1. Informed Consent for Electronic Survey

Purpose: You are being invited to participate in a survey research study. The study for which you are being asked to participate is designed to examine the relationships among self-efficacy, knowledge, social support, and self-care activities for senior Korean immigrants with diabetes, living in the United States.

Procedure: To be a voluntary participant in this study, you will be asked to complete a one-time online survey. The survey will take approximately 15 minutes to complete.

Possible Risks: It is expected that participation in this study will provide you with no more than minimal risk or discomfort which means that you should not experience it as any more troubling than your normal daily life. If you feel uncomfortable or distressed, please tell the researcher and she will ask you if you want to continue. The foreseeable risks in this study include emotional discomfort or sad feeling related to self-care of diabetes, unhappy past experiences, or personal background by answering questionnaire. If you experience any discomfort during the survey, you may stop the participation at any time. There is no penalty. If there is a concern about your immediate health or safety, you need to contact your primary care physician or local health offices.

Benefits:  There are no direct benefits to participating in this study, however, your response will help us to better understand the research topic. Furthermore, in the future, healthcare providers will understand better about self-care of senior Korean immigrants and develop culturally tailored health strategies to improve self-care of senior Korean immigrants. Your participation may also benefit other people with similar concerns.

Confidentiality: The investigator involved this study will not be collecting any personal information for the study. All responses to this survey are anonymous and confidential. Your name or identity will not be linked in any way to the research data. Concerning your rights or treatment as a research subjects, you may contact the Research Integrity Officer at Azusa Pacific University (APU) at (626) 815-6000, extension 3796 or disaak@apu.edu.

Compensation: You will not receive financial compensation for participation in the study.

Voluntary Status: Your participation is voluntary which means you can choose whether or not you want to participate. You may withdraw any time without penalty.

Consent: I understand that my participation in this study is entirely voluntary and that I may refuse to participate or may withdraw from the study at any time without penalty. I have read this entire form and I understand it completely. By clicking below and completing the online assessments that follow, I am acknowledging that I am at least 55 years of age and am giving my consent to participate in this study.

Jung Eun Kim, RN, PhD student,
School of Nursing, Azusa Pacific University







Question Title

* 1. I understand that my participation in this study is completely voluntary. I give consent to participate in this online survey.