Intimacy, Passion, and Commitment as Predictors of Couples' Relationship Satisfaction

CONSENT FORM: Invitation to Participate in a Psychological Study of Couples’ Relationships

 
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This study has been approved by Capella University's IRB 101194-1, effective from September 7, 2010 through September 7, 2011
My name is Doreen Lewis and I am a doctoral learner in the School of Psychology at Capella University. I am doing a research study called Intimacy, Passion, and Commitment as Predictors of Couples’ Relationship Satisfaction. This research is being supervised by Dr. Rick Van Haveren (contact information below). I would like to invite you to participate in this research study. The main purpose of this form is to provide information about the research so that you can make a decision about whether you want to participate. If you choose to participate, please select "YES" at at the end of this form.

Researcher: Doreen Lewis
Email: info@thelovesurvey.org
Fax: 727.255.5011

Supervisor: Richard A. Van Haveren, Ph.D.
Licensed Psychologist
richard.vanhaveren@faculty.capella.edu

WHAT IS THE RESEARCH ABOUT?
This is a survey about romantic relationships. The survey measures satisfaction level in the participants’ current romantic relationship. Questions on the survey are related to intimacy, commitment, and passion. You are eligible to participate if you are English speaking, live in the United States, and are over the age of 18. You must be currently in a heterosexual relationship. It is also necessary to have internet access to take the survey.

WHAT DOES PARTICIPATION IN THIS RESEARCH STUDY INVOLVE?
If you decide to participate in this study, you will be asked to rate your relationship on several factors. The questions use a point system. For each question you will assign a number that shows how strongly you feel about a certain aspect of your relationship. An example question is, “I communicate well with my partner.” You would choose an answer based on a nine-point scale. On the scale, 1 means "not at all," 5 means "moderately," and 9 means "extremely," with points in between to indicate these values. Your participation in the survey will take about 20 minutes.

WHY ARE YOU BEING ASKED TO PARTICIPATE?
You are invited to be in a study that furthers research about romantic love. The study is part of the researcher’s work in the psychology of love. When completed the survey will be a published dissertation. It may potentially become a published book. Your participation is anonymous. Your participation is important because you represent the population of American couples. Your responses will be analyzed along with all survey participants to help determine what factors play a role in relationship satisfaction.

WHAT ARE THE RISKS INVOLVED IN THIS STUDY?
Although no study is completely risk-free, we do not expect you to be harmed or distressed by taking the survey. If you find yourself becoming uncomfortable, you may stop at any time.

ARE THERE ANY BENEFITS TO PARTICIPATION?
There are no direct benefits to you from participation in this study. However, results of the study will be reported at a website for those interested. The website address is: www.thelovesurvey.org.

WHAT HAPPENS IF THE RESEARCHER GETS NEW INFORMATION DURING THE STUDY?
The researcher will post a notice of any new information at the survey website, www.thelovesurvey.org.

HOW WILL THE RESEARCHER PROTECT PARTICIPANTS’ CONFIDENTIALITY?
The results of the research study will be published, but your name or identity will be private. Information submitted online is encrypted. No information will be shared that would identify you in any reports to the public. Research records will be kept in a locked file. Only the researchers will have access to the records.

WHAT HAPPENS IF A PARTICIPANT DOESN’T WANT TO CONTINUE IN THE STUDY?
Participation in this study is voluntary. If you choose not to participate or if you choose to withdraw from the study, you may do so at any time. There will be no consequence.

WILL IT COST ANYTHING TO PARTICIPATE IN THE STUDY? WILL I GET PAID TO PARTICIPATE?
There is no cost to participate.

WILL PARTICIPANTS BE COMPENSATED FOR ILLNESS OR INJURY?
You are not waiving any of your legal rights if you agree to participate in this study, however no funds have been set aside to compensate you in the event of harm. If you suffer harm because of this research project, you may contact the researcher at info@thelovesurvey.org. You may also contact the Capella Human Research Protections Office at 1-888-227-3552, extension 4716.

VOLUNTARY CONSENT
At the bottom of this page is a question that asks if you would like to continue the study. If you click YES, you are giving your consent to participate in the study. Further, you indicate that you have read this form or have had it read to you. You also understand the risks and benefits of the study and know what you are being asked to do. If at any time you do not wish to participate, you may simply close the browser and all answers will be erased. The researcher will be happy to answer any questions you have about the research. If you have any questions, please feel free to contact the researcher at info@thelovesurvey.org

If you have questions about your rights as a research participant, the Capella Human Research Protections Office is available to help. If you have any concerns about the research process or the researcher, please contact us at 1-888-227-3552, extension 4716. If there are any unexpected problems with the research please also be sure to contact us. Your identity, questions, and concerns will be kept confidential.

By clicking on YES below, you are saying that you have read this information and understand what you are being asked to do. Please print a copy of this consent information for your records. NOTE: If at any time, you do not wish to participate, you may simply close the browser and all answers will be erased.
1. Do you agree to the consent information listed on this form and wish to participate in the study?
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