Please complete the survey below. Thank you!
We are asking you to take part in a brief confidential survey to help us determine whether you are eligible to participate in the Mom2Be research study being done by Drs. Gerald Nestadt and Lauren Osborne at Johns Hopkins University School of Medicine. Completing this survey is optional.
The survey will take about 5-10 minutes to complete and you will be asked to provide your name and a way for us to contact you. You can opt out of the survey at any time. We will keep your answers confidential and will not share your personal information with anyone outside the research team. A member of our team will contact you shortly to let you know if you are eligible for the Mom2Be study.
Questions? Please contact Dr. Janice Krasnow at jkrasno3@jhmi.edu. If you have questions or concerns about your rights as a potential research participant, or if you would like to obtain information or offer input, you may contact the Institutional Review Board at 410-502-2092 or by email to jhmeib@jhmi.edu.
If you want to complete the study pre-screening process, please provide a signature and continue with the survey.
I have read the information provided here. I have asked all the questions I have at this time. I voluntarily agree to participate in this screening survey.
Yes
No
Please sign here to indicate your consent to continue with the survey.
Please type your full name here.
First Name:
* must provide value
Last Name:
* must provide value
Phone number:
* must provide value
If we call you at the number provided, can we leave a detailed message?
Yes
No
Email address:
* must provide value
Best time of day to reach you:
Preferred contact method (select all that apply):
Address:
* must provide value
How did you hear about the study?
(Please check all that apply)
If you selected "other" above, please specify:
Are you 18 years of age or older?
Yes
No
Are you able to speak, read, and write fluently in English?
Yes
No
Are you currently in your first or second trimester of pregnancy?
Yes
No
What is your current week of pregnancy?
Less than 18 weeks
18-24 weeks
More than 24 weeks
Please specify your current week of pregnancy (for example, 20):
Is this a multiple pregnancy (twins, triplets, etc.)?
Yes
No
Don't know
Do you currently have an acute medical illness, or a surgical procedure scheduled in the next 2 months?
Yes
No
Do you have an autoimmune disease (for example, lupus, rheumatoid arthritis, Crohn's or colitis)?
Yes
No
We're sorry that you are not eligible for this study. We very much appreciate your time.
OBQ
Please continue with the next set of questions, below.
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The following questions list different attitudes or beliefs that people sometimes hold. Read each statement carefully and decide how much you agree or disagree with it. For each of the statements, choose the answer that best describes how you think. Because people are different, there are no right or wrong answers. To decide whether a given statement is typical of your way of looking at things, simply keep in mind what you are like most of the time . In making your ratings, try to avoid using the middle point of the scale ("Neither agree nor disagree"), but rather indicate whether you usually disagree or agree with the statements about your own beliefs and attitudes.
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We're sorry that you are not eligible for this study. We very much appreciate your time.
The following statements refer to experiences that many people have in their everyday lives.
Select the answer that be describes:
How much that experience has DISTRESSED or BOTHERED YOU DURING THE PAST MONTH.
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Thank you for completing the survey! A staff member will reach out to you shortly.
Thank you very much for your time!