Form Approved
OMB No. 0920-0798
Exp. Date: 01/31/2011
Attachment 10
Consent to Participate in Telephone Interview
You are being asked to participate in a telephone interview along with your spouse or partner. RTI International is conducting a series telephone interviews with couples sponsored by the Centers for Disease Control and Prevention (CDC). The purpose of the interviews is to learn about how women and their partners work together and communicate about women’s health and healthy behaviors. You are eligible to take part in the discussions because you are married or in a committed relationship. About 150 people total will take part in the discussions.
If you agree to participate, you will take part in an interview over the telephone for about 60 minutes.
An experienced interviewer from RTI will moderate the discussion. Another member of our project team will take notes during the interview. The discussion will also be audio recorded. The recordings will help us get everything you have to say. It is possible that someone from the CDC would be listening to our call so they can better understand the views and opinions of couples. If they are on the call, we will let you know. They also will not participate in any way during the call. They will only listen to the interview.
We do not expect any risks to you and your spouse or partner from participating in the interview. It is possible that some of the things we discuss could make you uneasy; however, if either one of you find that any of the questions make you uncomfortable, you do not have to answer them.
There are no direct benefits to you and your partner or spouse from answering the questions except the satisfaction of helping CDC better understand issues relating to women’s health and healthy behaviors so that they may develop better health information for both women and their spouses or partners.
Each of you will receive $35.00 for your time and effort to participate in the telephone discussion.
Your answers will be used to write a summary report, but we will not use any real names in the report. Your name will not be given to anyone. The notes and the tapes will be kept in a locked file cabinet in the RTI office and will be destroyed after the project is completed.
RTI and CDC will not contact you in the future regarding this study.
Your decision to take part in this interview is completely voluntary. You can refuse any activity and you can stop participating at any time. You can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.
If you have any questions about the telephone discussions, you may call Dr. Megan Lewis at RTI at 1-800-334-8571 extension 26834. If you have any questions about your rights as a focus group participant, you may call RTI’s Office of Research Protection toll-free at 1-866-214-2043.
Public reporting burden of this collection of information is estimated to average 5 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0798)
| File Type | application/msword |
| File Title | Consent to Participate in Telephone Interview |
| Author | Karen Isenberg |
| Last Modified By | Karen Isenberg |
| File Modified | 2010-06-24 |
| File Created | 2010-06-24 |