Attachment D.1 Key Informant Interviews Consent Script_Baseline030712

Multi-site Evaluation of the In Community Spirit Program

Key Informant Interviews

PHONE SCRIPT AND VERBAL CONSENT

Hello, my name is [INSERT NAME] and I work for ICF Macro, a research and consulting firm. ICF Macro is conducting the multi-site evaluation of the federally funded In Community Spirit Program on behalf of the Office on Women’s Health (OWH). As part of this study, ICF Macro is conducting qualitative interviews with five key program participants and partners from each OWH grantee community. Specifically, these interviews are being conducted to obtain feedback from key stakeholders in the In Community Spirit Program about how grant funds are used to support HIV prevention programming with American Indian and Alaska Native women, program activities, service capacity, policy and protocol development, resource availability, and collaborations in order to create a picture of the program’s impact with your target population being served.

You have been chosen to be an interview respondent to discuss the OWH funded effort because of your position as a [INSERT RESPONDENT POSITION] at [INSERT INSTITUTION/ORGANIZATION]. We are asking that you participate in this phone interview which will take no more than approximately 45 minutes of your time for each administration. If you agree to be interviewed, here are some things you should know:

Privacy: Your answers to the interview questions will be kept private, except as otherwise required by law. There is no link between your name and the information you will be providing. Identifying information will not be disclosed to anyone but the researchers conducting this evaluation. The information that we report to OWH will not contain any identifying information, and your name will not be used in any reports about this evaluation.

Procedures: We are conducting interviews twice with five program participants and partners of each OWH In Community Spirit Program. Your input is important to us over time. In six months, another administration of interviews will be completed with the same participants, and we will contact you to provide consent and participate again. Therefore, your input is very important to understand the impact of the In Community Spirit Program over time. We will call to interview you at a time that is most convenient for you. The interview questions will ask you about your role and participation in the HIV prevention efforts at [INSERT OWH GRANTEE NAME].

Risks: This interview poses few, if any, risks to you. You may choose to stop the interview at any time or not answer a question, for whatever reason. If you stop the interview, at your request, we will destroy your survey.

Your participation is voluntary. Refusal to participate involves no penalty or loss of benefits. If you agree to be interviewed, here are some additional things you should know:

• You may discontinue participation in the interview at any time without penalty or consequence.

• You may choose to not answer a question at any time without penalty or consequence.

• We would like to get your permission to record this interview to ensure that we accurately capture details that you provide. However, if you do not agree to be recorded, we will not record the interview. If you agree to be recorded, only ICF Macro staff will be able to use the recording. To protect your privacy, we will keep the notes and recordings in private files and only ICF Macro study staff members will be allowed to use them. All tapes will be destroyed at the end of the evaluation, approximately 2 years from now. Your name and other information linking your name to what is said during the groups will not be reported when we present this study or publish its results. Do I have your permission to record the interview?

• YES

• NO

• ICF Macro staff will take notes during the interview.

• Any questions you have about this study will be answered before the interview begins. We will provide you contact information for the project director, who you may contact with any questions that arise after your participation in this interview.

• You will receive a copy of this consent form via e-mail or regular mail.

• Your name will not be used in any reports about this interview.

Incentive: If you decide to participate, the interview will take no more than 45 minutes, and you will receive $20 for your time. If you are interested I will give you some more information and get your verbal consent. Can I continue?

Contact information: If you have any concerns about your participation in this study, or have any questions about the research, please contact the project director, Robin Davis, at (404) 592-2188 or rdavis@icfi.com.

Do you agree to participate in the interview?

[INTERVIEW INSTRUCTION: Record answer, provide a signature, and follow the procedures outlined]

• YES (Verbal consent provided)

• NO

[INTERVIEWER INSTRUCTION: RECORD THE FOLLOWING]

Date of consent obtained:

Time of consent obtained:

Site ID:

Participant ID:

Interviewer signature: ___________________________________________________________

[INTERVIEWER INSTRUCTION: If “NO” ABOVE, THANK THE PERSON FOR THEIR TIME AND END THE CALL. IF “YES” above, state the following: I’m glad that you consent to be interviewed. Let’s set up a date and time that is most convenient for you to conduct the interview. The interview will take approximately 45 minutes.

[INTERVIEWER INSTRUCTION: SCHEDULE DATE/TIME FOR THE INTERVIEW]

DATE
TIME

Also, I would like to send you an electronic reminder before our interview. Can you please confirm your name, address, phone number, and e-mail?

[INTERVIEWER INSTRUCTION: RECORD THE FOLLOWING]

Name
Mailing Address
Work Telephone		Cell Phone
E-mail

Please contact me at [PHONE NUMBER] if your schedule changes, so that we can reschedule a time to talk. Otherwise, I look forward to talking with you on [Month/Day/Year] AT [Time].

Thank you!

Multi-site Evaluation of the In Community Spirit Program Key Informant Interviews Consent Script