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MHNMAS1591_Crohn's and UC Patients / Caregivers
1.
HAVE YOU JOINED OUR DATABASE? IF NOT, DO SO NOW BY COPYING THE LINK BELOW:
https://www.surveymonkey.com/r/2026_Join
Murray Hill National is conducting a study on the topic of INJECTIONS and would like your opinions to be included. If you qualify for this study, we are offering an incentive to participate. Please be assured that we are not selling anything and the information we gather will remain confidential and be used for research purposes only. We have a few questions to ask before providing more details and determining if you qualify to participate. By signing up for this paid research you are automatically joining our database and could be contacted for other paid studies. We do have an opt out option however it could take some time to be removed from the database and active panel.
Name
Company
Address
City/Town
State/Province
Zip/Postal Code
Email Address
Phone Number
Job Title
Industry
2.
Has your child been diagnosed with any of the following conditions?
Crohn’s disease
Ulcerative colitis
Other (please specify)
None of the above
3.
Are you the caregiver of someone OF ANY AGE who has been diagnosed with any of the following conditions?
Crohn’s disease
Ulcerative colitis
Other (please specify)
None of the above
4.
When were they first diagnosed with their condition?
Within the past 6 months
6 months – 1 year ago
1 – 5 years ago
More than 5 years ago
5.
How old is
your child/the adult patient
you care for?
0-11 years old
12-13 years old
14-15 years old
16-17 years old
18-24 years old
25-45 years old
46-65 years old
66+
6.
What medications have been prescribed to treat this
child/the adult patient's
condition?
o Steroid [prednisone (eg, Deltasone, Intensol, PredniSONE, Rayos), budesonide (eg, Entocort EC, Uceris), methylprednisolone (Medrol, Medrol Dosepak, Methylpred-DP), corticosteroids (eg, Clobetasol, Triamcinolone, Hydrocortisone)]
o 5ASA [mesalamine (eg, Apriso, Asacol, Canasa, Delzicol, Lialda, Pentasa, Rowasa), sulfasalazine (eg, Azulfidine, Sulfazine), balsalazide (eg, Colazal, Giazo), olsalazine (eg, Dipentum)]
o Immunomodulator [methotrexate (eg, Trexall, Otrexup), azathioprine (eg, Azasan, Imuran), mercaptopurine (eg, Purinethol, Purixan)]
o Biologic [infliximab (eg, Remicade, Inflectra, Renflexis), adalimumab (eg, Humira), certolizumab (eg, Cimzia), golimumab (eg, Simponi), ustekinumab (eg, Stelara), vedolizumab (eg, Entyvio), etanercept (eg, Enbrel), secukinumab (eg, Cosentyx), guselkumab (eg, Tremfya), Tildrakizumab (eg, Ilumya), Brodalumab (eg, Siliq)]
Other (please specify)
None of the above
7.
Has
the child/patient OR have you (the caregiver)
ever injected medication subcutaneously to them/yourselves or someone else including pets? Subcutaneous means beneath the skin.
This can be related to UC/CD, or it can be unrelated. All reasons for injection should be considered when answering this question
Yes, the child has
Yes, I have
No, neither of us have ever injected a medication under the skin on ourselves/someone else/a pet
8.
-IF YES FOR INJECTIONS:
What types of devices did they/you use?
9.
-IF YES FOR INJECTIONS:
How many injections have they/you given?
The child
The adult patient
Myself
10.
-IF YES FOR INJECTIONS:
When was the last time the child/you injected medication?
More than 60 days ago
Less than or equal to 60 days ago
11.
Does the
the child/patient OR have you (the caregiver)
have any difficulties with weakness or dexterity in their hands and fingers?
For example, would they find it difficult to button up a shirt, turn a key in a lock, hold and write with a pen, or perform any similar task?
Yes, the child does
Yes, my adult patient does
Yes, I do
No
12.
Are they/you left or right-handed?
The child
The adult patient
Myself
13.
What are your ethnicities?
The child
The adult patient
Myself
14.
Which gender does the child/yourself most closely identify with?
The child
The adult patient
Myself
15.
The study will evaluate an injection device that will be used for the treatment of ulcerative colitis or Crohn’s disease. This would include hands-on use of the injection device containing a needle and active medication with a fake skin pad, followed by a one-on-one interview about your experience with
the device.
You would not be performing any real injections to yourself or anyone else, only simulated injections into a skin pad. The study session will be documented through audio and video recording to help with accurate research reporting, however all responses and feedback, as well as your identity, will be kept confidential. The study will last up to 90 minutes, and you will
be compensated for your time. The study is taking place in person.
Does this sound like something you would be interested in?
Yes
No
16.
Are you within a commutable distance of any of the below?
Cambridge, MA
Chadds Ford, PA
Atlanta, GA
San Jose, CA
Dallas, TX
None of the above