Help iCAN by Sharing Your Feelings About Injections

This questionnaire will be used by iCAN to better understand youth perception of injections (including subcutaneous and intramuscular injections).  The goal for this information is to create a gold standard for manufacturers and regulatory bodies worldwide to consider when developing injectable drugs for pediatric health care.

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* 1. How do you feel about injections? 

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* 2. Do you have a diagnosed condition that requires injections?  

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* 3. For your diagnosed condition(s), how many of your prescribed medicine(s) are required to be injected? 

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* 4. If you have an injection, do you prefer an Auto-Injector or a Syringe to be used?

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* 5. Are you currently wearing a medical device that requires an injection using a needle threaded cannula or a sensor wire?

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* 6. How often is your medical device needle- threaded cannula or wire sensor inserted into your skin?

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* 7. How much of an advance warning do you like to have before receiving an injection?

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* 8. Are there techniques that you like to use to help relieve pain symptoms associated with an injection?  Choose all that apply.

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* 9. Do you have a preference for where you would like your injection to be given?  Choose all that apply.

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* 10. Are there any areas on your body that you do not prefer to have injections? Please share and explain why (embarrassing, hurts, can't reach). 

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* 11. Are you able to measure and draw up your own medicine into a syringe or Auto-Injector?

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* 12. Are you able to inject a needle into your skin independently of a caregiver?

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* 13. If you do not give yourself injections, which of these caregivers do? Please select all that apply.

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* 14. Are you injections administered at home or away from home? 

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* 15. Please select all options that make it difficult to administer injections. Add any locations that are not listed.

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* 16. How frequently do you need injections?

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* 17. Do you have difficulty in remembering when you need an injection? 

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* 18. How is the medicine used for your injections stored? (If you use more than one injected medicine, please fill out 'other' with storage needs).

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* 19. When your medicine is injected, is there less pain if the medicine is stored at room temperature?  

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* 20. Do side effects to your injected medicine impact your desire to have future injections? 

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* 21. Do you have to keep your injected medicine with you at all times?  

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* 22. Please share how you store your injected medicine when you are traveling. 

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* 23. Please share how you dispose of your syringe needles or Auto-Injector.  

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* 24. Is there anything you would like us to know about kids and injections?  

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* 25. What is your age? 

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* 26. Are you a member of an iCAN Chapter?  

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