example informed consent form - Psychology

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EXAMPLE PARTICIPANT INFORMATION SHEET [see end of document for example sheet and form for
childen]
PROJECT TITLE
The Effects of X on Y
INVITATION
You are being asked to take part in a research study on…
(Describe the general research aim(s), say who you are, and who is supervising the research [if anyone else], the
university affiliation and, once obtained, that the project has been approved by the Psychology Research Ethics
Committee)
WHAT WILL HAPPEN
In this study, you will be asked to…
(To the extent that it is possible, and in light of your research aims and subject to ethical approval, provide a
complete explanation of the procedures; this explanation must be sufficiently detailed to ensure that
participants can provide “informed” consent; if you cannot fully inform participants (again, subject to ethical
approval), you must provide a complete debriefing to participants at the earliest point possible following their
participation)
TIME COMMITMENT
The study typically takes X minutes (per session) across X sessions.
(Let participants know how long the study is expected to last and, if applicable, the number of sessions)
PARTICIPANTS’ RIGHTS
You may decide to stop being a part of the research study at any time without explanation. You have
the right to ask that any data you have supplied to that point be withdrawn/destroyed. You will still
be paid for your contribution (or as appropriate, e.g., “and without penalty”).
You have the right to omit or refuse to answer or respond to any question that is asked of you (as
appropriate, “and without penalty”).
You have the right to have your questions about the procedures answered (unless answering these
questions would interfere with the study’s outcome). If you have any questions as a result of reading
this information sheet, you should ask the researcher before the study begins.
BENEFITS AND RISKS
There are no known benefits or risks for you in this study.
(Or as appropriate)
For example, if your study involves use of assessment procedures which may unveil psychological or
physical problems of which your participants might be unaware and which may endanger their present
or future well-being:
Revised by PREC Convenor 3 April, 2013
Participation in this study involves completion of some standardised tests [specify as relevant] which
are routinely used as preliminary screens for clinical conditions involving psychopathology/cognitive
impairment [as relevant to the particular study] of which you may not be aware. Scores from these
tests would not be sufficient basis for clinical decisions or diagnosis, contain substantial margins of
error, and are not used for diagnostic purposes in this study. Though it is not possible to provide
feedback of individual scores to participants, these scores might hint at health problems that some
people would want to discuss with an appropriate health professional.
COST, REIMBURSEMENT AND COMPENSATION
Your participation in this study is voluntary. / You will receive … in return for your participation.
(payment, credit, other, as appropriate).
CONFIDENTIALITY/ANONYMITY
The data we collect do not contain any personal information about you except… (describe as
appropriate)./ No one will link the data you provided to the identifying information you supplied (e.g.,
name, address, email). (as appropriate)
(Also say something about your intentions regarding use of the data, e.g., presentation at conferences,
publication, etc. In doing so, make clear the extent to which individual participants will or will not be
identifiable, as appropriate)
FOR FURTHER INFORMATION
(Supervisor’s/PI’s name) will be glad to answer your questions about this study at any time. You may
contact him/her at …. (provide at least two ways to contact the supervisor/PI, e.g., email, phone,
physical address)
If you want to find out about the final results of this study, you should… (procedure).
Revised by PREC Convenor 3 April, 2013
If you are collecting identifying information as part of (or in the process of) your research, written
consent must be obtained from participants. In other words, if participants are not completely
anonymised, you will need to document their consent. From University of Edinburgh guidelines
concerning Research and the Data Protection Act:
The data is only completely anonymised if it is impossible to identify the individuals from that
information plus any other information that the University holds or is likely to hold. For example if you
anonymise a list of patients by giving each patient a number and then keep a separate list of the
numbers and the names of the patients to which they refer, the data is not completely anonymised
and would still qualify as personal data under the Act. If you do not keep a “key” to the identities of
the patients and it is not possible for the patients to be identified from any other information, for
example sick leave data, that the University holds, or is likely to hold, then the data is completely
anonymised.
EXAMPLE INFORMED CONSENT FORM
PROJECT TITLE
PROJECT SUMMARY
By signing below, you are agreeing that: (1) you have read and understood the Participant
Information Sheet, (2) questions about your participation in this study have been answered
satisfactorily, (3) you are aware of the potential risks (if any), and (4) you are taking part in this
research study voluntarily (without coercion).
_________________________________
Participant’s Name (Printed)*
_________________________________
Participant’s signature*
_________________________________
Date
_______________________________
Name of person obtaining consent (Printed)
_________________________________
Signature of person obtaining consent
*Participants wishing to preserve some degree of anonymity may use their initials (from the British
Psychological Society Guidelines for Minimal Standards of Ethical Approval in Psychological Research)
Revised by PREC Convenor 3 April, 2013
If your study involves use of assessment procedures which may unveil psychological or physical
problems of which your participants might be unaware and which may endanger their present or
future well-being, the following is an example of the kind of required additional language likely
appropriate.
I am aware that participation in this study involves completion of some standardised tests [specify as
relevant] which are routinely used as preliminary screens for clinical conditions/impairments of which
I might not be aware. I understand that these assessments are not sufficient for diagnostic purposes,
nor will they be used in this manner in this study. I also understand that the researchers cannot
inform participants of individual test scores, but in the event that I produce scores of potential clinical
concern, researchers should (check one and provide relevant contact information):
______Contact me at:_______________________________________
______Contact my GP at ____________________________________
______Do nothing. I absolve the researchers of any obligation to contact me about this.
Revised by PREC Convenor 3 April, 2013
Information Sheet
Developmental Science at the University of Edinburgh
Project title: [e.g., Understanding sociality in infancy].
INVITATION
Your child is being invited to take part in a research study assessing …
(Describe the general research aim(s), say who you are, and who is supervising the research [if anyone else], the
university affiliation and, once obtained, that the project has been approved by the Psychology Research Ethics
Committee)
WHAT WILL HAPPEN
In this study, your child will be asked to take part in ...
(To the extent that it is possible, and in light of your research aims and subject to ethical approval, provide a
complete explanation of the procedures; this explanation must be sufficiently detailed to ensure that caregivers
can provide “informed” consent to their child’s participation; if you cannot fully inform participants (again,
subject to ethical approval), you must provide a complete debriefing to participants at the earliest point
possible following their participation. Note that informed consent from caregivers is required for children under
16, but that you should also get their verbal assent. See the BPS Research Ethics code for documentation on
this.).
TIME COMMITMENT
The study typically takes between …. over … sessions. We will work with your child to ensure the
study is not taxing.
PARTICIPANTS’ RIGHTS
You may decide to stop your child’s participation at any time. You have the right to ask that any data
supplied to that point be withdrawn/destroyed.
We will ask your child’s permission before we begin the study, and they can stop at any point.
Feel free to ask questions at any point. If you have any questions as a result of reading this
information sheet, you should ask the researcher before the study begins.
BENEFITS AND RISKS
[This study poses no known risks to your child/This study poses the following risks. [It provides the
following benefits…/ It does not provide any tangible benefits beyond advancing scientific
knowledge.]
COST, REIMBURSEMENT AND COMPENSATION
Your participation in this study is voluntary, but we can reimburse….
CONFIDENTIALITY/ANONYMITY
[the following should be taken as an example]
Revised by PREC Convenor 3 April, 2013
As a default, the data/videos we collect will only be seen by members of the lab, and will not be
linked to any identifying information (e.g., name, address, email) that you supplied. The data collected
will be presented at conferences and in academic publications, however, we will only present data
averaged over many participants. Your child’s individual data will not be identifiable.
(Also say something about your intentions regarding use of the data, e.g., presentation at conferences,
publication, etc. In doing so, make clear the extent to which individual participants will or will not be
identifiable, as appropriate)
FOR FURTHER INFORMATION
(Supervisor’s/PI’s name) will be glad to answer your questions about this study at any time, and can
inform you about the results of the study once data collection is complete. You may contact her/him
at …
Revised by PREC Convenor 3 April, 2013
Developmental Science Consent Form
[Project Name]
[very brief description]
By signing below, you are agreeing that: (1) you have read and understood the Participant
Information Sheet, (2) questions about your child’s participation in this study have been answered
satisfactorily, and (3) you are willing for your child to take part in this voluntary research study
voluntarily.
_________________________________
Caregiver’s Name (Printed)*
_________________________________
Child’s name (Print)*
_________________________________
Caregiver’s signature*
_________________________________
Child’s Date of Birth
_________________________________
Today’s Date
_______________________________
Name of person obtaining consent (Printed)
_________________________________
Signature of person obtaining consent
*Participants wishing to preserve some degree of anonymity may use their initials (from the British
Psychological Society Guidelines for Minimal Standards of Ethical Approval in Psychological Research)
Revised by PREC Convenor 3 April, 2013
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