Verbal Consent

Attach 5_Verbal Consent IDI-FG FINAL 062117.docx

CDC and ATSDR Health Message Testing System

Verbal Consent

OMB: 0920-0572

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Antibiotic Use Campaign—R2 Concept Testing

Verbal Consent Script – Consumers and HCPs

ICF is conducting digital [interviews, focus groups] with [healthcare professionals, consumers] on behalf of the Centers for Disease Control and Prevention (CDC) to gather feedback on creative concepts—similar to logos, television ads, and print ads—to use in CDC’s communications materials about antibiotic use. We expect this [interview, focus group] to take [45-60 minutes, 90 minutes].

We want to hear your opinions and suggestions, so I encourage you to speak openly and honestly. There are no right or wrong answers. Should you agree to participate, here are some points you should know:

  • Rights Regarding Participation: Your participation is completely voluntary. You may choose to leave the [interview, focus group] and/or not answer a question at any time for any reason.

  • Privacy: We will take every precaution to protect your identity and ensure your privacy unless otherwise determined by law. Your contact information will be kept separate from any [interview, focus group] responses and your name will never be linked to any responses. We also will never use your name in any reports.

  • Benefits: Your participation in the [interview, focus group] will not result in any direct benefits to you. However, your input will help to develop a communication campaign on antibiotic use.

  • Risks: The [interview, focus group] poses no risks to you. None of the questions are of a sensitive nature.

  • Incentive: In appreciation of your time, you will receive a gift of [$35 (consumer), $75 (NP/PA), $125 (physician)] for participating in the [interview, focus group].

  • Audiotaping: The discussion will be audio-taped as a backup to our notes to help us keep track of all responses. We will keep all information, notes, and audiotapes on a secure computer file. Only study staff will be able to access the information.

  • Observers: Individuals from CDC will be observing this [interview, focus group] silently. They will not participate in the discussion. All observers have signed confidentiality forms stating that they will not discuss the specifics of the [interview, focus group].

  • Questions: We will answer any questions you have about this [interview, focus group] discussion before you take part.

  • Contact Information: If you have any questions about this discussion or the communication campaign, please contact the Research Director, Ashani Johnson-Turbes, PhD, at 404-321-3211.

Do you consent to participate in the [interview, focus group]? Yes No

Do you agree to be audiotaped? Yes No

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