Part 1: Socio-Demographic

Name

Gender  Male
 Female
 Other
Age

Marital Status  Single

 Married
 Divorced
Number of members in family

Address of stay (area name)

Occupation

Education

Languages known

Household income per month

Do you have arthritis  Yes

 No
How long have you had arthritis for?

Disease activity  Low

Method of treatment currently undergoing
Diagnosed at (Doctor/Hospital name)
 Moderate
 High Commented [SAV1]: https://file.scirp.org/pdf/OJRA_201
 Treatment over the counter (Without 4103114091860.pdf page no 4
medical advice)
 Leave treatment against medical advice
 Consult paramedics
 Accept opinion of lay people Commented [SAV2]: https://file.scirp.org/pdf/OJRA_201
4103114091860.pdf Page no 5

Count of hospital visits in the past year Commented [SAV3]: https://file.scirp.org/pdf/OJRA_201

4103114091860.pdf page no 4
Part 2: Marketing & Competitor Analysis

Type of treatment  Allopathy

 Homeopathy
 Herbal
 Other
________________

Who prescribed you the  Self

drugs for RA?  Orthopaedist
 Pharmacist
 Other
__________________________

Drugs being used for the (Size & Form of the drug) (Brand) (Mode of Buying)
treatment
(Names)
Part 3: Patient Preferences

Please rank the following questions on a scale of 1 to 5.

How satisfied are you with the current method  1
of treatment?  2
(1 – Very dissatisfied, 5- Very satisfied)  3
 4
 5
How likely would you go for herbal treatment?  1
(1-least likely, 5- most likely)  2
 3
 4
 5
How likely would you go for homeopathic  1
treatment?  2
(1-least likely, 5- most likely)  3
 4
 5
How likely would you go for allopathy  1
treatment?  2
(1-least likely, 5- most likely)  3
 4
 5
What made you prefer the current form of
treatment?
Do you use herbal medicines in any illness  Yes
(acute/chronic)?  No
 Not Sure
If yes where do you buy them from and who
prescribed them?
If yes name the herbal drugs used (along with
brand names)

Do you prefer herbal medicines over allopathy?  Yes

 No
 Not Sure
If yes, in which form?
Do you ask your allopathic doctor about herbal  Yes
medicines when you want to use them?  No
 Not Sure
Do you self-prescribe herbal medicines for  Yes Commented [SAV4]: Patients' preference for
yourself?  No integrating homeopathy (PPIH) within the
standard therapy settings in West Bengal, India: The part
 Not Sure 1 (PPIH-1)
Do you visit ayurvedic doctor when you want to  Yes study
use any herbal medicine?  No Munmun Koley a, *, Subhranil Saha a, Jogendra Singh
 Not Sure Arya a, Gurudev Choubey a,
Aloke Ghosh b, Kaushik Deb Das c, Subhasish Ganguly d,
Name few herbal brands which has products to Samit Dey e, Sangita Saha f,
treat RA Rakesh Singh g, Kajal Bhattacharyya h, Shubhamoy Ghosh
i, Sk. Swaif Ali j
Name fee herbal brands (for any disease)
Part 3: Knowledge attitude awareness of the disease by the patient

Name of the disease Commented [SAV5]: https://www.ejmanager.com/mnst

Are you aware of the symptoms of the disease?  Yes emps/33/33-1454652688-REV.pdf?t=1469463199
 No
 Not Sure
If yes, what are they?
Is deformity expected in RA?  Yes
 No
 Not Sure
Are internal organs affected with RA?  Yes
 No
 Not Sure
Does RA cause disability?  Yes
 No
 Not Sure
Genetics cause RA  Yes
 No
 Not Sure
Is RA contagious?
RA is predominant in females. Do you agree?  Yes
 No
 Not Sure
Is treatment available for RA?  Yes
 No
 Not Sure
RA requires lifelong treatment  Yes
 No
 Not Sure
What do you think is the cause of RA?  Environmental
(Tick the options)  Genetic
 Obesity
 Cigarette Smoking
 Dietary
 Exercise
 Don’t Know
 Other
_______________________

Rheumatoid Arthritis  occasionally affects the lungs, eyes or

other tissues
 is a long-term disease
Do you know the side effects of medications  Yes
used for RA currently  No
 Not Sure Commented [SAV6]: https://file.scirp.org/pdf/OJRA_201
If yes, list them 4103114091860.pdf page no 5
What are tissues affected by RA?  Nervous system
 Gastrointestinal system
 Respiratory system
 Skin
 Cardio-vascular system
 Bones
 Others
____________________________

What treatment types are used to treat RA?  NSAID

 Cytotoxic drugs
 Biological agents
 Alternative medicine (herbals,
acupunctures, clergyman, praying)
 Don’t know
Is RA an autoimmune disease?  Yes
 No
 Not Sure
Is changes in weather an aggravating factor for  Yes
RA?  No
 Not Sure
Is smoking habit an aggravating factor for RA?  Yes
 No
 Not Sure
Part 4: Impact of disease on their lifestyle, works & facilitating conditions that support them to
overcome negative impact of disease

Work Context
Job sector
How many hours do you work on an average per week?
How many work unpredictable hours do you encounter
per week?
How much control do you think you have on your job?
(1-very little, 10-verymuch)
How many flexible work hours do you have per week?
Any job modifications were made for arthritis by the
employer?
On a scale of 1-10 how much do you think arthritis
limits your work activity?
(e.g., getting to, from, and around the workplace;
sitting/standing for long periods; concentration at work;
job scheduling)
(1- no difficulty, 10-unable to do)
How satisfied are you with career?
(1-very little, 10-verymuch)

How many job disruptions happened due to arthritis in

the last 6 months? (e.g.: arriving late/leaving early,
extended breaks, missed meetings)
Number of days absent in the past 6 months related to
arthritis (including time off for appointments)
Rate the extent by which the arthritis treatment
resulted in your productivity loss
(1-not at all, 5-a great deal)
How stressful is your work?
(1-not at all stressful, 5- extremely stressful)
Commented [SAV7]: https://www.ncbi.nlm.nih.gov/pmc
/articles/PMC4118040/

Work-Health-Personal Life Balance

What are the symptoms and their effect on  Fatigue and lack of energy
daily work?  Pain and stiffness
 Physical limitations
 Concentration
 Others
__________________________ Commented [SAV8]: https://academic.oup.com/rheumat
ology/article/52/7/1254/1793323
You feel you are in control of your arthritis Agree 1 2 3 4 5 Disagree Commented [SAV9]: From Impact of advertisement OTC
I don’t have as much energy at work as I Agree 1 2 3 4 5 Disagree questionnaire
would like Commented [SAV10]: https://www.ncbi.nlm.nih.gov/pm
My symptoms are unpredictable which Agree 1 2 3 4 5 Disagree c/articles/PMC4118040/
creates stress
Having arthritis means I work harder to Agree 1 2 3 4 5 Disagree
compensate for my condition
Arthritis makes it hard to perform work task Agree 1 2 3 4 5 Disagree
Arthritis affects my professional image Agree 1 2 3 4 5 Disagree
Arthritis makes me look less competent Agree 1 2 3 4 5 Disagree
I feel guilty for not doing as good a job as I Agree 1 2 3 4 5 Disagree
would like
Working with arthritis means I’ve had to make Agree 1 2 3 4 5 Disagree
trade-offs in my life
Working means I have no time to look after Agree 1 2 3 4 5 Disagree
myself properly
I feel guilty for not taking as much care of my Agree 1 2 3 4 5 Disagree
arthritis as I would like
Working makes it hard to attend Agree 1 2 3 4 5 Disagree
appointments for my arthritis
I have so much to do in my personal life I Agree 1 2 3 4 5 Disagree
don’t have time to care for my arthritis
I’m so tired from all the other things I have to Agree 1 2 3 4 5 Disagree
do I don’t have energy to take care of myself
There are not enough hours in the day to deal Agree 1 2 3 4 5 Disagree
with work, personal demands and my health
I worry about how I will deal with all the Agree 1 2 3 4 5 Disagree
demands of my work, personal life and health
Work keeps me moving and active which Agree 1 2 3 4 5 Disagree
helps my condition
Work gives me a purpose—a reason to get up Agree 1 2 3 4 5 Disagree
My work is a part of who I am Agree 1 2 3 4 5 Disagree
Work gives me something to focus on other Agree 1 2 3 4 5 Disagree
than my health
Work allows me to do something I really enjoy Agree 1 2 3 4 5 Disagree