Fields marked with an * are required.
Participant Background
Age:
Gender: *
Gender
Male
Female
Non-binary
Prefer not to say
Where are you located? *
US
Canada
Other
ZIP Code or Postal Code *
What type of trial, or medical condition, did you sign up for?
How many trials have you participated in?
Which racial or ethnic group(s) do you identify with? *
Capturing information on ethnic backgrounds allows us to better understand how different groups may have different needs.
Please select all that apply.
American Indian or Alaskan Native
Asian
Black or African American
Hispanic Latino or Spanish
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Mediterranean (Greek/Italian/Portuguese/Spanish/etc)
Another race or ethnicity
I prefer not to answer
Awareness and Motivation
Has your doctor ever spoken with you about clinical trials you could participate in? *
Yes
No
Did you consider a clinical trial before you saw the digital advertisement? *
Yes
No
Was this trial for yourself/a child/someone in your care? *
Select all that apply.
Myself
My child/child in my care
Someone else in my care
I do not remember
What would make you want to participate in a clinical trial in general? *
Select all that apply.
Access to a new treatment
Contributing to medical research
Access to a healthcare provider
Potential health benefit to myself
Financial compensation
Medical costs being covered
Other
Please specify *
Digital Advertisement
What type of digital advertisement did you respond to? *
Social media ad (e.g. Facebook Instagram)
Search engine ad (e.g. Google)
Banner ad on websites
Email advertisement
Other
What made you want to learn more about the clinical trial based on the advertisement that you saw? *
Access to a new treatment
Contributing to medical research
Access to a healthcare provider
Potential health benefit to myself
Financial compensation
Medical costs being covered
Other
What other places do you go to find information about clinical trials? *
My doctor
My pharmacist
Word of mouth
Online search
Social media
Other
Clinical Trial Experience
After signing up online, did you visit a study site for the clinical trial? *
Yes
No
Why? *
Would you change anything about the study site or the study visits to improve your experience?
Yes
No
What would you change?
Were you able to participate in the clinical trial? *
Yes
No
How would you rate your overall experience with the clinical trial so far? *
Very positive
Positive
Neutral
Negative
Very negative
What is the reason for your selection above? *
Did you complete all the visits? *
Yes
No
Why did you decide to end your participation? *
Select all that apply.
Site staff told me I didn’t qualify / wasn’t a good candidate
Study requirements were too demanding (i.e. too many visits - too many tests etc.)
Site was too far from my home
Other
What is furthest stage in the trial that you completed? *
Signed up online but did not qualify
Answered questions over the phone but did not visit the site
Signed a consent form at the site
I participated in the trial (also known as enrolled)
Wrap-up
Would you consider signing up for a clinical trial again? *
Yes
No
Would you sign up for a clinical trial through an online advertisement again? *
Yes
No
What suggestions do you have for improving online recruitment for clinical trials? *
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