Fielding Graduate University Informed Consent Form

 Levels of Gender Role Conflict and Stigma by Association in Husband Caregivers of Women with Alzheimer’s Disease: Effects on Vulnerability to Self-Isolation

You are invited to participate in a web-based, online, survey research study on the experience of caregiving for women with Alzheimer’s Disease. This is a research study being conducted by Nicole Brundige, a doctoral student in the Clinical Psychology program at Fielding Graduate University, Santa Barbara, CA. This study is part of Nicole’s Fielding dissertation.  Her supervisor is Dr. Margaret Cramer, Ph.D., ABPP.  Participation should take approximately 45 minutes to complete.


PARTICIPATION
Your participation in this survey is voluntary. You may refuse to take part in the research or exit the survey at any time without penalty. You are free to decline to answer any question you do not wish to answer for any reason.

BENEFITS
You will receive no direct benefits from participating in this research study. However, your responses may help us learn more about Alzheimer’s Disease caregiver vulnerability to self-isolation.

RISKS
There are no foreseeable risks involved in participating in this study other than those encountered in day-to-day life in your role as primary caregiver. You may feel a little uncomfortable answering some sensitive survey questions, but you are free to skip those questions as stated above.

CONFIDENTIALITY
All information obtained during this study is strictly confidential and anonymous. Your answers to the questions contained in the survey will not ask that you disclose any identifying information. No personally identifiable demographic information will be requested or collected. The survey will ask, for example: Do you live with your wife/life partner? Do you receive formal help with caregiving? Please type the number of months that you have been caring for you wife/life partner since her AD diagnosis. Your survey answers will be sent to a link at SurveyMonkey.com where data will be stored in a password protected, electronic format. Survey Monkey does not collect identifying information such as your name, email address, or IP address. Therefore, your responses will remain anonymous. No one will be able to identify you, your answers, whether or not you are in distress, and whether or not you participated in the study. Access to all materials and information provided will be strictly limited to the researcher and her dissertation committee. Your cooperation and willingness to assist in this research is greatly appreciated.

STUDY RESULTS
Summaries of the study results will be made available to the Alzheimer Association of MA/NH for you to request a copy.

CONTACT
If you have questions at any time about the study or the procedures, you may contact my research supervisor, Dr. Margaret Cramer, PhD, ABPP via email at Mcramer@fielding.edu

If you have any distress as a result of participating in this study, please refer to the list of agencies below.

▪      US Department of Health and Human Services, Mental Health

o   Call toll free: (877) 726-4727

▪      NAMI-National Alliance on Mental Illness

o   Call toll free: (800) 950-6264

▪      National Institute of Mental Health

o   Call toll free: (866) 615-6464


 
7% of survey complete.

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