Public reporting burden for this collection of information is estimated to average 9 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form to this address.
OMB Number: 0925-XXXX
OMB Expiration Date: TBD
APPENDIX B
Interactive Informed Consent for Pediatric Clinical Trials
Perceptions Questionnaire:
If this had been a real study how likely would you (or your child) have been to participate?
0 1 2 3 4 5 6 7 8 9 10
Not likely Extremely likely
Please rate the quality of the information presented regarding the study
0 1 2 3 4 5 6 7 8 9 10
Poor quality Excellent quality
Please rate your ability to follow the information presented regarding the study
0 1 2 3 4 5 6 7 8 9 10
Impossible to follow Extremely easy to follow
How effective was the presentation of information in helping you understand the study?
p Not effective at all p Somewhat effective p Extremely effective
Was the amount of information that you received about the study :
p Too little p Just right p Too much
Overall, how clearly was the information about study presented?
p not at all clear p fairly clear p very clear
Please rate how easy it was to use the computer program to obtain information about the study?
0 1 2 3 4 5 6 7 8 9 10
Extremely difficult Extremely easy
Please rate your overall satisfaction with the computer program describing the study
0 1 2 3 4 5 6 7 8 9 10
Not at all satisfied Extremely satisfied
If you are asked to be in a real clinical study in the future, would you prefer the information about the study to be presented as: written information only, verbal information only, computer program only (like this one), written and verbal information, computer program and verbal information
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Jill Graygo |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |