Clinical Diversity Solutions
Questionnaire MAIN
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Cultural Affinity
What are your thoughts about participation in medical research?
Would you be more willing to participate in clinical research if (select all that apply):
The researcher is African American?
If the treatment being studied is for a disease that directly affects you or a loved one?
If the sponsoring company was managed by a person of color?
If the process was thoroughly explained to you and the process was completely transparent?
What scares you the most about medical research (select all that apply):
Possible side effects
Not being told the truth
Lack of transparency about the process
Lack of involvement of physicians of color and researchers of color
If a new drug or treatment might lead to a cure for a disease that affects you or your family would you be willing to participate in clinical research?
Yes
Maybe
No
If a new drug or treatment might lead to a cure for a condition that affects the black community would you be willing to participate in clinical research?
Yes
Maybe
No
If the disease was common in your community would you be willing to participate in clinical research?
Yes
Maybe
No
Free transportation to and from the research site would make me more willing to participate in clinical research.
Yes
Maybe
No
Being paid would make me more willing to participate in medical research.
Yes
Maybe
No
Being paid for time off work would make me more willing to participate in medical research.
Yes
Maybe
No
What information would a company or researcher need to provide in order to make you comfortable with participating in medical research?
Relevance to Black People
Safety of study
Length of time for study participation
All of the above
None of the above
Trust
What are your perceptions of medical research as an member of the Black Community
By having greater representation of African Americans in all aspects of medical research, I would be more willing to participate.
True
False
If the medical research (or clinical trial) is being led by African American researchers I would be more willing to participate.
True
False
If my personal physician asks me to participate in a clinical trial at another physician’s office, I would participate because he or she recommended it.
True
False
If my personal physician asks me to participate in a clinical trial that they are conducting in their office, I would be willing to participate.
True
False
If my Rabbi, Imam, Pastor or Priest suggested that I could help my community by participating in medical research, I would participate.
True
False
If a trusted politician that I respect suggested that I participate in a clinical trial because they felt it was safe, I would do it.
True
False
If my favorite athlete, actor or performer suggested that I participate in medical research that was beneficial to my community, I would do it.
True
False
If a civil rights leader that I trust and respect suggested that I participate in medical research that would benefit my community, I would do it.
True
False
To what degree do you trust TV/radio when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust political pundits (Sean Hannity, Rachel Maddow, Joy Reid) when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust your own doctor when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust your own family and friends when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust the Internet (social media) when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust the magazines and books when receiving medical information?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
To what degree do you trust the FDA to properly monitor the treatment of people of color in clinical trials?
1
2
3
4
5
Don't Trust
Trust
1 is Don't Trust, 5 is Trust
If the process of a particular medical research trial was explained to you (by someone who looks like you) in simple, understandable terms and how your participation may provide a “revolutionary” treatment for a disease that commonly affects your community, would you be more likely to participate?
Yes
No
Maybe
What scares you the most about medical research?
The history of medical research on blacks in the US
The potential side effects of an experimental treatment
Government or corporate dishonesty
The absence of African American clinicians involved in research
All of the above
None of the above
What would make you feel more secure and trusting about helping your community by participating in medical research (select all that apply)?
African American leadership and oversight of the research
Your personal physician being involved in the research
If the research is focused on a treatment of a disease that you or a member of your family have
Government oversight of the research
Knowing that the research has been certified by an independent review board (IRB) of diverse members that included African Americans
Has the political climate of the last several years (the Trump era) made you less trusting of the government and corporations (like pharmaceutical companies)?
Yes
No
Has the emergence of white supremacy and the killing of African Americans by police made you less trusting of large “white” institutions?
Yes
No
Are you fearful of taking the Pfizer or Moderna vaccine for COVID-19?
Yes
No
Did you trust the information being given in the news by infectious disease experts about the COVID-19 pandemic?
Yes
No
Background Information
Tell us what you're comfortable sharing about yourself
What is your Gender?
Male
Female
Other
I am
Black
White (non-Hispanic)
Hispanic
Asian
Native American/Pacific Islander
Bi-Racial
Rather not say
What is your age group?
< 20 years
20 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
61 - 70 years
>70 years
What is your highest level of education?
Elementary school
High School
Trade school or vocational training
Associates degree
College degree
Post-graduate degree
I live in
New England (Mass, Vermont, Maine, RI, CT, NH)
South (GA, Florida, Alabama, Tenn, Miss, Ark, Missouri, Louisiana)
Midwest (Michigan, Ohio, Indiana, Wisconsin, Dakotas, Iowa, Nebraska)
Southwest (Texas, Arizona, Oklahoma, Kansas, Colorado, New Mexico)
West (California, Washington, Oregon, Nevada, Idaho, Utah, Montana, Wyoming, HI, Alaska)
Mid-Atlantic (NY, NJ, PA, DE, MD, VA, West VA)
What is your employment status?
Unemployed
Part-time
Full time
Student
Retired
What is your annual household income?
< $25,000
$25,001 - $50,000
$50,001 - $100,000
$100,001 - $250,000
$250,001 - $500,000
>$500,000
How do you feel about the COVID Vaccine?
I refuse to take the vaccine
I took the vaccine but have not finished the series of 2 shots
I took the full series of shots and I'm going to get a booster when the time comes
I took the full series of shots but no more boosters for me
I took the full series of shots and have also completed at least one booster
What is your health insurance coverage?
None
Private/Employer health benefit
Medicare
Medicaid
Tricare
What health issues are currently affecting you and/or members of your immediate family? Select all that apply.
Heart disease
High blood pressure
Diabetes
COPD (lung disease)
Stroke
Arthritis
Cancer
Sickle cell anemia
Would you be willing to contribute to genetic research on diseases that are more likely to impact your family, or black people in general, if you knew that the information would be controlled by black researchers and stored at an African American institution?
Yes
Maybe
No
I have access to WIFI in my home.
True
False
For social media and the internet, I mostly use a smartphone or tablet.
True
False
I have easy access to a laptop or desktop computer.
True
False
For my medical records I prefer to communicate via email.
True
False
I would sign up for a clinical trial via social media (Facebook, Instagram, Twitter).
True
False
Get Involved
Explore what clinical trials have to offer. They can help you receive better medical care and help others understand more about illnesses that affect African Americans.
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