Trustinsurvey - Rutgers

TRUST IN RESEARCH

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This survey will ask you about your opinions on research and will take approximately 5 – 10 minutes to complete. We will also ask you for some basic information about yourself, but no information that could identify you (such as your name, birthday or address) will be collected. We do not foresee risks to subjects participating in this study. There is no direct benefit to you, however your participation may help inform and improve future research.
There is no penalty for declining to participate and you may stop at any time.
If you have any questions about the study or your rights as a research participant, we can provide you with a card with the contact information of the Principal Investigator as well as the contact information for the Rutgers New Brunswick/Piscataway HealthSci IRB.

Do you have any questions? [Research Assistant will answer any questions participates may have]

Do you agree to take part in this survey?

Yes No

Would you be willing to participate in a study;

*1.a. if only asked questions about health

Yes

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*1.b. if researchers wanted to see your medical records

Yes

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*1.c. if you had to give a blood sample

Yes

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*1.d. if you had to give a genetic sample

Yes

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*1.e. if you had to take medicine

Yes

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*1.f. if asked to stay overnight in a hospital or clinic

Yes

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*1.g. if you might have to use medical equipment

Yes

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*1.h. if you didn’t get paid

Yes

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For the following questions, answer [Strongly Agree / Agree / Neither Agree or Disagree / Disagree / Strongly Disagree]

*2. My attitude towards research is positive

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*3. Researchers would not involve me in research that might be harmful.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*4. It’s safe to be in a medical research study.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*5.Researchers sometimes involve patients in research without their knowledge or permission.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*6. To get people to take part in a study, researchers usually do not explain all of the dangers about participation.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*7. Researchers tell their patients everything they need to know about being in a research study.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*8. People who participate in research are like human guinea pigs.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*9. Researchers are more interested in helping their careers than in learning about health and disease.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*10. Researchers only care about what is best for each patient.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*11. Researchers act differently toward minority research participants than toward white participants.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*12. Researchers unfairly select minorities for their most dangerous research studies.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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*13. I would be more comfortable having research explained to me by a researcher with a racial or ethnic background similar to mine.

Strongly Agree

Agree

Neither Agree or Disagree

Disagree

Strongly Disagree

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The next questions ask about your opinions on health in the community.

*14. In the following list, what do you think are the three most important factors for a “Healthy Community?” (Those factors which most improve the quality of life in a community.)

Good place to raise children
Low crime / safe neighborhoods
Low level of child abuse
Good schools
Access to health care
(e.g. family doctor)
Parks and recreation
Clean environment
Affordable housing
Arts and cultural events
Excellent race relations
Good jobs and healthy economy
Strong family life
Healthy behaviors and lifestyles
Low adult death and disease rates
Low infant deaths
Religious or spiritual values
Other

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*15. In the following list, what do you think are the three most important “health problems” in our community? (Those problems which have the greatest impact on overall community health.)?

Aging problems (e.g. arthritis,
hearing/vision loss, etc.)
Cancers
Child abuse / neglect
Dental problems
Diabetes
Domestic Violence
Firearm-related injuries
Heart disease and stroke
High blood pressure
HIV / AIDS
Homicide
Infant Death
Infectious Diseases
(e.g., hepatitis, TB, etc.)
Mental health problems
Motor vehicle crash injuries
Rape / sexual assault
Respiratory / lung disease
Sexually Transmitted
Diseases (STDs) Suicide
Teenage pregnancy

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*16. What is your age?

18–25

25–34

35–44

45–54

55–64

65–74

75–84

85 or older

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*17. What is your gender?

Male

Female

Non-binary / Third Gender

Prefer not to say

Other

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*18. What is your race/ethnicity?

Alaska Native

American Indian

Asian

Black or African American

Native Hawaiian/Pacific Islander

White/Caucasian

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*19. Are you Hispanic / Latino?

Yes

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*20. What is your ethnicity?

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*21. What is the highest level of education you have completed?

No high school

Some high school

High school diploma

Some college

Associates degree

Bachelor’s degree

Professional or doctorate degree

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*22. What is your employment status?

Retired

Unable to work

Employed

Homemaker

Unemployed

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23. How long did it take you to travel here today?

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#	Time	Memory	Function	Location
1	0.0003	370832	{main}( )	...\index.php:0
2	0.0003	371144	require( 'C:\wamp64\www\wp-blog-header.php )	...\index.php:17
3	0.1674	9278304	require_once( 'C:\wamp64\www\wp-includes\template-loader.php )	...\wp-blog-header.php:19
4	0.1744	9300056	include( 'C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php )	...\template-loader.php:106

*24. Date

( ! ) Warning: Undefined variable $q24Error in C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php on line 1573
Call Stack
#	Time	Memory	Function	Location
1	0.0003	370832	{main}( )	...\index.php:0
2	0.0003	371144	require( 'C:\wamp64\www\wp-blog-header.php )	...\index.php:17
3	0.1674	9278304	require_once( 'C:\wamp64\www\wp-includes\template-loader.php )	...\wp-blog-header.php:19
4	0.1744	9300056	include( 'C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php )	...\template-loader.php:106

25. Location of survey

( ! ) Warning: Undefined variable $q25Error in C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php on line 1586
Call Stack
#	Time	Memory	Function	Location
1	0.0003	370832	{main}( )	...\index.php:0
2	0.0003	371144	require( 'C:\wamp64\www\wp-blog-header.php )	...\index.php:17
3	0.1674	9278304	require_once( 'C:\wamp64\www\wp-includes\template-loader.php )	...\wp-blog-header.php:19
4	0.1744	9300056	include( 'C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php )	...\template-loader.php:106

26. Name of event survey took place at (if applicable)

( ! ) Warning: Undefined variable $q26Error in C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php on line 1596
Call Stack
#	Time	Memory	Function	Location
1	0.0003	370832	{main}( )	...\index.php:0
2	0.0003	371144	require( 'C:\wamp64\www\wp-blog-header.php )	...\index.php:17
3	0.1674	9278304	require_once( 'C:\wamp64\www\wp-includes\template-loader.php )	...\wp-blog-header.php:19
4	0.1744	9300056	include( 'C:\wamp64\www\wp-content\themes\RUwebsite\page-trustinsurvey.php )	...\template-loader.php:106

If you have any additional questions about this study, you can contact:

Principal Investigator, XinQi Dong, MD, MPH: ( 848-9323817), email: xinqi.dong@ifh.rutgers.edu
Rutgers New Brunswick/Piscataway HealthSci IRB: (732) 235-9806
Rutgers Human Subjects Protection Program: (973) 972-1149, email: humansubjects@ored.rutgers.edu

Click here to read more about the study

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