Consent

Attachment D: Informed Consent Forms

Consent Form for Focus Groups

INFORMED CONSENT FORM

For Participation in a Focus Group

Project Name: Focus Group Study of U.S. Adults’ Knowledge, Attitudes, and Practices of Foodborne Disease Outbreaks and Illness Prevention

EurekaFacts, LLC

About the study

Thank you for your interest in participating in the project described below. This consent form explains the project. This project is conducted by EurekaFacts on behalf of the Centers for Disease Control and Prevention (CDC). We are conducting this project to understand people’s perceptions about foodborne illnesses, outbreaks, and prevention. The purpose of the focus group is to help us make sure that the information that CDC shares to the public on foodborne illness is clear and easy to understand. Your participation will help us improve the messaging shared by CDC so that more people can be informed and aware of foodborne illnesses and outbreaks.

Focus group session

During this session you will participate in a focus group. During the focus group, a moderator will lead a group conversation on topics related to food safety and how to improve the information shared with the public. The moderator will ask questions to follow-up on your feedback. The focus group session will not last more than 100 minutes.

Privacy We will keep the information that you provide private and secure to the extent permitted by law. You will be assigned a unique identifier (ID), and your name will not be linked to your answers or comments. Your responses will be used only for project purposes and will not be disclosed or used, in identifiable form. The focus group session will be audio recorded and the recordings will be used only by the team members conducting the project. No one else will hear the recordings and recordings will be destroyed after 1 year after the conclusion of the project. Project members may also observe the focus group discussion.

Potential Risks

This research does not involve any foreseeable risks.

Voluntary Participation

Your participation in this project is completely voluntary. You do not have to respond to any questions that you do not want to answer. You can withdraw at any time.

By signing below, you agree that you will participate in this project and that you have read and understood the information provided above. You will receive a $75 Visa gift card at the conclusion of the focus group to thank you for your time and effort. We thank you for your voluntary participation and ask you to sign the form below.

Print Name: __________________________________

Signature: ____________________________________ Date: ________________

Email address: ______________________________________________________

If you have any questions about this research please contact Mila Sugovic, the Principal Investigator at 240-403-4800, ext. 218 or sugovicm@EurekaFacts.com.

Consent Form for Interview Session

INFORMED CONSENT FORM

For Participation in a Evaluation Project

Project Name: Focus Group Study of U.S. Adults’ Knowledge, Attitudes, and Practices of Foodborne Disease Outbreaks and Illness Prevention

EurekaFacts, LLC

About the project

Thank you for your interest in participating in the project described below. This consent form explains the project. This project is conducted by EurekaFacts on behalf of the Centers for Disease Control and Prevention (CDC). We are conducting this project to understand people’s perceptions about foodborne illnesses, outbreaks, and prevention. The purpose of the focus group is to help us make sure that the information that CDC shares to the public on foodborne illness is clear and easy to understand. Your participation will help us improve the messaging shared by CDC so that more people can be informed and aware of foodborne illnesses and outbreaks.

Interview session

During this session you will participate in a brief interview, followed by participation in a focus group. During the interview, you will be asked about food safety and foodborne illnesses. The interviewer will ask open-ended questions to follow-up on your feedback. During the focus group, a moderator will lead a group conversation on topics related to food safety and how to improve the information shared with the public. The moderator will ask questions to follow-up on your feedback. The overall session will not last more than 100 minutes.

Confidentiality

You will be assigned a unique identifier (ID), and your name will not be linked to your answers or comments. Your responses will be used only for project purposes and will not be disclosed or used, in identifiable form. The focus group session will be audio recorded and the recordings will be used only by the team members conducting the project. No one else will hear the recordings and recordings will be destroyed after 1 year after the conclusion of the project. Project members may also observe the focus group discussion.

Potential Risks

This project does not involve any foreseeable risks.

Voluntary Participation

Your participation in this project is completely voluntary. You do not have to respond to any questions that you do not want to answer. You can withdraw at any time.

By signing below, you agree that you will participate in this project and that you have read and understood the information provided above. You will receive an $75 Visa gift card at the conclusion of the focus group to thank you for your time and effort. We thank you for your voluntary participation and ask you to sign the form below.

Print Name: __________________________________

Signature: ____________________________________ Date: ________________

Email address: ______________________________________________________

If you have any questions about this project please contact Mila Sugovic, the Principal Investigator at 240-403-4800, ext. 218 or sugovicm@EurekaFacts.com.