7th Grade Curricula Parent Satisfaction Questionnaire

Attachment OOOO:

Student Assent for Communication Focus Group Participation

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Communication Focus Group Student Assent Form

What am I being asked to do?

We are asking you to participate in a discussion group called a Focus Group Researchers conducted by Ogilvy Public Relations on behalf of the Centers for Disease Control and Prevention. The purpose of this Focus Group is to help us learn more about teenagers’ relationships with other people, including people they date or hang out with.

You were selected to participate in this study because you are currently enrolled at <insert middle school name>. Although some of the questions we will ask during the Focus Group session will be about relationships with boyfriends and/or girlfriends, you do not need to have a current or past boyfriend or girlfriend to participate in this discussion.

What will I be doing?

A focus group is a special group discussion that includes the research staff from Ogilvy Public Relations and about six or seven other students from your school. We will meet with a small group of students in a private room to be able to talk about your opinions and attitudes, the things you do, what you think about things, and your relationships with other people, including boyfriends or girlfriends or people you hang out with.

We will take notes during the group meeting in order to understand your experience with the project activities. The discussion will be audio recorded. We will destroy our recordings as soon as we complete our project report. Our job is to ask you questions, to keep the group focused on the topic we want to discuss, and to make sure we don’t run out of time. We really want you to feel free to talk together as a group, so if the students are talking about the questions we asked, we will mostly just listen to your ideas and take notes. Our discussion will take about 90 minutes to complete.

How will my privacy be protected?

To protect your privacy, we will not write down your name on any of our notes we take during the Focus Group. Our research team will keep your private information (your name and your answers to the focus group questions) and your answers will only be used to inform a report based on the answers of teens we talk to from all over the country. We will not record how much you personally talked in the focus group meeting.

Your participation in this group is completely voluntary. You can leave the group at any time, for any reason. Although we value your participation in this Focus Group, we understand that you may not be comfortable telling the entire group what you have to say out loud. In these cases, if you prefer, you can write down your idea or thoughts. We will give you several sheets of paper and a pencil so that you can write down any ideas that you do not feel like sharing with the entire group. When you are finished writing down your idea you can put your paper in an envelope that we will give you and seal/close the envelope. Feel free to write down all of your ideas that you do not want to share with the entire group on the provided paper. You do not have to put your name or initials anywhere on the paper or the envelope. At the end of the focus group, you will turn in your envelope to the researcher. No one else will be able to see your idea except for the researchers. At the end of each focus group, we will collect any envelopes and place them into a larger manila envelope. We will review and analyze the contents of the envelopes at our office in Washington, D.C. and once completed we will seal the envelopes in the larger manila envelope and secure that in a locked filing cabinet in the Principal Investigator’s office. We will take steps to assure that the paper documents/envelopes are kept secure in our Washington D.C. offices.

Who will see my answers?

Your comments made during the Focus Group are confidential. That is a big word that means that your answers and information are totally private. Your parents, your teachers, and your friends will never see your answers. Only the researcher will see your answers. No identifying information, such as your name, will be used.

The only exception to this is if you tell us that you are planning to hurt yourself or someone else, or if a grown up is hurting you. Then we will have to tell someone so we can get help.

The information we collect could be really helpful to other researchers who are trying to improve the lives of teenagers too. Since this study is funded by the Centers for Disease Control, which is part of the government, the information we collect will be made available to other researchers who are interested in whether the programs we are conducting work and how teenagers think and act. However, no information that could be used to identify you will be released to other researchers— that means that there won’t be any way for anyone to know that you participated in a focus group or know how you answered the questions.

What if I don’t know the answers?

Some of the questions may be about things you’ve never thought about before. Some of the questions may seem like they don’t apply to you. That is fine—just give the best answer you can. There are no right or wrong answers.

Do I have to do this?

No, you don’t. Your participation in this focus group is voluntary. You can say that you don’t want to participate in the focus group and that is fine. You are also free to stop participating at any time without consequences. It is important that you feel comfortable answering the questions honestly. You do not have to answer any questions that you do not want to answer.

What if the questions are upsetting?

We don’t think you’ll be upset by our general (not personal) discussion, but if you are, <Name of Adult> is available to talk to and to help. You can also talk to your parents or another adult about the focus group. We will also give you a list of places in your community you can call to get help with any of problems that we discuss in the focus group session.

What are the risks?

Because you will be speaking with us in a group of other students, there is the possibility that other participants in the focus group meeting will tell other people about your participation. Group members may repeat what you have said during the meeting to other people. However, we will ask everyone in the group to keep what is said in the group confidential, or secret. We hope you will feel comfortable enough to be open and honest in your responses to our questions.

Are there any benefits to participating?

There are no direct benefits to participating in this Focus Group. However, you may benefit from knowing that your participation has the potential to help future middle school and high school students have healthy and safe relationships with peers and dating partners. Your ideas may help teachers around the country think about how to make their schools safer places.

What will be done with the results of this Focus Group?

Your comments will be combined with other students’ comments and summarized in a report. Then we will write a report on the focus group results from many schools and other data we collect. We will never write the students’ names in any reports. We will be careful not to include information that could be used to identify the students who participated in the focus group. Only general themes and some direct things you say will be included in our final report. In the event that we use something you said directly, we will only describe those words as coming from “a student in <site name>” instead of using any names.

Thanks so much!

Even though you don’t have to participate, we really hope you will. You are the expert, and we are hoping to learn from you. If you have any questions about this study, you may contact Ogilvy Public Relations at <phone> or via e-mail at <email>. For additional information regarding the rights of human participants in research, you may contact the CDC IRB Manager, at xxx-xx-xxxx.

You will be given $ (insert amount appropriate for market) for your time. Note: We often recruit more people than we need. If you were invited to participate but are not included in the discussion because we already have the maximum number of people, you will still be paid.

____ I agree to participate in the focus group session. I understand this means that I will take part in a discussion with 6-7 other students in a private room, led by a researcher. The researchers will not list my name as a participant and will not write down my name next to comments I make. I understand I don’t have to answer any questions I don’t want to.

____ I do not agree to participate in the focus group session.

____________________________________ _____________

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