Att 4a Consent Form-FG_reinstatement_07-14-20

Form Approved

OMB No: 0920-1169

Exp. Date: 03/31/2020

Development of CDC’s Let’s Stop HIV Together Social Marketing Campaign for Consumers

Attachment 4a: Message, Concept, and Materials Testing Focus Group Consent Form

Consent Form –Message/Concept/Materials Testing

Focus Groups

Formative Research for the Development of Let’s Stop HIV Together Social Marketing Campaign for Consumers

Introduction and Purpose:

You have been asked to take part in a focus group (group interview) as part of a study. The purpose of the focus group is to hear your thoughts on materials that are being developed about HIV. RTI International, a non-profit company in North Carolina is doing the focus group. The focus group is sponsored by the Centers for Disease Control and Prevention (CDC).

Procedures:

During the focus group, we will ask you to talk a little bit about yourself and what you think and feel about various aspects of HIV such as HIV testing, prevention, or treatment. The focus group, including the brief survey, will take about 2 hours.

We will be doing focus groups with approximately 500 people throughout the United States.

The person doing the focus group will take notes. CDC staff working on this project may observe the focus group.

Risk/Discomforts:

You might feel embarrassed or upset by the things that are talked about during the group. If that happens, we will refer you to someone who can talk with you about your concerns. You can decline to talk about any topic for any reason. You can stop being in the focus group at any time. Before or after the focus group, you may be asked to fill out a brief survey. Your name will not go on this survey. The survey will contain some personal questions about your sexual behavior and HIV. It is your right to refuse to answer any questions or stop taking the survey at any time.

Benefits:

There is no direct benefit to you for being in this focus group. However, you may learn more about your own risk behaviors and HIV. What we learn from the focus group will help us to develop materials about HIV testing, prevention, or treatment.

Privacy:

We will be [digitally recording] the focus group. Recordings will be kept in a [locked cabinet/secure online server]. They will be destroyed at the end of the project. Notes will be made of the [recording]. We will only refer to first names in the notes. Your comments will be kept secure to the extent allowable by law. The notes will be kept on a password-protected computer. Only authorized project staff will be able to see them. Any forms related to the project that have your name or information that could identify you will be kept in a [locked file cabinet/secure online server]. These forms will be destroyed once the project ends. However, there is still a small risk that your privacy could be broken.

Also, any information that this local facility already has about you -- because you have been in other projects -- will still be kept there. You may be contacted by them to be in other projects in the future. If you have not been contacted by this facility before this project, they will not keep any of your contact information.

Payment:

You will receive $75 as a token of our appreciation.

Right to Refuse or Withdraw:

It is your choice to do this focus group. You can choose not to talk about any topic. You can stop being in the focus group at any time.

Persons to Contact:

If you have questions about the focus group, you can call Jennifer Uhrig at 1-800-334-8571 extension 3311. She can be reached between 9 AM and 5 PM Eastern Standard Time Monday - 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.

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.

[ ] I agree to be in the focus group.

[ ] I do not agree to be in the focus group.