Consent for Adult Interview

Attachment D1: Consent Adult Interview

Usability Testing to Inform Development of the

CDC Division of Sexually Transmitted Disease Prevention’s Website
Consent Adults Interview

Project Description

The purpose of this evaluation is to test the usability of a website with information about sexually transmitted diseases or STDs. You are being asked to participate in this evaluation because of your age, pregnancy status, or sexual preferences. We would like you to take part in a telephone interview while reviewing and interacting with a website about STDs. Your responses to questions about the website and how you would use it, along with observations of you using the site to find information, will help the Centers for Disease Control and Prevention or CDC (a government health agency) improve their existing website and help them communicate effectively about STDs. A researcher will conduct the interview.

Procedures

If you take part in this evaluation, we will ask you to read and sign a consent form and participate in an interview. The interview will last 1 hour and 15 minutes and will take place over the telephone on _________. We will not ask personal questions about your sexual health.

Discomforts and Risks

The risks due to being in the evaluation are small. You may be uncomfortable reviewing some of the website’s information. We will keep all information safe and private.

Benefits

There are no direct benefits to you for being in the evaluation, although you may find it interesting or learn something new. It is designed for the researcher to learn more about the usability of CDC’s STD website. This study is not designed to treat any illness or to improve your health.

Study Sponsor

The sponsor for this evaluation is the CDC, a government health agency.

Cost to Participant and Compensation

There is no cost to you for participating; however, you will receive a $40 online gift card as a token of appreciation. If you join late or leave the interview before it has been completed, you will not receive the gift card.

Voluntary Participation

Your participation is voluntary. If you choose to take part in this evaluation, you have the right to stop and/or not answer a question at any time.

Questions and Contact Information

We will answer any questions you have about the interview before you take part. The researcher carrying out this evaluation is __________________. If you have questions later, you may call _________________. You will be given a copy of this form to keep.

_____Initials

Confidentiality

Any information collected during the interview will stay private and will be kept in secure files. Although we will record the discussion, the recording will be transcribed and then erased. Your name will not be written down on the paper transcripts—it will be kept separately in secure files. The final data that the CDC will receive won’t include any participant names and will be aggregated (grouped together with all responses so no one person’s answer stands out). The results of this research may be presented at meetings or in published articles. However, your name will never be included.

If there is any part of this consent that you do not understand, ask the researcher before signing.

AUTHORIZATION:

I have read this paper about the study or it was read to me. I understand the possible risk and benefits of this evaluation. I know that my participation is voluntary and that I can stop at any time. I choose to be in this evaluation. I will get a copy of this consent form. (Initial all the previous pages of the consent form).

Signature: ________________________________________________________

Print Name (participant) ____________________ Date ___________

Consent form explained by: __________________________________________

Print Name _________________ Date ___________

Signature ___________________________