Feasibility study: type 1 diabetes conference

1. Adult type 1 diabetes conference survey.

 
This survey aims to determine interest levels in a conference focused on adult type 1 diabetes patients.
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1. Name
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2. Gender
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3. Year of birth
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4. When were you diagnosed with diabetes?
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5. What kind of diabetes do you have?
6. Please tell us about any diabetes conferences that you know of specifically targeted at adult type 1 diabetics?
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7. Please rate your interest in attending a conferences targeted at adults with any of the following conditions:
Would not attendUnlikely to attendLikely to attendWould certainly attend
Type 1 diabetes
Type 2 diabetes
Type 1.5 diabetes (Latent autoimmune diabetes of adults-LADA)
Gestational diabetes
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8. Please rate the following cities in terms of your willingness to travel to these locations for an adult type 1 diabetes focused conference:
Would not attendUnlikely to attendLikely to attendWould certainly attend
Boston, MA
Providence, RI
San Diego, CA
San Francisco, CA
Seattle, WA
Washington, DC
9. Please name a city for which you would certainly attend an adult type 1 diabetes focused conference.
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10. Please rate the following type 1 related diabetes therapies in terms of subject matter you may want to hear discussed at a conference focused on adults with type 1 diabetes.
Would not want to discussSomewhat interested in discussingInterested in discussingWould certainly want to discuss
New injection needle technology
New insulins in development
Insulin pump technology
Continuous glucose monitoring
Symlin
The artificial pancreas
11. What else would you want to hear about or discuss at a conference focused on adults with type 1 diabetes?
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12. How important would you consider the following conference events to be?
Least importantLess importantMore importantMost important
Single speaker presentations
Panel presentations
Question and answer sessions
Small group discussions
Social events and entertainment
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13. Please rate the following in terms of the likelihood of your attending a session at a conference focused on adults with type 1 diabetes delivered by a member of one of the following categories:
Would not attendUnlikely to attendLikely to attendWould certainly attend
Athlete with diabetes
Celebrity with diabetes
Certified Diabetes Educator (CDE)
Doctor
Nutritionist
Person with diabetes
Psychologist
14. What would you consider to be a great name for a conference focusing on adults with type 1 diabetes?
15. We will be offering three exciting prizes to the most creatively fitting names for the adult type 1 diabetes conference that arise from this survey. Kindly provide an email address or any other contact information to enable us get in touch with you if your suggestion is selected.
All information provided will be kept strictly confidential.
16. Please let us know if you have any comments/suggestions/questions on anything that was or should have been addressed in this survey.
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