AttH2 - Informed Consent Latina

INFORMED CONSENT (LATINAS)

ICF Macro is conducting discussion groups on behalf of the Centers for Disease Control and Prevention (CDC) in [INSERT CITY], North Carolina. These groups are being held to help CDC develop more effective health promotion and communication campaigns aimed at Latinas aged 40-64 who may qualify for free breast cancer screening.

Breast cancer screening can help to find cancer earlier. When cancer is detected early, women have a better chance of survival. Many women do not know that they qualify for low- or no- cost breast cancer screening. This study will provide information to CDC on how to better inform Latinas about available breast cancer screening services.

You were chosen for these focus groups with other women who like you who met the eligibility criteria and qualify for low- or no-cost screening through your local screening program. The discussion group activities will take about 2 hours and 20 minutes. If you agree to be in the group, here are the things you should know:

• Your participation in the study is voluntary. If you do not participate, you will not lose any health care service that you expect to get apart from this study.

• You may choose to leave the group at any time for any reason with no penalty or consequence.

• Each discussion group will consist of six to ten women.

• You can choose not to answer any question at any time for any reason.

• You will not be asked any questions about your personal health.

• ICF Macro staff will take notes during the focus group discussion.

• We will record the discussion on audiotape. Only study staff will be able to use the tapes. The tapes are to help ensure our notes accurately capture what is said by all of you as you discuss the topics.

• Your answers in the group will be kept in a secure manner and will not be disclosed, except as otherwise required by law. Identifying information will not be disclosed to anyone but the researchers conducting this evaluation. The information that we report to CDC will not contain any identifying information and your name will not be used in any reports about this evaluation. We ask that you also respect the privacy of your fellow group members.

• To protect your privacy, we will keep the records and tapes in private files and only study staff will be allowed to use them. Your name and other information linking your name to what is said during the groups will not be reported when we present this study or publish its results.

• ICF Macro staff and CDC will observe the group behind a one-way mirror or a video feed.

• Your input in this discussion group poses few, if any risks to you. You can choose not to answer any question for any reason.

• Your participation in this focus group will not directly benefit you other than the financial incentive. However, the benefit of this group to you is that your input will help CDC develop more effective health promotion and communication campaigns aimed at Latinas like you. What you have to say could help increase the number of women who get screened for breast cancer and reduce the number of women who die from this disease.

• We will give you $50.00 as a token of appreciation. We will give you this $50 whether you finish the focus group or decide to withdraw before it ends.

• You are free to participate in the focus group, however, you may leave the discussion at any time for any reason. If you decide not to join the group, or to drop out later, you will lose no health care that you may expect apart from this study.

• You will be given a copy of this form for you to keep.

Contact Information: If you have questions about the study, please call Ashani Johnson-Turbes, ICF Macro Project Manager at 404-321-3211. If you have concerns about your rights in this research study, contact the CDC Deputy Associate Director for Science at 1-800-584-8814.

Please sign below to indicate that you have read the above and agree to take part in this discussion group.

Please Print Your Name:
Please Sign Your Name:
Witness Signature:
Date:

THANK YOU

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