Survey before video

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05/30/2017 10:19am www.projectredcap.org

Survey before video

Please complete the survey below.

Thank you!

nothing very little some things a lot almost

everything 1) How much do you know about

LYME DISEASE?

2) How much do you know about the TREATMENT of Lyme disase?

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3) How old is your child? (years) __________________________________

4) How would you describe your race / ethnicity? You may American Indian or Alaska Native

choose more than one option Asian/Asian-American

Black or African American Pacific Islander/Native Hawaiian White/Caucasian

Hispanic/Latino Not Hispanic/Latino Other Race/Ethnicity Don't Know/Refuse 5) What best describes the highest level of education Less than 12th grade

you completed? Graduated from High School, but not college

Graduated from 2 year college, 4 year college, or trade school

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6) Do you understand that your child DOES NOT have Lyme disease, and the following video an questions are

just asking you to PRETEND your child has Lyme disease?

Yes No

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Based on the video you just saw, please complete the survey below.

Thank you!

Have you watched the 10 minute video yet? if NO, THEN STOP HERE

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7) If your child was diagnosed with Lyme disease, would Yes you consent to your child participating in the No treatment study described in the video?

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8) Which of the following ways to treat meningitis due to Lyme disease do you think WORKS BEST?

Antibiotics by mouth IV antibiotics

I think they are equal

9) Which of the following ways to treat meningitis due to Lyme disease do you think is SAFEST for your child?

I think they are equally safe

10) Which of the following ways to treat meningitis due to Lyme disease would you PREFER?

I think they are equal

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11) What information would you have liked to hear more about to help you make your decision? (Check all that apply) Lyme disease

Meningitis

Antibiotic side effects IV (PICC line) side effects Other

12) Please specify what additional information would be __________________________________

useful.

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13) Now pretend that treatment with IV antibiotics was known to be better than antibiotics by mouth. How many days more of symptoms like headache, stiff neck, and fatigue would you think is OK if you could use antibiotics by mouth instead of through the IV?

I would always prefer the IV treatment

One more day would be OK if we could use antibiotics by mouth instead of through an IV Two more days would be OK if we could use antibiotics by mouth instead of through an IV Three more days would be OK if we could use antibiotics by mouth instead of through an IV One more week would be OK if we could use antibiotics by mouth instead of through an IV I would always prefer antibiotics by mouth as long as the symptoms eventually go away

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