Team Nutrition Cooks - State, Local, and Tribal Government

Attachment B – Program Operator Informed Consent

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0524.  The time required to complete this information collection is estimated to average 5 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.

Title of Information Collection: Formative Research on Team Nutrition Cooks!

Sponsor: U.S. Department of Agriculture

Principal Investigator: Sarah Evans, Ph.D.

Telephone: 571-858-3817 (24 Hours)

Address: Fors Marsh Group, LLC (FWA00011194)

1010 N. Glebe Road

Suite 510

Arlington, VA 22201

In the coming weeks, you will have the opportunity to lead nutritional education activities with children in the after-school program. You are receiving this form because, as a program operator, you are invited to provide feedback on the program and the implementation process.

Please read this document carefully. It contains important information about this research study. You can ask as many questions as you want. If there is any information that you do not understand, we will be happy to answer your questions.

Introduction: About this study

The goal of the study is to understand what activities will be most effective in teaching children about good nutrition and cooking skills. Fors Marsh Group, an applied research company, has been contracted by the U.S. Department of Agriculture’s (USDA) Food and Nutrition Service (FNS) to evaluate and revise educational cooking lessons for children. These activities and lessons are part of a cooking-based nutrition education program called Team Nutrition Cooks! We are working with two partners—the Michael Cohen Group (MCG), an applied research company, and Sudden Industries, a digital media service company—to conduct this research.

Procedure: What will I do during this study?

As a program operator, you are being invited to take part in a study that will be hosted in the after-school program at your facility. Your program has agreed to deliver five 90 minute nutrition education and cooking lessons to students. Student participation in the research is voluntary, so they will be eligible to participate in the educational lessons even if they do not wish to participate in the research study. For this study, you are being asked to participate in an initial kick off meeting (60 minutes), provide written feedback about each lesson in the form worksheet (an estimated 8 minutes to complete) and record student attendance (estimated 2 minutes to complete). After delivering all 5 lessons, you will also be asked to participate in a 30-minute interview with a trained researcher to share your thoughts on the overall experience of the program.

Study Benefits: What good comes from this study?

Your feedback will help us decide what ideas, images, messages, and lessons will be most effective for use in these educational lessons and how useful each of the program materials are in helping children develop nutritional eating and simple food cooking skills. Also, your opinions can help to refine the specific activities and inform the implementation processes associated with each lesson.

Token of Appreciation: Will I be paid for being in this study?

There is no cost to you for taking part in this study. You do not have to answer any questions that you do not want to. You will not be incentivized for your time in this study.

Anticipated Risks: Could anything bad happen to me during this study?

We will take care to minimize any risks of participating in this study. As with all research, there is a chance that privacy could be breached. For example, despite the best efforts of the research team to keep the information we collect during the study private, a breach may occur as a result of accidental human error or hacking. In the event a breach occurs, all participants will be contacted and notified as to the extent of the breach, any damages incurred, and future potential risks; contact information for additional inquiries will also be provided. No sensitive information will be collected from you.

If you have any questions about this research study, you may call Fors Marsh Group at 571-858-3817 or email a study representative at [email protected].

Privacy: Who will see the results of this study?

We will not disclose your identity in any report or presentation. Only researchers from Fors Marsh Group and the Michael Cohen Group will have access to the responses you provide. Staff from the USDA or Chesapeake Institutional Review Board (IRB)—a group of people who review research to protect the rights and safety of research participants—may also look at study records.

Your worksheet responses will not be linked back to you or any of your other personal information, meaning that no one outside the researchers will know how you responded. Everything you share will be kept private to the extent allowable by law. This means that we will not share any information you provide with anyone outside the study unless it is necessary to protect you, or required by law. However, if you indicate a direct threat of harm to yourself or others, we reserve the right to take necessary action out of concern for your welfare and the welfare of others.

The interview will be audio-recorded and transcribed for research purposes. You can opt out of being audio-recorded at the start of the session. The audio tapes will be destroyed once the interviews have been transcribed. No one outside of the researchers will know what you said during the discussions. We will not disclose your identity in any report or presentation.  

All of the information we collect, including anything you share in worksheets or in an interview, will be kept for three years. The information, audio files, and transcripts will be stored on a password-protected computer and/or in locked cabinets that only the research team can access. We will collect some personal demographic information from you, like age and race, but we will not collect any information that could identify you, like full name, address, or social security number. After three years, all of the collected data will be destroyed by securely shredding documents or permanently deleting electronic information.

Results from this study may appear in professional journals or at scientific conferences. No individual participants will be identified or linked to the results. We will not disclose your identity in any report or presentation.

Results may also be used in future research or shared data with other researchers. Other researchers will not have your name or any identifying information.

Participation and Withdrawal: Do I have to be in this study? What if I change my mind?

You can choose to take part in the study or not, regardless of what other program operators do. You can choose to not complete the worksheets or leave the interview and/or meeting at any time. You do not have to answer any questions you do not want to. The study is completely voluntary and you can stop participating at any time.

Who do I contact if I have questions about the study?

If you have questions or concerns about the study, you can contact:

Sarah Evans, Ph.D.

Fors Marsh Group

571-858-3757

orsmarshgroup.com

If you have questions about your rights as a research participant, please contact Chesapeake IRB and reference IRB #_______. An IRB is a group of people who review research studies to protect the rights and safety of research participants. Please keep a copy of this form for your records. If you would like an additional blank copy of this form, you can email Sarah Evans at [email protected].

PLEASE CHECK ONE OF THE BOXES AND SIGN BELOW.

Yes, I agree to participate in this study. I have read, understand, and had time to consider all of the information above. My questions have been answered and I have no further questions.

No, I do not agree to participate in this study. I have read, understand, and had time to consider all of the information above. My questions have been answered and I have no further questions.

_________________________________________________ __________________

Program Operator Signature Date

4