Instructions for Consent Form
Please read the following consent form carefully, before you proceed with the survey.
California State University, Fullerton (CSUF)
CONSENT TO ACT AS A HUMAN RESEARCH PARTICIPANT
Factors Influencing Intimate Partner Relationships among College Latinas
You are being asked to participate because you are a female undergraduate student of Latino heritage over the age of 18. Participation in this research study is completely voluntary. Please read the information below and ask questions about anything that you do not understand before deciding if you want to participate. A researcher listed below will be available to answer your questions.
INVESTIGATORS AND SPONSOR
Lead Researcher and Faculty Advisor
----Julie Stokes PhD - Department of Afro-Ethnic Studies and Psychology
Additional Researchers
----Adamina Camacho B.A. - Department of Psychology
Study Location:
----California State University Fullerton
Study Sponsor:
----This study is a student project.
PURPOSE OF STUDY
The purpose of this research study is to explore important factors that affect Latinas' intimate relationships in college.
PARTICIPANTS
Inclusion Requirements:
You are being asked to participate because you are an undergraduate female student of Latino heritage over the age of 18.
Number of participants:
The investigator plans to enroll 150 participants at this site.
PROCEDURES
--------Surveys/Questionnaires-Undergraduate students will participate to fulfill course requirements, but will receive no further compensation. Participants will sign up for the experimental session via the Psychology Research Participation System (Sona-system). Surveys will be posted online on the psychology department’s website, Sona, and will also be available via a web link displayed on Dr. Stokes' website. Eligibility requirements will be are included with the link. Instead of providing their name on the survey, each participant will provide the last four digits of their student ID number (explanation in Confidentiality section).
Although most of the survey items are in English, there are two portions that will be available in English or Spanish. Once you have completed the first part of the survey, you will be given the opportunity to choose the language (English or Spanish) version that you prefer to complete for the second and third part of the survey.
--------Participants will read an informed consent form online in which the benefits and risks of participating in the study will be explained. A web link will has been created on the consent form; instructions will read: "BY CLICKING ON ONE OF THE WEB LINKS BELOW YOU ARE CONSENTING TO PARTICIPATE IN THIS STUDY." Withdrawal from the study will involve no penalty and participants may discontinue participation at any time without loss of benefits to which they are otherwise entitled (i.e., course credit).
--------Upon immediate completion of the survey, participants will be debriefed online. They will be referred to the university's counseling and mental health center in case they experience distress while participating in the study. Researchers will assign credit to each participant within 48 hours of the experimental session via the Psychology Research Participation System (Sona system Confidentiality will be assured to the extent allowed by the law by anonymous participation.
--------Online format - The data will be collected via psychology department's website, Sona.
Total Time Involved:
Participants will have 60 minutes to complete the survey packet.
RISKS
Known risks
Risks of participating include the possibility of experiencing emotional distress as result of answering questions that may elicit stressful memories of current or past relationships.
BENEFITS
To the Participant
You will benefit directly from this study by gaining an increased understanding of and contributing to research regarding Latina college students' relationships.
To Others or Society
Others may benefit from the information gathered from this study as the results will inform university student services regarding factors relevant to Latinas college students' intimate relationships.
ALTERNATIVES TO PARTICIPATION
The alternative is to not participate in this study.
COMPENSATION/COST/REIMBURSEMENT
You will only receive non-monetary compensation for participation (i.e., course credit). Researchers will assign credit to you within 48 hours of your participation. You will not be required to pay for research related procedures/treatments.
COMPENSATION FOR INJURY
I understand that if I am injured as a result of my participation in this study, I will be provided reasonable and necessary medical care to treat the illness or injury at no cost to me or to my insurer/third party payer. CSU Fullerton does not provide any other form of compensation for injury. I understand that I must report any suspected study-related illness or injury to the study investigator immediately. If I experience emotional distress during the study, I can request and receive counseling services at the CSUF Student Health and Counseling Center (714-278-2813).
WITHDRAWAL OR TERMINATION FROM STUDY
You are free to withdraw from the study at any time without penalty or loss of benefits to which you are otherwise entitled.
CONFIDENTIALITY
Data Storage
Although all of your research information will be confidential and anonymous, you will need to provide the last four digits of your student ID; you will NOT be required to provide your name. THE LAST FOUR DIGITS OF YOUR STUDENT ID NUMBER WILL NOT BE LINKED TO YOUR RESPONSES. The number will be used strictly for the purposes of assigning you credit for the PSYCH 101 course requirement. This way your responses will be anonymous. The response data will be stored on a portable and secured USB drive which will be kept in a locked cabinet within a secured building. Data will be retained for use in educational seminars and/or conferences.
Data Access
The research team (including Dr. Julie Stokes and Adamina Camacho), authorized CSUF personnel, and regulatory entities may have access to your study records to protect your safety and welfare. Data will be kept confidential to the extent allowed by law. Data will be reported without identifiers.
Level of Privacy
--------The dataset will contain no personal identifiers when it is sent to the repository for use by other researchers.
--------The data will be collected anonymously. The researchers will not maintain a link between your identity and the research data. Disclosure of your participation in the research study will not be voluntarily released without your separate consent, except as specifically required by law.
--------Only group outcomes will be reported.
Data Privacy
--------The research data will be maintained indefinitely.
NEW FINDINGS
If during the course of this study, significant new information becomes available that may relate to your willingness to continue to participate, this information will be provided to you by the investigator upon request.
IF I HAVE QUESTIONS
For questions about your rights as a research participant, you may contact California State University, Fullerton Regulatory Compliance Coordinator at (714) 278-2327, or the Institutional Review Board (IRB) Chair at (714) 278-2141
Contacts:
--------Adamina Camacho B.A., Department of Psychology Daytime Phone: 714-224-6741 Email: camachoad@yahoo.com
--------Julie Stokes PhD, Department of Afro-Ethnic Studies and Psychology Daytime Phone: 714-278-3485 Email: jstokes@fullerton.edu
OTHER CONSIDERATIONS
Conflict of Interest
Investigators must satisfy campus requirements for identifying and managing potential conflicts of interest before a research study can be approved. The purpose of these requirements is to ensure that the design, conduct and reporting of the research will not be affected by any conflicting interests. If at any time you have specific questions about the financial arrangements or other potential conflicts for this study, please feel free to contact any of the individuals listed above.
You have been informed that the investigators have no personal financial interest in this study.
VOLUNTARY PARTICIPATION
I understand that participation in this study is voluntary. I may refuse to answer any question or discontinue my involvement at any time without penalty or loss of benefits to which I might otherwise be entitled. My decision will not affect my future relationship with CSU Fullerton. I understand that by CLIKCING ON ONE OF THE WEB LINKS BELOW, I CERTIFY THAT I HAVE READ AND UNDERSTAND THE CONSENT FORM AND THE STUDY AND, THEREFORE, I CONSENT TO PARTICIPATE.
Most of the survey is in English; however, there are two sections of this survey that are available in English and Spanish. Please select the version that you would like to complete.
English Version
Spanish Version
Thank You!