FULL-TIME .......... (SKIP TO F3) ................................1 YES, PART-TIME.......... (SKIP TO F3) ................................2 NO........................................................................................3 RF ........................................................................................7 DK ........................................................................................8

A. Are you currently looking for paid work? YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

F3. Are there any children under the age of 18 living with you in your household?

YES......................................................................................1 NO................................. (SKIP TO F4) ................................2 RF ................................. (SKIP TO F4) ................................7 DK ................................. (SKIP TO F4) ................................8

A. How many children? NUMBER OF CHILDREN .........................................

F4. Are you currently caring for a sick or disabled elderly family member, either in your own home or elsewhere?

YES......................................................................................1 NO........................................................................................2 RF ........................................................................................7 DK ........................................................................................8

F5. Were you born in the United States or another country?

U.S. ......................................................................................1 ANOTHER COUNTRY.........................................................2 RF ........................................................................................7 DK ........................................................................................8

F6. Do you consider yourself white, black or African American, Asian or Pacific Islander, or something else?

WHITE..................................................................................1 BLACK/AFRICAN AMERICAN.............................................2 ASIAN OR PACIFIC ISLANDER..........................................3 MIXED RACE.......................................................................4 OTHER............................ (SPECIFY) ..................................5 RF ........................................................................................7 DK ........................................................................................8

SPECIFY:________________________________________________________________________________

F7. Are you of Hispanic origin or descent? YES......................................................................................1 NO................................. (SKIP TO F9) ................................2 RF ................................. (SKIP TO F9) ................................7 DK ................................. (SKIP TO F9) ................................8

F8. Do you consider yourself (READ LIST)? Mexican ............................................................................01

Puerto Rican....................................................................02

Cuban ...............................................................................03

Dominican ........................................................................04

Costa Rican .....................................................................05

Brazilian............................................................................06

Some other nationality.......... (SPECIFY)......................07 RF ......................................................................................97 DK ......................................................................................98

Women’s Health Care Experiences Survey Page F-2

JHU • WCHPC

F9. What is the highest level of school you have completed or the highest degree you have received?

LESS THAN HIGH SCHOOL (GRADES 1–11, GRADE 12 BUT NO DIPLOMA) .........................................................1

HIGH SCHOOL GRADUATE OR EQUIVALENT (GED) .....2

SOME COLLEGE, BUT NO DEGREE (INCLUDING 2-YEAR OCCUPATIONAL OR VOCATIONAL PROGRAMS) ...................................................................3

TWO YEAR COLLEGE GRADUATE (E.G. AA DEGREE) ..4

COLLEGE GRADUATE (e.g. BA, AB, BS) ..........................5

POSTGRADUATE (e.g. MA, MS, MD, DDS, JD, PhD) .......6

RF ........................................................................................7

DK ........................................................................................8

F11. Do you receive any of the following? (READ LIST) YES NO RF DK

a. Food stamps..................................................... 1 2 7 8

b. TANF (Temporary Assistance to Needy

Families) ........................................................... 1 2 7 8

c. SSI (Supplemental Security Income)................ 1 2 7 8

d. Social Security .................................................. 1 2 7 8

e. Unemployment insurance................................. 1 2 7 8

F10. Which of the following income categories best describes your total 1998 household income before taxes? Was it (READ LIST)?

$7,500 or less..................................................................01

$7,501 to $15,000 ..........................................................02

$15,001 to $25,000 ........................................................03

$25,001 to $35,000 ........................................................04

$35,001 to $50,000 ........................................................05

$50,001 to $75,000 ........................................................06

$75,001 to $100,000 ......................................................07

$100,001 or above .........................................................08 RF ......................................................................................97 DK ......................................................................................98

F12. What is your current age? AGE........................................................................... RF ......................................................................................97

END TIME.................................................. :

Thank you very much for giving us your time today. We will use this information to help improve health care for all women.

ID ....................................................................

DATE ................................. MM DD YY

INTERVIEWER ID ....................................

TOTAL TIME................................................................

Women’s Social Roles and

Health Care Utilization Supplement

Prepared By

The Women’s and Children’s Health Policy Center The Johns Hopkins University Bloomberg School of Public Health

August 2002

Women’s Health Care Experiences Survey Page A-1 SECTION A: NEED-BASED UTILIZATION

START TIME.............................................. :

I would like to begin by asking you some questions about your health, in general, and the kinds of health care you receive.

A1. Would you say your health, in general, is excellent, very good, good, fair, or poor?

EXCELLENT ........................................................................1 VERY GOOD .......................................................................2 GOOD ..................................................................................3 FAIR.....................................................................................4 POOR...................................................................................5 RF ........................................................................................7 DK ........................................................................................8

A2. Compared with other women your age, would you say that you are healthier than most, as healthy as most, or not as healthy as most?

HEALTHIER THAN MOST...................................................1 AS HEALTHY AS MOST......................................................2 NOT AS HEALTHY AS MOST.............................................3 RF ........................................................................................7 DK ........................................................................................8

A3. All in all, do you think that you visit health care providers too often, not often enough, or about the right number of times each year?

TOO OFTEN ........................................................................1 NOT ENOUGH.....................................................................2 RIGHT NUMBER OF TIMES ...............................................3 RF ........................................................................................7 DK ........................................................................................8

A4. Now I am going to ask you about the specific health problems and health care needs that you may have had during the past 12 months—from (CURRENT MONTH, LAST YEAR) to (CURRENT

MONTH, THIS YEAR). At any time in the past 12 months (READ LIST):

YES NO RF DK

a. did you have a minor illness like the flu or an

infection? .......................................................... 1 2 7 8

b. did you need a regular checkup or routine

physical exam?................................................. 1 2 7 8

c. were you pregnant?.......................................... 1 2 7 8

d. did you need any screening or diagnostic tests, such as a Pap test, mammogram, or blood test? ........................................................ 1 2 7 8

e. did you need family planning or

preconceptional services? ................................ 1 2 7 8

f. were you a victim of violence or sexual

assault? ............................................................ 1 2 7 8

g. did you have an injury that you have not


h. did you need care for a chronic health problem, that is, one that goes on for a long time? ................................................................. 1 2 7 8

i. did you need surgery for a condition not


j. were you feeling depressed, anxious, or

highly stressed?................................................ 1 2 7 8

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We are interested in learning more about your responsibilities both in and outside the home. Specifically, we would like to ask you a few questions about your employment, caregiving responsibilities, and marital status.

Employment

S1. Are you currently working at a job for pay, either

full-time or part-time?

YES, FULL-TIME...................... .......................................... 1 YES, PART-TIME ..................... .......................................... 2 NO ....................................................................................... 3 RF........................................................................................ 7 DK........................................................................................ 8

S2. What is your job or occupation? Refer to list of CENSUS OCCUPATION CODES http://www.census.gov/hhes/www/ioindex/index.html

S3. As I read a list of types of health insurance, please tell me whether or not you are now covered by it. (READ LIST)

COVERED NOT

COVERED RF DK

a. Private health insurance through your own job or

union ......................................................................... 1 2 7 8

b. Private health insurance through a family

member’s job or union .............................................. 1 2 7 8

c. Private health insurance you or a family member

bought directly from an insurance company............. 1 2 7 8

d. Medicaid, MA, or Medical Assistance, a government plan that covers specific groups, including pregnant women with low income ............. 1 2 7 8

e. Medicare, a government plan that covers people

ages 65 and over and some disabled people........... 1 2 7 8

(IF E=1, ASK F)

f. Medigap or other supplemental Medicare 1 2 7 8

g. Military, TriCare Standard, or VA insurance............. 1 2 7 8

h. The Indian Health Service ........................................ 1 2 7 8

h. Dental Insurance ..................................................... 1 2 7 8

S4. Would your current job provide you with flexibility to change your work hours or to take time off if you had a family crisis, such as a sick family member?

Yes, job would provide flexibility…………………………..……1 No, job does not……………………………………………...…..2 Refused……………………………………………………………7 Don’t know………..……………………………………………….8

Women’s Social Roles and Health Care Utilization Supplement Page 1

Suggested interviewer script to women respondents:

Women’s Health Care Experiences Survey Page A-2 IF A4a NOT = 1, SKIP TO A6

A5. You said you had a minor illness like the flu or an infection in the past 12 months. Did you receive any health care for this?


A. What was the main reason you did not get care for this illness? CODE ONE ANSWER.

NO HEALTH INSURANCE ................................................ 01

WOULD COST TOO MUCH.............................................. 02

HEALTH INSURANCE DOES NOT COVER..................... 03

DIDN’T KNOW WHERE TO GET CARE ........................... 04

TOO BUSY ........................................................................ 05

PROVIDER TOO FAR AWAY............................................ 06

NO CHILDCARE OR DEPENDENT CARE ....................... 07

NO TRANSPORTATION ................................................... 08

AFRAID OR EMBARRASSED........................................... 09

COULD NOT FIND A PROVIDER I LIKED........................ 10

COULD NOT FIND A SPECIALIST ................................... 11

REFERRAL FORM OR PAPERWORK GOT LOST .......... 12

NOT SERIOUS/TOOK CARE OF IT MYSELF .................. 13

OTHER REASON ........... (SPECIFY)................................ 14

RF ...................................................................................... 97

DK ...................................................................................... 98

SPECIFY: ________________________________________________________________________________

SKIP TO A6

B. At what kinds of places did you get care for the minor illness? CODE UP TO 3 PLACES.

A DOCTOR’S OFFICE....................................................... 01

AN HMO OR MANAGED CARE PLAN.............................. 02

HOSPITAL OUTPATIENT DEPARTMENT........................ 03

HOSPITAL EMERGENCY ROOM (ER) ............................ 04

HOSPITAL CLINIC ............................................................ 05

HOSPITAL INPATIENT (OVERNIGHT STAY) .................. 06

FAMILY PLANNING CLINIC.............................................. 07

WOMEN’S HEALTH CENTER/CLINIC.............................. 08

PUBLIC HEALTH DEPARTMENT CLINIC ........................ 09

OTHER COMMUNITY/NEIGHBORHOOD CLINIC ........... 10

HEALTH PROGRAM AT PLACE OF WORK..................... 11

URGENT CARE CENTER................................................. 12

DENTIST’S OFFICE .......................................................... 13

TREATED/PRESCRIBED OVER TELEPHONE................ 14

OTHER (SPECIFY)........................................................... 15

RF ...................................................................................... 97

DK ...................................................................................... 98

SPECIFY:____________________________________________________________________________

JHU • WCHPC

Caregiving

S5. Are there any children under the age of 18 living with you in your household?

YES ..................................................................................... 1 NO ............................................ .......................................... 2 RF............................................. .......................................... 7 DK............................................. .......................................... 8

A. How many children? NUMBER OF CHILDREN.........................................

S6. What is the age of your youngest child? years (Range: 0-17)

“0” = less than one year Refused ……………………………………………………….….7 Don’t Know ……………………………………………………….8

S7. Are you currently caring for a sick or disabled relative? This could include your child, spouse or partner, parent, or other family member.

Yes, caring for relative ………………………………………… 1 No ……………………………….……………………………..… 2 Yes, sometimes (volunteered response)..…………………... 3 Care for someone other than a family member (volunteered response) ……………………..………………… 4 Refused ……………………………………………………...…. 7 Don’t Know ……………………………………………………….8

S8. How is this person related to you? Child ………………..………………………………………….… 1 Spouse/Partner…….…………………………………………… 2 Parent or parent-in-law ………………………………………… 3 Another relative ………………………………………………… 4 Refused ……………………………………………………….….7 Don’t Know ……………………………………………………….8

S9. Does this person live with you, live in his or her home, live in a group or nursing home, or some other place? (INTERVIEWER: If respondent provides care for more than one person; PROBE: Please answer about the person for whom you spend the most time providing care.)

Lives at respondent’s home …………………...……………… 1Lives in his/her own home …………………………………..… 2 Lives in a group/nursing home ……………………………..… 3

Lives in some other place …………………………...………… 4Lives with another family member (volunteered response) ………………………………………... 5 Refused ……………………………………………………….….7 Don’t Know ……………………………………………………….8

S10. In the past twelve months, have you missed any workdays to care for this person?

Yes, missed work days to care for a sick relative …………... 1 No, did not miss work days …………………………………… 2 Refused ……………………………………………………….….7

Don’t Know ……………………………………………………….8

S11. How many hours per week do you typically spend caring for this person? Please include time you spend taking this relative for medical visits as well as time you care for his or her needs. (IF NECESSARY: A rough estimate will be fine.) (INTERVIEWER: If respondent provides care for more than one person; PROBE: Please answer about the person for whom you spend the most time providing care.)

/___/___/___/ hours (Range 1-168)

Refused ……………………………………………………….….7 Don’t Know ……………………………………………………….8

Marital Status S12. Are you currently married or living with a partner,

single, widowed, separated, or divorced?

MARRIED OR LIVING WITH A PARTNER......................... 1 SINGLE ............................................................................... 2 WIDOWED, SEPARATED, OR DIVORCED ....................... 3 RF........................................................................................ 7 DK ....................................................................................... 8

Women’s Social Roles and Health Care Utilization Supplement Page 2

Table 1: Comparison of Natonal SurveysRelated to Women’s Health

a Dates following survey name indicate the version(s) used for this comparison.BMI = body mass index; ER = emergency room; HRT = hormone replacement therapy; MD = physician; ObGyn = obstetrician-gynecologist

Table 1. Comparison of National Surveys Related to Women’s Healtha

Behavioral Risk FactorSurveillance SystemQuestionnaire, 1998

Commonwealth FundSurvey of Women’sHealth, 1993 and 1998

Community TrackingStudy, Household Survey, 1996-1997

Kaiser Women’s Health Survey, 2002

GENERAL SURVEY DESCRIPTION

ACCESS

UTILIZATION

SOURCES OFHEALTHINFORMATION

HEALTH RISKS AND BEHAVIORS

PERCEIVEDQUALITY OF CARE

Cross-sectional monthlystate-level telephone sur-vey of households; surveyis not specific to womenbut includes brief sectionon women’s health

Cross-sectional telephonesurveys of national house-hold-based sample, withoversampling of specificethnic groups; coversbroad range of women’shealth issues; modifiedversion of survey for men

Cross-sectional and longi-tudinal telephone surveys;in-person interviews withhouseholds without tele-phones; 60 randomlyselected communities; sur-vey is not specific towomen

Telephone survey based ondisproportionate stratifiedrandom-digit telephonenumbers; oversampling ofunderserved subgroups;sample weighted using theCensus BureauDemographic Profile toadjust for variations andprovide for nationally repre-sentative sample

Usual source of care,health insurance coverage

Usual source of care, typesof regular physicians used(combination of generalistsand ObGyns; MD gender),types of insurance cover-age, gaps in coverage,types of health plans,length of enrollment in plan

Usual source of care, insur-ance coverage, types ofhealth plans,unmet/delayed care needs,barriers to care, out-of-pocket expenses

Usual source of care, typesof regular physicians used,where care is received,source of health insurance(public v. private), charac-teristics of plan (need forreferrals, etc.), delayedcare, gaps in coverage

Preventive/counselingservices received, screen-ing tests received

Number of visits and hospitalizations, clinicalpreventive and counselingservices received, servicesrelated to domesticviolence

Visits, ER use, hospitalstays, preventive services,surgeries

Number of health providervisits, types of servicesreceived, number and typeof medical tests

No relevant questions foundin the survey.




Exercise, smoking,nutrition, weight,alcohol use, injuries

Exercise, BMI, smoking,alcohol use, vitamins/ supplements, HRT, stressmanagement, depressivesymptoms, assault/abuse

SF-12, smoking Presence of chronic illness,disability, or other healthcondition (e.g. hyperten-sion), use of prescriptiondrugs

Rating of communicationand doctor performance,switching doctors due todissatisfaction, physiciangender preference

Trust in regular physician,satisfaction with care andwith choice of doctors,waiting time for visits,rating of communicationwith doctor

Rating of health plan,communication with doctors, switching doctorsdue to dissatisfaction,physician gender preference



Table 1. Comparison of National Surveys Related to Women’s Health


Medical ExpenditurePanel Survey, 1998

National Health Interview Survey, 1998

National Survey of Family Growth, 1995

Cross-sectional, longitudi-nal household survey; in-person interviews; over-sampling of specific vulnerable groups; surveyis not specific to women

Cross-sectional, longitudi-nal household survey; in-person interviews; over-sampling of specific ethnicgroups; survey is not specific to women

Survey is designed forwomen ages 15-44 and focuses on reproduc-tive issues (e.g., familyplanning)

Usual source of care,health professionals usedfor illness care, healthinsurance coverage,referrals

Usual source of care,health professionals usedfor care, health insurancecoverage, type of plan,delayed care and unmetneeds

Payment sources for services received, placewhere care received

Preventive servicesreceived, alternative services received

Home visits, phone con-tacts, physician visits, ERvisits, hospital episodes,surgeries, immunizations,HIV tests, household medical expenditures

Use of family planning,pregnancy, and infertilityservices; counseling onspecific services

No relevant questions found in the survey.



Tobacco use, smokingduring pregnancy, physicalactivity, alcohol use

Satisfaction with usualsource of care, overallcare, availability of care,costs, health plan

Ease of getting to doctor Affordability of pregnancy-related care

GENERAL SURVEY DESCRIPTION

ACCESS

UTILIZATION

SOURCES OFHEALTHINFORMATION

HEALTH RISKS AND BEHAVIORS

PERCEIVEDQUALITY OF CARE

a Dates following survey name indicate the version(s) used for this comparison.BMI = body mass index; ER = emergency room; HRT = hormone replacement therapy; MD = physician; ObGyn = obstetrician-gynecologist



Table 2: Descriptive Overview Information of National Surveys Relevant to Women’s Health

Table 2. Descriptive Overview Information of National Surveys Relevant to Women’s Health


*BRFSS=Behavioral Risk Factor Surveillance System Questionnaire; CMWF=Commonwealth Fund Survey of Women’s Health; CTS= Community Tracking Study Household Survey;KWHS=Kaiser Women’s Health Survey; MEPS=Medical Expenditure Panel Survey; NAMCS=National Ambulatory Medical Care Survey; NHAMCS=National Hospital AmbulatoryMedical Care Survey; NHANES=National Health and Nutrition Examination Survey; NHDS=National Hospital Discharge Survey; NHIS=National Health Interview Survey;NMIHS=National Maternal and Infant Health Survey; NSFG=National Survey of Family Growth; PRAMS=Pregnancy Risk Assessment and Monitoring System.

Goal Contact Information Sampling Design

BRFSS

CMWF

CTS

KWHS

MEPS

To collect uniform state-based dataon the behaviors and conditionsthat are linked to chronic diseases,injuries, and preventable infectiousdiseases in the United States.

National Center for Chronic DiseasePrevention and Health Promotion (NCCDPHP) through the Centers forDisease Control and Prevention (CDC)Atlanta, GA [email protected]/brfss/

• Sampling sizes and methodologies arecreated individually by the states tocreate a representative sample ofhouseholds with telephones.

• Most states use a disproportionatestratified sample design or a similarMitofsky-Waksberg-type sampledesign.

• The data are analyzed at the statelevel and can be compared state-to-state and state-to-nation.

To increase public awareness ofwomen’s health issues and identifyopportunities for improving theirhealth and quality of life.

The Commonwealth FundOne East 75th StreetNew York, NY [email protected]/programs/women/ksc_whsurvey99_332.asp

• In 1998 the survey sample consistedof 2,011 women and 1,084 men.

• African Americans, Hispanics, andAsian Americans were oversampled.

• The data was weighted by sex,race/ethnicity, education, insurancestatus, and geographic region usingthe 1997 Current Population Survey.

To track changes in the health sys-tem and their effects on peopleand to provide information to trackinsurance coverage, access tocare, service use and satisfactionwith care

Center for Studying Health SystemChange600 Maryland Ave SW #550Washington, DC 20024202-484-5261www.hschange.org/CONTENTS/160/

• Sample size: 33,000 families and60,000 individuals.

• Nationally representative of the civil-ian, non-institutionalized population.

• Data mostly from individuals living in60 randomly selected communitiesnationwide.

To learn more about the experi-ences of women with their healthplans and providers, with particularfocus on women who are minority,poor, Medicaid-insured or unin-sured.

The Henry J. Kaiser Family Foundation2400 Sand Hill RoadMenlo Park, CA 94025650-854-9400www.kff.orghttp://www.kff.org/content/2002/6027/6027final.pdf

• Sample size: 3,966 women ages 18 to64.

• Women who were nonelderly, Latina,African American, uninsured, low-income, or on Medicaid were over-sampled.

• A shorter companion survey of 700English-speaking men was conductedfor purposes of gender comparisons.

Agency for Healthcare Research andQuality (AHRQ)2101 E. Jefferson Street, Suite 501Rockville, MD [email protected]

• Sample size: 24,000 for HouseholdComponent

• Individuals and families in sampledrawn from a pool of NHIS partici-pants.

• Can analyze at the level of CensusRegion. Sample size is too small toanalyze at the state level.

Survey*

To collect and analyze informationon health care use and costs in theUnited States and to improve theaccuracy of economic projections.



Questionnaire Design Data Collection

BRFSS

CMWF

CTS

KWHS

MEPS

• The questionnaire consists of threesections; the core component, option-al modules, and state-added ques-tions.

• The core component consists of stan-dard fixed questions.

• The optional modules are voluntarysections of fixed questions.

• The state-added questions are volun-tary questions designed by each state.

• Data collection is done monthly, andanalysis is done annually.

• Data are collected through a state-based system of uniform monthlytelephone calls.

• Data are collected during a recom-mended 14-day period each month.

• A fixed questionnaire was designedand administered.

• The survey was administered in 1993and 1998.

• Data were collected through a tele-phone survey.

• A standard survey was administeredprimarily by telephone (in-personinterviews with households withoutworking telephones).

• Data were collected between July1996 and July 1997.

• Trained professional interviewers con-ducted interviews.

• A fixed questionnaire was designedand administered.

• The survey was administered in thespring and summer of 2001.

• Data were collected through a tele-phone survey.

• A standard questionnaire is designedand administered. There is no stateinvolvement.

Four data collection components:• Household Component: Data collected

continuously and includes severalrounds of interviews over a two-yearperiod for each individual.

• Nursing Home Component• Medical Provider Component• Insurance Component

Survey*





NAMCS

NHAMCS

NHANES

NHDS

NHIS

To collect data on the provision anduse of ambulatory medical careservices.

National Center for Health Statistics(NCHS), CDCHyattsville, MD 20782-2003301-458-4600www.cdc.gov/nchs/about/major/ahcd/namcsdes.htm

• Sample is drawn from non-federallyemployed physicians.

• Sampling is done with a multistagedesign using geographic primarysampling units (PSUs), physicians ineach PSU, random assignment to acollection week in the survey year,and a systematic random sample ofvisits to each physician.

To collect data on the provision anduse of ambulatory medical careservices in hospital emergency andoutpatient facilities.

NCHS, CDCHyattsville, MD 20782-2003301-458-4600www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm

• Sampling is done through a four-stageprobability design with samples ofgeographic PSUs, hospitals withinPSUs, clinics within hospitals, andpatient visits within clinics.

• PSUs consist of defined areas fromthe 1985-1994 NHIS.

To collect information about thehealth and diet of people in theUnited States and assess healthand nutritional status.

NCHS, CDCHyattsville, MD 20782-2003301-458-4636www.cdc.gov/nchs/nhanes.htm

• Sample size: 40,000• Participants selected through a multi-

stage sample design include US citi-zens who are non-institutionalizedcivilians aged two months and older.

• Sampling weights are used in theanalysis to adjust for probability ofselection, non-response, and non-cov-erage.

To collect information on charac-teristics of inpatients dischargedfrom non-federal, short-stay hospi-tals.

NCHS, CDCHyattsville, MD 20782-2003301-458-4636http://www.cdc.gov/nchs/about/major/hdasd/nhdsdes.htm

• Hospitals go through a three-stagestratified sampling process. The hos-pitals with the most beds and/or dis-charges are selected automatically.

• Remaining hospitals are divided intorandomly-selected PSUs based onsampling from the NHIS, hospitals arethen randomly selected within PSUs,and discharge records are then sam-pled randomly from each hospital.

NCHS, CDCHyattsville, MD 20782-2003301-458-4636www.cdc.gov/nchs/nhis.htm

• Sample size: 43,000 households and106,000 individuals.

• Sampling consists of a multistageprobability sampling technique to geta nationally representative sample ofhouseholds.

• African Americans and Hispanics areoversampled.

• Sample size is too small to providestate level data.

Survey*

To monitor the health of the UnitedStates through the collection andanalysis of data on a broad rangeof health topics.




Questionnaire Design Data Collection

NAMCS

NHAMCS

NHANES

NHDS

NHIS

• A standard questionnaire is designedand administered. There is no stateinvolvement in questionnaire design.

• Data are collected annually.• The survey is administered on paper.• Federal interviewers visit the physi-

cians prior to data collection toinstruct on how to fill out the forms.


• Data are collected annually.• The survey is administered on paper.• Federal interviewers visit the hospitals

prior to data collection to instruct onhow to fill out the forms.


• Data are collected annually.• Data collection involves both home

interview and health examination withsurvey participants.


• Data are collected annually.• Data are collected in two ways.• Patient information from hospital

records is recorded onto medicalabstract forms.

• Medical records are also purchasedfor the survey from commercialorganizations, state data systems,hospitals, and hospital associations.

• A standard questionnaire is designedand administered. There is no stateinvolvement.

• Data are collected weekly and ana-lyzed annually.

• Data are collected through a tele-phone survey by trained interviewersfrom the US Census Bureau.

Survey*





NMIHS

NSFG

PRAMS

To collect data needed by federal,state, and private researchers tostudy factors related to poor preg-nancy outcome.

NCHS, CDCHyattsville, MD 20782-2003301-458-4636www.cdc.gov/nchs/about/major/nmihs/abnmihs.htm

• Sample size in 1988 was 10,000 livebirths, 3,300 fetal deaths, and 5,300infant deaths.

• The study sample consists of motherswith live births, stillbirths, and infantdeaths during the reporting year.

To collect data on factors affectingpregnancy and women’s health.

NCHS, CDCHyattsville, MD 20782-2003301-458-4600www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm

• Sample size: 10,847 in 1995 NSFG.• A national sample of non-institutional-

ized, civilian women ages 15-44 istaken from participants of the NHIS.

To reduce infant mortality and lowbirth weights and better allocateresources to targeted subpopula-tions at risk for poor birth outcome.

Infant Health Initiative, CDCAtlanta, GA [email protected]/nccdphp/drh/srv_prams.htm

• Sample size: Approx. 1,600 - 2,500per state, per year.

• Sampling design is state controlled.• Participants are selected in a stratified

sample from current birth certificatefiles each month.

• Most states oversample for lowweight births and other high riskgroups

Survey*




Questionnaire Design

NMIHS

NSFG

PRAMS



• The design of the questionnaire issimilar for all participating states.

• The PRAMS questionnaire consists ofcore questions that are asked by allparticipating states and additionalstate-specific questions.

Survey*Data Collection

• Survey was first done in 1988 with alongitudinal follow up completed in1991.

• Data are collected through a mailedquestionnaire.

• US vital records are also used inanalysis with the mothers’ surveys.

• Data were last collected in 1995.• Data are collected through a personal

interview.• Trained professional female interview-

ers conduct interviews.

• Data are collected monthly and analy-sis is done annually.

• Data collection procedures are stan-dardized in all participating states.

• Participants are contacted through aseries of mailed questionnaires andtelephone follow-up calls.



Table 3. WHCES Items Matched with Similar Items in National Data Collection

Surveys with Same or Similar Questions*WHCES Question

SECTION A: NEED-BASED UTILIZATION

Would you say your health, in general, is excellent, very good, good,fair, or poor?

Compared with other women your age, would you say that you arehealthier than most, as healthy as most, or not as healthy as most?

All in all, do you think that you visit health care providers too often,not often enough, or about the right number of times each year?

Now I am going to ask you about the specific health problems andhealth care needs that you may have had during the past 12 months-from (CURRENT MONTH, LAST YEAR) to (CURRENT MONTH, THISYEAR). At any time in the past 12 months [READ LIST]

You said you had [ITEM] in the past 12 months. Did you receive anyhealth care for this?

What was the main reason you did not get care for this?

At what kinds of places did you get care for [ITEM]?

What kinds of health professionals did you see for [ITEM]?

How many outpatient visits in all did you make in the past 12 monthsfor [ITEM]?

How many times altogether did you visit a doctor or other health professional for outpatient health care in the past 12 months?

Some women have a regular health care provider. A regular healthcare provider is a person you usually go to first when you need healthinformation, a test, or treatment for a health problem. Is there oneperson that you depend on as your regular health care provider?

CMWF, CTS, KWHS, NHANES, NHIS, NMIHS(91)

MEPS

NONE

BRFSS—regular checkupCMWF—regular checkup, pregnant, victim of violence/sexual assault,

depressed/anxiousCTS—regular checkup, pregnant, injury, surgery, sickness, in-patient

hospital stay, ER, mental health care, preventive careKWHS —(in past two yrs) treatment of chronic illness, physical exam,

OB/GYN exam, eye or dental examMEPS—pregnantNHIS—injury, surgeryNMIHS—pregnantNSFG—depressed/anxious

CMWF, CTS, MEPS, NAMCS, NHIS

BRFSS, CTS, KWHS, MEPS, NHIS, PRAMS

BRFSS, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS, NSFG, PRAMS

CMWF, CTS, KWHS, MEPS, NAMCS, NHAMCS, NHANES

CTS, MEPS

CMWF, CTS, KWHS

BRFSS, CMWF, CTS, KWHS, MEPS, NHIS






What type of provider is the health professional you see most often forregular care?

Is this regular provider male or female?

About how many years have you been seeing this health careprovider?

In general, do you prefer to see a male or female health careprovider?

In addition to your regular health care provider, do you also see anobstetrician or gynecologist (OB-GYN)?

Is this obstetrician-gynecologist (OB-GYN) male or female?

In general, do you prefer to see a male or female obstetrician-gynecologist?

There are many reasons why some women do not have a regularhealth care provider. Can you tell me the main reason you do not havea regular health care professional?

There are many types of health care services that women receive. Iam going to read a list of specific services or tests, and I would likeyou to tell me if you have had each one in the past 12 months?

CTS, KWHS, NHIS

CMWF, KWHS, NHIS

CMWF, KWHS, NHIS

KWHS

CMWF, KWHS

CMWF

CMWF

CTS, NHIS

BRFSS—breast exam, mammogram, pap testCMWF—colon cancer screening, cholesterol, breast exam,

mammogram, pap testCTS— mammogramKWHS—blood cholesterol, breast exam, mammogram, pap smear,

colon cancer screening, HIV/STDs, blood pressureNAMCS—glaucoma, cholesterol, blood pressure, breast exam,

mammogram, pap test, HIV, other STD’s, pregnancy testNHAMCS— glaucoma, cholesterol, blood pressure, breast exam,

mammogram, pap test, HIV, other STD’s, pregnancy testNHANES—blood pressureNHIS—mammogram, pap test, flu shotNMIHS—HIV (91), family planning

What was the main reason you had [TEST]? NONE







In the past 12 months, did any of your health care providers talk withyou or give you information about [READ ITEM]?

I am going to read a list of other therapies that some people use. Foreach one, please tell me whether or not you have used it in the past12 months. Have you used [READ ITEM]?

BRFSS—smokingCMWF—smoking, nutrition, alcohol/drug use, exercise, hormone

replacement therapy, violence, preventing osteoporosisNAMCS—smoking, nutrition, exercise, stress management, family

planning, alternative therapiesNHAMCS—smoking, nutrition, exercise, stress management, family

planning, alternative therapiesNHIS —smoking, nutrition, alcohol/drug use, exercise, hormone

replacement therapy, preventing unintended pregnancies

CMWF—dietary supplementsNHANES—herbal medicines, dietary supplementsNHIS—chiropractic, acupuncture, massage, relaxation



During the past 12 months, was there any time, including now, whenyou had no health insurance of any kind?

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHDS, NHIS, NMIHS(91),NSFG, PRAMS

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS(91)

How many months of the last year were you without insurance? BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS(91)

There are many reasons why some people do not have health insur-ance. Please tell me whether any of these reasons apply to you.[READ LIST]

BRFSS, CTS, KWHS, NHANES, NHIS

Many people today are enrolled in managed care plans of one kind oranother. HMOs, or health maintenance organizations, are plans thatprovide a full range of health care services and usually require you tochoose doctors and hospitals on the plan’s list. PPOs, or preferredprovider organizations, give you a list of doctors they prefer you touse; if you use these doctors, you pay less than if you visit a doctornot on the list. Are you now enrolled in an HMO or PPO?

CMWF, CTS, MEPS, NAMCS, NHAMCS, NHANES, NHDS, NHIS

As I read a list of types of health insurance, please tell me whether ornot you are now covered by it. [READ LIST]

71 92 10/29/02 8:59 PM Page 85





Some health plans require women to select one primary careprovider, or PCP, to coordinate all of their care. Sometimes, womenare asked to select two PCPs—a family or general practice physicianand an obstetrician-gynecologist. What does your plan require you todo?

Can this PCP be an obstetrician-gynecologist?

Regarding your use of an obstetrician-gynecologist (OB-GYN), whichof the following best describes your health plan’s rules [READ LIST]

Does your current health plan require you to get a referral from yourprimary care provider, or PCP, in order to receive specialty care, suchas care from heart doctors, skin doctors, psychiatrists, and others?

Does your current health plan send you reminders when it is time foryou to get preventive health care services such as Pap tests or mammograms?

How long have you been enrolled in your current health plan? [Lessthan one year, one to two years, or more than two years?]

At the place where you get your regular health care, do they have anyof the following? (READ LIST) • A women’s health resource center (a place where you can get

information on women’s health and referrals to professional healthservices and community programs).

• Women’s support groups, such as groups to discuss menopause.• Health education programs specifically for women • Research projects on women’s health that you can participate in.

I am going to read a list of specific services. Please tell me whetheryour current health insurance plan covers any part of the cost ofthese services, even if you do not use the service yourself. [READLIST]

During the past 12 months, was there ever a time when your healthinsurance did not pay for a test or treatment that you thought youneeded?

CMWF, CTS, KWHS, MEPS, NHANES

NONE

NONE

CMWF, CTS, KWHS, NHANES

CMWF

CMWF, CTS

NONE

CMWF—regular checkups, prescription medications, contraceptives,home health services

MEPS—prescription medications, long-term/nursing home careNHANES—prescription medications, long-term/nursing home careNHIS—prescription medications, long-term care/nursing home care,

mammograms

CMWF, KWHS, MEPS

Overall, how difficult is it for you to get health care when you needit—would you say it is extremely difficult, somewhat difficult, not toodifficult, or not at all difficult?

CMWF, CTS






Women have different preferences for how they get health care. Foreach of the following options in women’s health care, please tell mewhether you would like it a lot, like it a little, or you don’t really careone way or another about it.

• A women’s health resource center that offers health informationand a referral network

• A women’s health center where you can get most of your basichealth care, including gynecological care, in one place

• The choice of getting regular health care from a professional whois not a physician, like a nurse practitioner or nurse midwife.

• Women’s health support groups on specific topics• A directory of opportunities to participate in women’s health

research projects

NONE

Surveys with Same or Similar QuestionsWHCES Question

SECTION C: COMMUNICATION

In general, how difficult have you found it to talk to health careproviders about your personal health concerns? Have you found itvery difficult, somewhat difficult, not too difficult, or not difficult at all?

MEPS

CMWF

You told me you have one health care provider whom you think of asyour regular provider. Please tell me whether this provider generallydoes an excellent job, a good job, a fair job or a poor job. [READ LIST]

CMWF—Listening to what you have to say, spending enough timewith you during your visits, answering your questions clearly, talking to you in a respectful and caring manner

CT—listening; explaining things

Have you ever changed doctors in the past 5 years because you weredissatisfied with the care you were receiving?

CMWF, CTS, KWHS

Over the past 12 months, how difficult was it for you to contact ahealth care provider over the telephone about a health problem? Wasit very difficult, somewhat difficult, not too difficult, or not difficult atall?





SECTION D: HEALTH INFORMATION SOURCES

Let’s begin with the news and other media. I will read a list of mediasources of health information, and for each one, please tell mewhether you have used it for health information at any time during thelast 12 months [READ LIST]

In the past 12 months, have you read any health books, like OurBodies, Ourselves or other books on women’s health?

NONE

NONE

In the past 12 months, have you used any computer-based healthinformation, like sites on the Internet or CD-ROM computer programsabout health topics?

NONE

Do you receive or subscribe to any women’s health newsletters, suchas those from local hospitals, universities, or women’s organizations?

NONE

I am now going to read a list of types of women’s self-help, aware-ness or advocacy groups. Please tell me whether you participate inany of these groups by contributing money, attending meetings, orvolunteering in any way. Do you participate in [READ LIST]

NONE

Do you belong to any on-line legislative action or information groupsconcerned with women’s health issues?

NONE

During the past 12 months, have you visited any women’s healthresource centers in your community, such as those located in hospi-tals, universities, churches, or community organizations?

NONE

During the past 12 months, have you attended any women’s healthfairs to get information or to learn about health services in your community?

NONE

During the past 12 months, have you requested a prescription for a specific medication you saw advertised on radio, TV, or in a magazine?

NONE

When you make decisions about your health, what sources of healthinformation do you find most useful? I am going to read a list, and foreach source of health information, please tell me whether it is veryuseful, somewhat useful, or not useful to you. [READ LIST]

NONE





SECTION E: HEALTH RISKS AND STATUS

In a typical week, how often do you exercise strenuously enough thatyou breathe heavily and your heart rate is accelerated for at least 20minutes?

Do you currently smoke cigarettes?

CMWF, NHANES, NMIHS

BRFSS, CMWF, CTS, NHANES, NHIS, NMIHS, NMIHS(91), PRAMS

How many cigarettes do you smoke per day? CTS, NHANES, NHIS, NMIHS

In a typical week, how many alcoholic drinks-such as a beer, a glassof wine, or a mixed drink-do you usually have?

BRFSS, CMWF, NHANES, NMIHS, NMIHS(91), PRAMS

Do you currently use [vitamin supplements, calcium supplements,herbal supplements, hormone replacement therapy/estrogentherapy]?

CMWF—calcium, HRT/ETNHANES—vitamin, calcium, herbal, HRT/ET

In the past 5 years, has a doctor ever told you that you have any ofthe following conditions?

CMWF—hypertension, heart disease, diabetes, depression/anxiety,arthritis, osteoporosis, obesity/overweight, cancer

KWHS—hypertension, heart disease, cancer, diabetes, nxiety/depression, osteoporosis, arthritis, obesity, asthma

NHANES—hypertension, heart disease, diabetes, migraineheadaches, arthritis, osteoporosis, obesity/overweight,cancer, thyroid problem

NHIS—hypertension, heart disease, diabetes, migraine headaches,arthritis, cancer

In the past 5 years, have you ever been the victim of a [sexualassault, rape, other type of physical assault]?

CMWF—Sexual assaultPRAMS—Sexual assault

A disability or chronic health problem, like one that goes on for a longtime, may interfere with people’s daily lives. In the past year, has sucha problem [kept you from participating fully in your regular majoractivities, required you to get the help of another person for your per-sonal care needs, required you to get the help of another person forhandling routine needs]?

CMWF—regular major activitiesCTS—regular major activities, routine daily activities, emotions, painKWHS— regular major activities (school, work, housework, etc)MEPS—regular major activities, personal care needs, routine needsNHIS— regular major activities, personal care needs, routine needs





SECTION F: SOCIODEMOGRAPHICS

Are you currently married or living with a partner, single, widowed,separated, or divorced?

Are you currently working at a job for pay, either full-time or part-time?

Are you currently looking for paid work?

Are there any children under the age of 18 living with you in yourhousehold?

How many children?

Are you currently caring for a sick or disabled elderly family member,either in your own home or elsewhere?

Were you born in the United States or another country?

Do you consider yourself white, black or African American, Asian orPacific Islander, or something else?

Are you of Hispanic origin or descent?

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHDS, NHIS, NMIHS,NMIHS(91), NSFG

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS, NMIHS(91),NSFG

CMWF, NHANES, NHIS, NSFG

BRFSS, CMWF, CTS, KWHS, MEPS (under 24), NHIS, NSFG, PRAMS

BRFSS, CMWF, CTS, KWHS, MEPS (under 24), NHIS, PRAMS

CMWF, MEPS

KWHS, NHANES, NHIS, NSFG

BRFSS, CMWF, CTS, KWHS, MEPS, NAMCS, NHAMCS, NHANES, NHDS,NHIS, NMIHS, NSFG

BRFSS, CMWF, CTS, KWHS, MEPS, NAMCS, NHAMCS, NHANES, NHDS,NHIS, NMIHS, NSFG

What is the highest level of school you have completed or the highestdegree you have received?

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS, NMIHS(91)

Do you receive any of the following? [Food stamps, TANF, SSI, SocialSecurity, Unemployment Insurance]

CMWF, KWHS, MEPS, NHANES, NHIS, NMIHS(91), NSFG, PRAMS

Which of the following income categories best describes your total1998 household income before taxes?

BRFSS, CMWF, CTS, KWHS, MEPS, NHANES, NHIS, NMIHS,NMIHS(91),NSFG

What is your current age? BRFSS, CMWF, CTS, KWHS, MEPS, NAMCS, NHAMCS, NHDS, NHIS,PRAMS


71 92 10/29/02 8:59 PM Page 90


Table 4. Women’s Social Roles & Health Care Utilization Supplement Matched with Similar Items in NationalData Collection

Social Roles QuestionSource of Questions used in

WSR & HCU SupplementNational Surveys with Same or

Similar Questions*

Employment

Caregiving

Are you currently working at a jobfor pay, either full-time or part-time?

WHCES question F2 BRFSS, CMWF, CTS, KWHS (indirectly -asks if have employer-based healthinsurance) MEPS, NHANES, NHDS, NHIS,NMIHS, NMIHS (91), NSFG, (PRAMS statemodules), WHCES

As I read a list of types of healthinsurance, please tell me whetheror not you are now covered by it.(READ LIST)

WHCES question B1 BRFSS, CMWF, CTS, MEPS, NHANES,NHDS, NHIS, NMIHS (91), NSFG, PRAMS,WHCES

Are there any children under theage of 18 living with you in yourhousehold?

WHCES question F3 BRFSS (2001, 2002), CMWF, CTS, MEPS(under 24), NHIS, NSFG, PRAMS, WHCES

What is the age of your youngestchild?

CMWF 1998 question 605 CMWF


DOMAIN

How is this person related to you?

What is your job or occupation? Modified NHANES question NHANES (What is the name and kind ofbusiness, and type of work you weredoing?)

Would your current job provide youwith flexibility to change your workhours or to take time off if you hada family crisis, such as a sick fami-ly member?


How many children? WHCES question F3A BRFSS, CTS, KWHS, MEPS (under 24),NHIS, PRAMS, WHCES

Are you currently caring for a sickor disabled relative? This couldinclude your child, spouse or partner, parent, or other familymember.

CMWF 1998 question 680, WHCES ques-tion F4 (modified)

CMWF, WCHES

CMWF 1998 question 700 CMWF, WHCESDoes this person live with you, livein his or her home, live in a groupor nursing home, or some otherplace?

CMWF 1998 question 650(modified)

CMWFIn the past twelve months, haveyou missed any workdays to carefor this person?



Table 4. Women’s Social Roles & Health Care Utilization Supplement Matched with Similar Items in National DataCollections

Marital Status

How many hours per week do you typically spend caring for this person?


Are you currently married or livingwith a partner, single, widowed,separated, or divorced?

WHCES question F1 BRFSS, CMWF, CTS, MEPS, NHANES,NHDS, NHIS, NMIHS, NMIHS (91), NSFG,WHCES

Social Roles QuestionSource of Questions used in

WSR & HCU SupplementNational Surveys with Same or

Similar Questions*DOMAIN


Documents

State Strategies for Improving Data on Women's Health