Pacific Disabilities Center
Consent to Participate in a Research Project:
Hawai‘i Neurotrauma Registry Survey
This survey is for Hawai‘i residents of all ages who have had at least one traumatic brain injury, stroke, or a spinal cord injury, which are known as neurotrauma injuries. It does not matter when or where the injury took place. Persons who provide care for those with these injuries may fill out the survey for someone who has had one or more brain injury, stroke, or spinal cord injury.
The State of Hawai‘i, Department of Health contracts with the Pacific Disabilities Center of the John A. Burns School of Medicine, University of Hawai‘i, to conduct this survey. The reasons for collecting this information are to:
- Describe the health and service needs of persons with neurotrauma injuries
- Identify gaps in services and supports for persons with neurotrauma injuries
- Educate service providers
- Develop safety and prevention plans and policies
Time Commitment: The survey takes about 10 minutes to complete. Please note that it may take you more or less time to answer the questions. Someone from the Pacific Disabilities Center or the State of Hawai‘i, Department of Health may contact you in the future with additional questions and/or to update your information.
There are questions about you, your injury, and how the injury has affected you. The survey also asks about the services you receive and the ones that you need.
By completing this survey, you may help us to identify and / or improve available services and resources for you, your family, and others with neurotrauma injuries in Hawai‘i. You don't have to answer any question you don’t want to, and you can decide to stop answering questions at any time.
If you choose to participate in the survey, you may be eligible to receive a thank-you gift valued at $10.
Confidentiality and Privacy: Your participation and responses are kept strictly confidential to the extent allowed by law. All information is kept in a secure location. Only project staff members have access to the data, although legally authorized agencies, including the University of Hawai‘i Human Studies Program, have the right to review research records.
All written or published reports do not give any information that will identify you in any way. Reports and the information will be given to State of Hawai‘i, Department of Health, Developmental Disabilities Division, Community Resources Branch to assist in planning for persons with neurotrauma injuries.
Continued on next page