Question Title

* 1. This Informed Consent will explain about being a participant in a research study. It is important that you read this material carefully and then decide if you wish to be a volunteer.

PURPOSE: To examine risk and protective factors that contribute to the physical and psychological health of fibromyalgia patients. Results from this study may provide a better understanding of how the mind and body might interact in fibromyalgia patients.

PROCEDURE and DURATION: You will be asked to complete an online survey which will take approximately 30-45 minutes of your time. You can access this survey online from any Internet-capable computer using the link provided in the study brochure. Your survey results are confidential. You will be assigned a subject ID number, which will be used, rather than your name to identify test results.

ALTERNATIVE PROCEDURES: You may choose not to participate in the study.

VOLUNTARY PARTICIPATION: Participation in this research experiment is voluntary. You may refuse to participate. You can stop the survey at any time.

POSSIBLE RISKS/DISCOMFORTS: There are no anticipated risks for participants. Some people may become distressed when completing study questionnaires of a psychological nature; however, the risks are minimal. If you should feel uncomfortable or distressed after completion of this survey, please contact Dr. Hirsch [(423) 439-4463;]. In addition, please see the attached community resources available for mental health assessment and treatment.

POSSIBLE BENEFITS: There are no benefits to you personally for participation in this research, although some people may gain satisfaction by completing surveys that offer some personal insight. Results from this study will provide a better understanding of the mental health issues and concerns fibromyalgia patients, which may have implications for the development of targeted interventions to improve well-being.

FINANCIAL COSTS: There are no additional costs to you as a participant in this research study.

CONTACT FOR QUESTIONS: If you have questions, problems or research-related medical problems at any time, you may call Dr. Hirsch at (423) 439-4463. You may call the Chairman of the Institutional Review Board at (423) 439-6054 for any questions you may have about your rights as a research subject. If you have any questions or concerns about the research and want to talk to someone independent of the research team or you can’t reach the study staff, you may call an IRB Coordinator at (423) 439-6055 or (423) 439-6002.

CONFIDENTIALITY: Every attempt will be made to see that your study results are kept confidential. A copy of the records from this study will be stored in Dr. Hirsch’s office in the Department of Psychology, for at least 5 years after the end of this research. The results of this study may be published and/or presented in group data format at meetings without naming you as a participant. Although your rights and privacy will be maintained, the Secretary of the Department of Health and Human Services, ETSU IRB and Dr. Hirsch have access to the study records.

Check this box to acknowledge that you have read and understand what will occur during your participation.