December 8, 2014
Questionnaire
Programming instructions are indicated in green font.
Notes to research team are indicated in red font.
[PROGRAMMER:
• Program progresses to the questioning in a “one-way” manner
• Record time in milliseconds spent on screen 1, screen 3, and screen 4. Record the start and end time for the total survey in seconds.
[PROGRAMMER: The OMB control number and Expiration Date should appear at the bottom of every screen (maybe above the privacy text). It should be as unobtrusive as possible.
After the first screen (Consent Screen 1), we show:
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. OMB Control #_0910-xxxx__ Expires xx/xx/xx
For every other screen we will show: OMB Control #_0910-xxxx____ Expires xx/xx/xx___]
PROG:
(CUSTOM TERMINATION) For
terminated 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. Thank you for your interest in this study and for taking the time to answer our questions today.
[Consent Screen 1]
You are being asked to participate in a survey about a new consumer product. If you agree to take part in this research, you will be asked to watch a TV ad and to answer some questions about the ad. The study will take about 30 minutes.
[Insert language about panel points/rewards]
[Insert language about panel privacy policy]
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.
OMB Control #0910-xxxx____ Expires xx/xx/xx_____
[PROGRAMMER: Screen 1. TIME SPENT ON SCREEN IN MILLISECONDS]
[Next Page: Screen 2]
SCREENING QUESTIONS
S1. Are you at least 18 years old?
Yes continue
No terminate and show custom termination screen
S2. In what year were you born? ______
If Year is < or = 1996 [continue]
If Year is > 1996 [terminate and show custom termination screen]
S3a. Have you been diagnosed by a physician for any of the following conditions?
a. Asthma _____Yes _____No
b. Diabetes _____Yes _____No
c. Insomnia _____Yes _____No [If checked, go to S3b.1]
d. High cholesterol _____Yes _____No [If checked, go to S3b.2]
e. Acid reflux or GERD _____Yes _____No
f. Depression _____Yes _____No [If checked, go to S3b.3]
[PROGRAMMER: if Respondents check more than one condition, assign them to the lowest prevalence condition first. The prevalence order is depression < insomnia < high cholesterol]
S3b. Are your currently taking a prescription drug to treat your … ?
Yes No |
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1.Insomnia |
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2.High Cholesterol |
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3.Depression |
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S4. Are you trained or employed as a health care professional?
Yes terminate and show custom termination screen
No continue
S5. Do you work for a pharmaceutical company, an advertising agency, or a market research company?
Yes terminate and show custom termination screen
No continue
[Next page: Screen 3]
[SCRIPT] Thank you for agreeing to participate in this study today.
Make sure you are comfortable and can read the screen from where you sit. This study is about advertising for prescription medication. Your answers are private and will not be connected with your name. Your input is extremely valuable.
Let’s begin.
We will ask you questions about the ad after you have finished watching it. Do your best to remember details about the ad. We will ask you to explain your answers. Make sure your computer sound is turned on and set at a comfortable volume.
[PROGRAMMER: Screen 3. TIME SPENT ON EACH SCREEN IN MILLISECONDS]
[Next page: Screen 4]
[SCRIPT] Please click the link below to view the ad. It may take a minute or two for the video to begin. You should be able to see and hear the video when it begins to play.
[PROGRAMMER: Randomize order of clutter reel]
[PROGRAMMER: Screen 4. TIME SPENT ON EACH SCREEN IN MILLISECONDS]
[Next page: Screen 5]
[SCRIPT] Please answer the following questions based on the ad you saw.
Q1. Were you able to view the entire ad for [DRUG]?
Yes
No [Skip back to ad]
Not sure [Skip back to ad]
[PROGRAMMER: If Q1a=No or Not sure, replay just the prescription drug ad. If, after this, they still say No or Not sure to Q1a, then terminate.]
Q2a. Have you seen this exact ad before?
Yes [Go to Q2b]
No [Continue to Q2c]
Not sure [Continue to Q2c]
Q2b. In the last 6 months, how often did you see this exact ad before?
Never
Rarely
Sometimes
Often
Very often
Q2c. Have you seen other ads for this product before?
Yes
No
Not sure
Q3. Please list the thoughts that were going through your mind as you viewed the ad for [DRUG] and list them below. Use one line for each thought.
[PROGRAMMER: Five separate text boxes]
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[Next page: Screen 6]
Q4. What condition does [DRUG] treat? [PROGRAMMER: randomize responses]
Seasonal allergies
Insomnia
Migraine headaches
High Cholesterol
Diabetes
Acid Reflux/GERD
Depression
Don't know
Q5. What are the benefits of [DRUG]? Use one line for each benefit you list. [Open-ended]
[PROGRAMMER: Provide separate text boxes. The exact number of lines TBD]
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Q6. What are the risks and side effects of [DRUG]? Use one line for each risk or side effect you list. [Open-ended]
[PROGRAMMER: Provide separate text boxes. The exact number of lines TBD]
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[Next page: Screen 7]
[PROGRAMMER: MATCH VERSION OF Q7 TO DISEASE AD SHOWN]
(Memory for benefits and risks)
Q7_1. Based on the information in the ad, please check which of the following are benefits or risks of taking [DRUG]. [Depression version]
[PROGRAMMER: randomize a-l]
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Yes |
No |
a. |
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b. |
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c. |
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d. |
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Q7_2. Based on the information in the ad, please check which of the following are benefits or risks of taking [DRUG]. [Insomnia version]
[PROGRAMMER: randomize a-k]
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Yes |
No |
a. |
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b. |
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c. |
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Q7_3. Based on the information in the ad, please check which of the following are benefits or risks of taking [DRUG]. [High cholesterol version]
[PROGRAMMER: randomize a-l]
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Yes |
No |
a. |
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b. |
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[Next page: Screen 8]
[PROGRAMMER: Randomize presentation order of the questions on screen 8]
(Perceived Benefit)
[SCRIPT] Please answer the following questions based on your impressions from the ad. Even though the ad didn’t tell you, please provide your best guess for the following questions
Q8. In your opinion, if 100 people take [DRUG], how many of the 100 would benefit from taking the drug?
[PROGRAMMER: Participants can slide an arrow to their answer.]
Q9. In your opinion, if [DRUG] did help a person’s [condition], how much would it help?
1 |
2 |
3 |
4 |
5 |
Would help [condition] a little |
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Would help [condition] a lot |
(Perceived Risk)
Q10. In your opinion, if 100 people take [DRUG], how many of the 100 would have any side effects?
[PROGRAMMER: Participants can slide an arrow to their answer.]
Q11. In your opinion, if [DRUG] did cause a person with [condition] to have side effects, how serious would they be?
1 |
2 |
3 |
4 |
5 |
Not at all serious |
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Very serious |
(Risk/benefit tradeoff)
Q12. Thinking overall about the risks and benefits of [DRUG], would you say it has:
1 |
2 |
3 |
4 |
5 |
Many more risks than benefits |
Somewhat more risks than benefits |
Equal risks and benefits |
Somewhat more benefits than risks |
Many more benefits than risks |
(Perceptions of risk statement)
[PROGRAMMER: Randomize order of Q13a-g.]
Q13. Please rate your agreement or disagreement with each of the following statements.
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Strongly disagree |
Somewhat disagree |
Neither disagree nor agree |
Somewhat agree |
Strongly agree |
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Q14. In my opinion, the prescription drug ad mentioned….
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Not enough risks and side effects |
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Too many risks and side effects |
Q15a. To what extent do you agree or disagree that the risks and side effects were:
[PROGRAMMER: Randomize order of Q15a.a-e.]
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Strongly disagree |
Somewhat disagree |
Neither disagree nor agree |
Somewhat agree |
Strongly agree |
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Q16a. Overall, the risks and side effects mentioned in the prescription drug ad were….
1 |
2 |
3 |
4 |
5 |
Not at all serious |
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Very serious |
Q16b. In your opinion, how serious are the following risks?
[PROGRAMMER: Randomize order of Q16b.a-f.]
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Not at all serious |
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Very serious |
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Q16c. In your opinion, how actionable are the following risks? We define ‘actionable’ as a symptom you would know you are at risk for (e.g., because of pre-existing condition or allergy) or recognize (e.g., because it is an observable physical or mental system) and can act upon to help lessen the risk (e.g., get immediate medical help to prevent a bad outcome).
[PROGRAMMER: Randomize order of Q16c.a-f.]
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Not at all actionable |
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Very actionable |
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Q16d. How likely is it that you would experience any of the following risks or side effects if you took [DRUG]?
[PROGRAMMER: Randomize order of Q16d.a-f.]
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Not at likely |
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Very likely |
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[Next page: Screen 9]
(Information seeking/intention items)
Q17. I am interested in trying [DRUG].
1 |
2 |
3 |
4 |
5 |
Strongly disagree |
Somewhat disagree |
Neither agree nor disagree
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Somewhat agree |
Strongly agree |
[PROGRAMMER: counterbalance 18/19 and 20/21]
Q18. How likely are you to talk to your doctor about [DRUG]?
1 |
2 |
3 |
4 |
5 |
Very unlikely |
Somewhat unlikely |
Neither likely nor unlikely |
Somewhat likely |
Very likely |
Q19. How likely are you to read the patient labeling for more information about [DRUG]?
1 |
2 |
3 |
4 |
5 |
Very unlikely |
Somewhat unlikely |
Neither likely nor unlikely |
Somewhat likely |
Very likely |
Q20. How likely are you to look for more information about [DRUG]?
1 |
2 |
3 |
4 |
5 |
Very unlikely |
Somewhat unlikely |
Neither likely nor unlikely |
Somewhat likely |
Very likely |
Q21. How likely are you to look for more information about [condition]?
1 |
2 |
3 |
4 |
5 |
Very unlikely |
Somewhat unlikely |
Neither likely nor unlikely |
Somewhat likely |
Very likely |
Q22. If one of your family members or close friends had [condition], how likely would you be to mention [DRUG] to them?
1 |
2 |
3 |
4 |
5 |
Very unlikely |
Somewhat unlikely |
Neither likely nor unlikely |
Somewhat likely |
Very likely |
[Next page: Screen 10]
[PROGRAMMER: Rotate order of Q22/Q22a and Q23/Q23a]
(Perceived Comparative Benefit and Risk)
[SCRIPT] For the next two questions, please think about other medicines you know of that treat [condition]. If you are not aware of other medicines that treat [condition], please choose the answer option “Neither disagree nor agree.”
When answering these questions, please base your impressions on the prescription drug ad you saw.
Q23. [DRUG] is more effective than other medicines that treat [condition].
Strongly disagree
Somewhat disagree
Neither disagree nor agree
Somewhat agree
Strongly agree
Q23a. What other medicines were you thinking about?
[PROGRAMMER: Add fill space for write-ins]
Q24. [DRUG] is safer than other medicines that treat [condition].
Strongly disagree
Somewhat disagree
Neither disagree nor agree
Somewhat agree
Strongly agree
Q24a. What other medicines were you thinking about?
[PROGRAMMER: Add fill space for write-ins]
Q25. Based on the information in the prescription drug ad, how would you rate the quality of [DRUG]?
1 |
2 |
3 |
4 |
5 |
Poor quality |
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Good quality |
[PROGRAMMER: Randomize order of Q25a-d]
(Attitude toward Ad. From Bhutada et al., 2009, Shen & Chen, 2007, and MacKenzie & Lutz, 1989)
Q26. In my opinion, the ad for [DRUG] was:
a. 1 2 3 4 5
Good Bad
b. 1 2 3 4 5
Pleasant Unpleasant
c. 1 2 3 4 5
Favorable Unfavorable
d. 1 2 3 4 5
Very Not at all
persuasive persuasive
(Self-reported attention)
Q27. How much attention did you pay to the prescription drug ad when you were watching it?
1 |
2 |
3 |
4 |
5 |
A little |
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A lot |
[Next page: Screen 11]
(Manipulation Checks)
Q28. Do you remember the prescription drug ad saying “This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information.”?
Yes
No
Not sure
[PROGRAMMER: If “no” or “not sure” add to script “This ad did say that “This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information.”]
[SCRIPT] Now we will show you the ad again. This ad said “This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information.” When answering the next few questions, please think only about that statement.
[PROGRAMMER: Play prescription drug ad again for all conditions EXCEPT the Control conditions. For control condition, skip to Q30]
[Next page: Screen 12]
(Inferences about Statement)
Q29a. In your own words, list all your thoughts, reactions and ideas that went through your mind when the statement, “This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information.” was presented. Please use a separate line for each thought.
[PROGRAMMER: Five separate text boxes]
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Q29b. For each of the thoughts, reactions and ideas you listed, indicate whether the thought was positive, negative or neutral.
[PROGRAMMER: Display responses from Q28a. For each response, include a drop-down choice box or other appropriate choice box with the choices POSITIVE, NEGATIVE, NEUTRAL]
You said… |
Is it… |
[insert each response from Q27a above in a separate box] |
POSITIVE NEGATIVE NEUTRAL |
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(Peripheral Cue)
Q30. To what extent do you agree or disagree that the statement about the list of risks and side effects (“This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information”) was:
[PROGRAMMER: Randomize order of Q30a-f.]
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Strongly disagree |
Somewhat disagree |
Neither agree nor disagree |
Somewhat agree |
Strongly agree |
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[Next page: Screen 13]
(FDA Perceptions/Knowledge)
Q31. Please rate your agreement or disagreement with each of the following statements.
[PROGRAMMER: Randomize order of Q31a-h]
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Strongly disagree |
Somewhat disagree |
Neither disagree nor agree |
Somewhat agree |
Strongly agree |
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[Next page: Screen 14]
[SCRIPT] Now we will ask a few questions to help us describe our sample of participants.
(Subjective Health Literacy)
Q32. 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?
1 |
2 |
3 |
4 |
5 |
Never |
Occasionally |
Sometimes |
Often |
Always |
Q33. How confident are you filling out medical forms by yourself?
1 |
2 |
3 |
4 |
5 |
Not at all confident |
A little bit |
Somewhat |
Quite a bit |
Extremely confident |
(Perceived illness knowledge)
Q34. In general, how much do you feel you know about [condition]?
1 |
2 |
3 |
4 |
5 |
Nothing at all |
Only a slight amount |
Some |
A good bit |
A lot |
Q35. In general, how much do you feel you know about treatments for [condition]?
1 |
2 |
3 |
4 |
5 |
Nothing at all |
Only a slight amount |
Some |
A good bit |
A lot |
[PROGRAMMER: If Respondent answered “no” to S3b, SKIP to Q37]
Q36. How long have you been taking prescription drugs for [condition]?
Less than 2 weeks
At least 2 weeks but less than 2 months
At least 2 months but less than 6 months
At least 6 months but less than 1 year
At least 1 year but less than 5 years
At least 5 years
Q37. In what year were you diagnosed with [medical condition]?
_______
Q38. 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.
Yes
No [Skip to Q40]
Don’t Know [Skip to Q40]
Q39. Does your current insurance plan help pay for prescription drugs?
Yes
No
Don’t Know
Q40. What did you use to complete today’s survey?
Desktop computer
Laptop computer
Tablet computer (e.g., Apple iPad, Samsung Galaxy Tab)
Mobile phone or smartphone
Other: ________________
Q41. Are you currently taking [DRUG]?
Yes
No
Don’t Know
[Next page: Screen 15]
(Attitudes toward Disclosures; From Thomas et al., 2013)
[SCRIPT] We would now like to ask you some questions about how you feel about the use of disclosures.
A disclosure qualifies, clarifies, or otherwise limits a specific advertising claim.
Examples of disclosures include:
“Certain rules and restrictions apply”
“Results not typical”
“This is not a full list of risks and side effects. Talk to your doctor and read the patient labeling for more information”
“Past performance is not necessarily indicative for future performances and transactions in financial products (including but not limited to securities, futures, options and other financial instruments) give rise to risks,”
“This statement has not been evaluated by the Food and Drug Administration”
“Prices include all cost to be paid by individual except for taxes, licensing, and registration”.
“Pay no interest for one year. If you transfer a balance from another card, you will be charged a 3% fee.”
Q42. Please indicate your level of agreement with each of the following items.
[PROGRAMMER: Randomize order of Q42a-h]
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Strongly disagree |
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Neither disagree nor agree |
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Strongly agree |
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(R indicates items that need to be reverse coded)
[Next page: Screen 16]
Q43. Would you like to receive the patient labeling for [DRUG] at the end of this survey to learn more about the complete list of risks and side effects?
Yes
No
Q44. What is your gender?
Male
Female
Q45. 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)
Q46. Are you:
Hispanic or Latino
Not Hispanic or Latino
Q47. 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
Q48. What is your household income?
Less than $30,000 per year
$30,001 - $75,000 per year
$75,001 - $150,000 per year
$150,001+ per year
[End time: ___________________ ]
[Next page: Screen 17]
[SCRIPT] The purpose of this research is to learn about consumer reactions to prescription drug advertising. In order to get your realistic reaction to this information, we used a real product; however the prescription drug ad was modified for the purpose of this study. Use of the brand name does not imply endorsement of the product by FDA. Please see your healthcare professional for questions about [condition].
You have been very helpful. Thank you very much for your participation!
[PROGRAMMER: If Respondent chooses “Yes” to Q43, at the end of the survey, after the debriefing, provide a link [or attach a PDF] to the patient labeling for the drug and include the following script: [SCRIPT] You indicated that you would like to receive the patient labeling for [DRUG] at the end of this survey to learn more about the complete list of risks and side effects. In the link below you will find the patient labeling for [DRUG]. Please see your healthcare professional for questions about [condition].
END
OMB Control # _____ Expires _____
File Type | application/msword |
File Title | APPENDIX 2 |
Author | Aikin |
Last Modified By | Mizrachi, Ila |
File Modified | 2014-12-16 |
File Created | 2014-12-16 |