Focus Groups - Parent / Guardian Informed Verbal Consent

Evaluation of health communication messages for

Infertility Prevention Campaign

Attachment 4B

Parent/Guardian Informed Verbal Consent Form (for 15-17 yr old participants) Focus Groups

2/3/2021Parent/Guardian Informed Verbal Consent Form (for 15-17 yr old participants) Focus Groups

Reading level: 7

The Academy for Educational Development (AED) and the Centers for Disease Control and Prevention (CDC), invite your daughter to be in a research study. The purpose of this research is to help CDC learn how to talk to girls/women your age about things they can do now to protect their health and future fertility. The study will help us design a health campaign for girls and young women. Please feel free to ask questions as I explain the study.

If you consent to your daughter’s interest to participate in the study, we will ask her a few questions to see if she qualifies. These questions should take less than 5 minutes. If she qualifies, we will schedule her to participate in a focus group discussion with up to 8 other girls her age.

The study itself will involve talking with teens about where and how they get health information, and how they talk about health issues. We will also ask for teens’ opinions about screening for sexually acquired infections and their prevention. Focus groups will be carried out by a trained moderator. Each focus group will last 2 hours. The information will be used to write a report that will inform CDC’s campaign.

During the focus group, only your daughter’s first name will be used. If she prefers, she can also use a false name. The focus group will be audio-taped, and one or more note-takers will listen in. Your daughter’s name will not be used during the focus group, nor will it appear in the report. All notes and tapes will be kept in a locked cabinet, and no one outside this project will have access to them. Tapes will be deleted after the study. The information you give us will also be kept private.

The focus group poses no risks to your daughter. She can refuse to answer any questions or stop the focus group at any time if she is uncomfortable. No one is trying to sell your daughter anything.

If you and your daughter agree to have her participate, she will receive a check for $75 at the end of the focus group.

If you have questions about your daughter’s rights as a participant, or if you think she has been harmed, please call CDC at 1-800-584-8814. Leave a message with your name and phone number, and someone will call you back as soon as possible. Do you have any questions at this point?

Parental Verbal Consent

I will read you a list of statements about this research. Afterwards, I will ask you to say your full name, your daughter’s full name, and if you consent to have her participate. This information will be kept in a secure place. It will not be connected to your daughter’s focus group. The focus group moderator will never know your or your daughter’s full identity. Giving consent does not mean that your daughter will participate in the focus groups; only girls who meet the CDC’s recruitment needs will be invited to participate in the group discussions.

I understand and agree that:

• The focus group will cover health topics, including infertility prevention

• My daughter may refuse to participate or stop participation at any time

• My daughter’s name and opinions will be kept confidential. Only my daughter’s first name will be used during the focus group. She can choose to use a false name if she prefers

• My daughter’s focus group will be audio taped and researchers may listen in

• The focus group will only be used for research

• No one will try to sell my daughter anything

• My daughter will receive $75 for participating

• I have asked any questions I have

Please state your name: ____________________________________________

Please state your daughter’s name: _______________________________________

Do you, _________________________________ (Parent/Guardian’s Name), the parent/legal guardian of _________________________________ (Daughter’s Name), give permission for your daughter to do a two hour focus group discussion of teen health issues?

[Circle response] Yes No

[Record date] ___________________________

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