Pretesting

Appendix A — Consent Form for Pretest and Main Study

Appendix A:
Consent Form for Pretest and Main Study

Any text in angle brackets “< >” indicates part of the script that will change based on the participant, or situation. The intended content (or content options) are indicated in the brackets.

Introduction and Purpose

Thank you for agreeing to participate in this research study. The purpose of the study is to learn more about prescription drug TV commercials. You will be viewing a prescription drug commercial on a tablet or television and answering some questions about what you watched.

RTI International, an independent non-profit research organization in North Carolina, is conducting the study. You are one of approximately <IF PRETEST: “240”, IF MAIN STUDY: “1,272“> people being asked to participate in this phase of the study, based on your answers to our telephone screener.

Procedures

If you agree to participate, you will watch a prescription drug commercial and then answer some survey questions about what you watched. Viewing the commercial and completing the survey will take approximately 25 minutes.

Benefits

There is no direct benefit to you for participating. However, you may find the commercial to be interesting.

Risks

There are no known risks to participating in this study. While the survey questions we ask are not meant to be sensitive, there is always a chance that you may feel uncomfortable with some of the questions. You do not have to answer any question that you don’t want to answer.

Confidentiality

The privacy and confidentiality of your information is of the highest importance, and we are committed to maintaining a secure environment in which you can participate. All information you share in this study will be kept confidential to the extent provided by law. The study team will not disclose your name or any of your responses, and your personal information (name, address, phone number) will not be linked to any of your responses. The information you share with us will be combined into a summary report so that details of individual questionnaires cannot be linked to a specific participant. You will not be re-contacted about this research study in the future.

Reimbursement

In appreciation for your time and travel, we will reimburse you <IF LOS ANGELES MARKET: “$75”, ELSE: “$40”> at the end of the session.

Right to Refuse or Withdraw

Your participation in this study is completely voluntary, and you can withdraw from the study for any reason at any time without penalty.

Persons to Contact

If you have questions about the study, you can call the project director, Jessica DeFrank, at 1-800-334-8571, ext. 22661. She can be reached between 9:00 AM and 5:00 PM Eastern Time Monday to Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Authorization and Consent

I have read this consent form. I had a chance to ask questions, and my questions were answered. I was given a copy of this consent form. I agree to participate in the study.

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Signature of Participant Date

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Signature of Person Obtaining Consent Date

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