Appendix H: Consent forms and fact sheets

Informed Consent for Warrenton, NC Service Providers

Introduction:
Hello, my name is and I'm going to be leading our interview today. This is , who will be taking notes and assisting me during our discussion. We'll be here about 90 minutes today to talk with you about your perspectives on the Warrenton community and about your experiences as a service provider in Warrenton. We are interviewing a variety of service providers in Warrenton who will all have different points of view about the community, and the purpose of our interviews is to gather these different viewpoints.

Consent:
You are not likely to experience any risks from participating in this interview.

Every effort will be taken to protect your identity in this interview. Nothing said during this interview will come back to you.

This project has been reviewed and approved by the UNC-Chapel Hill School of Public Health Institutional Review Board on Research Involving Human Subjects. This means that a panel of experts has looked over the questions we ask and the panel feels that you will be safe from harm if you agree to participate. Do you have any questions about this study or today's interview?

Your participation in this discussion is voluntary. You may refuse to participate, may refuse to answer any questions, or may quit at any time. Do you agree to participate in this discussion?

During the discussion we are going to record what is said on this piece of paper. If you have no objections, we will also tape record the discussion to make sure we don't miss anything. Only our 5 group members will listen to the tape. Afterwards, the tape will be erased. You can ask for the recorder to be turned off at any time during the discussion. Do you agree to have this discussion taped?

Okay, let's begin [Turn on tape recorder.]

1. Please talk in a voice at least as loud as mine.
2. There are no wrong answers, just different opinions. I'm looking for different points of view, so just say what's on your mind. If you don't feel comfortable answering a question or don't have an opinion, just let me know.
3. We do have a lot to cover, so you may be interrupted at some points so that we can keep moving and avoid running out of time.
4. We value your opinions, both positive and negative, and I hope you choose to express them during the discussion.
5. Everything said is confidential and will not be repeated.
6. We are interested in your perspective as a service provider in Warrenton, so please keep that perspective in mind during the discussion.

If you have any questions or concerns about this project, or about your rights as a research participant, please do not hesitate to contact our project preceptor, our faculty advisor, or us. Our names and contact information are listed below. Feel free to contact us by calling collect, if necessary.

Thank you for your time. We appreciate your participation.

Community Member Focus Group Information and Consent

• Thank you for taking the time to meet with us. My name is ___________ and this is _________. We recognize that your time is valuable and we appreciate your participation.
• We are graduate students from UNC School of Public Health, Department of Health Behavior and Health Education. One of our degree requirements is to work with a community in NC to conduct a community diagnosis. This means that we help the community identify its strengths, weaknesses, and future program directions for promoting health and well being in Warrenton. The information we gather will be summarized and shared with the community in a written document. In addition, we will present our results to the community at a public forum in the spring.

• This focus group will last between about an hour. Is there anyone who cannot stay that long? We would like to have the whole group start and end together if possible.
• This project has been reviewed and approved by the UNC-Chapel Hillapel Hill School of Public Health Institutional Review Board. This means that a panel of experts has looked over the questions we ask and feels that you will be safe from harm if you agree to participate.
• Your comments will remain confidential. We will be reporting summaries of the comments made by community members, but will not identify the names of the individuals we interview. We request that you not share anything you hear with other people. Do you agree to participate?
• We would like to take notes and tape record this focus group because your input is important and we want to make sure we accurately record what you tell us. You may refuse to answer any question we ask or stop the tape recorder at any time. After we are finished using the tapes for this class, the cassettes will be recycled or destroyed. Is this okay with you?

Ground Rules

• Please speak one at a time in a voice at least as loud as mine
• I need to hear from all of you during the discussion, but you do not need to answer every question
• This focus group will be most effective if you t
hink about it as a conversation among yourselves. We are just here to point you in some directions.
• If at any time while we're talking you don't want to answer a question, you don't feel comfortable, or you want to end the focus group, please feel free to let me/us know.
• There are no wrong answers, just different opinions. That is what we are looking for so just say what is on your mind.
• We may have to interrupt you at some point so that we can cover everything and finish on time
• Everything said is confidential and will not be repeated by members of our group to anyone outside of our group.

Do you have any questions about anything I've said so far?
Do you agree to participate?

Contact Information

Summary of community member focus group participants

Back to TOC

Interview analysis forms