Att 12_ORAL INFORMED CONSENT STATEMENT

Oral Informed Consent Statement

Thank you for taking the time to speak with us today as a part of the research being conducted by ICF Macro, an ICF International Company, on behalf of the Centers for Disease Control and Prevention (CDC). We are conducting a pre-evaluation assessment site visit to assess local-level initiatives (programs, policies, etc…) that have been implemented with apparent potential to improve the eating habits and physical activity levels.

• The pre-evaluation assessment is not about measuring the initiative’s outcomes.

• The pre-evaluation assessment is not about measuring whether the initiative is effective.

• Rather, through the pre-evaluation assessment, we hope to learn from your initiative and, where possible, provide insights by suggesting areas for improving program performance and evaluation potential.

These visits will help CDC in their understanding of the role that these types of initiatives may have in improving people’s eating habits and physical activity levels.

We are conducting this interview to learn more about your initiative, to get a composite picture of the initiative. You are the expert on your experience, and your opinions and thoughts are invaluable.

There are no right or wrong answers. This discussion is not meant to evaluate you; rather it is meant to learn insights from your initiative.

Steps will be taken to protect your privacy; no information that identifies you will be shared with anyone except our project staff. We will only include your role or title as a participant in the section of our report that lists all the individuals we contacted. We will never report your comments by name in any report, unless we have received direct written permission from you before the report is shared. Data will be treated in a secure manner and will not be disclosed, unless otherwise compelled by law.

Your participation is voluntary. You may choose not to answer some of the questions or you may choose not to participate without penalty. You can choose to discontinue the interview at any time for any reason. If you have questions about your rights as a participant you may contact the project director, Nicola Dawkins, at 404-321-3211.

Notes will be taken to accurately capture our discussion and they will be destroyed upon conclusion of the project. You may keep this for your records.