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Asthma Survey


Welcome and thank you for participating in our survey. The goal of this survey is to help us better understand your awareness of factors that can raise someone’s chances of having severe or uncontrolled asthma, as well as your awareness of treatment options for severe asthma. The results of this survey will help us develop an educational activity for healthcare providers on factors that contribute to severe asthma as well as newer treatment options to help patients better control their asthma. Your responses will remain anonymous.

Use the arrows/buttons at the bottom of the pages to move through the survey. Questions marked with an asterisk are required.

Any information you provide will be used in accordance with our Privacy Notice.

1. How old are you? *This question is required.
2. Which of the following statements best applies to you? *This question is required.
2. How would you describe yourself/your child? (Select all that apply.)  *This question is required.
2. How would you describe your/your child’s asthma? *This question is required.
2. How well does your/your child’s current asthma management plan help you/your child avoid severe asthma attacks? *This question is required.
2. Has your doctor discussed adding any of the following medications to your/your child’s current controller medication regimen? *This question is required.
2. How difficult do you find each of the following regarding asthma management? (extremely = 5, not at all = 1) *This question is required.
Space Cell 5-Extremely4321-Not at all
Finding time to attend regular doctor visits
Finding a medication that works
Remembering to take my controller medication as directed
Affording or accessing medication
2. How well do you/your child adhere to your/their current asthma management plan? *This question is required.
2. Did this education teach you about new treatment options for moderate/severe asthma that you did not know about before? *This question is required.
2. How likely are you to seek health information from each of the following sources?  *This question is required.
Space Cell Extremely likelyVery likelySomewhat likelyNot very likelyNot at all likely
Doctor or healthcare provider
Friend or family
Social media
2. Based on the results of your most recent search for health information, how much do you agree or disagree with each of the following statements? *This question is required.
Space Cell Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagreeN/A
It took a lot of effort to get the information I needed
I felt frustrated during my search for the information
I was concerned about the quality of the information
The information I found was hard to understand
2. Have you ever taken action on your health based on something you have seen on social media? *This question is required.
2. What did you do? *This question is required.
2. How frequently do you use each of the following social media platforms? *This question is required.
Space Cell Multiple times per dayOnce per dayA few days per weekOnce per weekRarelyNever
2. What is your ethnicity?  *This question is required.
2. What is your race? (Select all that apply.)  *This question is required.
2. What is your gender identity?  *This question is required.