Michigan School of Psychology Informed Consent
I hereby agree to voluntary participation in the research project on Understanding the Relationship between Psychological Distress, Diabetes Mental Health Education, and Diabetes Management for Adults with Type 2 Diabetes conducted by Jennie-Marie Johnson. This study has been approved by the Michigan School of Psychology’s Institutional Review Board (IRB# 210101). I understand that the purpose of the study is to determine if individuals who were formally diagnosed with type 2 diabetes would better manage their diabetes symptoms if they were provided with diabetes mental health education regarding the psychological distresses of diabetes (i.e. depression, stress, anxiety). The procedure will entail completing an online survey questionnaire addressing depression, anxiety, stress, and diabetes management. I understand that my participation in the study will take approximately 20 minutes.
In order to be eligible to participate in this study, I am confirming that I am at least 18-years of age or older. I have been formally diagnosed with Type 2 Diabetes by a medical professional for at least 6-months. I do not have hypertension, hyper or hypothyroidism, or cardiovascular disease.
I understand the risk of harm from participating in this study is minimal and no greater than what I would encounter in my everyday life. In terms of benefits, I understand that participating in the study will potentially contribute to a better understanding of diabetes distress as it relates to mental health. Indirect benefits may include contributing to a research study that could provide information about the role diabetes education plays in the management of type 2 diabetes. When my participation is complete, I may request information regarding the general findings of the research by contacting Jennie-Marie Johnson by email jjohnson@msp.edu.
I understand that my responses to research materials will remain confidential and my identity will never be connected with my participation or research outcomes. I understand that my participation is voluntary and that I am free to withdraw from this study at any time. I understand that if I have any questions about my rights or treatment as a research participant, I should contact the Institutional Review Board Chair at the Michigan School of Psychology, (248) 476-1122, or irb@msp.edu.
Upon completion of the survey questionnaire, I understand that I can enter a raffle to win one of three Visa eGift cards valued at $50. I understand that entry is voluntary. To be eligible to win, I am to send a blank e-mail with the subject line RAFFLE to a designated email address after completing the survey. The email address will be provided at the end of the survey. I understand that since this e-mail will not be connected to the research site nor the research data, my anonymity will be preserved. I understand that if selected at random, I will win an eGift card that I will receive via the e-mail I used to enter the raffle. The odds of my winning are 1:300. I understand that my name and e-mail address will not be stored for any reason, and will not be used for future solicitation by this researcher or a third party. To further protect my identity, I understand that prize dissemination will occur after the data has been analyzed and can in no way be associated with me.
I have read and understand the information provided above. By clicking below, I am agreeing to participate in this online survey.
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