Women's Health Needs STUDY_SCREENER

Women’s Health Needs Study Informed Consent to be a Research Participant

My name is _______________and I am working with NORC and the Centers for Disease Control and Prevention on this study.

Why we are doing this study? We are trying to find out about the health care needs of women age 18 to 49 years in your community. We plan on interviewing about 2,000 women for this study.

Who is funding this study? This study is funded by the Centers for Disease Control and Prevention.

What would I be asked to do if I am in this study? The interview will take you about 45 minutes. We will read you the questions in your preferred language. We will be asking you some questions to see if you are eligible to be in the study. These will be about things like where you and your family are from, what languages you speak, and if you have lived in certain countries. If you are eligible, give consent, and then choose to enroll in the study, then we will be asking you questions such as how long you have been in the US, if you have had a medical exam, your childbirth experiences, and what you and your family thinks about female circumcision and your experiences with female circumcision. Some of the study questions may make you feel uncomfortable. You can skip any question. Your answers are completely private and only results from the whole group of women will be included in any report.

How long will it take for me to participate in this study? For this study you will do one interview that will take about 45 minutes to complete. This will end your time in the study.

Are there any risks for me if I decide to participate? The risks to participating in this research are minimal. However, some of the questions are personal and might make you uncomfortable. You are free to skip or not answer any questions. You can stop at any time. I have community resources available for you if you need help finding support or services in your community.

If you choose to do the survey whether you complete the survey or not, you will not lose access to any services that you would otherwise be eligible for. Your answers will be kept private to the extent allowed by law and will be used only for research. The study has a Certificate of Confidentiality and a Privacy Certificate, so no one outside the study, even an official of the court, the government or law, can request your information. However, if interviewers and other study staff learn of immediate plans to have your minor daughter circumcised they may be legally obligated to report this as child abuse to state or local authorities The study does not ask you about circumcision in your daughter.

Employees of CDC, or experts and contractors working for CDC, may review information sent through computer networks to assess security. We will not collect your name or other information that identifies you during this interview. When results from this research are presented, we will not include any information that might be used to figure out who you are.

Are there any benefits for me if I decide to participate? There is no direct benefit to you for participating in the study. We believe the answers you provide will help us better understand the health care needs of women in your community.

Payment for participation: If you agree to be in this study we will give you $25 for your travel and/or child care expenses. In addition, if you recruit another women to be in this study, we will give you $10 for cell phone calls and/or transportation. You may recruit up to 3 women and receive $10 for each woman you recruit. You may need to contact these 3 women with our study invitation card. You will be able to receive a total of $55 reimbursement for expenses you may need to participate in the study and for recruiting up to three women.

A unique passcode will let us know which women you helped recruit so that we can reimburse you. Your name will not be collected at any time during this study.

Do I have to be in this study? No you do not. If you choose to be in this study, you can stop at any time and you are also free to skip or not answer any questions.

What happens if I would like to stop this interview? If you start the interview and decide to stop, that is perfectly OK. You will still receive the $25 for your travel and/or any child care expenses you may have during this interview. We will be able to keep and use the information you have shared up until that point. If you do not want your responses to be included, let us know and we will destroy your information.

Right to Ask Questions: Please contact the WHNS Study contact number with questions, complaints or concerns about this research at the toll-free phone number (866) 315-7130. If you have any questions or concerns about your rights as a research participant, please contact the NORC IRB Manager by toll-free phone number at (866) 309-0542. An Institutional Review Board (IRB) operates under Federal regulations and they review research involving human subjects to ensure the ethical, safe, and equitable treatment of study participants.

Do you have any questions about this study? If you have any questions or concerns regarding this study please ask. If you think of them later, contact the WHNS Study number at 866-315-7130.

What if I do not want to be in this study? If you do not wish to participate, we sincerely thank you for your time.

If you would like to participate: You must be 18 to 49 years of age to take part in this research study.

Participation in this study implies that you have reviewed and understand what is being asked of you for this study and that you are voluntarily willing to take part of this study. Your answers will be private and you can stop at any time.

Would you like a copy of this form?

Ogolaansho faahfaahsan oo laxariira kaqaybgalka cilmi baarista

Magacaygu waa _______________waxaan lashaqaynayaa haayada NORC iyo Xarumaha Xakamaynta iyo Kahortaga Xanuunada oo ayagu daraasadaan samaynaaya.

Maxaan usamaynaynaa daraasadaan? Waxaan rabnaa inaan wax ka ogaano baahiyaha caafimaadka ee haweenka da'doodu udhaxayso 18 ilaa 49 ee ku dhexnool bulshadaada. Waxaan qorshaynay inaan 2,000 oo haween ah ku waraysano daraasadaan.

Yaa maalgalinaaya daraasadaan? Daraasadaan waxaa maalgalinaaya Xarumaha Kahortaga iyo Xakamaynta Cududrada.

Maxaa layga doonayaan inaan sameeyo haddaan daraasadan kaqaybgalo? Waraysiga ayaa kugu qaadanaaya kudhawaad 45 in lagu dhamaystiro. Waxaan su'aalaha ku akhrinaysaa luuqada aad jeceshahay. Waxaan ku weydiin doonaa su'aalo dhowr ah si aan u aragno haddii aad u qalantid in aad daraasadda ku jirto. Kuwani waxay noqon doonaan wax ku saabsan waxyaabaha sida halka adiga iyo qoyskaaga aad ka imaateen, luuqadaha aad ku hadasho, iyo haddii aad ku noolaatay dalal gaar ah. Waxaan wax kaawaydiinayaa waxyaabaha sida meeshaad katimid, mudada aad Maraykanka joogtay, inaad baaritaan caafimaad martay iyo inkale, fikradaha qoyskaagu kaqabaan gudniinka gabdhaha, khibradahaaga dhanka dhalmada, iyo fikirkaaga shaqsiga ah ee ku aadan gudniinka gabdhaha. Qaar kamid ah su'aalaha daraasadaan ayaa laga yaabaa inaadan kuqancin. Waad kaboodai kartaa su'aashaad rabto. Jawaabaha aad bixiso waa kuwo si buuxda gaar kuugu ah kaliyana natiijooyinka lagasoo qaado dhamaan haweenka lawaraysto ayaa lagu darayaa wixii warbixin ah.

Muddo intee le'eg ayay igu qaadan doontaa inaan ka qayb qaato daraasaddan? Daraasaddani dhexdeeda, waxaad sameyn doontaa hal wareysi oo kugu qaadan doona qiyaas ahaan 45 daqiiqo inaad dhamaystirto. Tani waxay dhameeyn doontaa waqtigaaga daraasadda.

Ma jiraan wax halis ii ah haddii aan go'aansado in aan ka qayb qaato? Halista ka qayb qaadashada cilmi-baaristan ​​waa mid aad u yar. Si kastaba ha ahaatee, qaar ka mid ah su'aaluhu waa gaar oo waxaa laga yaabaa inaad dhibsato. Waxaad xor u tahay inaad ka boodid ama aadan ka jawaabin wax su'aalo ah. Waad joojin kartaa wakhti kasta. Waxaan haystaa ilaha bulshada oo aad heli karto haddii aad ubaahato caawimaad ah sidii aad u heli lahayd taageero ama adeegyada bulshada.

Haddii aad dooratid inaad kaqeybqaadato sahankan, haddii aad dhamaystirtid ama aadan dhamaystirin sahanka, ma waayi doontid helitaanka adeegyo kasta oo aad u qalantid. Jawaabahaaga waxaa loo hayn doonaa si gaar ah illaa xadka uu sharcigu oggol yahay waxaana loo isticmaali doonaa cilmi-baarista oo kaliya. Daraasada waxay leedahay Shahaadada Qarsoonida iyo shahaadada sirta shaqsiga, sidaas darteed qof ka baxsan daraasada ma codsan karo macluumaadkaaga, xitaa ha noqdo sarkaal maxkamad, dowlada ama sharciga. Si kastaba ha ahaatee, haddii wareystayaasha iyo shaqaalaha kale ee daraasadda ay ogaadaan qorshooyin oo degdegah oo ah in gabadhaada yar la gudi rabo, waxaa laga yaabaa inay sharci ahaan waajib ku tahay in ay uga war bixiyaan dawladda ama maamulka degaanka maadaama ay arrintaas tahay ku xadgudubka carruurta. Daraasadda kuma weydiin doonto wax ku saabsan gudniinka gabadhaada.

Shaqaalaha CDC, ama khabiirada iyo qandaraasleyda u shaqeynaya CDC, waxay dib u eegi karaan macluumaadka lagu diro shabakadaha kombiyuutarada si ay u qiimeeyaan amniga. Ma aruurin doonno magacaaga ama macluumaadkaaga kale ee aqoonsiga inta lagu jiro waraysigan. Marka natiijooyinka ka soo baxa cilmi-baaristaan ​​la soo bandhigayo, kuma dari doono wax macluumaad ah oo loo isticmaali karo in lagu ogaado qofka aad tahay.

Ma jiraan wax faa'iido ii ah haddii aan go'aansado in aan ka qayb qaato? Ma jirto faa'iido toos ah oo aad ka heleeysa ka qayb qaadashada daraasadda. Waxaan aaminsan nahay in jawaabaha aad bixiso ay naga caawinayaan inaan si fiican u fahanno baahiyaha daryeelka caafimaadka ee haweenka bulshadaada.

Lacag bixinta kaqeybqaadashada: Hadaad oggolaato inaad daraasadan ka mid noqoto waxaan ku siinaynaa $25 si aad isaga dabarto safarkaaga iyo/ama daryeelka ilmaha. Intaa waxaa dheer, haddii aad ka soo qeybgeliso haweeney kale daraasaddan, waxaan ku siin doonaa $10 oo loogu talagalay wicitaannada teleefoonka iyo/ama gadiidka. Waxaad daraasada ka soo qeybgelin kartaa ilaa 3 haween waxaadna heli doonta $10 oo haweenay kasta oo aad keento. Waxaad ubaahan kartaa in aad 3dan haweeney kula xiriirto adiga oo isticmaalaya kaarkeena casuumaada ee daraasada. Waxaad heli doontaa inaad hesho lacag dhan $55 si aad ugu dabarto qarashadka aad ugu baahantahay kaqaybgalka daraasada iyo keenista 3da haween ee aad ka soo qeybgelineyso daraasada.

Fura gaar ah ayaa noo sheegi doona haweenka aad caawisay qoristooda si aan kuu siino lacagta. Magacaaga lamasoo qoraay marna inta daraasadaan socoto kaqaybgalkaaguna wax lacag ah kaama cunaayo.

Ma inaan ku jiraa daraasaddan? Maya, maha inaad ku jirto. Haddii aad doorato inaad ku jirto daraasaddan, waxaad joojin kartaa wakhti kasta waxaadna xor u tahay inaad ka boodid ama aadan ka jawaabin wax su'aalo ah.

Maxaa dhacaya haddii aan jeclaado inaan joojiyo waraysigan? Haddii aad bilowdo wareysiga oo hadana aad go'aansato in aad joojiso, taasi waa wax caadi ah. Waxaad weli heli doontaa $25 oo ah kharashaadka safarkaaga iyo/ama xanaanada ilmahaagu ee laga yaabo inaad geshey inta lagu jirey waraysiga. Waxaan awoodi doonaa inaan hayno oo aan isticmaalno macluumaadka aad wadaagtay inta aad joojin ka hor. Haddii aadan rabin in jawaabahaaga lagu daro, nala soo socodsii waana baabiin doonaa macluumaadkaaga.

Xaquuqda Su'aal Weydiinta: Fadlan la xiriir lamabarka Daraasada WHNS haddii aad qabto su´aalo, cabashooyin ama walaac ku saabsan cilmi baaristan ka wac taleefoonka bilaashka ah ee (866) 315-7130. Haddii aad qabto wax su'aalo ah ama walaac ah oo ku saabsan xuquuqdaada maadaama aat tahay kaqeybqaataha cilmi-baarista, fadlan kala xiriir Maamulaha NORC IRB lambarka bilaashka ah (866) 309-0542. Guddiga Dib U-eegista Hay'adaha (IRB) wuxuu ku shaqeeyaa sharciyada Federaalka ah waxayna dib u eegaan cilmi-baarista ku saabsan maadooyinka ah aadanaha si loo hubiyo wanaajinta anshaxa, nabadgelyada, iyo hab-nololeedka ka qayb qaatayaasha daraasada.

Miyaad qabtaa su'aalo ku saabsan daraasaddan? Haddii aad qabtid wax su'aalo ama walaac ah oo ku saabsan daraasaddan fadlan weydii. Haddii su'aalaha kugu soo dhacaan xilli dambe, la xiriir lambarka daraasada WHNS 866-315-7130.

Maxaa dhacaya haddii aanan rabin in aan ku jiro daraasaddan? Haddii aadan jeclayn inaad ka qayb qaadato, waxaan si daacad ah kuugu mahad celineynaa wakhtigaaga.

Haddii aad jeclaan lahayd inaad ka qeyb qaadato: Waa inaad tahay 18 ilaa 49 sanno jir si aad uga qayb qaadato daraasaddan cilmi-baarista.

Ka qayb qaadashada daraasaddan waxay muujinaysaa inaad dib u eegtay oo aad fahantay waxa lagu waydinayo daraasaddan dhexdeeda iyo in aad si ikhtiyaari ah u doonayso inaad ka qayb qaadato daraasaddan. Jawaabahaagu waxay noqon doonaan kuwa gaar ah, waadna joojin kartaa wakhti kasta.

Ma jeclaan lahayd nuqulka foomkan?

Flesch-Kincaid Grade Level 8.5