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Table 1 Chronic Kidney Disease Screening Questionnaire

From: Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung city

Measure Description
Service Quality Part 1. Please mark a score from 1 to 7 for the following questions on your expectations and perceptions of the quality of the kidney disease screening service, (strongly disagree = 1 to strongly agree = 7).
  1 Did the screening have up-to date equipment?
  2 Are the physical facilities in the screening visually appealing to you?
  3 Did the staff have a nice and neat appearance?
  4 Did the facilities and equipment in the screening correspond to their service?
  5 Did the screening provide its services in a timely manner?
  6 Did the staff have a sincere interest in solving the patients' problems?
  7 When patients had problems, was the staff sympathetic and reassuring?
  8 Did the staff provide services within their promised time?
  9 Did the screening insist on error-free records?
  10 Did the staff tell patients exactly when services would be performed?
  11 Did the staff provide prompt service?
  12 Was the staff always willing to help patients?
  13 Was the staff ever too busy to respond to your request?
  14 Did the staff instill confidence in you?
  15 Did the staff provide a sense of safety to you?
  16 Was the staff courteous?
  17 Did the staff have the knowledge to answer patients' questions?
  18 Did the staff give you individual attention?
  19 Did the screening have hours convenient to your needs?
  20 Did the staff give patients' personal attention?
  21 Did the staff seem to have the patients' best interests at heart?
  22 Did the staff understand the individual needs of the patients?
Loyalty Part 2. Please mark a score from 1 to 7 for the following questions on your attitude towards the kidney disease screening service, (strongly disagree = 1 to strongly agree = 7).
  23 Your overall satisfaction and evaluation regarding the screening.
  24 Your willingness to recommend this screening to your friends.
Demographic Variable 25 Gender: 1. Female 2. Male
  26 Age: ______
  27 Job: 1. housekeeper 2. public servant 3. business worker 4. labor worker
5. farmer 6. student 7. service worker 8. other
  28 Highest Educational Degree: 1. primary school 2. junior high 3. senior high
4. college 5. post-graduate