Skip to main content
. 2014 Jan;8(1):123–131. doi: 10.1177/1932296813511733

Table 1.

Participant Screening Questionnaire.

Question Code Route
QX—Firstly, do you or does anyone in your household work in any of the following industries? READ OUT
 Pharmaceutical packaging and manufacture 1
 Advertising 2
 Marketing 3
 Market research 4 CLOSE
 Journalism 5
 Public relations 6
 Pharmacy retailing 7
 Health care (nursing/doctor professions) 8
 None of these 0 QY
QY—Have you taken part in any market research in the last 6 months?
 Yes 1 CLOSE
 No 2 Q1
Q1—Record sex (do not ask)
 Male 1 See quotas
 Female 2
Q2—Could you please tell me which of these bands your age falls into?
 Under 18 1 CLOSE
 18-39 2
 40-49 3 See quotas
 50-59 4
 60-69 5
 Over 70 6
Q3a—Have you ever been diagnosed (by a doctor) with having Diabetes?
 Yes diabetes type 2 1 Q3b
 Yes diabetes type 1 2 CLOSE
 No 3 CLOSE
Q3b—Only if answer was yes to diabetes type 2
I am now going to ask you a few questions about the treatment you have been prescribedfor Diabetes. Firstly, what sort of medication have you been prescribed for this condition?
 Injection of insulin 1
 Oral (eg, tablets) or other 2 See quotas
 Injection of GLP-1 (exenatide or liraglutide) 3 CLOSE
 None of the above 4 CLOSE
Q3c—Please state the name of the medication you take for this condition:
Q4—Do you have arthritis in your hands?
 Yes 1 See quotas
 No 2
Q5—Do you have a visual impairment (ie, partial blindness due to cataracts, macular degeneration, or glaucoma)?
 Yes 1 See quotas
 No 2
Q6 −The research may be filmed or recorded for internal client use only, are you OK with this?
 Yes 1 Recruit
 No 2 CLOSE