Welcome to My Survey

Thank you for participating in our survey. Your feedback is important.

Informed Consent for Online Surveys

You are invited to participate in a study being conducted by Tiffany Murray, a Louisiana State University Shreveport Graduate Student in the Master of Public Health program.  The purpose of the study is to examine discrimination and bias towards minority maternity patients during their office visit with their obstetrician.   Participation should take approximately 20-30 minutes to complete.


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 may skip any question you do not wish to answer for any reason.


You will receive no direct benefits from participating in this research study. However, your responses may help us learn more about bias towards minority patients during maternity care.  There is the risk that you may find some of the questions to be sensitive and may cause emotional discomfort.

Your survey answers will be stored initially with SurveyMonkey.com in a password protected electronic format.  Data will later be downloaded an stored in two password protected excel files, one file with the identifiers which will include the participants’ name and their email address and one file without the participants’ name and email addresses and solely identifying them by their participant number.  The participants’ name and email addresses will be collected in case follow-up questions are needed.  IP address may be collected to ensure participants are within the United States.  


At the end of the survey you will be asked if you are interested in participating in an additional interview by email. If you choose to provide contact information such as your phone number or email address, your survey responses may no longer be anonymous to the researcher. However, no names or identifying information would be included in any publications or presentations based on these data, and your responses to this survey will remain confidential.


At the end of the survey participants will be entered into a raffle for a chance to win a $25 Amazon gift card that will be emailed to the email address they provide in the survey.


If you have further questions or concerns about your rights as a participant in this study, contact the Office of Sponsored Research at (318) 795-4237 or sponsored_research@lsus.edu.  If you have questions concerning the study, contact the principal investigator, at (214) 616-0814 or by email at murrayt30@lsus.edu or my Responsible Faculty Dr. Matthew Kelley at (318) 797-5114 or by email at matthew.kelley@lsus.edu 

Question Title

* 1. ELECTRONIC CONSENT:  Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that:

·       You have read the above information

·       You voluntarily agree to participate

·       You are 18 years of age or older

·       You live in the United States currently and during your pregnancy

·       You are in the minority population

·       You are a woman that received obstetric care during your pregnancy