ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
DOCUMENTATION OF INFORMED CONSENT AND HIPAA AUTHORIZATION
You are being asked to participate in a research study called survey of childhood experiences in OCD and related disorders. Your participation is voluntary -- it is up to you whether you would like to participate. It is fine to say “no” now or at any time after you have started the study. If you say “no,” your decision will not affect any of your rights or benefits.
Why is this study being done?
|The researcher in charge of this project is called the “Principal Investigator.” His name is Dr. Michael Wheaton, Ph.D. You can reach Dr. Wheaton at:
1165 Morris Park Ave
Bronx, NY 10461
Telephone #: 718-862-1875
For questions about the research study, or if you believe you have an injury, contact the Principal Investigator or the IRB.
|The Institutional Review Board (IRB) of the Albert Einstein College of Medicine and Montefiore Medical Center has approved this research study. The IRB # is in the stamp in the upper right hand corner. If you have questions regarding your rights as a research subject you may contact the IRB office at 718-430-2253 or by mail:
Albert Einstein College of Medicine
1300 Morris Park Ave., Belfer Bldg #1002
Bronx, New York 10461
The goal of this study is to investigate the childhood and developmental experiences associated with OCD, hoarding, and related disorders. We hope to compare the prevalence of certain experiences, such as being bullied, among individuals who have these problems in order to find out what types of life experiences might predispose some people to have issues with OCD and related disorders.
Why am I being asked to participate?
You are being asked to participate in this study because you are over the age of 18 and identify as having OCD. We hope to obtain data from 800 anonymous people. This is a single-site study.
What will happen if I participate in the study?
You will complete an online survey about experiences that some people have growing up, as well as questions about feelings of anxiety, depression, OCD and related phenomena. This survey should take about 45 minutes to complete. You do not have to answer any questions you do not wish to answer, for any reason. More specific directions will be provided during the study, and you may ask questions at any time. We will also tell you more about the rationale for the study afterwards.
How many people will take part in the research study?
You will be one of about 800
people who will be participating in this study.
Will I be paid for being in this research study?
You will not be paid for participating in this survey. However, at the end of the survey you will have the option to enter your email address to enter a raffle to win a $50 giftcard (to Amazon.com), which will be awarded at the completion of the study. You contact information will not be provided to anyone and will be kept entirely confidential. Your email address will be removed from the data as soon as it is downloaded.
Will it cost me anything to participate in this study?
There will be no cost to you to participate in the study.
Are there any risks to me?
Risks of the study are minimal. There may be a risk of minor psychological discomfort associated with answering questions related to emotional topics (anxiety, depression, OCD symptoms). In the event that answering personal questions in the course of the study does cause distress, you can be provided referrals for assistance by contacting the National Alliance of Mental Illness HelpLine at 1 (800) 950-NAMI (6264). This information will be provided at the end of the survey.
We will keep your information confidential, however, a risk of taking part in this study is that your confidential information might be shared accidentally with someone who is not on the study team and is not supposed to see or know about your information. This is very unlikely, because the study team takes confidentiality of your information seriously. Your research records will be kept confidential and your name will not be collected or used in any written or verbal reports. Your information will be given a code number and separated from your name or any other information that could identify you. The form that links your name to the code number will be kept in a locked file cabinet and only the investigator and study staff will have access to the file. All information will be kept in a secure manner and computer records will be password protected. Your study information will be kept as long as they are useful for this research.
The only people who can see your research records are:
-the research team and staff who work with them
-the organization that funded the research
-groups that review research (the Einstein IRB, and the Office for Human Research Protections)
These people who receive your health information, may not be required by privacy laws to protect it and may share your information with others without your permission, if permitted by laws governing them. All of these groups have been asked to keep your information confidential.
Are there possible benefits to me?
You will not experience any direct benefit personally from participating in this study. We hope you will participate because the study will generate important information about the developmental correlates of OCD and related disorders.
Are there any consequences to me if I decide to stop participating in this study?
No. If you decide to take part, you are free to stop participating at any time without giving a reason. However, some of the information may have already been entered into the study and that will not be removed.
CONSENT TO PARTICIPATE
I have read the consent form and I understand that it is up to me whether or not I participate. I know enough about the purpose, methods, risks and benefits of the research study to decide that I want to take part in it. I understand that I am not waiving any of my legal rights by consenting with this document. I can save a copy of this page for my records.
By clicking below and continuing on to the
online survey, I acknowledge I am providing my
tacit consent to participate in this study