Consent Form

Attachment 4: Focus Group Consent Form

Focus Groups Consent Form for Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults

Introduction and Purpose:

[CONSULTING COMPANY] is conducting focus groups with adult men and women to evaluate and hear opinions about a suite of health communication materials. We expect this focus group to take up to 2 hours.

You are the expert on your experience, and your thoughts and opinions are greatly valued and appreciated. We want to learn from you. We encourage you to speak openly and honestly about your experience. There are no right or wrong answers. Should you agree to participate in the discussion, here are some points you should know:

• Rights Regarding Participation: This discussion is completely voluntary. You may choose to leave the focus group and/or not answer a question at any time for any reason.

• Privacy: We will take every precaution to protect your identity and ensure your privacy unless required by law. We will keep your name and identifying information private and your identity will not be disclosed, nor included in any summary reports. Your contact information and name will not be attached to any of your responses.

• Benefits: Your participation in the focus group will not result in any direct benefits to you. However, your input will help to develop effective communication materials.

• Risks: The focus group poses minimal, if any, risks to you. None of the questions are of a sensitive nature, so none of the questions should make you uneasy or uncomfortable.

• Incentive: In appreciation of your time, you will receive an incentive of $75 for participating in today’s focus group.

• Audiotaping and Notes: The discussion will be audio-recorded. No quotes or comments you make will be linked with your name in any way. We will take notes throughout the focus group today to help us keep track of your responses. We will keep all information, notes, and audiotapes locked in a file cabinet or a secure computer file. Only study staff will be able to access the information. These notes and audio recordings will be destroyed upon conclusion of the project.

• Observers: Individuals from the study team will be observing this focus group silently. They will not participate in the discussion.

• Questions: We will answer any questions you have about this focus group discussion before you take part.

• Contact Information: If you have any questions about this discussion or the communication materials, please contact [INSERT POINT OF CONTACT AT CONSULTING FIRM].

Your 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. The above document describing the benefits, risks, and procedures for this research study has been explained to me. 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