Clinical Trial Data in Professional Prescription Drug Promotion

IMPROVE Study Phase 2

Participant Screener 1-25-2016

Clinical Trial Data in Professional Prescription Drug Promotion

OMB: 0910-0695

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Participant Screener


FDA Physician Interviews

Screener with Programming Notes

Version 1 (10-19-15)


PROGRAMMER:

  • Program progresses through the questioning in a “one-way” manner; participants should not be able to return to questions after they have answered them.

  • Responses to all questions are voluntary; if respondent does not answer a question, the respondent should stay on the same page and be shown the “MISSING ANSWER(S)” validation, after which they should be allowed to move to the next page. If any of the screener questions are missing after validations, please terminate.

  • Include one additional variable in the dataset not shown in this document: Respondent_ID (a unique identifier).

  • If ineligible, please show THANK AND TERMINATE MESSAGE on NEW SCREEN:

“Thank you for your time. You do not qualify to participate in the current survey. Please continue to check for opportunities to participate in research through Doctor Directory.”


[INTRO TEXT]

Thank you for your interest in participating in this study. Please make sure to answer all of the following questions during this initial screening process to determine if you are eligible to participate in this study.


Physician. Are you a physician?

[SINGLE PUNCH]


Yes, I have an M.D. 01

Yes, I have a D.O. 02

No 03


[IF Physician=03 (“No”), THEN INELIGIBLE. THANK AND TERMINATE.]




[NEW SCREEN]


Area. Which best describes your medical specialty?

[SINGLE PUNCH]

Emergency medicine 01

Endocrinology 02

Family medicine 03

General medicine 04

Hospitalist 05

Internal medicine 06

Obstetrics and gynecology 07

Pediatric medicine 08

Psychiatry 09

Other 10


[IF Area=01 (“Emergency medicine”), 05 (“Hospitalist”), 07 (Obstetrics and gynecology”), 08 (“Pediatric medicine”), 09 (“Psychiatry”), or 10 (“Other”), THEN INELIGIBLE. THANK AND TERMINATE.]


[SOFT QUOTA FOR AREA]

Physician Type

Soft Quota

Primary Care Physician (Family medicine, General medicine, Internal medicine)

48

Endocrinologist

24





[NEW SCREEN]

Activity. What do you consider as your major professional activity?

[SINGLE PUNCH]


Office-based practice 01

Hospital-based practice 02

Resident 03

Medical teaching 04

Medical research 05

Administration 06

Other 07


[IF Activity=03 (“Resident”), 04 (“Medical teaching”), 05 (“Medical research”), 06 (“Administration”), or 07 (“Other”), THEN INELIGIBLE. THANK AND TERMINATE.]


[NEW SCREEN]


RxVolume. Over the course of a week, about how many prescriptions do you write?

[SINGLE PUNCH]


Less than 50 per week 01

50 to 99 per week 02

100 to 149 per week 03

More than 150 per week 04


[IF RxVolume=01 (“Less than 50 per week”), THEN INELIGIBLE. THANK AND TERMINATE.]


[NEW SCREEN]


PriorResearch. When, if ever, was the last time you participated in a marketing research study?

[SINGLE PUNCH]


Within the past three months 01

More than three months ago 02

Never 03


[IF PriorResearch=01 (“Within the past three months”), THEN INELIGIBLE. THANK AND TERMINATE.]

[NEW SCREEN]


Age. What is your age?

[OPEN-END NUMERICAL]




years old

[SOFT QUOTA FOR AGE]

Age Category

Soft Quota

44 or Under

25

45-64

30

65 or Older

17


[NEW SCREEN]


Race. Which of the following best describes your race/ethnicity? Mark all that apply

[MULTIPLE PUNCH]




NO

YES

Race_1.

American Indian or Alaska Native

00

01

Race_2.

Asian

00

01

Race_3.

Black or African American



Race_4.

Hispanic or Latino

00

01

Race_5.

Native Hawaiian or Other Pacific Islander



Race_6.

White

00

01

Race_7.

Other race/ethnicity not listed

00

01


[IF Race_5=01 (“Other race/ethnicity”), THEN INELIGIBLE. THANK AND TERMINATE.]

[SOFT QUOTA FOR RACE]

Race/Ethnicity Category

Soft Quota

Asian

13

Black or African American

5

Hispanic or Latino

5

White

49




[NEW SCREEN]


Gender. What is your gender?

[SINGLE PUNCH]


Male 01

Female 02


[SOFT QUOTA FOR GENDER]

Gender Category

Soft Quota

Male

42

Female

30


Zip. What is your work zip code?

[OPEN-END NUMERICAL]






[SOFT QUOTA FOR ZIP]

Urbanicity Category

Soft Quota

Large Urban (e.g., Washington, DC)

24

Small Urban (e.g., St. Louis, MO)

24

Suburban/Rural (e.g., Cortez, CO)

24

Per contract:

  • Participants must be located in at least 4 cities

  • One city must be Washington, DC

  • At least one other location must be a small city with a population less than 150,000 outside of the East Coast (e.g., Columbia, MO or Springfield, IL)

  • Specialists must be located in at least 2 cities


[IF INELIGIBLE DISPLAY (THANK AND TERMINATE)]

Thank you for your time. You do not qualify to participate in the current survey. Please continue to check for opportunities to participate in research through Doctor Directory.


[DISPLAY IF ELIGIBLE]

You are eligible to participate in the current study. Please click the button below to read through our consent form and then to schedule your interview through Doctor Directory.


[CONTINUE TO CONSENT FORM]

File Typeapplication/msword
AuthorSullivan, Helen W
Last Modified ByMizrachi, Ila
File Modified2016-01-25
File Created2016-01-25

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