Attachment D - Focus Group Consent Form 091311

Attachment D – Focus Group Consent Form

FINAL DRAFT 9.13.11

Introduction and Purpose:

You have been asked to be in a focus group as part of this study. The purpose of this study is to hear your opinions about tools and materials that can be used by health IT developers and purchasers. RTI International, a non-profit company in North Carolina, is conducting a series of focus groups. The focus groups are sponsored by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services.

Procedures:

A focus group is when about 6 to 10 people get together to talk about a topic and share their opinions. During the group, we will ask you to tell us your feedback on tools and materials. The group will take about 90 minutes.

We will be doing seven groups with a total of about 63 health IT developers and purchasers, either in-person or online via a webinar.

A moderator will be there to guide the discussion. Some of the people working on the project may observe the discussion and take notes through a one-way mirror (for in-person meetings) or listen to the discussion and take notes (for the webinar).

Risk/Discomforts:

There is no known physical risk to you from being in this study. You can decline to talk about any topic for any reason. You can also stop being in the group at any time.

Benefits:

There is no direct benefit to you for being in this focus group. What we learn from the group will help AHRQ to develop and deliver health IT information resources to various groups.

Confidentiality:

We will be audio recording the group discussion. The audio files will be destroyed at the end of the project. Notes will be made of the recordings. We will only refer to first names in the notes. Your comments will be kept private to the extent allowable by law. The notes will be kept on a password-protected computer. Only authorized project staff will be able to see them. Any forms related to the project that have your name or information that could identify you will be kept in a locked file cabinet. These forms will be destroyed once the project ends. However, there is still a small risk that your privacy could be broken.

Payment:

We will provide you with payment of $150 for your time, effort, and travel expenses.

Right to Refuse or Withdraw:

It is your choice to be in this group. You can choose not to talk about any topic. You can stop being in the group at any time.

Persons to Contact:

If you have questions about the focus group you can call RTI Project Director Dr. Jonathan Wald at 781-370-4019. He can be reached between 9 AM and 5 PM Eastern Standard Time Monday - Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Your Consent:

I have read this consent form. I had a chance to ask questions and my questions were answered. I was given a copy of this consent form.

Do you consent to participate in the group now?

__Yes

__No

Participant Signature Date

2