Consent for parents

Informed Consent (Focus Groups)—Parents

[Month and year of focus group to be inserted]

ICF Macro is conducting telephone focus groups on behalf of the Centers for Disease Control and Prevention (CDC) and the National Hemophilia Foundation (NHF). You have been invited to participate in a 90-minute focus group with other parents of children living with hemophilia. This telephone focus group will help us better understand how to best communicate messages on transition issues for young children aged 5–12 years and adolescents aged 16–19 years living with hemophilia.

Before you agree to join in this discussion, please review and consider the conditions listed below:

• Participation in this group discussion is completely voluntary.

• Any questions you have about this study will be answered before the group discussion begins.

• The discussion will be audio taped. The tapes will be used to help the leader of the focus group create a report.

• Project staff from CDC, NHF, and ICF Macro will be on the line listening to the discussion.

• We ask you to use your first name only and avoid using your last name during the focus group.

• The information you give will remain private and your name will not be associated with your answers.

• You may choose not to answer questions that you do not want to answer.

• You may choose to leave the group at any time for any reason.

• The risks to you from participating in this research are minimal, and you will receive no direct benefits, other than $50 for your time.

Contact information: If you have any concerns about your participation in this discussion group or have any further questions about the project, contact Mel Miller at ICF Macro, telephone number (240) 747–4750.

Your signature below means that you understand the conditions stated above and agree to participate in this group.

Signature _______________________________ Witness ____________________________________

Date _______________________________________