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Clinical Trials Survey
What is your age range?
Under 18
18 - 24
25 - 30
30 - 40
40 - 55
55 >
Which racial background do you most identify with?
Hispanic
African-American/Black
White/Caucasian
Pacific Islander
Native American
Two or more
Which do you identify?
Female
Male
How would you classify your socioeconomic status?
Lower economic class
Lower-Middle economic class
Middle economic class
Upper economic class
Highest level of education completed
Less than high school
High school graduate/GED
Associates degree
Bachelors degree
Masters or other professional degree
Profession
Primary language
Do you know what a clinical trial is?
Yes
No
Kind of, but I don’t know much
I have heard about clinical trials from: (Select all that apply)
Television
Radio
Newspaper
Magazine
Other
Have you ever been encouraged to participate in a clinical trial?
Yes
No
Not applicable
If yes, which therapeutic area?
If not, what factors have prevented you from participating?
Fear
Language barrier
Financial barrier
Other barriers (family obligations, transportation)
I did not know about them
I don’t know
If you have participated in a clinical trial, please rate your overall experience
Poor
Average
Good
Very good
Excellent
If you have participated in a clinical trial, what factor most influenced your decision to enroll?
A family member/ friend told me about it
My physician told me about it
I read about it online
I wanted to participate in the advancement of science
Other
What fears, if any, do you have about being involved in clinical trials?
What benefits, if any, do you believe clinical trials provide for society?
Which factors would make you more comfortable with participating in a clinical trial?
Having the possibility of curing my condition
The investigator or physician was same ethnicity as myself
Investigator spoke my native language
Feeling that the investigator truly cares about my health and well-being
The investigator is attentively listening to my concerns and needs
If I am offered some type of incentive to participate
If a family member or close friend participated in a clinical trial, and had a positive experience, would you be more likely to consider enrolling yourself?
Yes
No
I'm not sure
Quick Links
Home
Clinical Trials Booklet
Clinical Trials Videos
Clinical Trials Lectures
Clinical Trials Field Trips
Clinical Trials Mobile Pavilions
Glossary of Clinical Trials Terms
Clinical Trials Forms
For the General public, NBCI members churches, and Congregants
Avoiding Ethical Issues in working with the African-American Community
For African-American, Latino Researchers and Scholars
For Clinical Partners
The National Clinical Trial Strategic Plan
Current Clinical Trials and How you can Participate and Enroll
Understanding Side Effects and Clinical Trials
Understanding New Drugs and Their Impact on African-American Health