Digital Nutrition Education Materials for Middle School Teachers (SLT) - IC 1 of 2

OMB Control # 0584-0524

Expiration Date: 9/30/2019

Attachment A – Consent Package for Teachers: Teacher Consent Cover Letter, Teacher Informed Consent Form, Questionnaire for Participation in Pilot

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 3 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.

Teacher Consent Cover Letter

[DATE]

Dear Teacher,

Thank you for expressing interest in participating in the research pilot Digital Nutrition Materials for Middle School. The United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) is developing educational materials that promote healthy eating in middle school children. Michael Cohen Group (MCG) and Applied Curiosity Research (ACR) will be gathering feedback on these materials from teachers and students across the country.

Piloting these activities is an exciting opportunity for you to implement them into your classroom teachings, and to influence the development of nationally-available nutrition education materials so that they will be suitable for teachers like yourself. Included in this packet you will find information on the pilot study and your rights as a research participant, a consent form, and a brief questionnaire. Please scan or fax the consent form and questionnaire to the research team no later than <<DATE>>.

As a Pilot Teacher, your responsibilities will be:

• Complete three lessons within the provided lesson plan (~45 minutes each)

• Complete an educator journal tracking activity implementation

• Participate in a 30-minute in-depth interview

• Notify researchers of any problems or concerns associated with the activities or research project

• Participate in a 45-minute focus group with other teachers at your school

Once you have completed and returned this packet, the research team will send you the necessary materials. Throughout the pilot, researchers will continue to follow up and will be available to support you and answer any questions that arise.

We look forward to working with you!

Sincerely,

Gerad O’Shea

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 10 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.

Teacher Informed Consent Form

Study Title	USDA FNS Digital Nutrition Education Materials for Middle School Students and Teachers
Protocol Number	XXX
Principal Investigator	Gerad O’Shea
Contact Information	Phone: 646-801-4261 Email: [email protected]

Background & Purpose: You are invited to participate in a research study conducted by ACR and MCG as part of a USDA FNS sponsored effort to develop a curriculum that will raise awareness of the importance of healthy food choices among middle school children. We are working to help develop nutrition education materials that include lesson plans, informational texts, interactive applications, and videos that promote healthy food choices.

Process: As part of the research you will implement 3 activities including handouts, informational texts, video and an interactive application. A total of about 20 teachers will be selected across the country. To complete these activities, you will need a video projector and a computer with internet access. The materials will be available for download from a secure website link that will be provided to you. You will be asked to share your experience with the activities and to complete an educator journal. This will take approximately 45 minutes’ total over the course of the pilot. After completing the activities, you will be asked to participate in a 30-minute individual interview and a 45-minute focus group interview with other teachers at your school who have piloted the activities. Further, you will be asked to distribute passive parental consent forms to the students in your class. These forms will be used to inform parents of the activities. If parents do not want their child’s responses used for the research or they do not want their child to participate in the focus group, they will complete the consent form and return it to you. Children will still participate in the activities and the survey, even if the parents opt out.

Possible Risks & Benefits: We do not anticipate any risks associated with being in this study. You will receive a $75 incentive for participating in this study and your school will receive a $150 facility fee to cover the use of the school’s space for the focus group interviews. We also anticipate that most people will enjoy participating in the research process, which will lead to the development of free teacher resources developed by the USDA.

Compensation: You will receive an incentive of $75.

Participant’s Rights: Participation in this study is voluntary. We will not work with you unless you give your consent. You have the right to change your mind and withdraw your consent or discontinue participation at any time without any penalty or loss of the benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. Your name, addresses, and phone numbers will only be used to contact you about this research activity. They will not be given to anyone else for other purposes. The research may be audiotaped for research purposes only. Your name will never be used in any reports of our research findings. Your information will be kept secure and only used for research purposes, except as otherwise required by law. All data will be identified only by an ID number, not by any name.

Contact Information: If you have any questions, concerns or complaints about this research study, its procedures, risks and benefits, please contact the Principal Investigator, at the telephone number listed on the first page of this form.

If you have any questions or complaints about your rights as a research subject, contact:

Mail Study Subject Adviser Chesapeake Research Review, Inc. 7063 Columbia Gateway Drive, Suite 110 Columbia, MD 21046

Call collect 410-884-2900

Email [email protected]

Please complete the sections below if you agree to participate. A copy of this form will be emailed to you for your records.

I, _____________________________________, agree to the following:

I will implement the pilot Digital Nutrition Materials in my classroom.

I will participate in a focus group interview about the materials.

I will participate in an individual interview about my experience with the materials.

______________________________ _________________

Signature Date

____________________________________________

Phone (for research purposes only)

____________________________________________

Email Address (for research purposes only)

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 2 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.

Questionnaire for Participation in Pilot Activities

Please choose the option that best answers each question for you.

1. What grade(s) do you teach (please check all that apply)?

( ) 4^th Grade ( ) 6^th Grade ( ) 8^th Grade

( ) 5^th Grade ( ) 7^th Grade ( ) 9^th Grade

2. What subject(s) do you teach (please check all that apply)?

( ) English Language Arts ( ) Physical Education

( ) Math ( ) Health

( ) Science ( ) Professional Studies

( ) Nutrition ( ) Technology

( ) History ( ) Arts or Music

( ) Social Studies ( ) Foreign Language Studies

( ) Other__________

3. How many years have you been teaching?

( ) First year ( ) 11-15 years

( ) 2-5 years ( ) Over 15 years

( ) 6-10 years

4. Ethnicity

( ) Hispanic or Latino ( ) Not Hispanic or Latino

5. Race (select one or more)

( ) American Indian or Alaskan Native

( ) Asian

( ) Black or African American

( ) Native Hawaiian or Other Pacific Islander

( ) White

6. What is your current age?

( ) Under 25 ( ) 45-54

( ) 25-34 ( ) 55+

( ) 35-44

7. What is your gender?

( ) Female ( ) Male

( ) Other (please specify): __________________

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