Completes; pretest 1

Appendix B:
Questionnaires

OMB Control #: __________ 
Expires ____________ 

Market Claims in DTC Advertisements
Main Study
Draft Questionnaire

[PROGRAMMERS: Please be advised that skip logic is highlighted in gray. Please omit from
survey language.
Please collect information about the type of device being used to complete survey, including
Operating System.]
A. STIMULUS
[PROGRAMMERS: Each respondent will be assigned to 1 of 9 Stimuli.
Once assigned, Stimuli #1-9 is shown on the left side of the screen. Stimuli #10 [brief summary]
will be shown on the right side of the screen for everyone]
Stim. Please select the stimuli to use this wave:
1. Control, Control
2. Control, 46%
3. Control, 72%
4. #1 Prescribed, Control
5. #1 Prescribed, 46%
6. #1 Prescribed, 72%
7. NEW!, Control
8. NEW!, 46%
9. NEW!, 72%
[ASK ALL] [NUMERIC]
YEAR/MONTH. What is your date of birth (year and month)?
YEAR
SINGLE PUNCH DROPDOWN PREQUAL
_[ACCEPTABLE RANGE FOR YEARS: 1910
...
_2000
[IF RESPONDENT UNDER 18 YEARS TERMINATE]
[ASK ALL] [SINGLE CODE]
RESP_GENDER. What is your gender ?
_1 Male
_2 Female

OMB Control #: __________ 
Expires ____________ 

[COUNTRY10]
1 United States
2 Canada
3 Australia
4 United Kingdom
5 Other
[IF RESPONSE NE UNITED STATES (1), TERMINATE.]
[ASK ALL] [OPEN ENDED]
qMrkSize_US. Please enter your zip code.
[CODE OPEN ENDED RESPONSE – 5 digits only]
A. SCREENING QUESTIONS

[INDUSTRY SECURITY SCREENERS --- MULTI-CHECK]
S1.
In which industries or professions do you, or any member of your immediate household,
work? Please select all that apply. [Multi-Check Selection]
1
Advertising [Terminate]
2
Dining/Hospitality
3
Education
4
Entertainment (Radio, Video games, TV, etc.)
5
Financial Services
6
Government/Politics
7
Healthcare/Pharmaceuticals [Terminate]
8
Internet/E-Commerce
9
Insurance [Terminate]
10
Management Consulting
11
Marketing/Market Research [Terminate]
12
Pets (Grooming, Veterinary, Retail, Training)
13
Public Relations
14
Publishing (Newspaper, Magazines, Books)
15
Real Estate/Construction
16
Retail goods
17
Sports
18
Telecommunications (phone, cell phone, cable)
19
Transportation/Shipping
20
Travel/Tourism
21
None of the above [Exclusive]
[IF S1 = 1, 7, 9, 11 TERMINATE]

OMB Control #: __________ 
Expires ____________ 

[AUTOFIL FROM CORTEX]
S2.
What is your date of birth?
Year:_____________
[AUTOFIL FROM CORTEX]
S2b: What is your date of birth?
Month:__________________
[Using S2 and S2b, Code for AGE in years. TERMINATE if AGE < 18.]

S5.
Have you ever been diagnosed by a physician or other qualified medical professional
with any of the following conditions? [Multiple Selection]
Asthma
Cancer
Depression
Diabetes
Heart Attack
None of the Above
[TERMINATE IF ‘DIABETES’ NOT SELECTED]

OMB Control #: __________ 
Expires ____________ 

MQB
Ipsos, a national market research and public opinion firm, is conducting a research study on
behalf of a public health agency to gain a better understanding of how consumers perceive
advertisements (ads) that appear in magazines and newspapers.
The study will involve viewing a prescription drug ad and answering questions related to the ad.
Your answers are private and confidential. No one will ever be able to connect your name with
these answers. Your input is extremely valuable. There is no direct benefit to you for
participating. However, you may find the interview to be informative or interesting. Your
responses are very important because they will help researchers understand how people make
decisions about medications. There are no known risks to participating in this study. While the
survey questions we ask are not meant to be sensitive, there is always a chance that you may feel
uncomfortable with some of the questions. You do not have to answer any question that you
don’t want to answer. There is also a potential risk of loss of confidentiality. Every effort will be
made to protect your information, but this cannot be guaranteed.
If you have questions about this survey, please contact Dr. Aysha Keisler, the project director.
She can be reached between 9 AM and 5 PM Eastern Standard Time Monday – Friday at (202)420-2021.
This study will take about 30 minutes to complete and you will earn 180 iSay points in
appreciation of your time. We ask that you complete the survey in one sitting (without taking
any breaks) to avoid distractions.
Rights as a Participant
If you have any questions about your rights as a participant, you may wish to contact Ipsos’s
Office of Research Protection at (202) 420-2013.
Privacy and Confidentiality
As with other surveys you receive from Ipsos, the privacy and confidentiality of your
information is of the highest importance, and we are committed to maintaining a secure
environment in which you can participate. All information collected in this survey will be kept
confidential to the extent provided by law. Your name and your e-mail address will not be shared
outside of Ipsos, and they will not be associated with your answers or used in any report.
[SHOW AT BOTTOM OF SCREEN IN SLIGHTLY SMALL FONT]
DHHS research authorized by Section 1701(a)(4) of the Public Health Service Act (42 U.S.C.
300u(a)(4)). Confidentiality protected by 5 U.S.C. 552(a) and (b) and 21 CFR part 20.
[Consent Screen 2]
[SINGLE SELECT]
[PROMPT IF SKIP]
OMB Control #: __________ 
Expires ____________ 

Consent1. If you have read the previous screen and agree to participate, please click the
Yes button. If not, click the No button.
_Yes, I agree to participate. [SKIP Consent2]
_ No, I do not agree to participate. [CONTINUE TO Consent2]
[SINGLE SELECT]
[PROMPT IF SKIP]
[IF CONSENT1 = NO OR SKIP]
Consent2. Are you sure you don't want to participate? Your opinions are important to us.
Please select the Yes button to continue this survey. Select the No button to exit.
_ Yes, I agree to participate. [CONTINUE].
_ No, I do not agree to participate. [TERMINATE].

[FOR ALL TERMINATIONS—PLEASE SEND TO NEW PAGE]
-----------------------------------------------------TERMINATION PAGE-------------------------------------------------------Thank you for your participation in today’s survey. These are all of the questions we have for
you today.
----------------------------------------------------------------------------------------------------------------------------------------

On the next screen, you will see an ad for a drug. The name of the drug has been changed
for this study.
Even though it is on a computer screen, please read the ad as if it were in a magazine.
Imagine that the ad is for a product in which you might be interested.
Please pay close attention to the ad because we will ask you questions about it afterwards.
To enlarge the ad, please click on the image.

[PROGRAMMER: Display Stimulus #--Random Assignment.
 Record duration of time spent viewing ad
 Record time spent on each screen answering questions. Time spent on instruction screens
will be used as baseline reading speed measure.

OMB Control #: __________ 
Expires ____________ 

Participants are allowed to page back and forth between the display page and the brief
summary, but once they move beyond the final screen, do not allow participants to look
back at the ad.]
B. Ad Viewing Ability Check

We would now like to ask you some questions about the ad.
P1. Were you able to view the ad?
Yes
No

[Continue]
[Link to screening responses and record data; SHOW P1a]

[SHOW P1a IF P1 = NO; SKIP TO Q1 if P1 = YES]
[SINGLE SELECT]
P1a. Please explain why you couldn’t view the ad.
The webpage did not load.
The webpage loaded but the image did not.
I accidently hit ‘Next’.
Other (please specify) [SPECIFY BOX; PROMPT IF NO TEXT AND NO OTHER
OPTION CHOSEN]:
C. Main Message Recall & Brand Recognition
Q1.

What was the main message of the ad? [OPEN-ENDED RESPONSE]

Which of the following drugs did you see advertised?
[Multiple Selection]
[Randomize]
Q2.

Nuramen
Lyrica
Cymbalta
Carmitet
None of the above

D. Recall of Benefits and Risks

[PROGRAMMER: Randomize order of Q3 and Q4. Include thirteen separate text boxes. If a
participant leaves the question blank display the following prompt: “You did not enter an answer
to this question. Your answer to this question is important to us if you have one to offer. You can
enter ‘none’”. Participant can continue with no response after prompt.]
The advertisement you saw included messages about a prescription drug named Nuramen.
OMB Control #: __________ 
Expires ____________ 

According to the prescription drug advertisement, what are the benefits of Nuramen?
Please list as many benefits as you can remember. Use one line for each benefit you list. [Record
and Code Open End Responses on per-line basis. Standard 13 lines]
Q3.

According to the prescription drug advertisement, what are the risks and side effects of
Nuramen? Please list as many risks and side effects as you can remember. Use one line for each
risk or side effect. [Record and Code Open End Responses on per-line basis. Standard 13 lines]
Q4.

E. Market Claim and Efficacy Recognition

The next questions ask about information that may or may not have been in the
prescription drug ad.
Which of the following statements, if any, were in the prescription drug ad you saw?
Check all that apply. [Multiple Selection; Randomize Order]
Q5.

a.
b.
c.
d.
e.
f.
g.

New!
#1 Prescribed
Improved!
Best-selling
Most preferred by diabetes patients
The product logo
None of the above.

Which of the following statements, if any, were in the prescription drug ad you saw?
Check all that apply. [Multiple Selection; Randomize Order]
[Include the two efficacy claims used in the study and two efficacy claims not used in the
study.]
Q6.

a. In a clinical study, 46% of patients felt their nerve pain reduced by at least half, compared
to baseline. [low efficacy claim- actual]
b. In a clinical study, 72% of patients felt their nerve pain reduced by at least half, compared
to baseline. [high efficacy claim- actual]
c. In clinical studies, 35% of patients taking Nuramen stopped experiencing nerve pain, as
compared to 30% among patients with a placebo treatment. [low efficacy claimdistractor]
d. In clinical studies, 80% of patients taking Nuramen stopped experiencing nerve pain, as
compared to 30% among patients with a placebo treatment. [high efficacy claimdistractor]
e. None of the above.

[ROTATE SECTIONS F-G-H
OMB Control #: __________ 
Expires ____________ 

F. Perceived Risk and Efficacy: Interpretation of Ad’s Intent

[NEW SCREEN]
[INSTRUCTIONS TO RESPONDENT]
In the next section, we will ask you for your opinion about the ad message about Nuramen.
You may feel that you don’t know the “right” answer. That’s OK, we are simply interested in
your opinion.
There are no right or wrong answers.
[NEW SCREEN]
Q7. In your opinion, what is the ad’s message about how much relief Nuramen gives people from

diabetic nerve pain? [Single Selection]
1
2
3
No Relief

Slight Relief

4
Moderate
Relief

Some Relief

5
High Degree of
Relief

6
Complete
Relief

Q8. In your opinion, what is the ad’s message about whether Nuramen would be less effective or

more effective than other diabetic nerve pain drugs? [Single Selection]
1
Much less
effective

2
Moderately
less
effective

3

4

5
Slightly
more
effective

Slightly less They are the
effective
same

6
Moderately
more
effective

7
Much more
effective

Q9. In your opinion, what is the ad’s message about the overall quality of Nuramen ? [Single

Selection]
1
Very Poor
Quality

2

3

4

Poor Quality

Fair Quality

Good Quality

5
Very Good
Quality

6
Excellent
Quality

(A) In your opinion, what is the ad’s message about how serious the side effects of
Nuramen would be, if it did cause side effects? [Single Selection]
1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Extremely
Very Serious
Serious
Serious
Serious
Serious
Serious

Q10.

Q10. (B) In your opinion, what is the ad’s message about how many side effects Nuramen
might cause, if it did cause you to have side effects? [Single Selection]

OMB Control #: __________ 
Expires ____________ 

1

2

3

4

5

6

Very Few

Very Many

Q11. (A) In your opinion, what is the ad’s message about whether the side effects of Nuramen
would be less serious or more serious than other diabetic nerve pain drugs?
Nuramen’s side effects would be…
1
2
3
Much Less
Serious

Moderately
Less
Serious

4

Slightly
Less
Serious

5

6

7

They are the
Slightly More Moderately Much More
same
Serious More Serious Serious

Q11. (B) In your opinion, what is the ad’s message about whether Nuramen would have a
smaller or larger number of side effects compared to other diabetic nerve pain drugs?
1
Nuramen
would have a
much smaller
number of
side effects

2

3

…moderately …slightly
smaller
smaller
number
number…

4
They
are the
same

5

6

7

Nurman would
…slightly
have a much
…moderately
larger
larger number
larger number
number
of side effects

In your opinion, what is the ad’s message about the overall risk of Nuramen? [Single
Selection]
1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Extremely
Very Risky
Risky
Risky
Risky
Risky
Risky

Q11.

G. Perceived Risk and Efficacy: Subjective opinion

[NEW SCREEN]
[INSTRUCTIONS TO RESPONDENT]
In the next section, we will ask you for your opinion about Nuramen.
You may feel that you don’t know the “right” answer. That’s OK, we are simply interested in
your opinion.
There are no right or wrong answers.
[NEW SCREEN]
OMB Control #: __________ 
Expires ____________ 

In your opinion, if 100 people take Nuramen, how many will experience relief from
diabetic nerve pain? Please enter a number in the box below. [OPEN-ENDED RESPONSE.
ACCEPT NUMERIC VALUES 0-100 ONLY. PROMPT “Please enter a number between 0
and 100” FOR INVALID ENTRIES.]
people

Q12.

In your opinion, how much relief does Nuramen actually give people from their diabetic
nerve pain? [Single Selection]
1
2
3
4
5
6
Moderate
High Degree
No Relief
Slight Relief
Some Relief
Complete Relief
Relief
of Relief

Q13.

Do you think Nuramen would be less effective or more effective than other diabetic nerve
pain drugs? [Single Selection]

Q14.

1
Much less
effective

2
Moderately
less
effective

3

4

Slightly less They are the
effective
same

5
Slightly
more
effective

6
Moderately
more
effective

How would you rate the overall quality of Nuramen ? [Single Selection]
1
2
3
4
5
Very Poor
Very Good
Poor Quality
Fair Quality
Good Quality
Quality
Quality

7
Much more
effective

Q15.

6
Excellent
Quality

In your opinion, if 100 people take Nuramen, how many will have side effects? Please
enter a number in the box below. [OPEN-ENDED RESPONSE. ACCEPT NUMERIC
VALUES 0-100 ONLY. PROMPT “Please enter a number between 0 and 100” FOR
INVALID ENTRIES.]
people

Q16.

In your opinion, how serious would the side effects of Nuramen be, if it did cause you to
have side effects? [Single Selection]
1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Extremely
Very Serious
Serious
Serious
Serious
Serious
Serious

Q17.

Q18.

In your opinion, how many side effects might Nuramen cause, if it did cause you to have
side effects? [Single Selection]

OMB Control #: __________ 
Expires ____________ 

1

2

3

4

5

Very Few

6
Very Many

Do you think the side effects of Nuramen would be less serious or more serious than
other diabetic nerve pain drugs? [Single Selection]
Nuramen’s side effects would be…
4
1
2
3
5
6
7
They are the
Moderately
Slightly
Much Less
Slightly More Moderately Much More
same
Less
Less
Serious
Serious More Serious Serious
Serious
Serious
Q19.

Do you think Nuramen would have a smaller number or larger number of side effects
compared to other diabetic nerve pain drugs?

Q20.

1
Nuramen
would have a
much smaller
number of
side effects

2

3

…moderately …slightly
smaller
smaller
number
number…

4
They
are the
same

5

6

7

Nurman would
…slightly
have a much
…moderately
larger
larger number
larger number
number
of side effects

How would you rate the overall risk of Nuramen ? [Single Selection]
1
2
3
4
5
Not at all
Slightly
Somewhat
Moderately
Very Risky
Risky
Risky
Risky
Risky

Q21.

6
Extremely
Risky

H. Perception of Doctors’ Acceptance

These questions are about your opinion of what doctors might think of Nuramen.
[NEW SCREEN]
[INSTRUCTIONS TO RESPONDENT]
In the next section, we will ask you for your opinion about what doctors might think of
Nuramen.
You may feel that you don’t know the “right” answer. That’s OK, we are simply interested in
your opinion.
There are no right or wrong answers.
[NEW SCREEN]
Do you think doctors trust Nuramen less or more than other diabetic nerve pain drugs?
[Single Selection]

Q22.

OMB Control #: __________ 
Expires ____________ 

1
Trust Much
Less

2
Trust
Moderately
Less

3

4

Trust Slightly
Less

Trust Slightly
More

5
Trust
Moderately
More

6
Trust Much
More

Do you think doctors prefer Nuramen less or more than other diabetic nerve pain drugs?
[Single Selection]
1
2
3
4
5
6
Prefer
Prefer
Prefer Much
Prefer Slightly
Prefer
Prefer Much
Moderately
Moderately
Less
Less
Slightly More
More
Less
More

Q23.

Do you think doctors would rate Nuramen as less effective or more effective than other
diabetic nerve pain drugs? [Single Selection]

Q24.

1
Much less
effective

2
Moderately
less
effective

3

4

Slightly less They are the
effective
same

5
Slightly
more
effective

6
Moderately
more
effective

7
Much more
effective

How much relief do you think doctors believe Nuramen gives people from their diabetic
nerve pain? [Single Selection]
1
2
3
4
5
6
Moderate
High Degree of Complete
No Relief
Slight Relief
Some Relief
Relief
Relief
Relief

Q25.

Q25 . (A) How serious do you think doctors would rate the side effects of Nuramen, if it did
cause you to have side effects? [Single Selection]
1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Extremely
Very Serious
Serious
Serious
Serious
Serious
Serious

Q25. (B) How many side effects do you think doctors believe Nuramen might cause, if it did
cause you to have side effects? [Single Selection]
1
2
3
4
5
6
Very Few

OMB Control #: __________ 
Expires ____________ 

Very Many

Q26.

Do you think doctors believe that the side effects of Nuramen would be less serious or
more serious than other diabetic nerve pain drugs?

Nuramen’s side effects would be…
1
2
3
Much Less
Serious
Q27.

6

7

They are the
Slightly More Moderately Much More
same
Serious More Serious Serious

Slightly
Less
Serious

2

3

4

…moderately …slightly
smaller
smaller
number
number…

5

They
are the
same

7

6

Nurman would
…slightly
have a much
…moderately
larger
larger number
larger number
number
of side effects

How do you think doctors would rate the overall quality of Nuramen? [Single Selection]

1
Very Poor
Quality
I.

5

Do you think doctors believe that Nuramen would have a smaller number or larger
number of side effects compared to other diabetic nerve pain drugs?

1
Nuramen
would have a
much smaller
number of
side effects

Q28.

Moderately
Less
Serious

4

2

3

4

Poor Quality

Fair Quality

Good Quality

5
Very Good
Quality

6
Excellent
Quality

Benefit and Risk Recognition

[PROGRAMMER: Randomize Q29 and Q30]
Q29.

Think back to the prescription drug ad. Read each statement and indicate whether or not
was mentioned as a benefit of taking Nuramen . Even if you think a statement is true,
please select “Yes” only if it was written in the ad.
[PROGRAMMER: RANDOMIZE ORDER]
a. relieves diabetic nerve pain [accurate]
b. only needs to be taken once a day[accurate]
c. relieves problems with urination [inaccurate]
d. reduces indigestion, nausea, or vomiting
[inaccurate]

OMB Control #: __________ 
Expires ____________ 

Yes,
statement
is in the ad

No,
statement is
not in the ad

e. most patients reported that they felt better and could
do more[accurate]
f. safer than other drugs for nerve pain associated with
diabetes [inaccurate]

Q30.

Based on the prescription drug ad, please indicate whether each of the following was
mentioned as a side effect or risk of taking Nuramen. Even if you think a statement is
true, please select “Yes” only if it was written in the ad.
[PROGRAMMER: RANDOMIZE ORDER]

Yes,
statement
is in the ad

No,
statement is
not in the ad

a. dizziness [accurate]
b. allergic reaction [accurate]
c. addiction [accurate]
d. blurred vision [inaccurate]
e. diarrhea [inaccurate]
f. dry mouth [inaccurate]

J. Intention for Drug Use and Information Seeking

For the following questions, we are interested in your initial impression and honest
opinions. There are no right or wrong answers.
Based on the prescription drug ad, please rate how likely or unlikely you would be to take
each of the following actions if you saw such an ad in a magazine.
[Single Selection per line]
[ROTATE]

Q31.

Not at
Extremely
all
Slightly Somewhat Moderately Very Likely
Likely Likely
Likely
Likely
Likely
a. Look for information
about Nuramen.
b. Talk with a friend or
family member about
Nuramen.
OMB Control #: __________ 
Expires ____________ 

c. Ask your doctor for
more information
about Nuramen.
d. Ask your doctor to
prescribe Nuramen.
e. Take Nuramen if your
doctor prescribed it.

K. Trust and skepticism
Q32.

To what degree do you believe the information written in the ad?

1
Do Not
Believe At
All

2

3

4

5

6

Slightly
Believe

Somewhat
Believe

Moderately
Believe

Very Much
Believe

Completely
Believe

L. Attention to Market and Efficacy Claims

Q33. How much attention did you pay to these features of the ad?
[ROTATE]

Did not
pay
Attentio
n at all
a. The product logo
[accurate]
b. The diagram of a
foot [accurate]
c. The phrase “New”
[ONLY FOR STIM
7, 8, and 9],
[accurate]
d. The phrase “#1
prescribed” [ONLY
FOR STIM 4, 5,
and 6], [accurate]
OMB Control #: __________ 
Expires ____________ 

Paid
Slight
Attentio
n

Paid
Some
Attentio
n

Paid
Moderat
e
Attentio
n

Paid
Very
Much
Attentio
n

Paid
Complet
e
Attentio
n

e. The statement, “In a
clinical study, [46%
OR 72%] of patients
felt their nerve pain
reduced by at least
half, compared to
baseline”
[Show 46% for stim
2, 5, and ;8
Show 72% for stim
3, 6, and 9;
Do not show for
stim 1, 4 and 7],
[accurate]
f. The drug name,
Nuramen
[accurate]
g. NURAMEN is
approved by the US
Food and Drug
Administration
(FDA) to be taken
every day for the
management of
nerve pain
[accurate]
h. The statement, “You
are encouraged to
report negative side
effects of
prescription drugs to
the FDA. Visit
www.FDA.gov/med
watch or call 1-800FDA-1088.”
[accurate]
i. The section labeled
“Important Safety
Information”.
[accurate]

OMB Control #: __________ 
Expires ____________ 

j. The section labeled
“What to do in case
of accidental
ingestion.”
[inaccurate]
k. The statement,
“Nuramen is the first
prescription drug
approved to treat
diabetic nerve pain
drug.” [inaccurate]
l. The phrase, “Not
tested on animals.”
[inaccurate]
m. The picture of a
Nuramen tablet.
[inaccurate]

M. General Perceptions of Market Claims

How much do you agree or disagree with the following statements:
New drugs tend to be more effective than drugs that have been on the market for a longer
time.
1
2
3
4
5
6
Strongly
Somewhat
Somewhat
Strongly
Disagree
Agree
Disagree
Disagree
Agree
Agree

Q36.

New drugs tend to be less risky than drugs that have been on the market for a longer time.
1
2
3
4
5
6
Strongly
Somewhat
Somewhat
Strongly
Disagree
Agree
Disagree
Disagree
Agree
Agree

Q37.

The #1 prescribed drug tends to be more effective than other drugs on the market
1
2
3
4
5
6
Strongly
Disagree
Somewhat
Somewhat
Agree
Strongly

Q38.

OMB Control #: __________ 
Expires ____________ 

Disagree

Disagree

Agree

Agree

The #1 prescribed drug tends to be less risky than other drugs on the market.
1
2
3
4
5
6
Strongly
Somewhat
Somewhat
Strongly
Disagree
Agree
Disagree
Disagree
Agree
Agree

Q39.

[SHOW Q40 AND Q41 IN MAIN STUDY ONLY. DO NOT SHOW IN PRETEST.]
N. Subjective Health Literacy

Next, we’d like to ask you a few questions about yourself.
Q40.

How often do you have someone (like a family member or friend) help you read
instructions, pamphlets, or other written material from your doctor or pharmacy?
[Single Selection]
1
Never

Q41.

2
Rarely

3
Sometimes

4
Often

5
Always

How confident are you filling out medical forms by yourself? [Single Selection]

1
Not at all
Confident

2
Slightly
Confident

3
Somewhat
Confident

4
Moderately
Confident

5
Very
Confident

6
Completely
Confident

O. Perceived Medical Condition Knowledge
Q42.

In general, how much do you feel you know about diabetes? Would you say you are:
[Single Selection]

1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Very
Extremely
Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl
e
e
e
e
e
e
Q43.

How familiar are you with prescription drugs that treat diabetes? [Single Selection]

1
Not at all
Familiar

2
Slightly
Familiar

OMB Control #: __________ 
Expires ____________ 

3
Somewhat
Familiar

4
Moderately
Familiar

5
Very Familiar

6
Extremely Familiar

P. Importance of Drug Attributes

When you consider taking a drug, how important are the following?
[ROTATE]
Somewha
Not at all
Slightly
t
Moderatel
Very
Importan Importan Importan
y
Importan
t
t
t
Important
t
If the drug
is new
How often
the drug is
prescribed
for the
condition
How many
patients are
helped by
the drug,
according to
clinical
trials
If people I
know
recommend
the drug
How many
people with
my medical
condition
use the drug
How often
the drug is
used,
compared to
other drugs
on the
market that
treat the
same
condition
The drug’s
side effects

Q44.

a.
b.

c.

d.

e.

f.

g.

OMB Control #: __________ 
Expires ____________ 

Extremel
y
Importan
t

h. The drug
cost and/or
copay
i. My doctor’s
recommend
ation

Q. Current Prescription Status
Q45.

Are you currently taking, or have you ever taken, any prescription drug(s) for diabetes?
[Single Selection]

Currently taking
Have taken in the past but not currently taking
Have never taken
R. Subjective Diabetes Severity
Q46.

In general, how severe is your diabetes? [Single Selection]

1
Not at all
Severe

Q47.

3
Somewhat
Severe

4
Moderately
Severe

5
Very Severe

6
Extremely
Severe

How concerned are you about the impact of diabetes on your life? [Single Selection]

1
Not at all
Concerned

Q48.

2
Slightly
Severe

2
Slightly
Concerned

3
Somewhat
Concerned

4
Moderately
Concerned

5
Very
Concerned

6
Extremely
Concerned

Have you experienced nerve pain (peripheral neuropathy) because of your diabetes?
[Single Selection]

I have never experienced nerve pain.
I used to experience nerve pain, but I no longer do.
I am currently experiencing nerve pain.
[IF RESPONSE = “I HAVE NEVER..” OR REF SKIP TO Q50]
Q49.

At its most severe, how severe was/is your nerve pain?
0

No pain

OMB Control #: __________ 
Expires ____________ 

[Single Selection]

1
2
3
4
5 Moderate pain
6
7
8
9
10 Worst possible pain

Q50.

Have you ever taken a prescription drug for nerve pain associated with diabetes?
[Single Selection]

I have never taken a prescription drug for nerve pain associated with diabetes.
I used to take a prescription drug for nerve pain associated with diabetes, but I no longer do.
I currently take a prescription drug for nerve pain associated with diabetes.

[SHOW Q51 IN MAIN STUDY ONLY. DO NOT SHOW IN PRETEST.]
S. Objective Numeracy
Q51.

Please answer the following questions to the best of your ability.
a. Imagine that you flip a fair coin 1,000 times.
What is your best guess about how many
times the coin would come up heads in
1,000 flips?

_____ [PROGRAMMER: Allow
open-ended response, up to 100
characters.]

b. In the Big Bucks Lottery, the chance of
Enter a number between 0 and 1,000
winning a $10 prize is 1%. What is your best _____ people [PROGRAMMER:
guess about how many people would win a
Allow only numbers or symbols]
$10 prize if 1,000 people each buy a single
ticket to the Big Bucks Lottery?
c. In Acme Publishing Sweepstakes, the
chance of winning a car is 1 in 1,000 What
percent of tickets to Acme Publishing
Sweepstakes will win a car?

OMB Control #: __________ 
Expires ____________ 

_____ % [PROGRAMMER: Allow
only numbers or symbols – please
allow decimals in the format
XX.X%]

T. Health Insurance
Q52.

Are you now covered by any form of health insurance or health plan? This includes any
private insurance plan through your employer or a plan that you purchased yourself, as
well as a government program like Medicare or Medicaid. [Single Selection]

Yes
No
Don’t know
Q53.

[Skip to Q54]
[Skip to Q54]

Does your current insurance plan help pay for prescription drugs? [Single Selection]

Yes
No
Don’t know
U. Demographics

Finally, we would like to ask you a few questions about yourself for statistical purposes. This
section will help us determine how representative the participants are who complete this
questionnaire.
[ETHNICITY]
Q54.

Are you Hispanic or Latino? [Single Selection]

Yes
No
[RACE]
Q55.

What is your race? You may select one or more races. [Allow Multiple Selections]

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Refuse to answer
[GENDER- MEASURED ON SCREENER]
[HOUSEHOLD INCOME]
Q57. Of these income groups, which category best represents your total combined family
income during 2014? [Single Selection]
Less than $20,000
$20,000–$39,999
$40,000–$59,999
OMB Control #: __________ 
Expires ____________ 

$60,000–$79,999
$80,000–$99,999
$100,000 or more
[LEVEL OF EDUCATIONAL ATTAINMENT]
Q58. What is the highest level of school you have completed or the highest degree you have
received? (Please select one.) [Single Selection]







Less than high school
High school graduate—high school diploma or the equivalent (for example: GED)
Some college but no degree
Associate degree in college
Bachelor’s degree (for example: BA, AB, BS)
Advanced or post-graduate degree (for example: Master’s degree, MD, DDS, JD, PhD,
EdD)

V. DEBRIEFING

You have been very helpful. Thank you very much for taking part in this survey!
The purpose of this research is to learn about how people feel about information provided
in direct-to-consumer prescription drug ads and to learn how people use this information
to understand how well prescription drugs work. Nuramen is not a real drug and is not a
product currently for sale. Please see your healthcare professional for questions about your
health and your medical conditions.

OMB Control #: __________ 
Expires ____________ 

Market Claims in DTC Advertisements
Follow Up Study
Draft Questionnaire
[PROGRAMMER: Please collect information about the type of device being used to complete
survey, including Operating System.]
A. SCREENING AND DEMO QUESTIONS
[INDUSTRY SECURITY SCREENERS --- MULTI-CHECK]
S1.
In which industries or professions do you, or any member of your immediate household,
work? Please select all that apply. [Multi-Check Selection]
1
Advertising [Terminate]
2
Dining/Hospitality
3
Education
4
Entertainment (Radio, Video games, TV, etc.)
5
Financial Services
6
Government/Politics
7
Healthcare/Pharmaceuticals [Terminate]
8
Internet/E-Commerce
9
Insurance [Terminate]
10
Management Consulting
11
Marketing/Market Research [Terminate]
12
Pets (Grooming, Veterinary, Retail, Training)
13
Public Relations
14
Publishing (Newspaper, Magazines, Books)
15
Real Estate/Construction
16
Retail goods
17
Sports
18
Telecommunications (phone, cell phone, cable)
19
Transportation/Shipping
20
Travel/Tourism
21
None of the above [Exclusive]
[IF S1 = 1, 7, 9, 11 TERMINATE]
[ASK ALL] [NUMERIC]
S2. What is your date of birth (year and month)?
YEAR
[SINGLE PUNCH DROPDOWN PREQUAL]
[ACCEPTABLE RANGE FOR YEARS: 1910 ... 2000 ]
[IF RESPONDENT UNDER 18 YEARS TERMINATE]
[ASK ALL] [SINGLE CODE]
OMB Control #: __________ 
Expires ____________ 

S3. RESP_GENDER. What is your gender ?
1 Male
2 Female

[COUNTRY10] [SINGLE PUNCH DROPDOWN PREQUAL]
S4. In which country do you live?
[COUNTRY10]
1
United States
2
Canada
3
Australia
4
United Kingdom
5
Other
[IF RESPONSE NE UNITED STATES (1), TERMINATE.]
[ASK ALL] [OPEN ENDED]
S5. [qMrkSize_US.] Please enter your zip code.
[CODE OPEN ENDED RESPONSE – 5 digits only]

S4. Have you ever been diagnosed by a physician or other qualified medical professional with
any of the following conditions? [Multiple Selection]
Asthma
Cancer
Depression
Diabetes
Heart Attack
None of the Above
[TERMINATE IF ‘DIABETES’ NOT SELECTED]
Introduction and Consent
Ipsos, a national market research and public opinion firm, is conducting a research study on
behalf of a public health agency to gain a better understanding of how consumers perceive
advertisements (ads) that appear in magazines and newspapers.
The study will involve viewing a prescription drug ad and answering questions related to the ad.
Your answers are private and confidential. No one will ever be able to connect your name with
these answers. Your input is extremely valuable. There is no direct benefit to you for
participating. However, you may find the interview to be informative or interesting. Your
responses are very important because they will help researchers understand how people make
decisions about medications. There are no known risks to participating in this study. While the
survey questions we ask are not meant to be sensitive, there is always a chance that you may feel
OMB Control #: __________ 
Expires ____________ 

uncomfortable with some of the questions. You do not have to answer any question that you
don’t want to answer. There is also a potential risk of loss of confidentiality. Every effort will be
made to protect your information, but this cannot be guaranteed.
If you have questions about this survey, please contact Dr. Aysha Keisler, the project director.
She can be reached between 9 AM and 5 PM Eastern Standard Time Monday – Friday at (202)420-2021.
This study will take about 15 minutes to complete and you will earn 90 iSay points in
appreciation of your time. We ask that you complete the survey in one sitting (without taking
any breaks) to avoid distractions.
Rights as a Participant
If you have any questions about your rights as a participant, you may wish to contact Ipsos’s
Office of Research Protection at (202) 420-2013.
Privacy and Confidentiality
As with other surveys you receive from Ipsos, the privacy and confidentiality of your
information is of the highest importance, and we are committed to maintaining a secure
environment in which you can participate. All information collected in this survey will be kept
confidential to the extent provided by law. Your name and your e-mail address will not be shared
outside of Ipsos, and they will not be associated with your answers or used in any report.
[SHOW AT BOTTOM OF SCREEN IN SLIGHTLY SMALL FONT]
DHHS research authorized by Section 1701(a)(4) of the Public Health Service Act (42 U.S.C.
300u(a)(4)). Confidentiality protected by 5 U.S.C. 552(a) and (b) and 21 CFR part 20.
[Consent Screen 2]
[SINGLE SELECT]
[PROMPT IF SKIP]
Consent1. If you have read the previous screen and agree to participate, please click the
Yes button. If not, click the No button.
_ Yes, I agree to participate. [SKIP Consent2]
_ No, I do not agree to participate. [CONTINUE TO Consent2]
[SINGLE SELECT]
[PROMPT IF SKIP]
[IF CONSENT1 = NO OR SKIP]
Consent2. Are you sure you don't want to participate? Your opinions are important to us.
Please select the Yes button to continue this survey. Select the No button to exit.
_Yes, I agree to participate. [CONTINUE].
OMB Control #: __________ 
Expires ____________ 

_ No, I do not agree to participate. [TERMINATE].

OMB Control #: __________ 
Expires ____________ 

B. Example screen
[INSTRUCTIONS TO RESPONDENT]
Before we start the survey, we’d like you to complete a practice question to get familiar
with the kinds of questions we’ll ask.
On the next screen, you will see information about two drugs. Both drugs are prescribed
for the treatment of diabetic nerve pain. The names of the drugs have been changed for this
study.
Imagine that you need to take this type of drug. Based on the information shown, please
select which of the two drugs you would prefer.
[NEW SCREEN]
Based on the information below, which drug would you prefer if you had to take a diabetic
nerve pain drug?

Drug A

Drug B

Advertised as the #1 prescribed
drug for diabetic nerve pain.

In a clinical study, 82% of patients felt
their nerve pain reduced by at least
half when taking Drug A, compared to
baseline.

In a clinical study, 10% of patients felt
their nerve pain reduced by at least
half when taking Drug A, compared to
baseline.

E1. Which drug would you prefer?
[SINGLE SELECT]
a. Drug A
b. Drug B
c. I am not able to view the information about the two drugs. [TERMINATE]

OMB Control #: __________ 
Expires ____________ 

[PROGRAMMER: ROTATE SECTIONS C AND D]
C. Market Claim Manipulation Check
[PROGRAMMER: Each respondent will complete 6 trials in this section. Show the following
question on a separate screen x6. Label trials MC1-MC6.]
[Each trial is assigned two attributes – CLAIM LEFT and CLAIM RIGHT - according to the
lookup table, C_CLAIM CHECK Lookup Table in the Excel file. Note that “None” means that
no message should be shown: do not write “None”.]
[RANDOMIZE ORDER OF TRIALS]
Now you’re ready to take the rest of the survey. You’ll see more questions like the one you
just answered, in which we’ll ask you to choose between two drugs.
You will see more pairs of drug diabetic nerve pain drugs. For each pair, you will see
information about each drug. Both drugs are prescribed for the treatment of diabetic nerve
pain. The names of the drugs have been changed for this study.
Imagine that you need to take this type of drug. Based on the information shown, please
select which of the two drugs you would prefer.
[NEW SCREEN]
Based on the information below, which drug would you prefer if you had to take a diabetic
nerve pain drug?

Drug A
[CLAIM LEFT]

In a clinical study, 27% of patients felt
their nerve pain reduced by at least
half when taking Drug A, compared to
baseline.
[MC1 – MC6]. Which drug would you prefer?
[SINGLE SELECT]
OMB Control #: __________ 
Expires ____________ 

Drug B
[CLAIM RIGHT]

In a clinical study, 27% of patients felt
their nerve pain reduced by at least
half when taking Drug B, compared to
baseline.

a. Drug A
b. Drug B
c. I am not able to view the information about the two drugs.

OMB Control #: __________ 
Expires ____________ 

D. Efficacy Manipulation Check
[PROGRAMMER: Each respondent will complete 6 trials in this section. Show the following
question on a separate screen x6. Label trials EFF1-EFF6.]
[Each trial is assigned two attributes – EFFICACY LEFT and EFFICACY RIGHT according to the lookup table, D_EFF CHECK Lookup Table, in the Excel file.]
[RANDOMIZE ORDER OF TRIALS]

Based on the information below, which drug would you prefer if you had to take a diabetic
nerve pain drug?

Drug A

Drug B

In a clinical study, [EFFICACY
LEFT]% of patients felt their nerve
pain reduced by at least half when
taking Drug A, compared to baseline.

In a clinical study, [EFFICACY
RIGHT]% of patients felt their nerve
pain reduced by at least half when
taking Drug B, compared to baseline.

[EFF1-EFF6]. Which drug would you prefer?
[SINGLE SELECT]
a. Drug A
b. Drug B
c. I am not able to view the information about the two drugs.

OMB Control #: __________ 
Expires ____________ 

E. Experiment Trials
[PROGRAMMER: Show the following question on a separate screen x48. Label Q1-Q48.]
[Each trial is assigned four attributes – EFFICACY LEFT, EFFICACY RIGHT, CLAIM
LEFT, CLAIM RIGHT - according to the lookup table, E_MAIN STUDY Lookup Table, in
the Excel file.]
[RANDOMIZE ORDER OF TRIALS]
Based on the information below, which drug would you prefer if you had to take a diabetic
nerve pain drug?

Drug A

Drug B
[CLAIM RIGHT]

[CLAIM LEFT]

In a clinical study, [EFFICACY
LEFT]% of patients felt their nerve
pain reduced by at least half when
taking Drug A, compared to baseline.

In a clinical study, [EFFICACY
RIGHT]% of patients felt their nerve
pain reduced by at least half when
taking Drug B, compared to baseline.

[Q1-Q48] Which drug would you prefer?
[SINGLE SELECT]
a. Drug A
b. Drug B
c. I am not able to view the information about the two drugs.

OMB Control #: __________ 
Expires ____________ 

F. Respondent Information
Next, we’d like to ask you a few questions about yourself.
[SHOW Q49-Q50 IN MAIN STUDY ONLY. DO NO SHOW IN PRETEST.]
Q49.

How often do you have someone (like a family member or friend) help you read
instructions, pamphlets, or other written material from your doctor or pharmacy?
[Single Selection]

1
Never
Q50.

2
Rarely

3
Sometimes

4
Often

5
Always

How confident are you filling out medical forms by yourself? [Single Selection]

1
Not at all
Confident

2
A little bit

3
Somewhat

4
Quite a bit

5
Very
confident

Perceived Medical Condition Knowledge
Q51.

In general, how much do you feel you know about diabetes? Would you say you
are: [Single Selection]

1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Very
Extremely
Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl Knowledgeabl
e
e
e
e
e
e

Q52.

How familiar are you with prescription drugs that treat diabetes? [Single Selection]

1
Not at all
Familiar

2
Slightly
Familiar

3
Somewhat
Familiar

4
Moderately
Familiar

5
Very Familiar

6
Extremely Familiar

Current Prescription Status
Q53.

Are you currently taking, or have you ever taken, any prescription drug(s) for
diabetes? [Single Selection]

Currently taking
OMB Control #: __________ 
Expires ____________ 

Have taken in the past but not currently taking
Have never taken

Subjective Diabetes Severity

In general, how severe is your diabetes? [Single Selection]
1
2
3
4
5
Not at all
Slightly
Somewhat
Moderately
Very Severe
Severe
Severe
Severe
Severe
Q54.

6
Extremely
Severe

How concerned are you about the impact of diabetes on your life? [Single
Selection]
1
2
3
4
5
6
Not at all
Slightly
Somewhat
Moderately
Very
Extremely
Concerned
Concerned
Concerned
Concerned
Concerned
Concerned
Q55.

Q56.

Have you experienced peripheral neuropathy, or nerve pain associated with
diabetes?
[Single Selection]

I have never experienced nerve pain.
I used to experience nerve pain, but I no longer do.
I am currently experiencing nerve pain
[IF RESPONSE = “I HAVE NEVER..” OR REF SKIP TO Q58]
Q57.

At its most severe, how severe was/is your nerve pain?

11 No pain
12
13
14
15
16 Moderate pain
17
18
19
20
21 Worst possible pain
OMB Control #: __________ 
Expires ____________ 

[Single Selection]

Q58.

Have you ever taken a prescription drug for nerve pain associated with diabetes?
[Single Selection]

I have never taken a prescription drug for nerve pain associated with diabetes.
I used to take a prescription drug for nerve pain associated with diabetes, but I no longer do.
I currently take a prescription drug for nerve pain associated with diabetes.

Objective Numeracy
[SHOW Q59 IN MAIN STUDY ONLY. DO NO SHOW IN PRETEST.]
Q59.

Please answer the following questions to the best of your ability.

d. Imagine that you flip a fair coin 1,000 times.
What is your best guess about how many
times the coin would come up heads in
1,000 flips?

_____ [PROGRAMMER: Allow
open-ended response, up to 100
characters.]]

e. In the Big Bucks Lottery, the chance of
winning a $10 prize is 1%. What is your best Enter a number between 0 and 1,000
guess about how many people would win a
_____ [PROGRAMMER: Allow
$10 prize if 1,000 people each buy a single
only numbers or symbols]
ticket to The Big Bucks Lottery?
f. In ACME Publishing Sweepstakes, the
chance of winning a car is 1 in 1,000. What
percent of tickets to ACME Publishing
Sweepstakes will win a car?

_____ % [PROGRAMMER: Allow
only numbers or symbols]

Health Insurance
Q60.
Are you now covered by any form of health insurance or health plan? This
includes any private insurance plan through your employer or a plan that you
purchased yourself, as well as a government program like Medicare or Medicaid.
[Single Selection]
Yes
No
Don’t know
Q61.

[Skip to Q62]
[Skip to Q62]
Does your current insurance plan help pay for prescription drugs? [Single
Selection]

Yes
OMB Control #: __________ 
Expires ____________ 

No
Don’t know

Demographics
Finally, we would like to ask you a few questions about yourself for statistical purposes. This
section will help us determine how representative the participants are who complete this
questionnaire.
[ETHNICITY]
Q62.

Are you Hispanic or Latino? [Single Selection]

Yes
No
[RACE]
Q63.

What is your race? You may select one or more races. [Allow Multiple Selections]

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Refuse to answer
[HOUSEHOLD INCOME]
Q64.

Of these income groups, which category best represents your total combined
family income during 2014? [Single Selection]

Less than $20,000
$20,000–$39,999
$40,000–$59,999
$60,000–$79,999
$80,000–$99,999
$100,000 or more
[LEVEL OF EDUCATIONAL ATTAINMENT]
Q65.







What is the highest level of school you have completed or the highest degree you
have received? (Please select one.) [Single Selection]

Less than high school
High school graduate—high school diploma or the equivalent (for example: GED)
Some college but no degree
Associate degree in college
Bachelor’s degree (for example: BA, AB, BS)

OMB Control #: __________ 
Expires ____________ 

 Advanced or post-graduate degree (for example: Master’s degree, MD, DDS, JD, PhD,
EdD)

DEBRIEFING
You have been very helpful. Thank you very much for taking part in this survey!
The purpose of this research is to learn about how people feel about information provided
in direct-to-consumer prescription drug ads and to learn how people use this information
to understand how well prescription drugs work. The drugs presented here are not real
drugs and are not products currently for sale. Please see your healthcare professional for
questions about your health and your medical conditions.

OMB Control #: __________ 
Expires ____________