2008-2009 Fashioned in Faith Calendar Assessment

1. Informed Consent for 2008-2009 Fashioned in Faith Calendar Assessment

 
Consent form for 2008-2009 Fashioned in Faith Calendar Assessment.
1. INFORMED CONSENT (Please read carefully before completing the survey.)

You are being asked to participate in a research project entitled, the 2008-2009 Fashioned in Faith Calendar Assessment.

The 2008-2009 Fashioned in Faith Calendar Assessment is an online survey of a breast cancer prevention calendar developed by the Vanderbilt-Ingram Cancer Center, Office of Minority Affairs (VICC-OMA), an office within the comprehensive cancer center and Sisters Network Nashville (SNN), an affiliate of Sisters Network Incorporated, the oldest African American breast cancer advocacy organization in the United States. The on-line survey (Title: “2008-2009 Fashioned in Faith Calendar Assessment”) takes approximately 15-20 minutes to complete. The survey contains twenty-three (23) multiple choice and short answer questions. The on-line assessment will be available from January– March 1, 2008.

Participation in the on-line survey is strictly confidential. You will not be asked to submit your name, e-mail address, or sign any documents. The Principal Investigator (PI) (Elizabeth Williams, Ph.D.) and Co-Principal Investigator (Co-PI) (Mary K. Smith, R.N.) for the project will not have access to either your name or e-mail address. You do not have to answer any question that makes you feel uncomfortable and you may stop the survey at any point. No individual participant will be identified. All information will be collected and presented as group data. Information collected from the on-line survey will help VICC-OMA and SSN develop more culturally competent cancer prevention materials and activities for minority populations in Nashville (including future editions of the calendar).

You will not be paid for completing the on-line survey.

There are no foreseeable risks to your participation in this on-line survey. You do not have to answer any question that makes you feel uncomfortable. You may stop the survey at any point.

There are no costs to you for completing the on-line survey.

Your participation in the on-line survey is completely voluntary. You may stop the survey at any point, without risk to your employment, healthcare or other services provided by the Vanderbilt-Ingram Cancer Center, Office of Minority Affairs or Sisters Network Nashville. To maintain confidentiality, the PI and Co-PI will only have access to data collected from the survey through a password protected data file.

If you agree to participate, please print a copy of this document for your records.

If you have any questions about this research study or possible injury, please contact Elizabeth A. Williams, Ph.D. or Mary K. Smith, R.N. at (615) 936-8924.

For additional information about giving consent or your rights as a participant in this study, contact the Vanderbilt University Institutional Review Board Office at (615) 322-2918 or toll free at (866) 224-8273.

Your participation in this research is voluntary, and you will not be penalized or lose benefits if you refuse to participate or decide to stop.

Checking the appropriate “consent to participate” box below means that you understand the research study, including the above information, and that you voluntarily agree to participate.
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