Consent to be in “Community-based tick control for the prevention of Rocky Mountain spotted fever in Hermosillo, Mexico, 2016”-knowledge, attitudes and practices survey
(Flesch-Kincaid grade level 9.0)
The Sonoran Ministry of Health, working with the Centers for Disease Control and Prevention (CDC), and the University of Sonora School of Medicine invites you to be in a survey. Please ask questions if there is anything you do not understand.
The purpose of this survey is to get the community’s thoughts and opinions about tick prevention and the Rocky Mountain spotted fever (RMSF) Rodeo and find the key knowledge and actions which can be used in the prevention of RMSF. If you agree, we would like to ask you some simple questions, and will take less than 20 minutes to complete.
It is unlikely that answering the questions will pose any risk to you, however, questions may be asked about knowledge of persons who have suffered and even died from RMSF. This may cause psychological distress.
Your participation in this survey will help inform us of the problems and successes associated with this program. It will help us to decide if this program should be started in other areas suffering from RMSF. Sensitive information will not be collected in the interview and all responses to questions will not be able to be tied to individuals. If you have any questions regarding the survey, please feel free to contact Naomi Drexler at (404) 718-4669.
You do not have to participate in this survey and you may ask to have your questionnaire withdrawn at any time.
I have been told about the survey and I have been allowed to ask questions. I had all of my questions answered. I would like to be in the survey. By signing this form, I agree to be in the survey.
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Signature Date
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Drexler, Naomi (CDC/OID/NCEZID) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |