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Please take this quick survey to share your input on support and treatment for women in Wicomico County.
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* Indicates required question
1. What is your age?
*
A. 18-29
B. 30-39
C. 40-49
D. 50+
2. Have you ever misused non prescription drugs?
*
Yes
No
*
3. Have you ever misused a prescription drug?
Yes
No
4. If so, how often did you misuse it/them?
*
A. Daily
B. Two or more times per week
C. Two or more times per month
D. Monthly
E. Less than once per month
F. N/A
G. Other _______________________________________
5. Have you ever misused prescription drugs while pregnant?
*
Yes
No
6. If so, how often during your pregnancy?
*
A. Daily
B. Two or more times per week
C. Two or more times per month
D. Monthly
E. Less than once per month
N/A
7. What trimester were you in when you received treatment?
*
A. First Trimester
B. Second Trimester
C. Third Trimester
D. Unsure
E. Continued to use
N/A
8. If you haven’t or didn’t receive prenatal care within the first trimester of your pregnancy, why haven’t/didn’t you?
*
A. Lack of support
B. Lack of resources
C. Stigma
D. Continued to use
E. N/A
9. In what ways could the Health Department or other agencies assist you in receiving prenatal care/treatment? (choose all that apply)
*
A. Provide a list of support groups
B. Provide a list of resources
C. Provide transportation
D. Provide unbiased/non stigmatizing assistance
E. None of the above
F. Other
10. Are/Were you open to getting addiction treatment while pregnant?
*
Yes
No
N/A
11. If you answered “No,” why not?
*
Your answer
12. If you received prenatal care, did the medical staff ask you if you use/d drugs?
*
Yes
No
N/A
13. Did your doctor refer you to treatment services?
*
Yes
No
N/A
14. When you received prenatal care, what was your experience?
*
A. Above satisfactory
B. Satisfactory
C. Neutral
D. Unsatisfactory
15. Explain your answer to #14:
*
Your answer
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