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University of Wisconsin-Madison
Department of Rehabilitation Psychology and Special Education

Research Participant Information and Consent

Title of the Study: Evaluating the WHO ICF Framework as an Employment Model for People with Epilepsy

Principal Investigator: Professor Fong Chan (608-262-2137;
Student Researcher: Connie Sung (608-320-5163;
You are cordially invited to participate in a research study about the employment situations of individuals with epilepsy. The research is being conducted by Ms Connie Sung as a part of her doctoral study in rehabilitation psychology at the University of Wisconsin-Madison, under the supervision of Professor Fong Chan. It is being sponsored by the Epilepsy Foundation and endorsed by the Epilepsy Foundation Wisconsin Affiliates. You have been asked to participate because you are a member of Epilepsy Foundation (EF).

The purpose of this study is to collect baseline information about employment status and to identify factors affecting employment rates and employment quality of people with epilepsy in Wisconsin. We are very interested in your experiences and perspectives related to employment, as indicated by your responses on the questionnaires. You are eligible to participate in the study if you are an individual with epilepsy between the ages of 18 and 65 who live in the community and can read or write at a 6th grade level or above.

We very much hope that you will participate in the study, however, participation is completely voluntary. Also, your responses will be completely confidential as no identifying information is requested on any of the questionnaires. Thus, no one will know how you have answered any of the items or even whether you have chosen to participate by completing the questionnaires.

If you decide to participate, you will be asked to complete a series of 13 self-report questionnaires. We hope that you will respond to all items, which will take approximately 30-45 minutes in total. However, if you find any items to be too personal or objectionable in any way, you are certainly free to skip them. As long as you do not lose your internet browser connection, you should be able to take breaks as you are completing the survey and go backward to change your answers if needed.

We do not anticipate any risks to you through your participation in this study.

We anticipate no direct benefits to you through participating in this study. However, the results of this study can help rehabilitation and health professionals develop effective vocational rehabilitation services to help people with epilepsy find jobs and to promote career opportunities for those who are underemployed. Thus, your participation will contribute to helping people with epilepsy enhance their employment and improve their quality of life. We plan to provide a summary of the results of the study to people associated with EF through articles included in EF newsletters and/or posted on the EF website.

Upon completion of all the questionnaires, you will receive a $20 Target Gift Card for participating in this study. You will have an option to sign up for the gift card. If you choose to, your mailing address will be required for us to send you the gift card. Please note that your names and mailing addresses will be obtained separately from your responses to the questionnaire.
If you choose to participate, your responses will be completely confidential. Neither your name nor any other identifiable information will be recorded. When the survey is successfully completed, you will have the option to click on a link and sign up for a $20 Target Gift Card. In order to receive the gift card, you will be asked to provide a name and mailing address, but this information is separate from the responses you will provide in the survey, so your answers will still remain confidential. In addition, your contact information will be kept in secure login and password protected web account until all gift cards are sent out. The dataset will be managed and used only by the investigator and co-investigator of this study. Only group information and aggregated results will be included in any reports from the study.

You may ask any questions about the research at any time. If you have questions about the research, you should contact either the principal investigator (Professor Fong Chan) or student researcher (Ms Connie Sung) at the phone numbers or email addresses above. If you are not satisfied with any responses from the research team, have more questions, or want to talk with someone about your rights as a research participant you should contact the Education Research and Social & Behavioral Science Institutional Review Board (IRB) Office at the University of Wisconsin-Madison (608-263-2320; If it is inconvenient to make these phone or email contacts, please contact the EF office, and they will get word to us to contact you. If you have any question about your health problems or mental health concerns, please contact your health professional consultants or others as suggested in the resource list.

Again, your participation is completely voluntary and confidential. If you decide not to participate or to withdraw from the study, it will have no effect on any services or treatment you are currently receiving or are entitled to. If you choose to participate, please proceed to the survey. Your completed online survey will indicate that you have read and understand the description of what you are being asked to do. And, you voluntarily consent to participate in this research study.

Thank you very much for your time and participation in this study!

Connie Sung, M.Phil.
Doctoral Candidate
Department of Rehabilitation Psychology and Special Education
University of Wisconsin-Madison

***Please answer the following questions for starting the survey.***

Question Title

* I have read the above information and I would like to participate in the study.