MS in African Americans: Detroit Patient Outreach
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Patient Survey
Which is your race?
Caucasian
African American
American Indian
Gender?
Male
Female
Which is your age group?
18-30
31-40
41-60
60 and over
What is your highest level of education?
Some High School
High School or Equivalent
Some College
Bachelor's Degree
Graduate Degree
How likely are you to see a doctor who is of the same race as you?
Very likely
Likely
Uncertain
Unlikely
Very Unlikely
How likely are you to see a doctor that is of a different race than you?
Very likely
Likely
Uncertain
Unlikely
Very Unlikely
Do you trust your Neurologist?
Strongly agree
Agree
Uncertain
Disagree
Strongly disagree
Do you feel like your Neurologist has truthfully informed you about your disorder?
Strongly agree
Agree
Uncertain
Disagree
Strongly disagree
How likely are you to personally research your condition?
Very likely
Likely
Uncertain
Unlikely
Very unlikely
Do you have access to the information you need to help manage your condition?
Yes
No
How likely are you to seek a second option regarding your diagnosis?
Very likely
Likely
Uncertain
Unlikely
Very unlikely
If your Neurologist approached you with a research study opportunity, how likely are you to participate?
Very likely
Likely
Uncertain
Unlikely
Very unlikely
Have you ever felt discriminated against because of race by medical personal?
Yes
No
If your doctor and your family/friends disagree on treatment, how likely are you to follow your Neurologist advice?
Very likely
Likely
Uncertain
Unlikely
Very unlikely
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