Generic Drugs - Patients 44276
Research Manager: Sandra Applebaum
email: [email protected]
phone: (212) 539-9746
February 12, 2015
44276 Generic Drugs
SUBJECTS FOR QUESTIONNAIRE:
SECTION 100: SAMPLE PRELOADS AND SCREENING
SECTION 200: PILL APPEARANCE PREFERENCES AND PERCEPTIONS
SECTION 300: PILL APPEARANCE CHANGES
SECTION 400: GENERAL QUESTIONS ABOUT BRAND-NAME AND GENERIC DRUGS
SECTION 500: DEMOGRAPHICS
SECTION 100: SAMPLE PRELOAD AND SCREENING QUESTIONS
BASE: ALL RESPONDENTS
Q105 Hello, this is _________________________ from ________________, a national research firm. We are conducting a survey about prescription medications. We are working with a team of physicians at Harvard Medical School and Brigham and Women’s Hospital on a study funded by the Food and Drug Administration. Your participation is voluntary. Is now a good time for you to answer some questions?
(IF NEEDED: The survey takes approximately 10-20 minutes, depending on your responses.)
(IF NEEDED: All of your answers will be kept confidential. Your answers will be grouped with hundreds of other people’s answers so that there is no possibility of identifying you or your answers.)
(IF NEEDED: Your telephone number was randomly generated by our computer system.)
1 Yes [GO TO Q268]
2 No [GO TO Q110]
8 Not sure (VOL)
9 Decline to answer (VOL) (INT: SCHEDULE CALL BACK) [TERM]
BASE: NOT A GOOD TIME TO ANSWER QUESTIONS (q105/2)
Q110 Is there someone else in the household who can answer some questions?
1 Yes [LOOP BACK TO Q105]
2 No
8 Not sure (VOL)
9 Decline to answer (VOL) [TERMINATE]
BASE: ALL RESPONDENTS
Q115 DO NOT ASK, RECORD FROM VOICE.
1 Male
2 Female
BASE: all CONTINUING respondents
Q120 Which of the following describes your age? (INTERVIEWER: READ LIST UNTIL RESPONSE IS GIVEN)
1 25 or under
2 26-33
3 34-41
4 42-49
5 50-57
6 58-65
7 66 and above
8 Not sure (VOL)
9 Decline to answer (VOL)
BASE: age 50+ (Q120/5,6,7)
Q130 Have you been diagnosed by a healthcare professional with any of the following conditions?
Q131
1 Yes
2 No
8 Not sure (VOL)
9 Decline to answer (VOL)
1 Epilepsy or seizure disorder
2 Diabetes
3 Hypertension
4 Hyperlipidemia
5 Depression
6 HIV
7 Cancer
8 Fibromyalgia
BASE: HAS BEEN DIAGNOSED WITH EPILEPSY OR DIABETES OR HYPERTENSION OR HYPERLIPIDEMIA OR DEPRESSION OR HIV (Q130/1-6 AND Q131/1)
Q135 Do you take generic medications for the following conditions?
Q136
1 Yes
2 No
8 Not sure (VOL)
9 Decline to answer (VOL)
[PN: INSERT YES RESPONSES FROM Q130/1-6
1 Epilepsy or seizure disorder
2 Diabetes
3 Hypertension
4 Hyperlipidemia
5 Depression
6 HIV
BASE: ALL RESPONDENTS
Q165 Qualification Status (does not appear on screen)
[PN: IF age 50 or older (Q120/5,6,7) and takes generic drugs for EPILEPSY OR DIABETES OR HYPERTENSION OR HYPERLIPIDEMIA OR DEPRESSION OR HIV (Q135/1-6 AND Q136/1), get code 1.
All otherS, GET CODE 2.
1 QUALIFIED
2 not Qualified
SECTION 200: PILL APPEARANCE PREFERENCES AND PERCEPTIONS
Q205 We are working with teams at Harvard Medical School and the FDA. The goal is to learn about your views on how your prescription drugs look. This survey will help guide future work aimed at promoting positive health outcomes among patients like you. Your answers will be confidential and grouped with hundreds of other people’s answers so there is no possibility of identifying you.
Q210 The first series of questions has to do with pill appearance. Appearance includes the pill’s color, shape, size, and any markings (such as text, lines, grooves, or designs) printed on the pill.
Thinking about the last year, which of the following best describes how pill appearance relates to your medication use? Do you…? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Always rely on pill appearance to make sure you take the correct medication
2 Usually rely on pill appearance to make sure you take the correct medication
3 Rarely rely on pill appearance to make sure you take the correct medication
4 Never rely on pill appearance to make sure you take the correct medication
8 Don’t know or don’t recall (VOL)
9 Decline to answer (VOL)
Q215 In the last year, how frequently did you refill a prescription in which the pill you received differed in appearance from the pills you received with the immediately prior prescription? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 4 or more times
2 2-3 times
3 1 time
4 Never
8 Don’t know or don’t recall (VOL)
9 Decline to answer (VOL)
[PN: SHOW HALF RESPONDENTS CODES 1-2 AND FOR HALF FLIP THE SCALE TO DISPLAY 2-1.]
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q225 Imagine you were ready for a normal refill of a prescription drug you had been on for a long time. How much would you prefer for the pills in the refill to have the same…?
[PN: AT Q226, SHOW HALF RESPONDENTS CODES 1-5 AND FOR HALF FLIP THE SCALE TO DISPLAY 5-1.]
Q226
1 Definitely would prefer
2 Probably would prefer
3 Have no preference
4 Probably would not prefer
5 Definitely would not prefer
8 Not sure/Don’t know
9 Decline to answer (VOL)
1 Color as usual
2 Shape as usual
3 Size as usual
4 Pill markings as usual
Q230 In the past year, when the appearance of one of your pills changed in appearance from one refill to another, did you think that change meant that a different manufacturer was making the pill? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-2 AND FOR HALF FLIP THE SCALE TO DISPLAY 2-1.]
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q235 In the future, if your pill appearance changes from one refill to another, which of the following best describes what you’d think? Would you…? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-5 AND FOR HALF FLIP THE SCALE TO DISPLAY 5-1.]
1 Definitely like to be notified of this change by the pharmacy
2 Probably like to be notified of this change by the pharmacy
3 Probably not like to be notified of this change by the pharmacy
4 Definitely not like to be notified of this change by the pharmacy
5 Have no preference to be notified of this change by the pharmacy
8 Not sure/Don’t know (VOL)
9 Decline to answer (VOL)
BASE: PROBABLY/DEFINITELY WOULD/HAVE NO PREFERENCE (Q235/1,2,5)
Q236 If your pharmacy notified you about the pill appearance change, how would you prefer to be notified? (INTERVIEWER: READ LIST)
1 Verbally, in person or on the phone
2 Using a sticker on the prescription bottle
3 No preference
8 Not sure/Don’t know (VOL)
9 Decline to answer (VOL)
Q240 Do you think that if your generic pill changed in its appearance during a routine refill that the new pill would be less effective? (INTERVIEWER: READ LIST)
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q245 Do you think that if your generic pill changed in its appearance during a routine refill that the new pill would be less safe? (INTERVIEWER: READ LIST)
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q250 Assume that generic pill A costs you $10 per month. It would cost the manufacturers an extra $5 per month to ensure that the appearance of generic pill A remains constant every time you refill it. Would you pay $15 per month for generic pill A to ensure that your pill has the same size, shape, and color at each refill? (INTERVIEWER: READ LIST)
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q255 Assume that generic pill B costs you $15 per month. It would cost the manufacturers an extra $10 per month to ensure that the appearance of generic pill B remains constant every time you refill it. Would you pay $25 per month for generic pill B to ensure that your pill has the same size, shape, and color at each refill? (INTERVIEWER: READ LIST)
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
Q260 Assume that generic pill C costs you $5 per month. It would cost the manufacturers an extra $1 per month to ensure that the appearance of generic pill C remains constant every time you refill it. Would you pay $6 per month for generic pill C to ensure that your pill has the same size, shape, and color at each refill? (INTERVIEWER: READ LIST)
1 Yes
2 No
8 Not sure
9 Decline to answer (VOL)
SECTION 300: PILL APPEARANCE CHANGES
Q305 The next series of questions is about a pill’s appearance. First, I’d like to remind you that pill appearance includes the pill’s color, shape, size, and any markings (such as text, lines, grooves, or designs) printed on the pill.
Please think back to the last time you refilled a medication you had been taking regularly and, during a routine refill, it changed in appearance.
What was the name of the drug? (INTERVIEWER: PROBE IF NECESSARY)
[TEXT BOX]
8 Not sure (VOL)
9 Decline to answer (VOL)
Q315 Approximately how long ago was the change in appearance? (INTERVIEWER: PROBE IF NECESSARY)
[RANGE: 0-x] [RANGE: 0-x] [RANGE: 0-x]
|__|__| years |__|__|months |__|__|weeks
8 Not sure (VOL)
9 Decline to answer (VOL)
Q325 As best you recall, did your pill change in…? (INTERVIEWER: READ LIST)
[MULTIPLE RESPONSE]
1 Color
2 Shape
3 Size
4 Any markings (such as text, lines, grooves, or designs) printed on the pill
8 Not sure (VOL)
9 Decline to answer (VOL)
Q330 When your pill changed in appearance, as best you recall, did your pharmacist…?
Q331
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
1 Talk to you about the change, in person or on the phone
2 Put a sticker on the pill bottle to let you know about the change
Q335 When your pill changed in appearance, as best you recall, did you…?
Q336
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
1 Think the pill you got was the same as before, even though it looked different
2 Think you got the wrong pill
3 Ask your pharmacist about the new pill’s appearance
Q340 Did your pharmacist relieve your concerns about the new pill’s appearance?
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
Q345 Thinking back again to the last time you refilled a medication you had been taking and it changed in appearance. Did you contact your physician or prescriber to ask about the new pill’s appearance?
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
Q350 Did your physician or prescriber relieve your concerns about the new pill’s appearance?
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
Q355 Thinking back again to the last time you refilled a medication you had been taking and it changed in appearance. Did you…?
Q356
1 Yes
2 No
3 Don’t recall (VOL)
9 Decline to answer (VOL)
1 Search the Internet to figure out the identity of the new pill
2 Not take the pill home, or tried to return it to the pharmacy after taking it home
3 Have concerns that the new pill would not work as well as the pill you were taking
4 Have concerns that the new pills would cause more side effects than the pill you were taking
5 Use the pill less frequently
6 Stop using the pill
7 Switch back to the prior pill version
Q360 After taking the pill with the new appearance, did you notice any changes in how you felt?
1 Yes
2 No
8 Not sure (VOL)
9 Decline to answer (VOL)
[MULTIPLE RESPONSE]
[RANDOMIZE]
1 Chest pain
2 Nausea
3 Headache
4 Allergic reaction
5 Swelling
6 Rash
7 Abdominal pain
8 Blurry or double vision
9 Diarrhea
10 Dizziness
11 Drowsiness
12 Runny nose
13 Indigestion
14 Insomnia
15 Shift in mood
16 Bleeding
17 Drowsiness
18 Dry mouth
19 Loss of appetite
97 None of the above EXCLUSIVE, ANCHOR
99 Decline to answer (VOL) EXCLUSIVE, ANCHOR
Q370 After taking the pill with the new appearance, did you need to…?
Q371
1 Yes
2 No
8 Not sure (VOL)
9 Decline to answer (VOL)
1 Have the dose of your pill adjusted by your doctor
2 Have another new medication for your condition added by your doctor
SECTION 400: GENERAL QUESTIONS ABOUT BRAND-NAME AND GENERIC DRUGS
Q405 The next questions are general questions about brand-name and generic drugs. Which of the following statements best describes what you think about generic and brand-name drug effectiveness? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Generic drugs are definitely as effective as their brand-name versions
2 Generic drugs are probably as effective as their brand-name versions
3 Generic drugs are probably not as effective as their brand-name versions
4 Generic drugs are definitely not as effective as their brand-name versions
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q410 Which statement best describes what you think about generic and brand-name drug safety? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Generic drugs are definitely as safe as their brand-name versions
2 Generic drugs are probably as safe as their brand-name versions
3 Generic drugs are probably not as safe as their brand-name versions
4 Generic drugs are definitely not as safe as their brand-name versions
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q415 Which statement best describes what you think about brand-name drug costs? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Brand-name drugs are more expensive than they should be
2 Brand-name drugs are priced about right
3 Brand-name drugs are less expensive than they should be
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q417 Which statement best describes what you think about generic drug costs? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Generic drugs are more expensive than they should be
2 Generic drugs are priced about right
3 Generic drugs are less expensive than they should be
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q420 Which statement best describes what you think about the active ingredient in generic and brand-name drugs? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Generic drugs are definitely made of the same active ingredient and dose strength as their brand-name versions
2 Generic drugs are probably made of the same active ingredient and dose strength as their brand-name versions
3 Generic drugs are probably not made of the same active ingredient and dose strength as their brand-name versions
4 Generic drugs are definitely not made of the same active ingredient and dose strength as their brand-name versions
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q420 Which statement best describes what you think about the side effects of generic and brand-name drugs? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Generic drugs definitely have the same side effects as their brand-name versions
2 Generic drugs probably have the same side effects as their brand-name versions
3 Generic drugs probably do not have the same side effects as their brand-name versions
4 Generic drugs definitely do not have the same side effects as their brand-name versions
8 Not sure or don’t know (VOL)
9 Decline to answer (VOL)
Q425 In general, in choosing between taking a generic vs. brand-name drug, would you say you…? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 Greatly prefer a brand-name drug
2 Slightly prefer a brand-name drug
3 Slightly prefer a generic drug
4 Greatly prefer a generic drug
5 Don’t prefer one or the other
9 Decline to answer (VOL)
Q430 In the last year, how many times have you asked your doctor to prescribe a brand-name drug rather than a generic? (INTERVIEWER: READ LIST)
[PN: SHOW HALF RESPONDENTS CODES 1-4 AND FOR HALF FLIP THE SCALE TO DISPLAY 4-1.]
1 4 or more times
2 2-3 times
3 1 time
4 Never
8 Don’t know or don’t recall (VOL)
9 Decline to answer (VOL)
SECTION 500: DEMOGRAPHICS
BASE: ALL QUALIFIED RESPONDENTS
Q505 Finally, we have a few questions about you.
Please tell me the 5-digit zip code for the primary location in which you live.
[RANGE: 00000-99999]
|__|__|__|__|
(INTERVIEWER: CONFIRM BEFORE MOVING TO THE NEXT SCREEN.]
BASE: ALL QUALIFIED RESPONDENTS
Q507 HIDDEN COMPUTE FOR REGION
1 East 1
2 East 2
3 Midwest 1
4 Midwest 2
5 South 1
6 South 2
7 West 1
8 West 2
BASE: ALL QUALIFIED RESPONDENTS
Q508 Including yourself, how many people age 18 or older live in your household? (INTERVIEWER: ENTER 98 FOR NOT SURE AND 99 FOR DECLINE TO ANSWER)
[RANGE: 1-50, 98, 99]
[NON-MANDATORY]
|_|_|
BASE: ALL QUALIFIED RESPONDENTS
Q474 Are you of Spanish or Hispanic origin, such as Latin American, Mexican, Puerto Rican, or Cuban?
1 Yes, of Hispanic origin
2 No, not of Hispanic origin
BASE: ALL QUALIFIED RESPONDENTS
Q480 Do you consider yourself…? (INTERVIEWER: READ LIST)
1 White/Caucasian
2 Black/African-American
3 Asian or Pacific Islander
4 Native American/American Indian/Alaskan native
5 Mixed racial background [ANCHOR]
6 Some other race [ANCHOR]
94 Decline to Answer [ANCHOR]
BASE: ETHNICITY IS TO BE ASKED AND HAVE ETHNIC CODES
Q485 [HIDDEN COMPUTE question]
[IF ANSWERED HISPANIC (Q474/1) ANSWER TO Q485 IS CODE 7, OTHERWISE Q485=Q480.]
White/Caucasian
Black/African-American
Asian or Pacific Islander
Native American/American Indian/Alaskan native
Mixed racial background
Some other race
Hispanic/Latino
94 Decline to Answer
BASE: ALL QUALIFIED RESPONDENTS
Q515 What is your occupation? (INTERVIEWER: IF RESPONDENT IS RETIRED, ASK WHAT WAS HIS OR HER OCCUPATION.)
[TEXT BOX]
BASE: ALL QUALIFIED RESPONDENTS
Q520 What is the highest level of schooling you have completed? (INTERVIEWER: READ LIST UNTIL RESPONSE IS GIVEN)
1 Less than high school
2 High School/GED
3 Some college or 2 year college degree (Associates)
4 4 year college degree
5 Masters degree
6 Advanced health-related degree (for example, MD, DDS, health-related PhD)
7 Advanced health-related degree (for example, JD, non-health-related PhD)
8 Not sure (VOL)
9 Decline to answer (VOL)
BASE: ALL QUALIFIED RESPONDENTS
Q525 Please estimate your total household income from all sources in 2014. (INTERVIEWER: READ LIST UNTIL RESPONSE IS GIVEN)
1 Less than $15,000
2 $15,000 to $29,999
3 $30,000 to $49,999
4 $50,000 to $74,999
5 $75,000 to $99,999
6 $100,000 or more
98 Not sure (VOL)
99 Decline to answer (VOL)
BASE: ALL QUALIFIED RESPONDENTS
Q462 Which of the following income categories best describes your total [INSERT LAST YEAR] household income before taxes? (INTERVIEWER: READ LIST UNTIL RESPONSE IS GIVEN)
1 Less than $15,000
2 $15,000 to $29,999
3 $30,000 to $49,999
4 $50,000 to $74,999
5 $75,000 to $99,999
6 $100,000 or more
98 Not sure (VOL)
99 Decline to answer (VOL)
IF INCLUDING CELL PHONE SAMPLE ALSO ASK THE FOLLOWING:
BASE: ALL QUALIFIED RESPONDENTS
Q360 At any time during the last two years, have you lived somewhere without a landline phone? By this I mean, did you live anywhere in which there was no phone that you would plug into a wall socket in order to make and receive calls?
1 Yes, lived somewhere without a landline phone
2 No, have not lived somewhere without a landline phone
8 Not sure (VOL)
9 Decline to answer (VOL)
BASE: ALL QUALIFIED PHONE RESPONDENTS (Qxxx/x)
PHONLNS In the home in which you currently live, how many separate telephone lines (not cell phones) with different telephone numbers do you have that can receive phone calls? Do not count those that are only used for faxes or modems. (INTERVIEWER: READ LIST)
1 None
2 One
3 Two
4 Three or more
8 Not sure (VOL)
9 Decline to answer (VOL)
BASE: ALL QUALIFIED LANDLINE RESPONDENTS (Qxxx/x)
Q1502 Do you personally have a working cell phone?
1 Yes
2 No
98 Don’t know or Not sure (VOL)
99 Decline to answer (VOL)
BASE: ALL QUALIFIED LANDLINE RESPONDENTS (Qxxx/x)
Q1503 Does anyone else in your household have a working cell phone?
1 Yes
2 No
98 Not sure (VOL)
99 Decline to answer (VOL)
BASE: ALL QUALIFIED CELL PHONE RESPONDENTS (Qxxx/x)
Q1504 Is there at least one telephone inside your home that is currently working and is not a cell phone?
1 Yes
2 No
98 Not sure (VOL)
99 Decline to answer (VOL)
BASE: ALL QUALIFIED RESPONDENTS
Q1506 Of all the telephone calls that you/your household receives, are…? (INTERVIEWER: READ LIST)
All or almost all calls received on cell phones
Some received on cell phones and some on regular home phones
Very few or none received on cell phones
98 Don’t know or Not sure (VOL)
99 Decline to answer (VOL)
BASE: ALL QUALIFIED RESPONDENTS
Q530 Before we finish, please let me know if you have any additional comments about your views about or experiences with changes in pill appearance.
[TEXT BOX]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | RO-Domestic Project Management Manual: 2.3 JFT_QN_Template.docx |
| Subject | Questionnaire Template |
| Author | Olivas, Sherrill |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |