Appendix D – Supplement to Appendix G
Flesch-Kincaid Grade Level = 8.2
Focus Group Consent Form for At Risk Women (Florida)
General Information about the Study
We are asking you to take part in a research study that is being done by the Centers for Disease Control and Prevention (CDC). The purpose of this study is to learn about young African American women living in Palm Beach County, Florida so that we can create a program that may help women improve their incomes and also make healthy decisions about their lives. We are particularly interested in the relationship between economic needs and risk for becoming infected with HIV and STDs.
We will ask questions related to work and young African American women in your community. Examples of questions are
What types of work are available to young women
How young women support themselves and their families
How much money is needed to support themselves and families
Why some women find it hard to find a job
What kinds of work would young women like to do
What types of work are needed in your community that can be done by young women
We want to hear what you think. There are no right or wrong answers.
We will ask you these questions during a group discussion. There will be up to 8 young African American women in the group. There will also be a female interviewer and a female assistant in the same room. The discussion will last about two hours. We will audiotape the discussion. The tapes will be later typed into a computer so they can be used for our research. At the end of the group discussion we will give you a short form asking you some basic information. The form will take about 5 minutes to complete. No names will be collected on this form.
Risks
Some things discussed in the group may make you feel uneasy. We respect your right to not answer any questions. Taking part in the group discussion is up to you. You can stop taking part in the discussion at any time. If you choose not to participate, it will not affect any services that you receive or are eligible for.
We will do our best to make the discussions comfortable. We will stress the importance of keeping the group discussion private. We will ask group members to respect each other’s confidentiality. However, we cannot guarantee that group members will keep information discussed during the group to themselves.
Confidentiality
The information that you share with us will be kept secure. The tapes of the discussion and notes will be kept in a locked file drawer in the Project Leader’s Office at the Centers for Disease Control and Prevention, Atlanta, Georgia.
We may contact you again to participate in another interview. So we will keep your name and contact information in a locked file cabinet in the Palm Beach County Department of Health.
Only project staff will have access to information about you, including your name, study number, contact information, audio tapes, and notes. This information will be destroyed within 6 months after the focus group.
Benefits
Although there are no direct benefits from being in the study, we believe this work can help young African American women in the south to take good care of themselves and those they care about.
Reimbursement
You will receive $25 for your time and any costs you may have for being in the study.
Persons to Contact
If you have questions about the study, you can contact Dale Stratford, the Project Leader, at the Division of HIV/AIDS Prevention, CDC. She can be reached at 404-639-6276. If you have questions about your rights as a participant in this research study or if you feel you have been injured or harmed as a result of the study, you can call CDC Human Research Protection Office at 1-800-584-8814.
Consent
I agree to be in this group discussion. I have been given a chance to ask questions and I feel that all of my questions have been answered. I know that being in this group discussion is my choice. I know that after choosing to be in this study, I may leave at any time. I have been told that the group discussion will be audio taped. I will not discuss or share what I have heard outside of this room.
I have been given a copy of this consent form to keep. □
Please check here if you would like to receive results from this study. □
Signature of participant Date
__________________________________________________________________
Signature of researcher Date
Appendix N – Supplement to Appendix G
Flesch-Kincaid Grade Level = 8.2
Focus Group Consent Form for At Risk Women (North Carolina)
General Information about the Study
We are asking you to take part in a research study that is being done by the Centers for Disease Control and Prevention (CDC). The purpose of this study is to learn about young African American women living in XXX County, North Carolina so that we can create a program that may help women improve their incomes and also make healthy decisions about their lives. We are particularly interested in the relationship between economic needs and risk for becoming infected with HIV and STDs.
We will ask questions related to work and young African American women in your community. Examples of questions are
What types of work are available to young women
How young women support themselves and their families
How much money is needed to support themselves and families
Why some women find it hard to find a job
What kinds of work would young women like to do
What types of work are needed in your community that can be done by young women
We want to hear what you think. There are no right or wrong answers.
We will ask you these questions during a group discussion. There will be up to 8 young African American women in the group. There will also be a female interviewer and a female assistant in the same room. The discussion will last about two hours. We will audiotape the discussion. The tapes will be later typed into a computer so they can be used for our research. At the end of the group discussion we will give you a short form asking you some basic information. The form will take about 5 minutes to complete. No names will be collected on this form.
Risks
Some things discussed in the group may make you feel uneasy. We respect your right to not answer any questions. Taking part in the group discussion is up to you. You can stop taking part in the discussion at any time. If you choose not to participate, it will not affect any services that you receive or are eligible for.
We will do our best to make the discussions comfortable. We will stress the importance of keeping the group discussion private. We will ask group members to respect each other’s confidentiality. However, we cannot guarantee that group members will keep information discussed during the group to themselves.
Confidentiality
The information that you share with us will be kept secure. The tapes of the discussion and notes will be kept in a locked file drawer in the Project Leader’s Office at the Centers for Disease Control and Prevention, Atlanta, Georgia.
We may contact you again to participate in another interview. So we will keep your name and contact information in a locked file cabinet in the xxx County Department of Health.
Only project staff will have access to information about you, including your name, study number, contact information, audio tapes, and notes. This information will be destroyed within 6 months after the focus group.
Benefits
Although there are no direct benefits from being in the study, we believe this work can help young African American women in the south to take good care of themselves and those they care about.
Reimbursement
You will receive $25 for your time and any costs you may have for being in the study.
Persons to Contact
If you have questions about the study, you can contact Dale Stratford, the Project Leader, at the Division of HIV/AIDS Prevention, CDC. She can be reached at 404-639-6276. If you have questions about your rights as a participant in this research study or if you feel you have been injured or harmed as a result of the study, you can call CDC Human Research Protection Office at 1-800-584-8814.
Consent
I agree to be in this group discussion. I have been given a chance to ask questions and I feel that all of my questions have been answered. I know that being in this group discussion is my choice. I know that after choosing to be in this study, I may leave at any time. I have been told that the group discussion will be audio taped. I will not discuss or share what I have heard outside of this room.
I have been given a copy of this consent form to keep. □
Please check here if you would like to receive results from this study. □
Signature of participant Date
__________________________________________________________________
Signature of researcher Date
| File Type | application/msword |
| File Title | APPENDIX D |
| Author | bbs8 |
| Last Modified By | bbs8 |
| File Modified | 2007-05-18 |
| File Created | 2007-05-18 |