Healthcare Study- People Diagnosed with ATTR Amyloidosis-1 hour webcam interview

Diagnosed with ATTR Amyloidosis

Funds for Focus is partnering with an independent healthcare market research agency to better understand the treatment and management of specific medical conditions. This research is non‑promotional, sponsored by a pharmaceutical company, and all information you provide will remain strictly confidential. Participation involves a 1‑hour webcam interview with a trained moderator on a secure platform. The session may be observed by members of the sponsoring company and will be recorded for analysis, but your personal details will not be shared — only aggregated insights. If you qualify and complete the interview, you will receive a $125 virtual Visa gift card sent 1–3 weeks after participation. Click the signup link to begin answering a few background questions to determine eligibility.

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First Name *
Last Name *
Email *
Phone Number *
State *
Age *
  Any side effects and/or product complaints that may arise during the course of this market research interview must be reported to the commissioning company to help them learn more about the safety of their medicines. If this happens, we will notify the pharmacovigilance department at the commissioning company, who may need to contact you for further information. This will have no impact on the confidentiality or anonymity of the interview. Do you consent to the interview on this basis?  
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Personal data about you will be collected and used for the purposes of the market research study. Such personal data may include your name, your contact information, your professional background and qualifications, and your opinions. We will only collect or process data that is absolutely necessary to conduct the study, and not all aforementioned categories will be applicable to all studies. To the extent your personal data is collected or processed in conjunction with the market research study, it may be transferred to third parties assisting with the study, such as a survey programmer or recruiter. In such cases, the necessary measures will be taken to ensure the safety of your personal data in accordance with applicable data protection laws. You can find out more about our privacy practices around processing and transferring data by reading Integro's Privacy Policy, which is available upon request (if you would like to request this, please let us know and we will have it sent to you).  Do you agree to the collection, processing, and transfer of the personal data necessary to participate in this study?


Are you willing to participate with the interview on this basis?


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Although your interview/group discussion will be conducted by one of our researchers, we often use AI tools to help in our analysis.  Do you consent to your responses being analyzed, possibly using machine learning or AI tools?  We will only analyze the information that you provide in the market research study and will not include any of your identifiable personal information and/or share the results with any third parties except for the study sponsor. 


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C1. Are you or is anyone in your household or immediate family currently employed by or affiliated with any of the following on a full or part time basis? (Select all that apply) SELECT ALL THAT APPLY


C2. For this research we would like to audio / video record your interview for research purposes only. Additionally, the recorded interview that you will participate in may be viewed at a later date so that the sponsoring pharmaceutical company, their affiliated companies and business partners can observe.  

Are you willing to participate in this interview with the understanding that your interview will be recorded, and that it may be observed by the sponsoring client company staff? You may withdraw this consent at any time.

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C3. Please let me know if you agree or disagree with each of the following statements. 

SELECT ONE PER ROW 

Agree
Disagree
I give Integro Permission to re -contact me about my involvement in this study
I give Integro Permission to use my recordings for the purpose of internal training post research
I give Integro Permission to pass my anonymized recordings/data to the client for pharmacovigilance checks
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S1.With which gender do you identify as …? SELECT ONE

 *

S2. What is your date of birth? 

MM
/
DD
/
YYYY

S3.Which, if any, of these conditions have you been diagnosed with by a health care professional? SELECT ALL THAT APPLY

S4.
When was your first Transthyretin Amyloidosis (ATTR) diagnosis? RECORD DIAGNOSIS DATE
RECORD: MM/DD/YYYY




S5.Do you recall whether you were diagnosed with hereditary ATTR (hATTR) or wild-type ATTR (wtATTR) amyloidosis? SELECT ONE

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S6B Have you been diagnosed with polyneuropathy caused by ATTR amyloidosis (ATTR-PN)? SELECT ONE

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S7.ave you ever taken any medications for the treatment of ATTR amyloidosis? SELECT ONE

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S8. Are you, or have you previously (in the past 5 years) been treated with any of the following drugs: SELECT ALL THAT APPLY

S9.

Have you been prescribed and taken anticoagulants (blood thinners) in the past 5 years?

For example:

Jantoven, Sofarin, Coumadin, Coufarin, Panwarfin (Warfarin)

Enoxiluv, Lovenox (Enoxaparin)

Heparin

Eliquis (Apixaban)

Xarelto (Rivaroxaban)


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S10.
We’re looking for people from different backgrounds. Which of the following best describe(s) your race/ethnicity? SELECT ALL THAT APPLY

S11.In which city/state do you currently live? RECORD CITY/STATE AND SEE BELOW

City/State:



S12.

What area best describes your residency? SELECT ONE

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S13.
Please select which one of the following descriptions best summarizes your ability to perform physical activity.  SELECT ONE 
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S14.
Which of the following statements best describes your knowledge of ATTR in general?
SELECT ALL THAT APPLY

S15.The next few questions are for statistical purposes only.  What is the highest level of education that you have completed? SELECT ONE TO BE LOCALIZED

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S16. Which of the following best describes the type of healthcare coverage you have? SELECT ALL THAT APPLY

T1.

What type of internet connection do you have on this computer? SELECT ONE
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T2.

What operating system does your computer run on? SELECT ONE
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T3.

Do you have / Are you willing to install Adobe Connect on your desktop/laptop for your interview? The installation is free, very quick, and not complicated. SELECT ONE
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Thank you for your answers. We would like to invite you to participate in our study.  As I mentioned earlier, participation in this study involves a 1-hour discussion with a highly trained moderator on a secure web platform


For participating in this research study, you will receive a monetary honorarium of $125 for participating in the 60-minute interview in appreciation of your time and effort.


Does this sound like a study in which you would like to participate?


The interview will be conducted on the Forsta InterVu platform.  The interview will take a full 1 hour. To participate, you will need to use a computer.  We mention using a computer and not a phone or tablet as we will have some materials for you to view during interview.  Are you willing to use the Forsta InterVu platform on a computer for a full 1 hours?
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Prior to your session, you can expect to receive an email from Forsta which will contain links to complete a tech check.  Please complete all of the tech checks required using the same computer and same internet location you plan to use for your interview.  This will help to ensure your computer has all of the tech requirements and internet speeds needed to complete the interview without any issues. We ask that you please complete this as soon as possible!  In the event your device does not meet the needs of the study, this will allow us time to problem solve with you.  


 Please provide the email address you would like to use for the login invitation for the platform: 

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