Directions and Informed Consent
Thank you for your interest in this research study and your willingness to participate. Please remember the criteria for participation:
- You must be age 18 or older
- You must be female
- You must have a diagnosis of fibromyalgia, chronic fatigue syndrome or both, and
- You cannot have any other chronic medical conditions such as systemic lupus erythematosis or multiple sclerosis or psychotic disorders such as schizophrenia
By completing this survey you are contributing toward understanding the experiences that help individuals cope with their chronic fatigue syndrome and/or fibromyalgia. If you wish to participate in the drawing for a $50 gift card, you will have an opportunity to provide your contact information so that it can be included in the drawing after you complete the survey. Several individuals (1 in 10 chance) will be randomly selected and each will receive a $50 gift card to one of several stores. These include Amazon.com, Bed Bath and Beyond, or Bath and Body Works. Your identifying information will be separate from your responses to protect your anonymity.
My name is Catherine Hammill and I am a doctoral candidate at Fielding Graduate University. My dissertation chair is April Fallon, Ph.D. I am conducting this research in partial fulfillment of the requirements to complete a Ph.D. in Clinical Psychology.
You are not required to participate in this research but if you choose to participate you can withdraw consent and discontinue participation at any time without any penalty. You may also request that previously provided information be removed from the study. Some of the questions on the questionnaire ask about very personal matters related to different types of childhood abuse. Some of these questions are very explicit. You may experience some emotional discomfort when answering these questions, but taking the survey is not expected to present any greater risk than you would encounter in everyday life when sending and/or receiving information over the internet. I will not able to provide counseling as it pertains to the survey, but if you want to talk about feelings as a result of answering the questions, please contact a counselor of your choice. Other options include The National Register of Health Service Providers in Psychology www.nationalregister.org
. This is an excellent source for finding a doctor in your area who can talk with you about your feelings. You may also contact Adult Survivors of Child Abuse (ASCA, www.ascasupport.org
) or Darkness to Light (www.darkness2light.com
) which deals specifically with issues concerning childhood sexual abuse. These resources along with additional information about them will also be available to you at the end of the survey.
If you have any questions about this research, or would like a synopsis of the results, please contact me at email@example.com
or my dissertation chair, Dr. April Fallon at Fielding Graduate University, 2112 Santa Barbara St., Santa Barbara, CA 93105. The phone number is 805-687-1099. If you have questions or concerns about your rights as a research participant, contact the Fielding Graduate University Institutional Review Board by email at firstname.lastname@example.org
or by telephone at 805-898-4033. The results of this research will be published in group summary format in dissertation and possibly in subsequent journal articles or other publications.
The survey consists of 52 questions regarding your current physical and mental health, your attitudes toward yourself and others and any maltreatment experiences you may have encountered during your