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OMB #: 0925-xxxx

Expiration Date: xx/xxxx

Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form to this address.

CONSENT FORM FOR INTERVIEWEES

Title of Research Project:

Assessing the Long-term impacts of research training programs supported by the John E. Fogarty International Center

Principal Investigator: Dr. Sara Bennett

Introduction

This consent form explains the research study you are being asked to join. Please review this form carefully and ask any questions about the study before you agree to join. You may also ask questions at any time after joining the study.

Purpose of Research Project:

This research is being implemented by the Johns Hopkins School of Public Health with the support of the John E. Fogarty International Center (FIC).

The Fogarty International Center (FIC) at the National Institutes for Health (NIH) is dedicated to supporting and facilitating global health research conducted by U.S. and international investigators, building partnerships between health research organizations¹ in the U.S. and abroad, and training the next generation of scientists to address global health needs. Fogarty programs invest in scientific human capital in LMIC settings and foster long-lasting collaborative research relationships between LMIC scientists and scientists in the US. These investments are intended to enhance opportunities for resolving major global health problems through the conduct of locally relevant research.

FIC has made substantial investment in Makerere University/University of Nairobi over the years, and is interested in developing a more comprehensive understanding of the long term impacts of FIC research training programs including not only the outcomes in terms of the professional development and career paths of individual trainees, but the broader effects upon organizational capacity, knowledge production, and policy development among other things.

You are being asked to participate in this study because either you have been closely involved in a FIC research training program yourself, or because you work with people who do so.

Procedures:

If you agree to participate in this study, the following will occur:

You will be asked to agree to be interviewed once. During this interview, you will meet with a member of our research team. You will be asked a series of questions the long term effects of FIC support to research training. Interviews will be conducted in a private setting and will take approximately 60 minutes. The interview will be tape-recorded. We will ask you to indicate how we can reach you for the interviews, and we will follow the procedures you request for contacting you.

It is your decision whether or not to be in this study. You can stop the interview at any time and refuse to answer any question. If you wish you can request to review the tapes or transcripts from the interview and you can ask for any of the remarks that you have made to be deleted from the tapes.

Risks/Discomforts:

Your name will not be used in any reports or publications of research. Your interview records will be handled as confidentially as possible. Tapes will be stored in a locked cabinet and all tapes will be destroyed at the end of the analysis phase of the study. If a question make you feel uncomfortable, you may refuse to answer a particular question and you may stop the interviews at any time.

Benefits:

There will be no direct benefit to you for completing the interview. Any benefit is in the long-term in that data collected from this study may be used to recommend changes in the nature of investment FIC makes in its training programs.

Confidentiality

The information we collect from you will be kept confidential. This means that the only persons who will have access to the information you provide will be people who work for the study. We will not put your name or other identifying information on records of the information you provide. We will destroy the identifying information after the last interview.

Compensation:

There is no compensation provided for participating.

Voluntariness:

Your participation in this research project is completely voluntary. You have the right to withdraw from the research study at any time. If you have any questions, comments, or concerns about participation in this study, you should first talk to the researchers who interviewed you. You may also ask the principal investigator listed below any questions you may have about this research study. You may ask him/her questions in the future if you do not understand something that is being done. The investigators will share with you any new findings that may develop while you are participating in this study.

Persons to Contact:

If you want to talk to anyone about this research study because you think you have not been treated fairly or think you have been hurt by joining the study, or you have any other questions about the study, you should call the principal investigator, Dr. Sara Bennett at +1 202 553 1417 or or the local contact person [TBD]. You may also contact the Institutional Review Board at Johns Hopkins School of Public Health phone number (tel +1 410 955 3193) and the FAX number which is +1 410 502 0584.

If you have read this document and you have been given the chance to ask any questions now, or at a later time or if the document has been read and explained to you, please sign below.

Print Name of Subject:_____________________________________________________

________________________________________________ _______________

Signature of Subject

________________________________________________ _______________

Signature of Person Obtaining Consent Date

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