Body Project Peer Lead Consent Form
Body Project Peer-Lead Consent Form
Permission to Take Part in a Human Research Study (Protocol 14-0610)
Title of research study: The CU-Boulder Body Project Study
Investigator: Rachel Vanderkruik, MSc; Sona Dimidjian, Ph.D. (Faculty Advisor)
Why am I being invited to take part in a research study?
We invite you to take part in this research study because of your role as a peer-leader in the Body Project at CU-Boulder. An objective of this study is to evaluate aspects of training that you received to be a peer-lead and to facilitate Body Project group sessions on campus.
What should I know about a research study?
· Someone will explain this research study to you.
· Whether or not you take part is up to you.
· You can choose not to take part.
· You can agree to take part and later change your mind.
· Your decision will not be held against you.
· You can ask all the questions you want before you decide.
Who can I talk to?
If you have questions, concerns, or complaints, or think the research has hurt you, talk to the research Principle Investigator, Rachel Vanderkruik, at 339-927-4088 or Rachel.email@example.com.
To speak with a licensed Clinical Psychologist involved in this study, you may also contact Co-Investigator and Faculty Advisory, Dr. Sona Dimidjian, at 303-492-3485 or sona.dimidjian@colorado, as well as Co-Investigator, Dr. Samantha Strife, at firstname.lastname@example.org.
This research has been reviewed and approved by an Institutional Review Board (“IRB”). You may talk to them at (303) 735-3702 or email@example.com if:
· Your questions, concerns, or complaints are not being answered by the research team.
· You cannot reach the research team.
· You want to talk to someone besides the research team.
· You have questions about your rights as a research subject.
· You want to get information or provide input about this research.
Why is this research being done?
The Body Project is being implemented at CU-Boulder the Fall Semester of 2014. You are participating in this study as a Body Project peer-lead. An objective of this study is:
To evaluate the effectiveness of the Body Project peer-leader training in order to inform future preparation and instruction on how to facilitate Body Project group sessions.
How long will the research last?
We expect that you will be in this research study for 1 school semester.
How many people will be studied?
We expect about 30 people at CU-Boulder will be in this research study as Body Project peer-leaders.
What happens if I say yes, I want to be in this research?
If you are participating in this research as a Body Project peer-lead (related to Objective 2), you will be asked to complete the following activities:
1. A baseline 45-minute focus group among Body-Project peer-leads to evaluate the training they received and assess your level of readiness and skills to facilitate the Body Project group sessions on campus.
a. A short survey will be handed out at the focus group to accompany the questions asked in the focus group and capture your quantitative ratings of effectiveness and satisfaction with the peer-lead training. This survey will take about 10 minutes to complete.
2. A follow-up 45-minute focus group as mentioned above to assess successes and challenges regarding facilitation of the Body Project group sessions at CU-Boulder and assess need for further training, guidance or support
a. The same accompanying 10-minute survey mentioned above in 1a.
Both focus groups will be audio-recorded for the purposes of accurately capturing key themes from the discussion. Only study personnel will have access to the audio-recording for data coding purposes.
What happens if I do not want to be in this research?
You can leave the research at any time and it will not be held against you. Your grades for any classes will not be influenced by whether you choose to participate in this study or not.
What happens if I say yes, but I change my mind later?
You can leave the research at any time it will not be held against you. Your grades for any classes will not be influenced by whether you choose to participate in this study or not.
Is there any way being in this study could be bad for me?
There are minimal foreseeable risks to participate in this study. There may be some psychological discomfort around discussion of sensitive issues related to body image and other personal topics. Additionally, the participation in groups poses some threat to privacy and confidentiality.
To minimize the potential of these risks, two of our study personnel are licensed clinical psychologists who can follow-up with the participant if any psychological discomfort arises. We will encourage respect of confidentiality when conducting any group activities and ask that participants do not repeat what is discussed outside of the group. Research subjects may withdraw from participation at any time.
If you are experiencing any distress, including symptoms of depression, anxiety, or disordered eating or other problems, please reach out for help.
CU-Boulder Mental Health resources include:
• Counseling and Psychological Services: Free and confidential counseling for students. Center for Community, S440 303-492-6766 (24/7 phone) counseling.colorado.edu
• Office of Victim Assistance: Free and confidential counseling and advocacy for students, staff, faculty and their significant others. Center for Community, S440 303-492-8855 (24/7 phone) http://cuvictimassistance.com
• Psychological Health and Psychiatry: Confidential counseling for a fee or free with Buff Gold Insurance. Wardenburg Health Center 303-492-5654 (24/7 phone)www.colorado.edu/healthcenter/
If you are experiencing any thoughts of suicide, please contact Boulder Emergency Psychiatric Services immediately: 303-447-1665
• Description of Service: 24 hour emergency mental health services. Telephone and in-person crisis intervention and evaluation for hospitalization if necessary. Walk-ins are welcome or evaluations take place at local hospitals.
Will being in this study help me any way?
Randomized prevention trials have found the Body Project program reduces thin-ideal internalization, body dissatisfaction, negative mood, unhealthy dieting, and eating disorder symptoms. Thus, participants may benefit from these improvements in healthy body image and related behaviors. These benefits cannot be guaranteed.
More generally, the information obtained from this study may help in the development and improvement of similar programs to improve body image among other target populations beyond college-aged women.
What happens to the information collected for the research?
Efforts will be made to limit the use and disclosure of your personal information, including research study and medical records, to people who have a need to review this information. We cannot promise complete secrecy. Organizations that may inspect and copy your information include the IRB and other representatives of this organization.
Data collected from this study will be retained indefinitely, however the data will be de-identified after 7 years. Research personnel may use the de-identified data from this study for other future research aims not specified in this protocol. Additionally, this de-identified data may be combined with other investigators’ data for other research purposes also not identified in this protocol. We contact you again in the future for follow up questions or future studies if relevant. You will have the option to decline any invitations to engage in future research opportunities.
Please type your name in the line below to indicate your permission to take part in this survey and then hit the submit button. A copy of this consent form is available to you upon request.