Public Health Prenatal/Postpartum Services
Jan. 2, 2024 - Jul. 3, 2024

Client Experience Questionnaire

Tell us about your experience! Your feedback helps us to improve the way we provide care. This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank.

Question Title

* Dignity, Respect and Trust:
(If question does not apply, leave blank)

	Strongly Agree	Agree	Disagree	Strongly Disagree
a. I was treated with respect.	a. I was treated with respect. Strongly Agree	a. I was treated with respect. Agree	a. I was treated with respect. Disagree	a. I was treated with respect. Strongly Disagree
b. My privacy was respected as best it could be.	b. My privacy was respected as best it could be. Strongly Agree	b. My privacy was respected as best it could be. Agree	b. My privacy was respected as best it could be. Disagree	b. My privacy was respected as best it could be. Strongly Disagree
c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)	c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs) Strongly Agree	c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs) Agree	c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs) Disagree	c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs) Strongly Disagree
d. Before providing care, staff members introduced themselves to me, where appropriate.	d. Before providing care, staff members introduced themselves to me, where appropriate. Strongly Agree	d. Before providing care, staff members introduced themselves to me, where appropriate. Agree	d. Before providing care, staff members introduced themselves to me, where appropriate. Disagree	d. Before providing care, staff members introduced themselves to me, where appropriate. Strongly Disagree
e. In general, staff were compassionate.	e. In general, staff were compassionate. Strongly Agree	e. In general, staff were compassionate. Agree	e. In general, staff were compassionate. Disagree	e. In general, staff were compassionate. Strongly Disagree

Question Title

* Information Sharing:
(If question does not apply, leave blank)

	Always	Usually	Sometimes	Never
a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.)	a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.) Always	a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.) Usually	a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.) Sometimes	a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.) Never
b. Staff talked to me about my health care options. (e.g. procedures/tests)	b. Staff talked to me about my health care options. (e.g. procedures/tests) Always	b. Staff talked to me about my health care options. (e.g. procedures/tests) Usually	b. Staff talked to me about my health care options. (e.g. procedures/tests) Sometimes	b. Staff talked to me about my health care options. (e.g. procedures/tests) Never
c. My healthcare provider used words I could understand.	c. My healthcare provider used words I could understand. Always	c. My healthcare provider used words I could understand. Usually	c. My healthcare provider used words I could understand. Sometimes	c. My healthcare provider used words I could understand. Never
d. I had the necessary information needed to make good decisions about my health.	d. I had the necessary information needed to make good decisions about my health. Always	d. I had the necessary information needed to make good decisions about my health. Usually	d. I had the necessary information needed to make good decisions about my health. Sometimes	d. I had the necessary information needed to make good decisions about my health. Never
e. The staff kept my information confidential and secure.	e. The staff kept my information confidential and secure. Always	e. The staff kept my information confidential and secure. Usually	e. The staff kept my information confidential and secure. Sometimes	e. The staff kept my information confidential and secure. Never

Question Title

* Participation:
(If question does not apply, leave blank)

	Always	Usually	Sometimes	Never
a. Staff involved me or my family/support system in making decisions about my care.	a. Staff involved me or my family/support system in making decisions about my care. Always	a. Staff involved me or my family/support system in making decisions about my care. Usually	a. Staff involved me or my family/support system in making decisions about my care. Sometimes	a. Staff involved me or my family/support system in making decisions about my care. Never
b. I was encouraged to take part in my care as much as I was able.	b. I was encouraged to take part in my care as much as I was able. Always	b. I was encouraged to take part in my care as much as I was able. Usually	b. I was encouraged to take part in my care as much as I was able. Sometimes	b. I was encouraged to take part in my care as much as I was able. Never
c. My choices were respected.	c. My choices were respected. Always	c. My choices were respected. Usually	c. My choices were respected. Sometimes	c. My choices were respected. Never
d. I was comfortable expressing concerns about my care.	d. I was comfortable expressing concerns about my care. Always	d. I was comfortable expressing concerns about my care. Usually	d. I was comfortable expressing concerns about my care. Sometimes	d. I was comfortable expressing concerns about my care. Never

Question Title

* Accessibility and Responsiveness:
(If question does not apply, leave blank)

	Strongly Agree	Agree	Disagree	Strongly Disagree
a. My care was well coordinated.	a. My care was well coordinated. Strongly Agree	a. My care was well coordinated. Agree	a. My care was well coordinated. Disagree	a. My care was well coordinated. Strongly Disagree
b. I was cared for in a timely manner.	b. I was cared for in a timely manner. Strongly Agree	b. I was cared for in a timely manner. Agree	b. I was cared for in a timely manner. Disagree	b. I was cared for in a timely manner. Strongly Disagree
c. I had access to the care I needed.	c. I had access to the care I needed. Strongly Agree	c. I had access to the care I needed. Agree	c. I had access to the care I needed. Disagree	c. I had access to the care I needed. Strongly Disagree
d. My concerns were taken seriously.	d. My concerns were taken seriously. Strongly Agree	d. My concerns were taken seriously. Agree	d. My concerns were taken seriously. Disagree	d. My concerns were taken seriously. Strongly Disagree
e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey.	e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey. Strongly Agree	e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey. Agree	e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey. Disagree	e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey. Strongly Disagree

Question Title

* Quality:
(If question does not apply, leave blank)

	Always	Usually	Sometimes	Never
a. I saw the healthcare provider(s) clean their hands before providing my care.	a. I saw the healthcare provider(s) clean their hands before providing my care. Always	a. I saw the healthcare provider(s) clean their hands before providing my care. Usually	a. I saw the healthcare provider(s) clean their hands before providing my care. Sometimes	a. I saw the healthcare provider(s) clean their hands before providing my care. Never
b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth)	b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth) Always	b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth) Usually	b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth) Sometimes	b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth) Never

Question Title

* Quality:
(If question does not apply, leave blank)

	Strongly Agree	Agree	Disagree	Strongly Disagree
c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.).	c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.). Strongly Agree	c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.). Agree	c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.). Disagree	c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.). Strongly Disagree
d. I felt staff were up to date on the skills needed to provide my care.	d. I felt staff were up to date on the skills needed to provide my care. Strongly Agree	d. I felt staff were up to date on the skills needed to provide my care. Agree	d. I felt staff were up to date on the skills needed to provide my care. Disagree	d. I felt staff were up to date on the skills needed to provide my care. Strongly Disagree
e. Overall, I was satisfied with the quality of care I received.	e. Overall, I was satisfied with the quality of care I received. Strongly Agree	e. Overall, I was satisfied with the quality of care I received. Agree	e. Overall, I was satisfied with the quality of care I received. Disagree	e. Overall, I was satisfied with the quality of care I received. Strongly Disagree

Question Title

* Public Health Program Specific Questions-
(If question does not apply, leave blank)

	Yes	No
a. Are you aware of how to access your local Public Health Nurse?	a. Are you aware of how to access your local Public Health Nurse? Yes	a. Are you aware of how to access your local Public Health Nurse? No
b. Were you connected with a Public Health Nurse during your pregnancy?	b. Were you connected with a Public Health Nurse during your pregnancy? Yes	b. Were you connected with a Public Health Nurse during your pregnancy? No
c. Were you offered a home visit within 1 week of being home after the birth of your baby?	c. Were you offered a home visit within 1 week of being home after the birth of your baby? Yes	c. Were you offered a home visit within 1 week of being home after the birth of your baby? No
d. Did you feel that the Public Health Nurse supported you with your feeding goals for your baby?	d. Did you feel that the Public Health Nurse supported you with your feeding goals for your baby? Yes	d. Did you feel that the Public Health Nurse supported you with your feeding goals for your baby? No
e. Were you invited to a Child Health Clinic for your baby’s immunizations or growth and development assessment?	e. Were you invited to a Child Health Clinic for your baby’s immunizations or growth and development assessment? Yes	e. Were you invited to a Child Health Clinic for your baby’s immunizations or growth and development assessment? No
f. Was your Public Health Nurse available during a time that worked for you?	f. Was your Public Health Nurse available during a time that worked for you? Yes	f. Was your Public Health Nurse available during a time that worked for you? No

If No, what hours would you prefer?

Question Title

* .

	Yes	No
g. Was a Public Health Nurse available at a location that worked for you?	g. Was a Public Health Nurse available at a location that worked for you? Yes	g. Was a Public Health Nurse available at a location that worked for you? No

If No, what location would be better?

Question Title

* .

	Yes	No
h. Did the Public Health Nurse offer or suggest resources and other services that were applicable to you?	h. Did the Public Health Nurse offer or suggest resources and other services that were applicable to you? Yes	h. Did the Public Health Nurse offer or suggest resources and other services that were applicable to you? No
i. Did your Public Health Nurse offer to review your immunization status?	i. Did your Public Health Nurse offer to review your immunization status? Yes	i. Did your Public Health Nurse offer to review your immunization status? No
j. Did your Public Health Nurse offer any vaccines to you and your family?	j. Did your Public Health Nurse offer any vaccines to you and your family? Yes	j. Did your Public Health Nurse offer any vaccines to you and your family? No

Demographics: (of the patient) Collected for statistical purposes only to target improvements.

Question Title

* Ethnicity (Race):

Caucasian (White)

Indigenous (First Nations, Inuit, Metis)

Black

Asian (South, East)

Chinese

Filipino

Japanese

Korean

Latin American

Middle Eastern

Prefer not to answer

Other (please specify)

Question Title

* Age:

15 years & under

16-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40-44 years

45 years & over

Question Title

* Comments:

Public Health Prenatal/Postpartum Patient Advisor Volunteers Needed!!
Someone just like you helped to design this survey!

We want to partner with existing Prenatal/Postpartum Patients who might be interested in helping us review, design or provide feedback to our services.
If you are interested in this, please leave your name, phone number and email address below:

Question Title

* Volunteer Contact Information:

Volunteer Full Name:

Home Community:

Phone Number:

Email Address:

Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations: email patientrelations@pmh-mb.ca or call 1-800-735-6596

Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca

Thank you for your participation!

Question Title

* Dignity, Respect and Trust:(If question does not apply, leave blank)

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* Information Sharing:(If question does not apply, leave blank)

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* Participation:(If question does not apply, leave blank)

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* Accessibility and Responsiveness:(If question does not apply, leave blank)

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* Quality:(If question does not apply, leave blank)

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* Quality:(If question does not apply, leave blank)

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* Public Health Program Specific Questions-(If question does not apply, leave blank)

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* Ethnicity (Race):

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* Age:

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* Comments:

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* Volunteer Contact Information:

* Dignity, Respect and Trust:
(If question does not apply, leave blank)

* Information Sharing:
(If question does not apply, leave blank)

* Participation:
(If question does not apply, leave blank)

* Accessibility and Responsiveness:
(If question does not apply, leave blank)

* Quality:
(If question does not apply, leave blank)

* Quality:
(If question does not apply, leave blank)

* Public Health Program Specific Questions-
(If question does not apply, leave blank)