Attachment #5:
Part 3: Focus Group
Consent Form
University of New Mexico Health Sciences Center
Informed Consent for Focus Group
Solar Cell: A Mobile UV Manager for Smart Phones (NCI)
Dr. Berwick, PhD, MD from the Department of Internal Medicine, is conducting a research study. The purpose of the study is to design a smart phone application, Solar Cell, which uses smart phone technology to aid users in protecting their skin from damaging ultraviolet radiation (UV) in sunlight, a primary cause of skin cancer. The goal of this part of the study is to review the concept and design specifications of Solar Cell with skin cancer survivors and explore their interest in, and design of, advice on when it is safe to go out in the sun without sun protection. You are being asked to participate in this study because you have experience with skin cancer and you own a smartphone.
Your participation will involve a one-hour discussion about the potential benefits and disadvantages in our developing the Solar Cell application. Your involvement in the study is voluntary, and you may choose not to participate. There are no names or identifying information associated with this focus group. The discussion may include questions such as, “What advice, if any, have you received from your doctor about being outdoors in the sun?” You can refuse to answer any of the questions at any time. There are no known risks in this study, but some individuals may experience discomfort when answering questions. All data will be kept for five years in a locked file in Dr. Berwick’s office and then destroyed.
The information you provide us will be kept private under the Privacy Act.
The findings from this project will provide information on how to best develop the smartphone application for the use with people who want to avoid risk factors for skin cancer. If published, results will be presented in summary form only.
If you have any questions about this research project, please feel free to call Dr. Marianne Berwick at 505-272-4369. If you have questions regarding your legal rights as a research subject, you may call the UNMHSC Office of Human Research Protections at 505-272-1129.
CONSENT
I have read this consent form. All my questions about the study and my part in it have been answered. I freely consent to be in this research study.
By signing this consent form, I have not given up any of my legal rights.
__________________________________________
Subject Name (printed)
CONSENT SIGNATURE:
________________________________________ __________________
Signature of Subject (18 years and older) Date
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Laura McLaughlin |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |