Rapid Message Testing with Consumer Panel; Clinical Trials Brochure

FDA RAPID – MESSAGE #1

Clinical Trials Brochure

Recruiting Screener -- SPANISH

Introduction

The U.S. Food and Drug Administration, or FDA, has developed some messages about health-related information and has hired Westat to test them. Research Now is helping Westat and FDA find people who may be interested in participating in an interview about those messages. To make sure you are eligible, please take about 3 minutes to answer the following questions.

1. Has a doctor, nurse, or other health professional ever told you that you had any of the following medical conditions? Check all that apply.

Diabetes or high blood sugar

High blood pressure or hypertension

Sickle-cell anemia

A heart condition such as a heart attack, angina, or congestive heart failure

Chronic lung disease, asthma, emphysema, or chronic bronchitis

Hepatitis

HIV/AIDS

I have a medical condition that’s not listed here

I do not currently have any health condition

REF

DK

2. Have you ever participated in a clinical trial?

YES  INELIGIBLE

NO

REF  INELIGIBLE

DK  INELIGIBLE

3. It’s not necessary that you speak English to participate in the study, but please answer the next questions about English. How well do you speak English? Would you say…

Very well,  INELIGIBLE

Well,  INELIGIBLE

Not well, or

Not at all?  GO TO REQUEST FOR CONTACT

DK

RF

4. Would you say you speak Spanish better than English, English better than Spanish, or both about equally well?

SPANISH BETTER

ENGLISH BETTER  INELIGIBLE

BOTH EQUALLY  INELIGIBLE

Request for Contact Information

Thank you for your answers to these questions. You are eligible and may be selected to participate in the study. Do you give permission for Research Now to share your contact information with Westat?

YES

NO  INELIGIBLE

Information about the Interview

If you’re selected to participate and you complete an interview, you will receive $50 [INSERT INCENTIVE NAME]. Also, at the beginning of the interview, the interviewer will ask your permission to audio record it. This allows Westat to carefully review the discussion and draw the proper conclusions.

Ineligible

We’re sorry, you are not eligible for an interview at this time. Thank you for taking the time to answers these questions.

Contact Information

In the space below, please provide the best contact information for reaching you by phone, email, and regular mail. Please be assured that Research Now and Westat keep all the information you provide confidential.

Contact Information

Name ______________________________________________________________________

Address 1 ___________________________________________________________________

Address 2 ___________________________________________________________________

City, State, ZIP _______________________________________________________________

Phone Number _______________________________________________________________

Email Address________________________________________________________________

Available Times

Please mark the times you’re available to participate in a 45-minute interview between August 1 and August 11.

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.

Time Zone

Please select your time zone below.

DROP DOWN LIST OF U.S. TIME ZONES

Closing

Thank you for your answers to these questions. If you’re selected to participate in the study, a Westat interviewer will be back in touch with you within about 3 days. If you’re selected, you will also receive a package in the mail containing the materials we’ll be talking about during the interview. Please make sure you have the package with you during the interview, but do not open it until instructed to do so during the interview.