Consent Forms

Attachment 6

Consent Form

Knowledge Networks Panel Participants

Reading Level 7.9 (assessed by Fleish-Kincaid)

Introduction and Purpose:

You have been asked to be in a research study. RTI International (RTI), a research company in North Carolina, and Knowledge Networks in California are doing this study. The purpose of the study is to learn about your attitudes and beliefs about HIV testing. The study is funded by the Centers for Disease Control and Prevention (CDC). About 1,630 people will be in this study.

Procedures:

If you choose to be in the study, there will be four steps:

1. We will ask you to do a Web survey that will take about 15 minutes. Some of the questions will ask about personal matters like the types of sex you have, your HIV status, HIV testing, and injection drug use.

2. You may be asked to listen to radio ads and look at an online booklet using your computer. Whether or not you listen to the ads and look at the booklet will be decided randomly, like the flip of a coin. If you are asked to listen to the radio ads and look at the booklet, it will take about 30 minutes.

3. Two weeks after you do the first Web survey, you will be asked to do another Web survey that will take about 15 minutes. These questions will be about things like your attitudes and beliefs about HIV testing, what you might do in the future, and what you thought about the radio ads and the booklet if you heard or saw them.

4. Four weeks after that survey you will be asked to answer one more short Web survey that will take about 5 minutes.

It will take a total of about 65 minutes to do all of the four steps in the study.

Risk/Discomforts:

There is a risk that someone else could see your answers if they look at your computer screen when you are doing the survey. Also, the radio ads that you might hear and the booklet that you may look at will be about HIV. You might feel embarrassed or upset by what you look at or the questions you are asked. If that happens, you can call 1-800-CDC-INFO to get answers to your questions about HIV/AIDS and how to protect yourself.

Benefits:

There is no direct benefit to you for being in this study. What we learn from this study will help us to develop HIV testing messages and programs in the future.

Confidentiality:

Your answers will be kept private to the extent allowed by law. We will use an ID code instead of your name to identify your answers. Your answers to the survey will be kept on a password-protected computer. Only authorized project staff will be able to see them. Your name and other facts that might identify you will not appear when we present this study or publish its results. There is a small risk that your privacy could be broken, but we promise to do our best to keep this from happening.

Payment:

To thank you for the time you spend doing each survey, we will give you 20,000 Knowledge Networks bonus points after you do the first survey. We will give you 10,000 bonus points after you do the second survey. We will give you 10,000 bonus points after you do the third survey. If you do all three surveys, you will get a total of 40,000 bonus points.

Right to Refuse or Withdraw:

It is your choice to be in this study. You can skip any question for any reason. You can drop out of the study at any time.

Persons to Contact:

If you have any questions about the study, you can call Dr. Jennifer Uhrig from RTI at 1-800-334-8571 extension 3311. If you have any questions about your rights as a research participant in this study, you can call RTI’s Office of Research Protection at 1-866-214-2043.

Your Consent:

Please print a copy of this consent form to keep. Selecting the consent to participate link below indicates that you have read this consent form, got answers to your questions, and have freely decided to be in this study.

I consent to participate in this study

I DO NOT consent to participate in this study

E-mail List Sample Participants

Reading Level 7.9 (assessed by Fleish-Kincaid)

Introduction and Purpose:

You have been asked to be in a research study. RTI International (RTI), a research company in North Carolina, and Knowledge Networks in California are doing this study. The purpose of the study is to learn about your attitudes and beliefs about HIV testing. The study is funded by the Centers for Disease Control and Prevention (CDC). About 1,630 people will be in this study.

Procedures:

If you choose to be in the study, there will be four steps:

1. We will ask you to do a Web survey that will take about 15 minutes. Some of the questions will ask about personal matters like the types of sex you have, your HIV status, HIV testing, and injection drug use.

2. You may be asked to listen to radio ads and look at an online booklet using your computer. Whether or not you listen to the ads and look at the booklet will be decided randomly, like the flip of a coin. If you are asked to listen to the radio ads and look at the booklet, it will take about 30 minutes.

3. Two weeks after you do the first Web survey, you will be asked to do another Web survey that will take about 15 minutes. These questions will be about things like your attitudes and beliefs about HIV testing, what you might do in the future, and what you thought about the radio ads and the booklet if you heard or saw them.

4. Four weeks after that survey you will be asked to answer one more short Web survey that will take about 5 minutes.2

It will take a total of about 65 minutes to do all of the four steps in the study.

Risk/Discomforts:

There is a risk that someone else could see your answers if they look at your computer screen when you are doing the survey. Also, the radio ads that you might hear and the booklet that you may look at will be about HIV. You might feel embarrassed or upset by what you look at or the questions you are asked. If that happens, you can call 1-800-CDC-INFO to get answers to your questions about HIV/AIDS and how to protect yourself.

Benefits:

There is no direct benefit to you for being in this study. What we learn from this study will help us to develop HIV testing messages and programs in the future.

Confidentiality:

Your answers will be kept private to the extent allowed by law. We will use an ID code instead of your name to identify your answers. Your answers to the survey will be kept on a password-protected computer. Only authorized project staff will be able to see them. Your name and other facts that might identify you will not appear when we present this study or publish its results. There is a small risk that your privacy could be broken, but we promise to do our best to keep this from happening.

Payment:

To thank you for the time you spend doing each survey, we will give you $20 after you complete the first survey. We will give you $10 after you complete the second survey and $10 after you complete the third survey. If you do all three surveys, you will get a total of $40.

Right to Refuse or Withdraw:

It is your choice to be in this study. You can skip any question for any reason. You can drop out of the study at any time.

Persons to Contact:

If you have any questions about the study, you can call Dr. Jennifer Uhrig from RTI at 1-800-334-8571 extension 3311. If you have any questions about your rights as a research participant in this study, you can call RTI’s Office of Research Protection at 1-866-214-2043.

Your Consent:

Please print a copy of this consent form to keep. Selecting the consent to participate link below indicates that you have read this consent form, got answers to your questions, and have freely decided to be in this study.

I consent to participate in this study

I DO NOT consent to participate in this study