Attachment 11: Consent Form – Observational Feeding Study
NCI Feeding Study Informed Consent
Information about what Americans eat allows researchers and law makers to develop programs about ways to stay healthy. For this reason, it is important for them to be able to collect good quality information about what Americans are eating. This project will compare different ways to get information about foods from individuals.
Participation in the study typically takes about 3 hours over two consecutive days. If you agree to participate, you will come to Westat to eat 3 meals (breakfast, lunch and dinner), which are provided for you. The next day you will return to provide information about your diet and health. It will take approximately 45 minutes for each meal, and then about 45 minutes to complete the second day interview.
Your answers and opinions are very important to the success of this project since you represent others with similar lifestyles and habits. Your participation is voluntary, and you may refuse to answer any questions or leave the study at any time. Your information will not be used if you decide not to participate in the middle of the study, if you tell us not to use it.
The risks and discomfort involved in filling out questionnaires are minimal. There are no direct benefits to you from being in the study. You may take satisfaction in helping the National Institutes of Health in their goal of improving the health of Americans. Also, you will receive three meals one day and $120 for your participation.
You will be identified by a code number and data files will not include your name, phone number or any other personal information. Your answers will be grouped with those of other people in this study. All responses are also treated as confidential. The data will be used by the research team and may be shared with other researchers in the future. The results of this research study can be shared with you at a later date, if you are interested.
Participants should be aware that information provided over the Internet for this study is collected from a "secure" (https) website and responses cannot be viewed by unauthorized third parties (e.g., computer hackers). Westat will keep all of your responses and contact information in secure files.
The study has been approved by an Institutional Review Board at the National Institutes of Health (NIH), which monitors the protection of privacy and rights of participants in NIH studies. The study was also approved by the Office of Management and Budget (OMB), the office that reviews all federally-sponsored surveys.
Please speak with Westat staff if you have any questions about this study at this time. In the future, if you have more questions or problems about this study or about your rights as a research participant, you may call Westat toll-free at _______________ Monday-Friday 8:00 am-11:00 pm; Saturday 11:00 am-5:00 pm; Sunday 1:00-9:00 pm.
If you understand the statements above and agree to participate in the study, please print your name, sign, and date below.
_____________________________________________
PRINTED NAME
_____________________________________________ _______________
SIGNATURE DATE
| File Type | application/msword |
| File Title | NCI Feeding Study Informed Consent |
| Author | Bosire, Claire (NIH/NCI) |
| Last Modified By | Vivian Horovitch-Kelley |
| File Modified | 2009-08-03 |
| File Created | 2009-05-14 |