Att 13 - Informed Consent Script

Oral Informed Consent Script

Thank you for taking the time to speak with us today as a part of the research being conducted by Research Triangle Institute (RTI) for the Centers for Disease Control and Prevention. The purpose of this study is to learn more about how your community/state is implementing the Communities Putting Prevention to Work effort. We are talking with CPPW staff and partners who have been engaged in CPPW activities to learn about more about how this effort is being implemented, what is being learned, and the successes and challenges they have had. We are talking with up to 20 representatives from each of 21 CPPW communities and states and 3 ACA communities for this work, and hope to gain insight into these types of efforts so that CDC can improve what is known about reducing obesity and tobacco use through policy, system and environmental changes.

Our discussion should last approximately [select 30 minutes, one hour, 1.5 hours, or 2 hours, depending on the type of respondent]. There are no right or wrong answers – we just want to know about your organization’s experiences with the CPPW initiative. You can refuse to answer any questions you do not want to answer. Your participation in this study is voluntary, and you may stop at any time. There will be no negative consequences if you choose to stop or if you choose not to participate at all.

All interview data will be treated in a secure manner and will not be disclosed, unless otherwise compelled by law. All data collected will be logged for analysis. A linking file will be created to help track the data collected. This file will contain your organization name and role, community/state name and the date of the interview. It will also contain a unique code assigned to your interview. Neither your name or your contact information will be included in the file to ensure that your responses are maintained in a secure manner, The linking file will only be available to senior RTI management on this project, and will not be provided to CDC staff. All analyses will be conducted using the de-identified data file. Additionally, all RTI team members have signed a non-disclosure agreement ensuring that they will not discuss any data collected outside of the project team.

The benefit of participating in this study is that your organization’s experiences will help researchers and policy makers understand and make recommendations on policy, systems and environmental change as a way to improve public health. There are no risks to those who participate. Your responses will be reported in aggregate in a case summary that is specific to your community/state as well as in an overall cross site analysis summary, which will examine the data collected across all case study sites.

Before we begin, we would like to have your permission to audio record our discussion so that we can ensure our notes are accurate and complete. The audio recordings will be deleted once the project is complete, in July 2013.

This study will include a second set of interviews to be conducted towards the end of the CPPW program period. If you give your permission, we will maintain your name and contact information in the event that this team needs to contact you for additional feedback for the second phase of data collection at the end of the CPPW funding period. If you do not wish to be contacted, we will delete your name and contact information from our records.

Would it be okay to contact you for the second phase of data collection if it is appropriate?

Yes

No

If you have any questions about your rights as a study participant, you can call Dr. Amy Roussel toll-free at 1-866-RTI-1958 then extension x28324 or you can call RTI's Office of Research Protection at (919) 316-3358 in Durham, NC or 1-866-214-2043 (a toll-free number).

Do you have any questions?

Do you consent to participate in this study?