“Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men”
0920-09CJ
Attachment 4c. Phase Three Focus Groups Consent
Form Approved
OMB No. 0920-XXXX
Expiration Date XX/XX/XXXX
“Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men”
Phase Three Focus Groups Consent
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BEATS Project Phase Three
Consent to Participate in a Research Study
Reading Level: 7.7
We want to learn about issues young Black men who have been recently arrested or in jail face. We are hoping this information you give us will help us to develop better health programs.
This study is funded by the Centers for Disease Control and Prevention and will be lead by Dr. Scyatta Wallace, Department of Psychology, College of Liberal Arts and Sciences, St. John’s University.
If you agree to be in this study, you will be asked to take part in a discussion group.
If you agree to take part in the discussion group, we will ask you about what you know about HIV and HIV testing. We will also ask you about what information you have seen about HIV testing in your community or while you were arrested/incarcerated. We will like your input on materials we have developed. We hope your comments will help us to develop better HIV testing educational materials for Black men like you.
The discussion group will take 2 hours.
There is little risk for being in this discussion. You may be uncomfortable discussing topics such as HIV testing.
When you are done, you will get a list of health services and information about health for young Black men like you.
We would like your permission to record the discussion so staff can keep track of your responses. Names or anything that can be used to identify you will be taken off of the transcripts. You may review these audio-tapes and ask that all or part of it be destroyed. If you mention names and other information that can identify you, we will delete them from the interview notes. Audio tapes and notes will be given a code number.
All contact information will be destroyed after each discussion is complete. Notes will be kept in a locked file cabinet in Dr. Wallace’s private office. Consent forms will be kept in a locked file separate from the data. No research materials will be kept at Fortune Society. Transcripts will be stored in a locked safe away from the signed consent forms. The staff at Fortune Society and your parole/probation officer will not have access to this information. Your responses will be kept private by the researcher but privacy cannot be guaranteed by others in the group.
We would like your permission to use the audio-recording for professional purposes, such as presentations. We will not reveal your identity in any presentation or publication.
Your participation in the study is voluntary. You can say no or withdraw at anytime. If you do not feel like answering certain questions, you can skip them. Not taking part in the survey or stopping early will not affect the services you receive at Fortune Society or your probation/parole status.
For taking part you will be reimbursed with a $50 gift card. If you stop before the end of the study, you will not be compensated.
Contact Dr.Wallace if you are unsure about the study or have any questions.
The contact information is: (718) 990-2398, [email protected], Department of Psychology, St. John’s University, 8000 Utopia Parkway, Jamaica, NY 11439.
If you have questions about your rights as a research participant, contact the Human Subjects Review Board at St. John’s University. The number is (718) 990-1440.
Agreement to Participate
By signing this consent form you agree that you have read this form or had it read to you. You agree to answer questions as best as you can. You also agree that you have been given a copy of the consent form and you agree to be in the study.
Research Participant’s Name:
Research Participant’s Signature:
Date:_______________________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | “Exploring HIV Prevention Communication Among Black Men Who Have Sex with Men in New York City: Project BROTHA” |
| Author | ibi0 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |