Informed Consent Example: (Long version)
La Sierra University Developmental Delay Project
The study you will participate in is designed to help us understand what issues concern families who have a developmentally delayed child. It is unique in that it will especially help us learn about the needs of single-parent families.
Your part in the research involves meeting with a researcher who will conduct an interview in your home, at a date and time of your choosing. You will be asked many questions and your answers will be audiotaped. The interview includes questions about your child’s experiences, your beliefs, challenges you have faced in dealing with your child’s developmental delays, and the coping mechanisms you and your child have successfully employed. We want you to know that you can choose to skip any questions that you don’t feel comfortable answering, you are free to withdraw from this study at any time, and that there are no negative consequences for you or your child associated with doing so.
No risks or discomfort are expected. All information you give will be completely confidential—your identity will not be revealed. Only the researcher who conducts the interview and a member of the project staff who will transcribe the tape will have access to your responses. You will be assigned a code number in the typed transcript and the audiotape will be destroyed as soon as the transcription is complete (within two weeks of the date of the interview). The transcript will be kept in a locked file cabinet in a secure, private office on the campus of La Sierra University. Information will be analyzed on a group basis only—no individual responses will be divulged. It is possible that discussing these issues may elicit some negative emotions or identify things that warrant additional discussion with a professional. Although we are not able to provide any funding or compensation to do so, we encourage you to contact Dr. Helpful (951/785-2454) or another professional if necessary.
The benefits of this research include: (a) examining issues that are important to you, (b) contributing to the knowledge base about the impact of a child with developmental delay on families, and (c) the opportunity to obtain a report of the final results if desired (if you do wish to receive a copy of the final report, please notify the researcher today, or contact the researcher at a later time using the information provided below).
Questions: Do not hesitate to ask questions if anything appears uncertain to you. Dr. Nora Human, the primary investigator for this project can be reached at La Sierra University, 4500 Riverwalk Parkway, Riverside, CA 92515 (951/785-2454; Human@fakemail.com), and will answer any questions you have. Any concerns you may wish to discuss, such as your rights, with someone other than Dr. Human may be addressed to Dr. In-Kyeong Kim, chairperson of the Institutional Review Board at La Sierra University (951/785-2542; firstname.lastname@example.org).
Consent: If you understand the procedure, have had the opportunity to ask questions, and you agree to the terms of this study, please sign and date below.
Institutional Review Board Secretary
Phone: (951) 785-2099
Fax: (951) 785-2918
Ambs Hall 109