S. No.

Questions

Category

Remark

201

Did you know about PMTCT service before?

Yes

No

202

If yes, source of information about the PMTCT service

1. Health workers/health facility

2. Mass media

3. Friends/family

4. Other (specify) __

203

How long did you wait to see the health care provider? (in Minutes)

_____(minutes)

204

How much time did the counseling session (pretest and posttest counseling) took?

205

Was the counseling given by the same counselor in pretest and post test counseling?

1. Yes

2. No

206

Did the counselor speak the same language as you?

1. Yes

2. No

207

Would you have preferred to have a counselor that is?

・ Different sex

・ Older

・ Younger

1. Yes 2. No

1. Yes 2. No

1. Yes 2. No