Pretest Screener

Risk and Benefit Perception Scale Development

SCREENER DOCUMENT 2-26-2015

Pretest Screener

OMB: 0910-0784

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[PLEASE SHOW THE FOLLOWING STATEMENT AT THE BOTTOM OF THE FIRST SCREEN IN SMALL FONT]


This research is authorized by Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 300u(a)(4)). Confidentiality is protected by 5 U.S.C. 552(a) and (b) and 21 CFR part 20.


OMB Control #TBD. Expires TBD.



[FORCE TO ANSWER ALL QUESTIONS]


[DISPLAY ON THE SAME SCREEN WITH S1]

First, please answer the following questions.


S1. What is your current occupation?

    • Healthcare Provider (e.g., physician, nurse, counselor, physical therapist) TERMINATE

    • Pharmaceuticals (e.g., pharma rep) TERMINATE

    • Market research / Advertising TERMINATE

    • None of the above CONTINUE TO S2


S2. Have you ever experienced any chronic or long-lasting pain (more than aches and pains that go away quickly or are minor)?

  • Yes CONTINUE TO S3

  • No SKIP TO S6


S3. Did you experience this chronic or long-lasting pain for at least six months?

  • Yes CONTINUE TO S4

  • No SKIP TO S6


S4. Do you still have this chronic or long-lasting pain?

  • Yes ASSIGN TO CHRONIC PAIN GROUP

  • No CONTINUE TO S5


S5. Have you taken any medication for this chronic or long-lasting pain in the last 12 months?

  • Yes ASSIGN TO CHRONIC PAIN GROUP

  • No CONTINUE TO S6


S6. Have you ever been diagnosed by a health professional with high blood pressure?

  • Yes CONTINUE TO S7

  • No HOLD FOR MAIN STUDY WAVES 3 AND 4


S7. Do you still have high blood pressure?

  • Yes ASSIGN TO HYPERTENSION GROUP

  • No CONTINUE TO S8


S8. Have you taken any medication for high blood pressure in the last 12 months?

  • Yes ASSIGN TO HYPERTENSION GROUP

  • No HOLD FOR MAIN STUDY WAVES 3 AND 4



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKelly, Bridget
File Modified0000-00-00
File Created2021-01-26

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