Informed Consent

Attachment G. Focus Group Written Informed Consent Form

Older Adult Mobility Ride Share (OAMRS) Informed Consent

NORC at the University of Chicago – a not-for-profit research organization at the University of Chicago – is conducting a study of the barriers and facilitators of using ride share services. NORC is conducting this study on behalf of the Centers for Disease Control and Prevention (CDC). The purpose of this study is to understand older and younger adults' attitudes and beliefs toward using ride share services. This study will help CDC to identify strategies for meeting the transportation needs of older adults.

 

We are asking you to contribute to this study by participating in a focus group. Completing the focus group will take approximately 90 minutes. Your participation does not involve any risk beyond what you would encounter in daily life. You have the right to withdraw from the focus group at any time without any consequences. If at any point during the focus group you wish to withdraw as a participant, please notify the Facilitator. Note, however, that your previous responses will remain part of the study. In addition, you are free to refrain from answering any questions that you do not wish to answer. At the conclusion of the focus group, we will provide you with a check for $50 as a token of appreciation for your participation in this study.

NORC would like to audio record the focus group to ensure our notes are comprehensive. By signing this form, you agree to be audio recorded during the focus group. The recording will be deleted at the end of the study. All information collected during the focus group will be treated in a secure manner. We will not include your name in any reports.

If you have questions about the study, please contact the Project Director, Alycia Bayne, at 908-431-5438.

If you agree to participate, please sign and date the statements below, indicating your informed consent.

 

"I have read and understand the information presented in this document, and have been given the opportunity to ask any questions. I give my permission to be recorded using audio equipment during this research study. I understand that the audio recordings will be reviewed for analysis and deleted at the conclusion of the project. I freely choose to participate in this research study, and understand my right to withdraw as a participant at any time."

Print name of participant: ________________________________ Date: ______________

Signature of participant: _________________________________ Date: ______________