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Neighborhood Needs Assessment for Community Partnership of the Ozarks 2021-020

Confidentiality and Consent Form 2021-020

Confidentiality and Consent Form Pt. 1

Purpose:

This survey is a needs assessment of the Robberson neighborhood. The study is being conducted to gain information on adult neighborhood residents’ perceptions of Community Partnership of the Ozarks and of The O’Reilly Center for Hope and information related to their lives, households, and neighborhood. Demographic and housing information is also being collected.

This information is being collected with the hope of assisting Community Partnership of the Ozarks in building a positive relationship with the neighborhood in which The O’Reilly Center for Hope is located (Robberson), with the hope that other goals—better serving the neighborhood, gaining information about neighborhood residents, alleviating concerns residents may have concerning the center, and tailoring services to neighborhood residents, may also be served.

Another purpose is to determine the extent of the population of older adults (adults aged 65 and older, for the purposes of this survey) in the neighborhood and to determine some of their needs, particularly concerning technology.

Procedure:

The study will consist of this survey which will be administered electronically, by paper, or by phone. Together, reading this form and taking the survey should take about 15-45 minutes.

Risks:

Participation is completely voluntary. There are no consequences for choosing not to participate in the study. Participants have the right to skip any questions or stop taking the survey at any time with no penalty. Some risks are associated with participation. Taking the survey will take some time, which carries a risk of discomfort. Participants are also exposed to the risk of discomfort from questions that ask about their life, housing, and neighborhood. Adults aged 65 and older will also be exposed to the risk of discomfort through a question that asks about their confidence using certain electronic devices and a question that asks about their interest in taking related classes. Those working on the research and the agency will be responsible for maintaining confidentiality and will work to uphold confidentiality, but there is always a risk that confidentiality may be breached. Part of this study is targeted at learning more about adults 65 and older, with some questions, as mentioned above, directed toward this group specifically. It should be noted adults 65 and older can be considered to have limited freedom of consent.

Conflict of Interest:

The researcher is a practicum student at Community Partnership of the Ozarks.

Benefits:

There are no benefits expected to be received by a participant personally for participating in the study, though the information they provide may be used to guide agency programming in the future. In case resources for assistance are desired, the following resources are provided:

● You can dial 211. 211 connects callers, at no cost, to available community resources. Dial 211 to speak to a trained professional 24 hours a day, seven days a week.

● You can also follow this link to a resource page on the Prosper Springfield website:

https://prosperspringfield.org/gethelp/


1.Confidentiality and Consent Form Pt. 2

Confidentiality:

Participant data will be accessible to those working on the research project (including the primary researcher and an Evangel University faculty member) and those with access to the Community Partnership of the Ozarks SurveyMonkey account used for the study (this currently includes three Community Partnership of the Ozarks staff members). Participant data will be used in accordance with the SurveyMonkey Privacy Notice. It can be read here: https://www.surveymonkey.com/mp/legal/privacy/ 
Also note that "any personal data collected from them [respondents] in the survey may be transferred to various countries, including the United States and other locations SurveyMonkey has offices" (https://help.surveymonkey.com/articles/en_US/kb/How-do-I-create-a-consent-form-or-disqualify-respondents-from-a-survey). As stated above, those working on the research project and at the agency will work to keep your data confidential, but there is always a risk that confidentiality may be breached.

When your responses are reported, they will not be linked to your identity. They will be combined with responses from others and then reported together in contexts such as a university research symposium and through or at Community Partnership of the Ozarks to staff, interns, volunteers, or partners. The combined responses will be connected to the Robberson neighborhood in some reports, and the neighborhood will not be explicitly named in others. Electronic records containing research data will be destroyed after at least five years have passed and hard copy data will be shredded at the conclusion of the study.

Consent: 

Selecting "yes" to this next question indicates your agreement with this confidentiality and consent form.

Contact: 

For questions or comments you may email the primary researcher, Abigail O’Connell, at aoconnell@cpozarks.org.

Do you consent to the terms outlined in the Confidentiality and Consent Form?(Required.)
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