Attachment 2: Consent form for virtual focus groups Form Approved
OMB No. 0920-0990
Exp. Date 09/30/2016
Consent Form
Thank you for taking the time to join us today. This focus group is being conducted by Research Triangle Institute International (RTI), a non-profit research organization. The Centers for Disease Control and Prevention (CDC) and March of Dimes has asked us to conduct six virtual focus groups about medication use during pregnancy. In total, we plan to speak with roughly 72 individuals as part of our series of focus groups.
Our discussion should last no longer than 90 minutes today.
There are no right or wrong answers. You may refuse to answer any questions you do not want to answer. Your participation in this study is completely voluntary, and you may stop at any time. There will be no negative consequences if you choose to not participate or to stop at any time.
There is a minor risk of psychological discomfort on the part of the participants because some of the questions ask about issues related to reproductive health and taking medications during pregnancy. Please know that your responses will be kept secure and no names will be reported with our summary.
You will be asked to provide a name for the purpose of moderating the discussion. We request that you make up a user-name for the purpose of this discussion.
All focus group data will be treated securely and will not be disclosed. Neither your name nor your contact information will be included in our data file, and analyses will be conducted using a de-identified data file. Your responses will be aggregated and a summary report provided to the CDC and March of Dimes. Careful attention will be paid to protecting your anonymity.
We hope your participation will help the CDC and March of Dimes develop of communication messages and materials for women about risks and benefits of taking medication during pregnancy in an effort to help reduce the risk of birth defects and other negative birth outcomes.
The focus group will be audio recorded so we may ensure our notes are accurate and complete. The audio recordings will be deleted once the project is complete.
As a token of appreciation for your interest, you will receive a check in the amount of $50. You should receive it within 5-7 business days. If you do not receive the check, please contact Molly Lynch at 1-800-334-8571 (extension 22709).
If you have any questions about your rights as a study participant, you may call Molly Lynch toll-free at 1-866-RTI-1958 then extension x22709 or you can call RTI's Office of Research Protection at (919) 316-3358 in Durham, NC or 1-866-214-2043 (a toll-free number).
Do you consent to participate in this study?
Click here for Yes: Click here for No:
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Suzanne |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |