IMPROVING DIABETES EDUCATION Our Mission
Please carefully read the information below to decide if you would like to be a part of this study. INFORMED CONSENT FORM 1. Purpose of this Study: This study presents questions related to diabetes and your attitudes, beliefs, and social support. This survey will help us to understand the challenges associated with having diabetes, and help us to create educational programs that may be of help to you. 2. Benefits of the Study: As a result of this study, we plan to create educational programs to assist people with diabetes, as well as their families. In addition, at the conclusion of the survey, you will be re-directed to an alternate site to register for an opportunity to receive a $5 gift card! 3. What You Will Be Asked to Do: This study will take about 20 minutes and contains multiple choice and fill-in-the-blank questions. You will also be asked to answer some basic questions about yourself (for example, age and sex). 4. Risks: There is minimal risk in this study. You will be asked some questions about your beliefs and attitudes, and this might make you uncomfortable. To avoid this, you may skip any questions that you do not want to answer. 5. If you would like more information about the study: You may contact the primary researcher, Dr. DePalma, at diabetes@ithaca.edu or (607) 274-1323. If you are interested in the results, Dr. DePalma will be able to let you know when they will be available. 6. Withdrawal from the Study: Taking part in this study is optional and confidential. If you feel at any time that you do not want to answer a question you may choose to skip certain questions. You may end the study at any time by simply closing your web browser. 7. How the Data Will Be Maintained: Your participation in this study will be confidential. We have no need to connect your identity to your responses. However, participants will each receive a $5 gift card. If you choose to receive a gift card, we will need to collect contact information. Continuing to the next page of this survey shows that you understand the potential risks involved with participation in this study. In addition, it will show that you understand that you may skip any questions and that you are free to end your participation at any time without penalty. In order to complete the survey, you must be a person with diabetes who is at least 18 years of age. If you do not want to participate in this study, or you are not at least 18 years of age, please exit your Web browser. We appreciate your input! When you are ready to go to the next page, click continue.
Maintained by MT DePalma(diabetes@ithaca.edu)
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