Consent Script
Hello, my name is ______________and I'm from the Centers for Disease Control and Prevention, or CDC here in Atlanta. We are here to test some survey questions about things that may affect the health of mothers and their babies. As a mother of a baby, you may be able to help us determine the best way to ask these survey questions. The survey is part of a research study called the Pregnancy Risk Assessment Monitoring System or "PRAMS" for short, and it is supported by CDC.
Taking part in our survey activity today is voluntary. If you don't want to participate at all, or if you don't want to answer a particular question, that's okay. There is no risk to you if you decide to participate, and there is also no direct benefit.
The clinic has given us permission to invite mothers to participate. Your participation or refusal will not affect the services you receive at the clinic.
Participating in this survey test will not affect your place in line to see the doctor. If you get called in to see the doctor, we will complete the survey after your appointment.
We are not collecting your name or any identifying information on this survey, and we will not be sharing your answers with anyone outside of our survey team. Your answers will be grouped with those from other women.
[If doing a "mail" survey: What we're asking you to do is fill out a short questionnaire, and then speak with me about the questions. We will discuss what you thought about the survey—things like whether you understood the questions, or if you had trouble choosing an answer. It will take about 15-20 minutes of your time.]
[If doing the "phone" survey: What we're asking you to do is answer a few survey questions. I'll ask you the questions and record your answers. Then, when you've answered all the survey questions, we will discuss what you thought about the survey—things like whether you understood the questions, or if you had trouble choosing an answer. It will take about 15-20 minutes of your time]
Your answers are important to us because they will help us to improve the questions we ask other mothers across the United States. We are interested in your comments about the questions in the survey.
If there are questions about your rights as a participant in this survey, you can call Leslie Harrison PRAMS Project Team Leader, 770-488-6335.
Could you please take a few minutes to answer these questions, and then speak with me about them?
(be sure to get a clear yes or no answer).
If Yes:
Thank you very much for agreeing to help us.
If No:
Okay, thanks.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Field Testing Consent Script |
| Author | all0 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |