Informed Consent

Title of Project: Perceptions of Diabetes Self-Management Education and Support, Diabetes Self-
Management Behavior, and Self-Reported Health in Persons with Type II Diabetes

Investigator Name: Tracy M. Towne, MSN, RN
E-Mail Contact Information:

Dissertation Advisor Name: Laura P. Kimble, PhD, RN,
E-Mail Contact Information:

You are invited to participate in an online survey for a research project conducted through Mercer University. Mercer University’ IRB requires investigators to provide informed consent to participate in this project.

The purpose of this online research study is to examine persons with Type II diabetes. It is designed to assess what factors influence how persons with Type II diabetes manage their diabetes. The education and support persons receive about their diabetes will also be examined. Your participation in the study will contribute to a better understanding of Type II diabetes. You must be at least 25years old to participate.

The survey will take approximately 30 minutes of your time. You will receive a $5.00 gift card from a local merchant for your time.

There are no foreseeable risks associated with the study. The questionnaires you will be
completing on-line are similar to
questions you would be asked by your healthcare provider. One of the questionnaires in the
study involves screening for depression. If we find that your symptoms indicate possible
depression we will tell you about this and give you information about numbers you can call to
talk to health professionals about your feelings. There will be no costs for participating. Although your participation in this research may not benefit you personally, it will help us understand what information person with diabetes think is most important to receive. All information obtained will be held in strict confidentiality. The results of this study may be published but the information will be reported for the entire group so that you will not be personally identified. After a period of 3 years the information will be destroyed.

Your decision to participate or decline participation in this study is voluntary. You may decline to answer any question and you have the right to withdraw from participation at any time. Withdrawal will not affect your relationship with Mercer University in anyway. If you do not want to participate, click on the “stop survey” arrow or close the browser window.

If you do not want to receive any more reminders, you may email us at

If you have any questions about the study contact the investigator Tracy M. Towne at 608-8150267 or send an email to Mercer University’s Institutional Review Board (IRB) reviewed study #( H1312323 ) and approved it on 03/20/2014.

If you have questions about your rights or are dissatisfied at any time with any part of this study, you can contact, anonymously if you wish, the Institutional Review Board by phone at (478) 301-4101 or email at ORC_Research

Thank you in advance for your time and participation!

Please do not forward this e-mail to others.

Please print a copy of this document for your records.

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