Healthcare Perceptions Consent Form

We are asking you to participate in a research study titled “Healthcare Perceptions and Experiences in Kink Communities ”. We will describe this study to you and answer any of your questions.  This study is being led by Kate L Jansen, in the Clinical Psychology department.
What the study is about

The purpose of this research is to examine the experiences with and perceptions of the healthcare field from individuals who identify as members of the BDSM community.  We are researching health risks associated with specific BDSM activities, experiences with health care providers, and perceptions of the medical field. Participation is completely voluntary. If you agree to participate, you can always change your mind and withdraw. There are no negative consequences, whatever you decide.

What we will ask you to do

We will ask you to complete several surveys about physical and psychological injuries that may have been obtained in the course of participation in BDSM activities and their treatment.  We will also ask you questions about your perception of the healthcare community and experiences you’ve had receiving mental and physical healthcare. We expect the survey should take about 15 minutes to complete.

Risks and discomforts

·      Some questions may be personal or upsetting. You may experience discomfort recalling past injuries and/or negative health  care experiences.

·      You can skip any questions you don’t want to answer, or stop the survey entirely.

·      Online data being hacked or intercepted: This is a risk you experience any time you provide information online. We’re using a secure system to collect this data, but we can’t completely eliminate this risk.

·      Breach of confidentiality: There is a chance your data could be seen by someone who shouldn’t have access to it. We’re minimizing this risk in the following ways:

o   No identifying information is being collected, so your name cannot be linked to your survey responses.

o   Only members of the research team will have access to the survey results

Benefits

Though there is no direct benefit to participants in this study, there are benefits to the BDSM community. We hope to learn more about the experiences members of the BSDM community have had with medical and mental health care providers. Information from this study may benefit other people in the future, as the information will be used to make recommendation to the medical and psychological community.

Compensation for participation

Participants will be given the option to enter into a drawing for one of four (4) $25 Amazon gift cards. Entry into this drawing is optional, and contact information for this drawing is not linked to individual survey responses.

In the unlikely event that you suffer an injury or illness directly related to your participation in this research project, upon your request, Midwestern University will arrange for the provision of treatment for such injury or illness at the closest medical facility. Payment for such treatment will be your responsibility, although your commercial insurance carrier, if any, may pay all or part of the medical expenses that you might incur. Midwestern University will not pay any monetary compensation for research related injury or illness or pay for treatment outside any MWU-affiliated Hospitals or Medical Centers.  You are not waiving any of your legal rights by volunteering to participate in this study.
Privacy/Confidentiality/Data Security

We will not collect any identifying information about you. If you choose to enter into the drawing for the $25 gift cards, your email address and contact information will be kept separate from the survey responses. Your contact information cannot be linked to individual survey responses and the email addresses collected for the drawing will be destroyed upon completion of the drawing.

Please note that the survey(s)is being conducted with the help of Survey Monkey,  a company not affiliated with MWU and with its own privacy and security policies that you can find at its website. We anticipate that your participation in this survey presents no greater risk than everyday use of the Internet.

In the case that you are selected for the gift card drawing, please note that email communication is neither private nor secure. Though we are taking precautions to protect your privacy, you should be aware that information sent through e-mail could be read by a third party.

Your confidentiality will be kept to the degree permitted by the technology being used. We cannot guarantee against interception of data sent via the internet by third parties.

Sharing De-identified Data Collected in this Research  

De-identified data from this study may be shared with the research community at large to advance science and health. We will remove or code any personal information that could identify you before files are shared with other researchers to ensure that, by current scientific standards and known methods, no one will be able to identify you from the information we share. Despite these measures, we cannot guarantee anonymity of your personal data.

Taking part is voluntary

You do not have to agree to be in this study, and you may change your mind at any time.

You may skip any questions that make you feel uncomfortable, with no penalty.

 
If you have questions

This study has been reviewed and approved by the Midwestern University Institutional Review Board (AZ #1288). If you have questions about this research project and the research subjects’ rights please contact the principal investigator, Kate L Jansen at 623-572-3712 or email KJanse@midwestern.edu 

If you have any questions regarding the rights of being a research subject, please call the Office of Research and Sponsored Programs at 623-572-3728 or via email: AZORSP@midwestern.edu.

 
Statement of Consent

I have read the above information, and have received answers to any questions I asked. I consent to take part in the study. I may print a copy of this consent form.

Question Title

* 1. 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

Thank you for your consideration. 

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