1. Study Purpose and Informed Consent

11% of survey complete.
You are invited to participate in a research survey for a study of bariatric surgery patients, their weight management practices, social support, possible participation in support groups, quality of life and psychological problems. This research is being conducted by Sofia Shepsis, MS and Dr.Michael Christopher of Pacific University. Results of this study will be used to advance research on how to better support bariatric patients. For the purposes of this study, a “bariatric patient” is defined as a person seeking or having had a weight loss surgery. You will be answering questions regarding your demographic information, weight, weight loss, details about your participation in any in-person or online support groups, quality of life and psychological problems. This project has been approved by the Pacific University IRB and will be completed by December 2013.

This internet survey will be administered via SurveyMonkey.com and will take approximately 20-30 minutes to complete. The security of information transmitted through the internet cannot be guaranteed. Furthermore, this survey is administered through a group SurveyMonkey account. Any person able to use this account (administrators, staff, faculty, students), regardless of whether or not they are involved with this project directly, has unrestricted access to all aspects of the survey and the information gathered through it. However, SurveyMonkey.com is a widely used internet survey software which uses secure protocols and identifying information will not be collected. You will not be asked to write your name, so your results will be entirely anonymous. Your name will not be associated with your answers at any time. Other personal information about you or the internet protocol (IP) address of the computer from which you submit the survey will not be collected.

The results of this research may be presented or published in the future, but it will not be possible to identify you or your original survey responses.

Participation in this survey is completely voluntary. You can withdraw from this study at any time without penalty. There is no direct benefit to you as a participant in this research. There is no form of payment for participation in this research.

As with any type of survey research there is a possible risk of emotional discomfort while answering the questions. If you do become uncomfortable during the survey, you may choose to not answer any question or discontinue participation at any time. Please feel free to contact the investigator with any concerns. If you notify us that a minor adverse reaction occurred that seems to be a consequence of participating in this study (e.g., an anxiety attack), the investigators must notify the IRB (Pacific University Institutional Review Board) by the next normal working day. In the case of more serious adverse events the investigators will notify the IRB within 24 hours. During your participation in this project it is important to understand that you are not a Pacific University clinic patient or client, nor will you be receiving any form of medical care as a result of your participation in this study. If you are injured during your participation in this study and it is not due to negligence by Pacific University, the researchers, or any organization associated with the research, you should not expect to receive compensation or medical care from Pacific University, the researchers, or any organization associated with the study.

Please contact the study investigator Sofia Shepsis (shep0171@pacificu.edu) or the faculty advisor Dr. Michael Christopher (mchristopher@pacificu.edu or 503-352-2498) with any questions or concerns. If you are not satisfied with the answers you receive, please call Pacific University’s Institutional Review Board, at (503) 352 – 1478.

* 1. Only click on the “I agree to participate” button below if:
• You have read and understand the information above,
• Do not have any questions,
• Are 18 years of age or older and legally able to grant consent, and
• Agree to participate in this study.