Verbal Consent for Participants of Focus Group regarding Travel Health Messages - English

Department of Health and Human Services OMB Approved

Centers for Disease Control and Prevention Control No. 0920-0932

Expiration Date07/31/2018

Attachment E – Verbal Consent for Participants of Focus Group regarding Travel Health Messages

Intro: Thank you for taking the time to talk with me. Before we begin, can I ask you to confirm that you are over the age of 18 (for US residents or 21 for Puerto Rican residents)? (If person cannot confirm, give thanks and ask them to end participation.) My name is (x) and I work with Centers for Disease Control and Prevention in ___________ (Atlanta, Georgia; San Juan, Puerto Rico). We are talking with sending agencies like yours about travel health information, especially for volunteer groups traveling internationally. We want to learn what people know about travel health and how they share that information with their volunteers. This will help us to improve our health messages.

• I’d like to talk to you for about 20 minutes– how long is up to you and the time you have available. We are inviting you to participate in a focus group session online.

• I won’t ask for the name of anyone in your family or any of your organization’s members.

• Our discussion will be confidential, to the extent allowed by law – that means whatever you tell me doesn’t get repeated to other people in the community. I might ask other people the same questions, but I won’t repeat to them what you say.

• We will be writing up a report from these discussions, and I might include some of the ideas that you give me, but I won’t use your name or anything else to identify you.

• I will take notes while we’re talking in order to better help me remember our conversation.

• This whole discussion is voluntary. If there is a question that you don’t want to answer, you don’t have to. There are no right-or-wrong answers for these questions. It’s important to say what you think. If you want to end our discussion at any time just tell me.

So, given these points are you OK with being in our group discussion?

Thanks.

Grade Level: 6.7