consent

Attachment 5:

Verbal informed consent for Telephone Interview

[The following is read to each respondent before beginning the interview. The respondent must agree to continue the interview after the following is read to him or her.]

Good morning/afternoon. My name is X and I am a researcher at NORC at the University of Chicago. The Office on Women’s Health (OWH) is collaborating with NORC to evaluate the Women’s Health Leadership Institute (WHLI), a Community Health Worker (CHW) training program held between 2011 and 2014. I’m joined by X, who is also a researcher at NORC, who will be taking notes during our discussion.

The purpose of the research study is to determine the long-term impacts and outcomes of the WHLI and to assess whether the WHLI has been effective in training CHWs to implement community projects that result in system-level changes to reduce health disparities. This evaluation will enable OWH to demonstrate the long-term effectiveness of the WHLI and further improve the training and overall program.

 

This interview will last no longer than 30 minutes. Your participation does not involve any foreseeable risks other than what you would encounter in daily life. Your participation in this study is completely voluntary and you may skip questions, and stop the interview at any time without any adverse consequences. Whether or not you choose to participate in the interview, or decide to withdraw at any point, will not affect you in any way. All information collected will be kept private to the extent possible by law. While your responses will be used in a final report for the Office on Women’s Health, you and your organization will not be identified. If you have any questions about your rights as a participant in this research project, please call the NORC IRB Manager by toll-free phone number at (866) 309-0542. If you have any questions about this project, please feel free to call 1-800-604-2698 or e-mail WHLIsurvey@norc.org for assistance.

We will be emailing gift cards in the amount of $10 as a thank you for your time and participation, or if you prefer we can mail you this gift card. Your name, email address, and mailing address will be kept completely separate from any information we record in this discussion and will not be used at all for research purposes.

Do you have any questions for me?

Do you consent to participate in this interview? [All parties on line must say “yes” to proceed.]

[If “yes” then proceed. If “no” then terminate interview.]

NORC would like to audio record the interview in order to help us to take comprehensive notes of our discussion. We will not share the audio tape with any other party, and all tapes will be destroyed after we have reviewed them. Only NORC researchers assigned to this study will have access and will listen to these recordings. All data collected during the interview will remain completely confidential and your full name and other identifying information will never be connected to this recording.

Is it okay with you if we record the interview?

[If all parties indicate “yes” then proceed and begin to record the interview.]

[If “no” then say: “That's fine. Please be patient as I take notes." Do not begin the recording]