Number to Complete the Screener

APPENDIX E

Screener

Eligibility Criteria

• Participants must be age 18 and over.

• Participants must have had symptoms of heartburn or acid reflux disease in the last three months.

• Participants must be able to read, understand, and speak English.

• Participants must not be healthcare professionals.

• Participants must not work for a pharmaceutical company, an advertising agency, or a market research company.

• Recruitment targets for each of the following demographic characteristics will be established using 2007 NHIS data as a basis: age, sex, race, and ethnicity. Recruitment will continue until quotas have been met or the end of the study period.

• Each interview will last approximately 20 minutes.

Screening Questions

Q1. Are you at least 18 years old?

1. YES

2. NO  eliminate [Closing for Ineligible Participants]

Q2. Have you had symptoms of heartburn or acid reflux disease in the last three months?

• Yes  continue to question 7

• No  eliminate [Closing for Ineligible Participants]

Q3. Are you trained or employed as a health care professional?

• Yes  eliminate [Closing for Ineligible Participants]

• No  continue

Q4. Do you work for a pharmaceutical company, an advertising agency, or a market research company?

• Yes  eliminate [Closing for Ineligible Participants]

• No  continue

Q5. Can you read, understand, and speak English?

• Yes  continue

• No  eliminate [Closing for Ineligible Participants]

Demographic Questions

Q1. Gender

• Male

• Female

Q2. What is your date of birth?

_____month [pull down menu]

_____year [pull down menu]

Q3. What is the highest level of school you have completed or the highest degree you have received?

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)

Q4. Are you Hispanic or Latino?

􀂉 No

􀂉 Yes

Q5. What is your race? You may select one or more races.

􀂉 American Indian or Alaska Native

􀂉 Asian

􀂉 Black or African American

􀂉 Native Hawaiian or other Pacific Islander

􀂉 White

􀂉 Some Other Race

Closing for Ineligible Participants:

I’m sorry, but you are not eligible for this study. There are many possible reasons why people are not eligible. These reasons were decided earlier by the researchers. However, thank you for your interest in this study and for taking the time to answer our questions today.