Medicine | QuestionPro

Arkansas Tech University
Emergency Management & Homeland Security

Informed Consent Statement

Project Statement: How the medications are related to human life and how often they use when they got sick?

I invite you to participate in a web-based online survey that is anonymous. The survey will be 20 people who will have opportunity to fill out this survey. Your participation in this survey is very important to achieving this goal.

The survey is part of a research project to assess normal life medication in use and an open mind question is related to medical insurance.

The survey should take less than 10 minutes to complete.

Participation in this research project is voluntary:

There are no direct benefits to you for participating in this research. There are no financial or reimbursement cost for you participation in this study.

The information will be used as part of a Master’s student thesis research project. The results will be published in the thesis. Participants may request a copy of the results by sending an email to the address below.

You may decline to participate in this survey or you may decline to answer certain questions. The web-based survey can be stopped at any time. There is no penalty or loss of benefits.

Your information will be kept confidential.

The web-based survey is administered through QuestionPro. QuestionPro does not collect or maintain any information that would identify who has taken the survey. Only the answers to the questions are recorded. There is no way for the researcher to know who answered which question. All questions are complied into a database for analysis. There are no questions in the survey that could lead to the identification of the individuals taking the survey. Any contact with the researcher must be made by the individual taking the survey, either by phone or email.

Statement of Risk:

There is no foreseeable risk other than the loss of the time to take this survey.

Questions about the research study or this survey:

You may contact the graduate student, (Ruixiao Gao), directly by email ([email protected]) or the faculty thesis advisor (Jan Kallberg, [email protected]) or the Department of Emergency Management at Arkansas Tech University at 479-356-2159.

QUESTIONS REGARDING YOUR RIGHTS AS A RESEARCH SUBJECT
THESE MAY BE DIRECTED TO DR. MARY GUNTER – DEAN OF THE GRADUATE COLLEGE, ARKANSAS TECH UNIVERSITY COMMITTEE FOR THE PROTECTION OF HUMAN SUBJECTS (479-968-0398).

By proceeding past this point in the survey you are indicating that you consent to participation in this study. Please print out a copy of this consent form for your records.

Thank you for your time,
(Ruixiao Gao)

I Agree