0920-AsthmaEd_Att 7. Informed Phys

Attachment 7: Participant Information Sheets/Informed Consent for Physicians

Asthma Education Study

April 2012

Project Officer: Scott A. Damon, MAIA, CPH, RPCV

Centers for Disease Control and Prevention

National Center for Environmental Health

Division of Environmental Hazards and Health Effects

Air Pollution and Respiratory Health Branch

U. S. Department of Health and Human Services

Asthma Education – Physician In-depth Interviews (IDIs)

Information for Participants

Purpose of this study

You are being asked to participate in a discussion being held by the Centers for Disease Control and Prevention (CDC), with the assistance of The Oak Ridge Institute for Science and Education. In the discussion, you will be asked your opinions and practices regarding some asthma-related issues. Your answers can help efforts to improve self-management education provided during the initial asthma diagnostic encounter. The discussion will be recorded (audio only) to be sure we get all the information.

Please remember that:

You choose to participate.

You are not required to answer any questions that may make you feel uncomfortable.

This session should last about one half hour.

You will receive a token of appreciation of $75.00 for participating in the discussion.

You are free to leave at any time without losing the token of appreciation or other penalty.

Risks

The risks you take by taking part in the discussion are the same as you encounter in daily life.

Benefits

You may be better informed about a public health issue.

You may have a sense of satisfaction from contributing.

Your comments may help improve the information physicians and patients receive.

Safeguarding Information

We will keep the information you give us private to the extent allowed by law. Your name will not be used in the final report. No statement you make will be linked to you by name. We plan that only members of the research staff will be allowed to look at the records. When we present this study or publish its results, your name or other facts that point to you will not be shown or be used.

Persons to Contact

If you have questions about this session, or taking part in it, you may call:

Scott Damon, Centers for Disease Control and Prevention, Atlanta, GA 30329, 770-488-3718.

If you need more information about your rights as a study participant, you may contact:

Chair, Oak Ridge Site-Wide Institutional Review Board, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831-0117, 865- 576-1725.

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