Attach4_Consent_Life

Attachment 4: CONSENT FORM

Usability testing of the “Life in a Day” phone Application – In Person and Web-Ex Follow-up

PURPOSE: We are inviting you to participate in a research activity. The purpose of this activity is to test a new diary and activity recall smartphone application called “Life in a Day” developed by the National Cancer Institute. Today, we will get you acquainted with the phone application. Over the next two days, you will use the app to record your daily activities. We will call you at the end of each of those days to ask about your experience using the application as well as any problems or issues you encountered.

SPONSOR: The project is being conducted in collaboration with, and funded by, The National Cancer Institute.

RESEARCHERS: The project director is Jennifer Crafts, from Westat, a social science research company located in Rockville, MD.

WHAT IS INVOLVED: Participation in this research is voluntary. You will be asked to share your opinions about the app. Today’s session will take approximately 60 minutes. After this session, you will be able to use the app as much as you like. The follow-up session will take approximately 60 minutes. To thank you for your participation in the study, you will receive a $40.00 check once you have completed the follow-up and we have received the smartphone from you.

WHAT IS INVOLVED: Participation in this research is voluntary. Today’s session will take approximately 60 minutes. To thank you for completing both sessions, we will send you a $40 check after we have received the smartphone from you.

RECORDING:

We plan to record this initial session using an audio recorder. On the final session we will use a web-based software that will capture the audio comments and what is shown on screen as I share my desktop with you. Others on the research project may review the session at a later time to benefit from what you say.

CONFIDENTIALITY: Information you provide will be treated as secure; no participants will be identified by name in summaries of the sessions. No one but the researchers will ever review the recordings. The tapes will be destroyed within 6 weeks of the end of the study.

RISKS: The only cost to you is the time and effort to provide your opinion.

BENEFITS: There are no direct benefits to you for participating in this study. However, you will be helping with an important research project.

QUESTIONS: For questions about the project, you may call the Project Director, Jennifer Crafts, at 301-610-4881. For questions about your rights and welfare as human subjects in this study, you may call the Institutional Review Board at Westat at 301-610-8828.

I have read the consent form. My questions have been answered. My signature on this form means that I understand the information and I consent to participate in this study. I also certify that I am 18 years of age or older.

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PARTICIPANT SIGNATURE DATE

I have reviewed the above material with the respondent and offered to answer any questions about it.

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MODERATOR SIGNATURE DATE