0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent

0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent.doc

Evaluation of the Parents Speak Up National Campaign: National Media Tracking Surveys

0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent

OMB: 0990-0345

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Assurances of Confidentiality and Study Descriptions
Provided to Respondents


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In this survey, we will ask you questions about you and your child. Some of the questions are about sensitive matters and may make some people feel uncomfortable. Before we show you the survey questions, we’d like give you a little more background on the study.


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Title of Research: Study About Family Communication


Introduction

You are being asked to participate in a research study. Before you decide whether you want to take part in this study, you need to read this Informed Consent form so that you understand what the study is about and what you will be asked to do. This form also tells you who can be in the study, the risks and benefits of the study, how we will protect your information, and who you can call if you have questions. If you have anything you don’t understand before you make your decision, please call Panel Relations at (800) 782-6899 and someone will direct your questions to the appropriate researchers Research Triangle Institute.


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Purpose

This study about family communication, paid for by the Office of Population Affairs (OPA), Department of Health and Human Services (DHHS), is being conducted by RTI International, a research organization located in North Carolina, and its subcontractor, Knowledge Networks, located in California. The purpose of this study is to learn about parents’ attitudes, beliefs, and communication with their pre-teens about sex. We are conducting a study that will last for approximately 5 years. There will be an initial survey to be followed by 8 additional surveys conducted every fall and spring after the initial survey for 4 years. We are inviting you to participate in each of these surveys.


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Procedures

If you agree to participate, you will be asked to complete a Web questionnaire at home on a personal computer.


You will be asked questions about things like your attitudes and beliefs about teen sex and family communication about this topic. Your pre-teen doesn’t have to be sexually active for you to be in the study. You can skip any question you like. Your participation is entirely voluntary, and you can stop at anytime.


Study Duration


Your participation in the Web survey will take about 24 minutes of your time. There will be 8 additional surveys conducted every fall and spring for 4 years after the initial survey. Each additional survey will take about the same amount of time to complete.


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Possible Risks or Discomforts

It is possible that some of the survey questions may make you uncomfortable or upset. You can refuse to answer any question. There is a risk that your answers to the questionnaire could be seen by someone other than the project staff, but we promise to do our best to keep this from happening. It is also possible that a family member could view your questionnaire answers on your personal computer while the survey is in progress, which could create family problems. Your name will be replaced with a number for the purposes of this study. After each round of surveys is completed, a summary will be written that contains information from all participants, but no names. The staff conducting this study will not use your name in the report and will keep your answers private.


In addition to the risks and discomforts listed here, there may be uncommon or previously unknown risks. You should report any problems to Panel Relations at (800) 782-6899.


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Benefits


Your Benefits


There are no direct benefits to you from participating in this study.

Benefits for Other People


We hope that this research will help us understand more about family communication and improve related programs designed for families.


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Payment for Participation

You will receive a total of 15,000 Knowledge Networks bonus points for your participation in this survey


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Confidentiality

Many precautions have been taken to protect your information. Your name will be replaced with *a number. Other personal information like your address and telephone number will be stored by Knowledge Networks separately from the answers you provide on the questionnaire. Your name, address, and phone number will not be shared with RTI.


The Institutional Review Board (IRB) at RTI has reviewed this research. An IRB is a group of people who are responsible for assuring that the rights of participants in research are protected. The IRB may review the records of your participation in this research to assure that proper procedures were followed. A representative of the IRB may contact you for information about your experience with this research. This representative will be given your name, but will not be given any of your confidential study data. If you wish, you may refuse to answer any questions this person may ask. In addition, all project staff have signed confidentiality agreements.


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Future Contacts


If you choose to participate in this survey, we will contact you to participate in the follow up surveys every fall and spring for the next 4 years from now. If you choose not to participate, we will not contact you in the future.


Your Rights


Your decision to take part in this research study is completely voluntary. You can refuse any part of the study, 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.



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Your Questions

If you have any questions about the study, you may call Panel Relations at (800) 782-6899 and someone will direct your questions to the appropriate researchers RTI. If you have any questions about your rights as a survey participant, you may wish to contact the Research Triangle Institute Office of Research Protection and Ethics. If you contact Panel Relations at (800) 782-6899 and indicate that you would like to contact the RTI Office of Research Protection and Ethics, someone will provide you with the appropriate contact information.


Click here if you would like to see the consent form in its entirety. You may also choose to print it out for your reference later.



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Selecting the consent to participate link below indicates that you have read the information provided above, have received answers to your questions, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.


Please select the appropriate link below.


I consent to participate in the study


I DO NOT consent to participate in the study


File Typeapplication/msword
File TitleAssurances of Confidentiality and Study Descriptions
Authorkcdavis
Last Modified ByDHHS
File Modified2009-04-07
File Created2009-04-07

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