Consent Form

Appendix J:
Informed Consent Form

North Carolina State University

INFORMED CONSENT FORM for RESEARCH

Study title: Food preparation in the home

Principal Investigator: Dr. Ben Chapman, [email protected],
919-515-8099

Introduction

You are being asked to take part in a research study. Your participation in this study is voluntary. You have the right to be a part of this study, to choose not to participate or to stop participating at any time without penalty. The purpose of research studies is to gain a better understanding of a certain topic or issue. You are not guaranteed any personal benefits from being in a study. Research studies also may pose risks to those that participate. In this consent form you will find specific details about the research in which you are being asked to participate. If you do not understand something in this form it is your right to ask the researcher for clarification or more information. A copy of this consent form will be provided to you. If at any time you have questions about your participation, do not hesitate to contact the researcher(s) named above.

Purpose

This research study is being conducted by RTI International and North Carolina State University (NCSU), with funding from the U.S. Department of Agriculture’s (USDA’s) Food Safety and Inspection Service (FSIS). The purpose of the study is to test several recipes. You are one of approximately 400 adults who will participate in this study.

Procedures

If you agree to participate, you will be asked to prepare two recipes while being video recorded. These recipes may include frying, grilling, baking, microwaving, cutting, slicing and preparing meats and vegetables. You will also be asked to take part in a short interview after preparing the recipes. The interview will ask about your food preparation practices. We will use the recordings and interview findings to prepare a summary report; however, your identity will not be associated with your behaviors in any reports.

Study Duration

Your participation in this study, including preparing the recipes and being interviewed, will take no more than 2 hours.

Possible Risks or Discomforts

There are minimal psychological, social, or legal risks to participating in this study. You will be asked to prepare two recipes in a kitchen and complete a short interview. Your participation is voluntary, and you can choose to remove yourself from the study at any time. There are minimal risks to you as a preparer of food as there are heat sources (stove, oven, counter top grill) and sharp objects that may result in cuts (knives, forks, slicers). The items and appliances are common home kitchen equipment; we anticipate that the risk of injury is the same as the risk if you were preparing food in your own home. Each study kitchen is equipped with a first aid kit and fire extinguisher. Researchers will be available just outside of the kitchen to assist in case of injury by providing the first aid kits and alerting medical staff if needed. There is no provision for free medical care for you if you are injured as a result of this study.

Benefits

There are no direct benefits to you from participating in this study. Knowledge may be gained that can help others.

Payment for Participation

You will receive $75 for your participation and a free gift.

Confidentiality

Video information will be shared with the RTI and NCSU study team. Because videos include visual information about participants, they are not considered to be de-identified. However, your name will not be connected to the recording of your recipe preparation or your interview responses. All data will be identified by a unique identification number and stored securely. At the completion of this study, the recordings will be destroyed.

The Institutional Review Board (IRB) at NCSU has reviewed this research. An IRB is a group of people who help make sure that research is compliant with federal laws and that participants’ rights are not violated and protected. The IRB may review the records of your participation in this research to ensure that proper procedures were followed. A representative of the IRB may contact you for information about your experience with this research. This representative will be given your name but will not be given any of your confidential study data. If you wish, you may refuse to answer any questions this person may ask.

Future Contacts

We will not contact you in the future.

Your Rights

Your decision to take part in this research study is completely voluntary. You can stop participating at any time, and you can refuse to answer any question. If you decide to participate and later change your mind, you will not be contacted again or asked for further information.

Your Questions

If you have any questions about the study, you may call Benjamin Chapman of NCSU at 919-515-8099. if you have any questions regarding your rights as a research participant, please contact Deb Paxton NCSU’s IRB Office at 919-515-4514.

YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP.

Your signature below indicates that you have read the information provided above, have received answers to any questions you may have, and have freely decided to participate in this research. By agreeing to participate in this research, you are not giving up any of your legal rights.

Date Signature of Participant

_______________________________________

Printed Name of Participant

I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above-named individual.

______________________________________

Date Signature of Person Obtaining Consent

_______________________________________

Printed Name of Person Obtaining Consent

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 0583-XXXX and the expiration date is XX/XX/201X. The time required to complete this information collection is estimated to average 1 minute 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.