Appendix D - Informed Consent

Endorser Status and Explicitness of Payment in Direct-to-Consumer Promotion

Appendix D - Informed Consent

OMB: 0910-0894

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FDA Endorsers Project Questionnaire
Study 1


Thank you for your willingness to complete the survey. Your contribution is important to us.


This survey asks about prescription drug advertising and how it might affect your attitudes and behaviors. The survey will take about 20 minutes to complete.


Taking part is voluntary and you do not have to answer any questions you do not want to. We respect your privacy. Your personal information will remain private to the fullest extent allowable by law and will not be linked to your answers or used in any report.


There are no known risks for participation in this research study. All information you provide will be treated as confidential. While we will take every precaution to protect your information, there is a small risk that others may gain access to your responses, despite all our best efforts. In the case of a breach of confidentiality, appropriate steps will be taken to notify participants. There are no direct benefits to you for participating in this study. However, you will be helping with an important research study.


This study is being conducted by Westat, a survey research organization, on behalf of the U.S. Food and Drug Administration (FDA). If you have any questions about this research, including why it is being conducted or how the results will be used, please contact us at 1-855-XXX-XXXX or email [EMAIL ADDRESS]. If you have questions about your role as a research participant, please contact the Westat Human Subjects Protections Office at 1-888-920-7631.


Do you agree to participate in this survey?


Yes, I agree to participate in this survey. Continue

No, I do not agree to participate in this survey. Terminate


FDA Endorsers Project Questionnaire
Study 2


Thank you for your willingness to complete the survey. Your contribution is important to us.


This survey asks about Instagram posts about prescription drugs for endometriosis and how they might affect your attitudes and behaviors. The survey will take about 20 minutes to complete.


Taking part is voluntary and you do not have to answer any questions you do not want to. We respect your privacy. Your personal information will remain private to the fullest extent allowable by law and will not be linked to your answers or used in any report.


There are no known risks for participation in this research study. All information you provide will be treated as confidential. While we will take every precaution to protect your information, there is a small risk that others may gain access to your responses, despite all our best efforts. In the case of a breach of confidentiality, appropriate steps will be taken to notify participants. There are no direct benefits to you for participating in this study. However, you will be helping with an important research study.


This study is being conducted by Westat, a survey research organization, on behalf of the U.S. Food and Drug Administration (FDA). If you have any questions about this research, including why it is being conducted or how the results will be used, please contact us at 1-855-XXX-XXXX or email [EMAIL ADDRESS]. If you have questions about your role as a research participant, please contact the Westat Human Subjects Protections Office at 1-888-920-7631.


Do you agree to participate in this survey?


Yes, I agree to participate in this survey. Continue

No, I do not agree to participate in this survey. Terminate




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorO'Donoghue, Amie
File Modified0000-00-00
File Created2021-10-13

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