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H.1896-0421 Haemophilia

You are about to fill in a short survey which will help determine your suitability to this research project. Please be aware that all data you provide us with will be held in accordance with the data protection policy outlined on our website. For further information please visit https://www.healthcareopinions.co.uk/privacy-policy/

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What is your name, contact number and email address?
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Please tell us your age.
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Are you...
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What is your working status?  
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If applicable, what is your occupation? 
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Are your details currently registered with us? If you haven't, please do so here http://https://www.healthcareopinions.co.uk/
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Where did you hear about this research participation opportunity?
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 Have you, or your child, been diagnosed with Haemophilia A or B, or von Willebrand type 2 or type 3 requiring infusions into vein, or other condition that requires infusions?

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Please tell us the condition your child has been diagnosed with that requires infusions...
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Please tell us the condition you have been diagnosed with that requires you to have infusions...
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Please tell us the condition your family member has been diagnosed with...
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Please tell us how old your child with this diagnosis, will be on July 8th 2021...
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Please tell us the gender of your child with this diagnosis...
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Would you agree to, during the session, allow your child to independently perform the tasks involved in preparing and simulating infusions?
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Which is your child's dominant hand? 
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Which is your dominant hand? 

Have you performed infusions to yourself or to another person using a syringe or vial kit in the last 2 years?

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Have you performed more than 3 infusions in the last year? With what frequency?
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Has your child ever performed infusions to themselves or to another person with a syringe or vial kit? 

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When your child has an infusion, can they do it themselves or do they require help from you?

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Do you require any assistance to perform the infusions?
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Has your child performed more than 3 infusions in the last year? if so, how often do they perform them? 
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Please tell us where on the body your child has experience of infusing and how recently...
How does/did your child perform/receive the infusions?
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How do/did you to perform the infusions?
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Does your child have a severe hearing impairment that significantly affects their daily life?
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Do you have a severe hearing impairment that significantly affects your daily life?

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Does your child have any severe visual impairments that is not corrected by wearable glasses/lenses?
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Do you have a severe visual impairment that is not corrected by wearable glasses/lenses?
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Does your child have any issues using their hands that significantly affects their daily life? 
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Do you have any issues using your hands that significantly affects your daily life? 

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Please tell us the condition your child has that affects their manual dexterity...
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Please tell us the condition you have that affects your manual dexterity...
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Does/would your child require any assistance while infusing due to this hand impairment?
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The study will not include needles, but it does involve a transfer device/vial adapter that has a plastic spike.

Are you or your child afraid of slightly exposed sharp plastic elements?

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Are you or your child allergic to latex? 
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Do you or your child have any of the following conditions that might be impacted by the current Covid-19 situation?

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Can you please confirm if you and/or your child are comfortable with the sessions being audio- and video recorded?
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When was the last time you took part in a market research or usability study relating to infusion devices?
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When was the last time your child took part in a market research or usability study relating to infusion devices?

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If you or your child is enrolled in the research study, you will be required to inform the recruiting staff if you, you or your child or anyone in your household develop any symptoms or come into contact with someone who tests positive for COVID- 19 leading up to your scheduled interview date. Do you agree to keep the recruiters informed?

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Please tell us your highest educational achievement to date...
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Are you, or is anyone in your household employed in any of the following industries?