Testing FDA's Drug Safety Communications with Consumers to Improve Consumer Knowledge About How FDA Communicates Risks and Benefits of Prescription Medicines

Data to Support Drug Product Communications as Used by the FDA

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Testing FDA's Drug Safety Communications with Consumers to Improve Consumer Knowledge About How FDA Communicates Risks and Benefits of Prescription Medicines

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FDA Drug Safety Communications Questionnaire DRAFT




FDA DSC QUESTIONNAIRE SCREENER

[PROGRAMMER NOTE: Headings (internal use only) are in red. Programming instructions are in blue.


[GENERAL SCREENER]


[ASK ALL] [SINGLE CODE]

S1. What is your gender ?


_1  Male

_2  Female


[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] [OPEN ENDED]

S3. Please enter your zip code.

[CODE OPEN ENDED RESPONSE – 5 digits only]


[ASK ALL] [MULTI CODE]

S4. Are you trained or employed as (select all that apply):


[RANDOMIZE]

[ROWS]

Health care professional [IF YES TERMINATE]

Professional scientist or researcher [IF YES TERMINATE]

Educator

Electrician

Lawyer


[COLUMNS]

Yes

No


[ASK ALL] [MULTI CODE]

S5. Do you work in any of the following industries (select all that apply):


[RANDOMIZE]

[ROWS]

Pharmaceuticals [IF YES TERMINATE]

Advertising [IF YES TERMINATE]

Market research [IF YES TERMINATE]

Publishing

Energy

Engineering


[COLUMNS]

Yes

No



[CONDITION/DRUG USE SCREENER]


[ASK ALL] [SINGLE CODE]

C1. Have you ever been told by a doctor or other health professional that you have any of the following health problems (Select one for each)?


[RANDOMIZE]

[ROWS]

Asthma

Insomnia

Depression

Constipation

Diabetes or sugar diabetes

High blood pressure


[COLUMNS]

Yes

No

Not sure



[ASK IF FEMALE (2) @S1 AND IF YES (1) FOR “DIABETES OR SUGAR DIABETES” @C1] [SINGLE CODE]

C2. Other than during pregnancy, have you ever been told by a doctor or a health professional that you have diabetes or sugar diabetes? (Select one)


Yes

No

Not sure


[ASK ALL] [SINGLE CODE]

C3. Have you had any of the following symptoms in the last 3 months (Select one for each)??


[RANDOMIZE]

[ROWS]

  • Trouble having a bowel movement (straining) during at least 25% of bowel movements

  • Lumpy or hard stools in at least 25% of bowel movements

  • A sense that everything didn’t come out for at least 25% of bowel movements

  • Sensation of blockage for at least 25% of bowel movements

  • Needing help to have at least 25% of bowel movements (e.g., use of finger to assist, using hands to support rectal or vaginal muscles)

  • Fewer than three bowel movements per week


[COLUMNS]

Yes

No

Not sure



[PROGRAMMER: ELIGIBILITY FOR SURVEY

IF C1=”DIABETES” AND S1=”MALE”, THEN DIABETES-FLAG=1

IF C1 DOES NOT =”DIABETES” AND S1=”MALE” OR “FEMALE”, THEN DIABETES-FLAG=0


IF C1=”DIABETES” AND S1=”FEMALE” AND C2=YES, THEN DIABETES-FLAG=1

IF C1=”DIABETES” AND S1=”FEMALE” AND C2=NO OR NOT SURE, THEN DIABETES-FLAG=0


IF C1=”CONSTIPATION” OR TWO ITEMS=YES @C3, THEN CONSTIPATION-FLAG=1

IF C1 DOES NOT = “CONSTIPATION” OR LESS THAN TWO ITEMS=YES @C3, THEN CONSTIPATION-FLAG=0]



[PROGRAMMER: FILTERING INTO QUOTA CONDITION

IF DIABETES-FLAG=1 AND CONSTIPATION_FLAG=0, THEN QUOTA CONDITION=DIABETES


IF DIABETES-FLAG=0 AND CONSTIPATION_FLAG=1, THEN QUOTA CONDITION=CONSTIPATION


IF DIABETES-FLAG=1 AND CONSTIPATION_FLAG=1 AND BOTH CONDITIONS ARE OPEN, RANDOMLY ASSIGN QUOTA CONDITION


IF DIABETES-FLAG=1 AND CONSTIPATION_FLAG=1 AND ONE CONDITION IS CLOSE, ASSIGN TO OPEN CONDITION]





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CLASSIFIED INTERNAL USE

Classified - Internal use

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