My name is Ileana Ungureanu, and I am a doctoral student at Syracuse University. I also hold an MD from the University of Medicine and Pharmacy, Timisoara, Romania. I am inviting you to participate in a research study. Involvement in this study is voluntary. Therefore, you may refuse to take part in the survey and you may withdraw at any time without penalty. I will explain the study in this consent form and I encourage you to ask any questions you may have over email at iungurea@syr.edu. I am interested in learning about the quality of committed relationship in couples where at least one of the partners is diagnosed with fibromyalgia. You will be asked to answer questions in four questionnaires. The first is an evaluation of the impact of fibromyalgia symptoms on your daily life. The second evaluates alexithymia (a condition that affects our ability to recognize and describe emotions), while the third one is an adult attachment style questionnaire, which is designed to show how people behave in intimate relationships. The fourth questionnaire evaluates the quality of your long-term relationship. As a reward for your participation in this study, you will be entered into a raffle to receive one of three $50 gift certificates to a local massage clinic. The approximate odds of receiving one of the four gift certificates are 1/50. If you are one of the winners, you will receive the gift certificate via email to the address you specified entering the raffle. Only participants that complete the study will be entered in the raffle for the gift cards.
Taking the survey will take approximately 30 minutes. This survey is anonymous. The data collection method used on surveymonkey.com does not allow responses to be connected with a particular participant. The only email addresses I will have access to, are the addresses provided by you to be introduced in the raffle. However, the internet network is not 100% secure. The administrators at surveymonkey.com employ multiple layers of security to make sure that the account and the data remains private and secure. They employ a third-party firm to conduct daily audits of the security, and the data resides behind the latest in firewall and intrusion prevention technology, to insure that the data is collected in an encrypted environment.
You will be asked to provide some demographic data (gender, age, race, occupation, religion). The benefit of this research is that you may help advance the knowledge of the impact of fibromyalgia symptoms, a domain where little is known to date. Through this study you may help fibromyalgia suffering people be more visible. A possible risk of taking this survey might be emotional discomfort with the subject. Should any such discomfort arise, you can stop taking the survey, and you can email me. I will do my best to identify local agencies that provide psychotherapeutic services.
Please feel free to contact me or my advisor with any questions. I can be reached by phone at 315-443-3023 or by email at iungurea@syr.edy. My advisor, Linda Stone Fish can be reached by phone at 315-443-3024 or by email at flstone@syr.edu.
The Syracuse University Institutional Review Board (IRB) has approved this research study. If you wish, you may contact them with questions regarding your rights as participants. If you have questions, concerns, or complains, or if you want to talk to someone other than the investigators please call 315-443-3013 to speak with an IRB representative.
Please print a copy of this consent script for your records.
Clicking bellow indicates that I have read the description of the study, I am 18 or older, and I agree to participate.