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Questionnaire for LAMA. Docx

The document is a consent statement and a questionnaire designed to gather demographic information and reasons for patients leaving the hospital against medical advice (LAMA). It includes sections on hospital visit information, communication with healthcare providers, patient experiences, and suggestions for improvement. The aim is to understand factors contributing to LAMA for research purposes while ensuring confidentiality.

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mphamed
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32 views

Questionnaire for LAMA. Docx

The document is a consent statement and a questionnaire designed to gather demographic information and reasons for patients leaving the hospital against medical advice (LAMA). It includes sections on hospital visit information, communication with healthcare providers, patient experiences, and suggestions for improvement. The aim is to understand factors contributing to LAMA for research purposes while ensuring confidentiality.

Uploaded by

mphamed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Consent Statement: I understand that my responses will be used for research purposes only

and will remain confidential.

Signature: ________________________
Date: ________________________

Questionnaire for Factors Contributing to Leaving Against Medical Advice


(LAMA)

Section 1: Demographic Information

1. Age: _______________
2. Gender:
1. Male
2. Female
3. Other (please specify): _______________
3. Nationality: _______________
4. Marital Status:

1. Single
2. Married
3. Divorced
4. Widowed

5. Occupation: _______________
6. Level of Education:
1. No formal education
2. Primary school
3. Secondary school
4. College/University
5. Other (please specify): _______________
7. Monthly Income Range (if applicable): _______________

Section 2: Hospital Visit Information

8. What department were you admitted to when you decided to leave? (e.g., Emergency,
Inpatient, MCH, etc.) _______________
9. How long were you in the hospital before deciding to leave? ______________
10. What was your primary health concern or reason for the visit?____________
Section 3: Reasons for Leaving Against Medical Advice

11. What were the reasons for leaving the hospital against medical advice?
(Select all that apply):

 Financial constraints
 Dissatisfaction with care
 Long waiting time
 Lack of clear explanation of condition/treatment
 Family obligations
 Fear of medical procedures
 Preference for alternative/traditional care
 Language barriers
 Other (please specify): _______________
Section 4: Communication and Understanding

12. Did you understand the doctor’s explanation of your condition and treatment?

 Yes
 No
 Partially

a) If not, what was unclear? _______________


b) Were you given enough time to ask questions and discuss your concerns with the
healthcare team?
a. Yes
b. No
c) Did language barriers impact your understanding of the doctor’s instructions?
a. Yes
b. No
d) Were you informed about the risks of leaving the hospital against medical advice?
a. Yes
b. No

Section 5: Experience and Perception

17. How would you rate your overall experience at the hospital before leaving?

 Excellent
 Good
 Average
 Poor

1. What improvements would have convinced you to stay and complete your treatment?
(Select all that apply):

 Shorter waiting times


 Better communication with staff
 More affordable care
 Clearer explanation of condition and treatment
 Involvement of family in decision-making
 Other (please specify): _______________

Section 6: Follow-Up and Suggestions

19. Did you seek medical care elsewhere after leaving the hospital?

1. Yes
2. No

a) Would you recommend Kebribeyah Primary Hospital to others?


a. Yes
b. No
b) Please provide any additional comments or suggestions on how the hospital can
reduce the rate of LAMA: _______________

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