Diet and Physical Activity Survey for Adult Residents of Nueces County
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Survey Consent Form
The purpose of this form is to provide you information that may affect your decision as to whether or not to participate in this research study. If you decide to participate in this study, this form will also be used to record your consent.
You have been asked to participate in a research project studying the physical/recreational environment of adult citizens of Nueces County. The purpose of this study is to understand how access to neighborhood recreational facilities such as parks and gyms impact the health of residents. Any adult resident of Nueces County that is over the age of 18 may participate. This study will be conducted as part of a Texas A&M University-Corpus Christi master’s research thesis requirement.
What will I be asked to do?
If you agree to participate in this study, you will be asked to describe your neighborhood, exercise and physical activities, (food) shopping habits, and some information about your background. If you decide to participate, the survey will take about 10-15 minutes.
What are the risks involved in this study?
The risks associated in this study are minimal and are not greater than risks ordinarily encountered in daily life.
What are the possible benefits of this study?
The possible benefits of participation are that you can help us identify characteristics of neighborhoods that need improvement to help its residents live healthier lives.
Do I have to participate?
No. Your participation is voluntary. You may decide not to participate or to withdraw at any time without your current or future relations with Texas A&M University-Corpus Christi and the Coastal Bend Diabetes Initiative being affected.
Will I be compensated?
Because this work is part of a graduate thesis project the budgetary allowance for this study is very small. We rely mostly on the interest and concern of survey participants as incentives for completing the survey.
Who will know about my participation in this research study?
This study is confidential. The records of this study will be kept private. No identifiers linking you to this study will be included in any sort of report that might be published. Research records will be stored securely and only Drs. Huang and Meyer and their research assistants will have access to the records.
Whom do I contact with questions about the research?
If you have questions regarding this study, you may contact Dr. Pamela S. Meyer (email: pamela.meyer@tamucc.edu; phone: 361 825-5818) or Dr. Lucy Huang (email: lucy.huang@tamucc.edu; phone: 361 825-2646) or Nyambura Njagi: nyambura.njagi@tamucc.edu.
Whom do I contact about my rights as a research participant?
This research study has been reviewed by the Research Compliance Office and/or the Institutional Review Board at Texas A&M University-Corpus Christi. For research-related problems or questions regarding your rights as a research participant, you can contact Erin Sherman, Research Compliance Officer, at (361) 825-2497 or erin.sherman@tamucc.edu
PLEASE NOTE: BY COMPLETING THE SURVEY YOU AGREE THAT YOU HAVE READ THE SURVEY CONSENT FORM AND ARE GIVING YOUR CONSENT TO TAKE THIS SURVEY.
You have been asked to participate in a research project studying the physical/recreational environment of adult citizens of Nueces County. The purpose of this study is to understand how access to neighborhood recreational facilities such as parks and gyms impact the health of residents. Any adult resident of Nueces County that is over the age of 18 may participate. This study will be conducted as part of a Texas A&M University-Corpus Christi master’s research thesis requirement.
What will I be asked to do?
If you agree to participate in this study, you will be asked to describe your neighborhood, exercise and physical activities, (food) shopping habits, and some information about your background. If you decide to participate, the survey will take about 10-15 minutes.
What are the risks involved in this study?
The risks associated in this study are minimal and are not greater than risks ordinarily encountered in daily life.
What are the possible benefits of this study?
The possible benefits of participation are that you can help us identify characteristics of neighborhoods that need improvement to help its residents live healthier lives.
Do I have to participate?
No. Your participation is voluntary. You may decide not to participate or to withdraw at any time without your current or future relations with Texas A&M University-Corpus Christi and the Coastal Bend Diabetes Initiative being affected.
Will I be compensated?
Because this work is part of a graduate thesis project the budgetary allowance for this study is very small. We rely mostly on the interest and concern of survey participants as incentives for completing the survey.
Who will know about my participation in this research study?
This study is confidential. The records of this study will be kept private. No identifiers linking you to this study will be included in any sort of report that might be published. Research records will be stored securely and only Drs. Huang and Meyer and their research assistants will have access to the records.
Whom do I contact with questions about the research?
If you have questions regarding this study, you may contact Dr. Pamela S. Meyer (email: pamela.meyer@tamucc.edu; phone: 361 825-5818) or Dr. Lucy Huang (email: lucy.huang@tamucc.edu; phone: 361 825-2646) or Nyambura Njagi: nyambura.njagi@tamucc.edu.
Whom do I contact about my rights as a research participant?
This research study has been reviewed by the Research Compliance Office and/or the Institutional Review Board at Texas A&M University-Corpus Christi. For research-related problems or questions regarding your rights as a research participant, you can contact Erin Sherman, Research Compliance Officer, at (361) 825-2497 or erin.sherman@tamucc.edu
PLEASE NOTE: BY COMPLETING THE SURVEY YOU AGREE THAT YOU HAVE READ THE SURVEY CONSENT FORM AND ARE GIVING YOUR CONSENT TO TAKE THIS SURVEY.