Team Nutrition Cooks - State, Local, and Tribal Government

Attachment A – Parent/Caregiver Informed Consent for Child Participation

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

This week, your child will have the opportunity to participate in research being conducted during the after-school program. The goal is to understand how cooking-based nutrition education activities can increase children’s knowledge and skills in cooking and nutrition, and how that can encourage healthier eating behaviors. You are receiving this form because you are the parent or legal guardian of a child who is eligible to take part in this study. Your child may take part in the educational activities without participating in the research. You may opt them out of the study by checking the “no” box at the bottom of page 3.

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 students 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 activities and lessons for children. These activities and lessons are part of a cooking-based nutrition education program called Team Nutrition Cooks! Students will participate in Team Nutrition Cooks! as part of the study, and provide information and feedback that we will use to improve the program. We will collect their thoughts and opinions about the materials that may be used in other schools and programs. We are working with two partners—the Michael Cohen Group (MCG), another applied research company, and Sudden Industries, a digital media service company—to conduct this research. The program will be delivered to students by the afterschool staff over the next five weeks. Each site will have about 10–20 children participating and there will be three sites selected across the country.

Procedure: What will my child do during this study? What will I do?

Your child will be asked to share his or her thoughts on healthy eating and cooking by taking a 15 minute survey two times during the study – before starting the program and after all five lessons. Each lesson will be about 90 minutes in length and will be administered during the afterschool program. Your child will also be asked to provide feedback after each lesson in the form of a worksheet which will take about 8 minutes to complete.

After each lesson, your child will be provided with a family handout that we hope s/he will share with you. You can get involved by asking your child what s/he learned in the lesson and what s/he thought about it.

Study Benefits: What good comes from this study?

You and your child may learn new cooking techniques and ideas for healthier eating. Your child’s feedback will help us decide what ideas, images, messages, and lessons will be most effective for use in these lessons.

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

There is no cost to you or your child for taking part in this study. Your child does not have to answer any questions that s/he doesn’t want to. S/he will be able to participate in the lessons even if s/he chooses not to answer some questions. Your child will receive food as part of each lesson. You will not be incentivized for your time in this study.

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

We will take care to minimize any risks of participating in this study. However, there is some risk inherent in food preparation, such as handling hot or sharp objects or exposure to potential allergens. The students will be under adult supervision throughout the lessons to reduce potential risks.

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.

Your child may want to discuss cooking and nutrition with you. S/he may also have questions or concerns about the lessons, images, or ideas s/he sees during this study. If your child becomes upset or wants to stop participating for any reason, s/he may stop participating in this study at any time.

If you or your child has 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 nor your child’s identity in any report or presentation. Only researchers from Fors Marsh Group and the Michael Cohen Group will have access to the responses your child provides. 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 child’s survey responses will not be linked back to his or her full name or other personal information, meaning that no one outside the researchers will know how s/he responded. Everything your child shares will be kept private to the extent allowable by law. This means that we will not share any information your child provides with anyone outside the study unless it is necessary to protect him or her, or required by law. However, if s/he indicates a direct threat of harm to himself or others, we reserve the right to take necessary action out of concern for his or her welfare and the welfare of others. Please note that we will not share information your child provides about his or her attitudes, beliefs, and behaviors with anyone outside of the research team. This means parents/guardians, teachers, and other school staff will not see the information that your child shares.

All of the information we collect, including anything your child shares, 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 your child, like age and grade, but we will not collect any information that could identify your child, like his or her 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 child’s or 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 child’s or your name or any identifying information.

Participation and Withdrawal: Does my child have to be in this study? What if s/he changes their mind?

Your child can choose to take part in the study or not, regardless of what other students choose to do. Your child can choose to leave the study at any time. Your child does not have to answer any questions s/he does not want to.

This study is completely voluntary. Your child 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 for my child 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 for my child 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.

_________________________________________________ __________________

Parent/Guardian Signature Date

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