Pretest Survey

1
Pretest and Main Study Survey
>>>>>>>>>>>>>>>
Quick notes:
 Block names are highlighted in yellow
 Notes for programming are highlighted in green
 [Notes for interviewer are in brackets and in blue]
>>>>>>>>>>>>>>>
[AVAILABILITY AND ABILITY TO USE ADEQUATE PROVISION OPTIONS]
INSTRUCTIONS_1
Next, I will ask about how available internet, phone lines, and magazines are to you, as well as your
abilities to use these services.
//NEW SCREEN//
Question Type: Grid
Q1. Would you say each of the following is not available, sometimes available, or always available?
[IF NEEDED, CLARIFY TO PARTICIPANT THAT S/HE CAN SELECT ANY ITEM]
Variable Label: Q1: Level of availability
Variable Name

Variable Text
Variable Label
The internet at home, without Q1_A: Availability: The internet at home without
Q1_A
help from another person
help
//PROGRAMMING NOTE: ASK Q1_A2 ONLY IF Q1_A=1 or 2, OTHERWISE, SKIP TO Q1_B//
The internet at home, with the Q1_A2: Availability: The internet at home with
Q1_A2
help of a family member or friend help
The internet outside of your
Q1_B: Availability: The internet outside home
Q1_B
home, without help from another
without help
person
//PROGRAMMING NOTE: ASK Q1_B2 ONLY IF Q1_B=1 or 2, OTHERWISE, SKIP TO Q1_C//
The internet outside of your
Q1_B2: Availability: The internet outside home
Q1_B2
home, with the help of a family
with help
member or friend
Q1_C
A landline telephone
Q1_C: Availability: A landline telephone
A cellular telephone to make a
Q1_D
Q1_D: Availability: A cellular telephone
phone call
Q1 _E
A magazine advertisement
Q1_E: Availability: A magazine advertisement
Value
01
02
03
-99

Value Label
Not available
Sometimes available
Always available
Refused [DO NOT READ]

//NEW SCREEN//

2

Question Type: Grid
Q2. Next, would you say you have no ability, some ability, or complete ability to:
Variable Label: Q2: Level of ability
Variable Name

Variable Text
Variable Label
Use the internet at home, without Q2_A: Ability: Use the internet at home without
Q2_A
help from another person
help
//PROGRAMMING NOTE: ASK Q2_A2 ONLY IF Q2_A=1 or 2, OTHERWISE, SKIP TO Q2_B//
Use the internet at home, with
Q2_A2: Ability: Use the internet at home with
Q2_A2
the help of a family member or
help
friend
Use the internet outside of your
Q2_B: Ability: Use the internet outside of your
Q2_B
home, without help from another
home without help
person
//PROGRAMMING NOTE: ASK Q2_B2 ONLY IF Q2_B=1 or 2, OTHERWISE, SKIP TO Q2_C//
Use the internet outside of your
Q2_B2: Ability: Use the internet outside of your
Q2_B2
home, with the help of a family
home with help
member or friend
Q2_C
Use a landline telephone
Q2_C: Ability: Use a landline telephone
Use a cellular telephone to make
Q2_D
Q2_D: Ability: Use a cellular telephone
a phone call
Q2 _E
Read a magazine advertisement
Q2_E: Ability: Read a magazine advertisement
Value
01
02
03
-99

Value Label
No ability
Some ability
Complete ability
Refused [DO NOT READ]

//NEW SCREEN//
[PREFERENCE FOR AND EXPERIENCE USING ADEQUATE PROVISION OPTIONS]
INSTRUCTIONS_2
Next, I will specifically ask about how you like to get information about prescription drugs. I will also
ask about your experiences getting this information.
Prescription drugs advertised on television provide only limited product information. For example, not
all of the product’s risks and side effects are described. Imagine you wanted to obtain additional
product information before seeing your health care provider.
//NEW SCREEN//
Question Type: Grid
Q3. Would you say you are very unlikely, somewhat unlikely, neutral, somewhat likely, or very likely to
use:
Variable Label: Q3: Likeliness to use

3
//PROGRAMMING NOTE: RANDOMIZE Q3_A–Q3_C//
Variable Name

Variable Text
Variable Label
The company’s web page for the
Q3_A: Likeliness to use: The company’s web
Q3_A
drug, without help from another
page for the drug without help
person
//PROGRAMMING NOTE: ASK Q3_A2 ONLY IF Q3_A=1 or 2, OTHERWISE, SKIP Q3_A2.
The company’s web page for the
Q3_A2: Likeliness to use: The company’s web
Q3_A2
drug, with the help of a family
page for the drug with help
member or friend
A
toll-free
phone
number Q3_B: Likeliness to use: A toll-free phone
Q3_B
maintained by the drug company number maintained by the drug company
A print ad that appears in a Q3_C: Likeliness to use: A print ad that
Q3_C
magazine on most newsstands
appears in a magazine on most newsstands
Value
01
02
03
04
05
-99

Value Label
Very unlikely
Somewhat unlikely
Neutral
Somewhat likely
Very likely
Refused [DO NOT READ]

//NEW SCREEN//
//PROGRAMMING NOTE: MAINTAIN ORDER USED IN Q3_A–C//
Question Type: Grid
Q4. I am going to read you a list of different sources for information. Please tell me whether you have
ever used any of the following sources to obtain additional information about a prescription drug
after seeing it advertised on television. Have you ever [INSERT ITEM] after seeing a prescription drug
advertised on television?
Variable Label: Q4: Looked for additional information in the past using this source
Variable Name
Variable Text
Variable Label
Q4_A
Used the company’s web page for Q4_A: Used source for information: The
the drug, without help from company’s web page for the drug without help
another person
//PROGRAMMING NOTE: ASK Q4_A2 ONLY IF Q4_A=0 or -99
Q4_A2
Used the company’s web page for Q4_A2: Used source for information: The
the drug, with the help of a family company’s web page for the drug with help
member or friend
Q4_B
Used the toll-free phone number Q4_B: Used source for information: A toll-free
maintained by the drug company number maintained by the drug company
Q4_C
Looked at a print ad that appears Q4_C: Used source for information: A print ad
in a magazine on most that appears in a magazine on most
newsstands
newsstands

4
Value
00
01
-99

Value Label
No
Yes
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Grid
Q5. If print ads were not available and you wanted to obtain additional product information about a
prescription drug, would you use:
Variable Label: Q5: Would use source to look for additional product information about prescription
drug?
//PROGRAMMING NOTE: MAINTAIN ORDER USED IN Q3_A-C//
Variable Name

Variable Text
Variable Label
The company’s web page for the
Q5_A: Would use source for information: The
Q5_A
drug, without help from another
company’s web page for the drug without help
person
//PROGRAMMING NOTE: ASK Q5_A2 ONLY IF Q5_A=0 or -99
The company’s web page for the
Q5_A2: Would use source for information: The
Q5_A2
drug, with the help of a family
company’s web page for the drug with help
member or friend
A
toll-free
phone
number Q5_B: Would use source for information: A tollQ5_B
maintained by the drug company free number maintained by the drug company
Q5_C: Would use source for information: Some
Q5_C
Some other source [open-end]
other source
//PROGRAMMING NOTE: SKIP Q5_D IF PARTICIPANT RESPONDS 1 TO ANY OF Q5_A – Q5C

Or, would you not get the
information if print ads were Q5_D: Would not use source of information
not available?

Q5_D

Value
00
01
-98
-99

Value Label
No
Yes
Don’t know [DO NOT READ]
Refused [DO NOT READ]

//PROGRAMMING NOTE: ALLOW TEXT ENTRY FOR QUESTION Q5_D//
//NEW SCREEN//
[ABILITY AND WILLINGNESS TO USE ADEQUATE PROVISION OPTIONS]
INSTRUCTIONS_3
Next, I will ask about your ability and willingness to use various sources to obtain full product
information about a prescription drug. For the purposes of these questions, please imagine that you
have an active interest in a specific prescription drug product.

5

//NEW SCREEN//
//PROGRAMMING NOTE: RANDOMIZE PRESENTATION OF Q6 – Q11 BY PARTICIPANT, BUT KEEP
ABILITY AND WILLINGNESS IN SAME ORDER FOR EACH PARTICIPANT//
Question Type: Single Punch
Q6. Would you say you are not able, somewhat able, or completely able to obtain the full product
information for a prescription drug without anyone’s help by using: The company’s web page for a
drug?
Variable Label: Q6: Ability to obtain full product information without help using the company’s web
page
Value
01
02
03
-99

Value Label
Not able
Somewhat able
Completely able
Refused [DO NOT READ]

//PROGRAMMING NOTE: SKIP Q6_2 IF Q6>2//
Question Type: Single Punch
Q6_2. Would you say you are not able, somewhat able, or completely able to obtain the full product
information for a prescription drug with the help from a family member or a friend by using: The
company’s web page for the drug.
Variable Label: Q6_2: Ability to obtain full product information with help using the company’s web
page
Value
01
02
03
-99

Value Label
Not able
Somewhat able
Completely able
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q7. Would you say you are unwilling, somewhat willing, or completely willing to obtain the full product
information for a prescription drug without anyone’s help by using: The company’s web page for the
drug.
Variable Label: Q7: Willingness to obtain full product information without help using the company’s
web page
Value
01
02
05
-99

Value Label
Unwilling
Somewhat willing
Completely willing
Refused [DO NOT READ]

//PROGRAMMING NOTE: SKIP Q7_2 IF Q7>2//

6

Question Type: Single Punch
Q7_2. Would you say you are unwilling, somewhat willing, or completely willing to obtain the full
product information for a prescription drug with the help of a family member or friend by using: The
company’s web page for the drug.
Variable Label: Q7_2: Willingness to obtain full product information with help using the company’s
web page
Value
01
02
03
-99

Value Label
Unwilling
Somewhat willing
Completely willing
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q8. Would you say you are not able, somewhat able, or completely able to obtain the full product
information for a prescription drug using: A toll-free phone number maintained by the drug company.
Variable Label: Q8: Ability to obtain full product information using toll-free phone number
Value
01
02
03
-99

Value Label
Not able
Somewhat able
Completely able
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q9. Would you say you are unwilling, somewhat willing, or completely willing to obtain the full product
information for a prescription drug without anyone’s help by using: A toll-free phone number
maintained by the drug company.
Variable Label: Q9: Willingness to obtain full product information using toll-free phone number
Value
01
02
03
-99

Value Label
Unwilling
Somewhat willing
Completely willing
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q10. Would you say you are not able, somewhat able, or completely able to obtain the full product
information for a prescription drug by using: A print ad that appears in a magazine on most
newsstands.
Variable Label: Q10: Ability to obtain full product information using magazine

7
Value
01
02
03
-99

Value Label
Not able
Somewhat able
Completely able
Refused [DO NOT READ]

//PROGRAMMING NOTE: Q10_2 AND Q10_3 ONLY FOR SPANISH SPEAKING PARTICIPANTS//
Q10_2. Would your response be different if the advertisement in the magazine was in Spanish?
Variable Label: Q10_2: Ability response change for Spanish
Value
00
01
-99

Value Label
No
Yes
Refused [DO NOT READ]

//PROGRAMMING NOTE: IF Q10_2=1 GO TO Q10_3. OTHERWISE GO TO Q11//
Q10_3. Would you say you are not able, somewhat able, or completely able to obtain the full product
information for a prescription drug by using: A print ad written in Spanish that appears in a magazine
on most newsstands.
Variable Label: Q10_3: Ability to obtain full product information using Spanish magazine
Value
01
02
03
-99

Value Label
Not able
Somewhat able
Completely able
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q11. Would you say you are unwilling, somewhat willing, or completely willing to obtain the full
product information for a prescription drug by using: A print ad that appears in a magazine on most
newsstands.
Variable Label: Q11: Willingness to obtain full product information magazine
Value
01
02
05
-99

Value Label
Unwilling
Somewhat willing
Completely willing
Refused [DO NOT READ]

//PROGRAMMING NOTE: Q11_2 AND Q11_3 ONLY FOR SPANISH SPEAKING PARTICIPANTS//
Question Type: Single Punch
Q11_2. Would your response be different if the advertisement in the magazine was in Spanish?
Variable Label: Q11_2: Willingness response change for Spanish

8
Value
00
01
-99

Value Label
No
Yes
Refused [DO NOT READ]

//PROGRAMMING NOTE: IF Q11_2=1 GO TO Q11_3, OTHERWISE GO TO Q12//
Question Type: Single Punch
Q11_3. Would you say you are unwilling, somewhat willing, or completely willing to obtain the full
product information for a prescription drug by using: A print ad written in Spanish that appears in a
magazine on most newsstands.
Variable Label: Q11_3: Willingness to obtain full product information using Spanish magazine
Value
01
02
05
-99

Value Label
Unwilling
Somewhat willing
Completely willing
Refused [DO NOT READ]

//NEW SCREEN//
[PRIVACY CONCERNS]
INSTRUCTIONS_4
Next, I will ask about privacy concerns you might have when getting full prescription drug product
information.
//NEW SCREEN//
Question Type: Single Punch
Q12. How much value do you place on privacy when seeking information about a prescription drug
you are considering taking: very low, low, neutral, high, or very high?
Variable Label: Q12: Value privacy when seeking information about prescription drug considering
taking
Value
01
02
03
04
05
-99

Value Label
Very low
Low
Neutral
High
Very high
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Grid
Q13. If privacy were a concern for you when getting full prescription drug product information, would
you say you are very unlikely, somewhat unlikely, neutral, somewhat likely, or extremely likely to use:

9
Variable Label: Q13: Likeliness to use source when privacy is a concern
//PROGRAMMING NOTE: MAINTAIN ORDER USED IN Q3_A – C//
Variable Name

Variable Text
Variable Label
The company’s web page for the Q13_A: Likeliness to use source when privacy
Q13_A
drug, without help from another is a concern: The company’s web page without
person
help
//PROGRAMMING NOTE: ASK Q13_A2 ONLY IF Q13_A<3
The company’s web page for the Q13_A2: Likeliness to use source when privacy
Q13_A2
drug, with help of a family is a concern: The company’s web page with
member or friend
help
A
toll-free
phone
number Q13_B: Likeliness to use source when privacy
Q13_B
maintained by the drug company is a concern: A toll-free number
A print ad that appears in a Q13_C: Likeliness to use source when privacy
Q13_C
magazine on most newsstands
is a concern: A print ad in a magazine
Value
01
02
03
04
05
-99

Value Label
Very unlikely
Somewhat unlikely
Neutral
Somewhat likely
Very likely
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q14. In the case that privacy were to be a concern for you and you were to call the toll-free phone
number to get the full prescription drug product information, which way would you prefer to receive
the information: [READ OPTIONS ONE TWO AND THREE]
Variable Label: Q14: Preference to receive product information when using toll-free phone number
and privacy is a concern
Value
01
02
03
-99

Value Label
A customer service agent to read the
information to you [OR]
The information be communicated through a
pre-recorded message [OR]
Request the information to be sent by mail
Refused [DO NOT READ]

//NEW SCREEN//
[OTHER QUESTIONS OF INTEREST]
INSTRUCTIONS_5

10
Next, I will ask about general topics pertaining to prescription drugs and their risks and side effects.
//NEW SCREEN//
Question Type: Single Punch
Q15. When you are considering taking a new prescription drug, would you say it is very unimportant,
somewhat unimportant, neutral, somewhat important, or very important to you to have access to
complete prescription drug product information?
Variable Label: Q15: Importance of access to complete prescription-drug information
Value
01
02
03
04
05
-99

Value Label
Very unimportant
Somewhat unimportant
Neutral
Somewhat important
Very important
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q17. Have you ever had a serious side effect from a prescription drug?
Variable Label: Q17: Had a serious side effect from a prescription drug
Value
00
01
-98
-99

Value Label
No
Yes
Don’t know [DO NOT READ]
Refused [DO NOT READ]

[EXPERIMENTAL MANIPULATIONS]
INSTRUCTIONS_6
Next, I am going to present a brief summary of risks and side effects for a prescription drug product.
Afterwards, I will ask for your opinion on the message of the prescription drug.
//NEW SCREEN//
//PROGRAMMING NOTE: PLEASE MERGE ONE E1 “OPENING STATEMENT” WITH E2
E1. OPENING STATEMENTS:
1. Desyflux can cause severe, life threatening reactions. These include…
2. Desyflux can cause serious reactions. These include…
3. Desyflux can cause reactions. These include…
E2. MAJOR STATEMENT:
A. …sleep walking and other activities, changes in behavior or mood, and allergic reactions. Get
medical help right away if you experience symptoms of an allergic reaction. Desyflux can

11
increase the risk of suicide in people who are depressed. Only take Desyflux if you have
seven to eight hours to sleep. Do not drive or operate heavy machinery until you are fully
awake. This is not a full list of risks and side effects. Talk to your doctor and read the patient
labeling for more information.
//NEW SCREEN//
Question Type: Single Punch
Q_E1. Would you say you are very unlikely, somewhat unlikely, neutral, somewhat likely, or very likely
to experience at least one side effect if you took Desyflux?
Variable Label: Q_E1: Risk-likelihood
Value
01
02
03
04
05
-99

Value Label
Very unlikely
Somewhat unlikely
Neutral
Somewhat likely
Very likely
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q_E2. Would you say Desyflux’s side effects are definitely not serious, probably not serious, neutral,
probably serious, or definitely serious?
Variable Label: Q_E2: Risk-magnitude
Value
01
02
03
04
05
-99

Value Label
Definitely not serious
Probably not serious
Neutral
Probably serious
Definitely serious
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Single Punch
Q_E3. Would you say Desyflux’s side effects would be short lived, somewhat short lived, neutral,
somewhat long lasting, or long lasting?
Variable Label: Q_E3: Risk-duration
Value
01
02
03
04
05

Value Label
Short lived
Somewhat short lived
Neutral
Somewhat long lasting
Long lasting

12
-99

Refused [DO NOT READ]

//NEW SCREEN//
[ADDITIONAL DEMOGRAPHIC ITEMS]
Question Type: Single Punch
GENDER. What is your gender?
Variable Label: Gender
Value
01
02
03
-98

Value Label
Male
Female
Other _______ [SPECIFY ANSWER IF PARTICIPANT PROVIDES ANSWER]
Don’t know [DO NOT READ]

Question Type: Single Punch
EDU. What is the highest level of education you have completed? [DO NOT READ LIST]
Variable Label: Education
[ENTER CODE 03-HS GRADUATE IF RESPONDENT COMPLETED VOCATIONAL, BUSINESS, TECHNICAL,
OR TRAINING COURSES AFTER HIGH SCHOOL THAT DID NOT COUNT TOWARD AN ASSOCIATE
DEGREE FROM A COLLEGE, COMMUNITY COLLEGE, OR UNIVERSITY (E.G., TRAINING FOR A
CERTIFICATE OR AN APPRENTICESHIP)]
Value
01
02
03
04
05
06
-99

Value Label
Less than high school
High school graduate [High school diploma or GED]
Some college but no degree
Associate degree [2-year]
Bachelor’s degree [4-year; BA, BS]
Advanced or postgraduate degree [MA, MD, DDS, JD, PhD, EdD]
Refused [DO NOT READ]

//NEW SCREEN//
Question Type: Multi Punch
RACE. What is your race? [ALLOW PARTICIPANT TO SELECT ALL THAT APPLY]
[IF RESPONDENT SAYS “HISPANIC” ASK, “Do you consider yourself a White Hispanic or a Black
Hispanic?] [CODE AS “BLACK OR AFRICAN AMERICAN” (03) OR “WHITE” (05)] [IF RESPONDENT
REFUSES TO PICK WHITE OR BLACK HISPANIC, RECORD HISPANIC AS “OTHER”]
Variable Label: Race
Value
01
02
03

Value Label
American Indian or Alaska Native
Asian
Black or African American

13
04
05
06
-99

Native Hawaiian and Other Pacific Islander
White
Some other race __________ [SPECIFY]
Refused [DO NOT READ]

//PROGRAMMING NOTE: ALLOW ENTERING TEXT IN RACE WHEN ANSWERING: “SOME OTHER
RACE”//
//NEW SCREEN//
Question Type: Single Punch
ETHNICITY. Are you Hispanic or Latino:
Variable Label: Ethnicity
Value
01
02
-98
-99

Value Label
Hispanic or Latino
Not Hispanic or Latino
Don’t know [DO NOT READ]
Refused [DO NOT READ]

Question Type: Single Punch
STATE. What state do you live in? [INSERT STATE LIST]
Variable Label: State
//PROGRAMMING NOTE: PLEASE INSERT STATE LIST//
//NEW SCREEN//
Question Type: Single Punch
INCOME. Of these income groups, which category best represents your total combined family income
in 2016? [READ LIST]
Variable Label: Income
Value
01
02
03
04
05
06
-98
-99

Value Label
Less than $20,000
$20,000–$39,999
$40,000–$59,999
$60,000–$79,999
$80,000–$99,999
$100,000 or more
Don’t know [DO NOT READ]
Refused [DO NOT READ]

//NEW SCREEN//
[PHONE USE]

14
Question Type: Single Punch
CELLADDITION. [ASK IF LANDLINE SAMPLE] Now, thinking about your cell phone use, does anyone in
your household, including yourself, have a working cell phone? [READ LIST]
Variable Label: Cell addition
Value
01
02
-98
-99

Value Label
Yes, respondent or someone else has cell phone in this household
No
Don’t know [DO NOT READ]
Refused [DO NOT READ]

//PROGRAMMING NOTE: ASK CELLADDITION ONLY IF LANDLINE//
//NEW SCREEN//
Question Type: Single Punch
LANDLINEADDITION. [ASK IF CELL PHONE SAMPLE OR CELLOWNER = 01] Now, thinking about your
telephone use, is there at least one telephone inside your home that is currently working and is not a
cell phone?
Variable Label: Landline addition
Value
01
02
-98
-99

Value Label
Yes, has a home telephone
No, no home telephone
Don’t know [DO NOT READ]
Refused [DO NOT READ]

//PROGRAMMING NOTE: ASK LANDLINEADDITION ONLY IF CELLPHONE//
//NEW SCREEN//
Question Type: Open end Numerical
NUMCELL. [ASK IF CELL PHONE SAMPLE OR CELLOWNER = 01] How many different cell phone
numbers do you personally answer calls for?
Variable Label: Number of cell numbers
Value Value Label
__________ [ENTER # CELL PHONE NUMBERS]
-99
Refused [DO NOT READ]
//PROGRAMMING NOTE: ASK Q29 ONLY IF CELLPHONE SAMPLE OR Q27=1//

READ AT END OF SURVEY: The Research Involving Human Subjects Committee (RIHSC) at
the Food and Drug Administration has reviewed this research. RIHSC is an institutional
review board (IRB), a group of people who are responsible for ensuring that the rights of
participants in research are protected. RIHSC is not involved in this study but may review the
records of your participation in this research to ensure that proper procedures were

15

followed. If you have questions about your rights as a study participant or concerns about
how you are treated in the study, you may contact RIHSC at 301-796-9605 or
RIHSC@fda.hhs.gov.