Rapid Message Testing with Consumer Panel - Public Service Announcement Video about Generic Drugs

Data to Support Drug Product Communications as Used by the FDA

0695 FDA RAPID_MSG3_Blue PSA Video_Screener

Rapid Message Testing with Consumer Panel - Public Service Announcement Video about Generic Drugs

OMB: 0910-0695

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FDA RAPID – MESSAGE #3

Generic Drugs Blue PSA Video

Recruiting Screener



Introduction

The U.S. Food and Drug Administration, or FDA, hired Westat to help them get opinions about health information. Research Now is helping Westat and FDA find people who may be interested in being interviewed about health information. To make sure you are a good fit for the interview, please take about 3 minutes to answer the questions below.

1. Do you regularly take any prescription drugs to treat a health condition?

YES

NO INELIGIBLE

Don’t Know INELIGIBLE

2. What is your gender?

  1. Female

  2. Male

3. What is your age?

  1. Under 18 INELIGIBLE

  2. 18 to 30

  3. 31 to 49

  4. 50 to 59

  5. 60 or older

4. What is the highest grade or level of education you have completed?

  1. Less than High School

  2. High School Diploma or GED

  3. Some College, including Associate’s Degree INELIGIBLE

  4. Bachelor’s Degree (for example: BA, BS) INELIGIBLE

  5. Graduate or Professional Degree INELIGIBLE

5. Are you of Hispanic, Latino, or Spanish origin?

YES

NO

6. What is your race? Please select one or more.

White

Black or African-American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander



7. What state do you live in? [DROP DOWN LIST OF US STATES, INCLUDING “OUTSIDE OF THE US”] [“OUTSIDE OF THE US” INELIGIBLE]



8. What is your yearly household income?

$24,999 or less

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999 INELIGIBLE

$100,000 to $149,999 INELIGIBLE

$150,000 to $199,999 INELIGIBLE

$200,000 or more INELIGIBLE





Request for Contact Information

C1. Thank you for answering the questions. Based on your answers, you may be chosen for an interview. If you are chosen for the interview and you finish it, you will get $35 E-Rewards Currency. At the start of the interview, the interviewer will ask if it’s okay to audio record it. This helps Westat to make sure they hear everything you say correctly. If you are chosen for an interview, you will get an email with a link to a YouTube video. Make sure you can access your email account and watch a YouTube video during the interview. Is it okay with you for Research Now to share your contact information with Westat?


YES

NO INELIGIBLE

Thank and Terminate

Thank you for taking our survey.

Contact Information

C2. In the space below, please give us the best information to contact you by phone, email, and regular mail. Please know that Research Now and Westat will not share your information with anyone else.

Contact Information



Name ______________________________________________________________________



Address 1 ___________________________________________________________________



Address 2 ___________________________________________________________________



City, State, ZIP _______________________________________________________________



Phone Number _______________________________________________________________



Email Address________________________________________________________________



Available Times

C3. Someone from Westat will call or email in the next 1-2 days to schedule an interview with you. Please mark the times you can be reached by phone in the next 1-2 days.

9 a.m. to Noon

Noon to 2 p.m.

2 p.m. to 5 p.m.

5 p.m. to 7 p.m.

7 p.m. to 9 p.m.


Technology Preferences

C4. The Westat interviewer would like to be able to show you information on her computer screen during the interview. Westat will send directions for how to view the interviewer’s screen. Which app do you prefer for screen sharing? [SINGLE SELECT]

  1. Skype

  2. Google Hangouts

  3. WebEx

  4. I am not able to use any of these, please just call me



Closing

Thank you for your answers to these questions. If you are chosen for an interview, someone from Westat will contact you with the next 1-2 days.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWeinberg, Jessica
File Modified0000-00-00
File Created2021-01-21

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