CYBERSENGA PHASE ONE
QUALITATIVE INTERVIEWS: ADULT CONSENT FORM
Background/ Purpose
We are from Mbarara University of Science and Technology, University of California, San Francisco, Internet Solutions for Kids (a US‑based nonprofit company), and Harvard Medical School, USA. We invite you to participate in the CyberSenga Study. The goal of this study is to better understand the information, motivation, and behavior skills young people in Mbarara have to engage in HIV prevention behavior. By participating in this study, you will be helping us understand youth sex-related behavior and communication.
Procedures
This study consists of doing a single interview. The interview you will do with us shall take place in a private location of your choice and shall last approximately one hour. In the interview, we shall ask for your thoughts on adolescents’ ideas about HIV transmission, the motivations youth may have for engaging in sex or abstinence, and the behavioral skills young people have to engage in HIV risk reduction behaviors. Topics shall include sexual activity and abstinence from sexual activity. Your ideas shall help us identify and refine concepts to be explored later in interviews with adolescents.
Participation in this study is completely voluntary; it is entirely up to you to choose to participate or not to participate. You can choose to leave this study at any time. Nothing will happen if you decide to stop.
Audio-recording
With your permission, we would like to audio record the interview. The audio recordings will be used in writing up the interview, to help make sure the write-up is accurate and complete. Only members of the research team shall have access to the recordings. The recording will be erased from the recorder as soon as it is transferred onto the computer. The computer files of the audio-recordings will be password protected during the study and destroyed at the end of the study. Refusing the recording does not mean you cannot participate in the study.
Risks and Discomforts
The risks of participating in this study are minimal. It is possible that you might get tired during the interview. You may find some of the questions uncomfortable or hard to answer. If this happens, we can (a) discuss the situation, (b) take a break, or (c) stop. If you choose to stop, we can either finish the interview another day or you can end your participation in the study.
Benefits
This research is intended to help us create a website that helps prevent the spread of HIV infection among youth. There are no direct benefits to you for participating.
Alternatives
The alternative to participating in the study is not to participate.
Compensation
There shall be no compensation for your participation in this study.
Confidentiality
Your privacy is protected as a participant in this study. There will be a number rather than your name on copies of your interview. All of the interviews and other research documents will be kept in a locked office of research study personnel at Uganda Research Initiative in Mbarara, Internet Solutions for Kids and at Harvard Medical School in the United States. Computer files will be protected with a password.
None of the information you give us will be shared with anyone outside the research project. Your name will not be used in any written reports or published articles that result from this project.
Though unlikely, there is always a chance of breach of confidentiality when taking part in a research study. We shall make every effort to protect you from this risk. Every effort will be made to ensure that descriptions of you as an individual in reports or articles are done in ways that mask your identity.
Rights of Refusal and Withdrawal
Your participation in this study is voluntary and you have the right to refuse to participate. If you change your mind about participating at any time, including during the interview, you have the right to withdraw.
Questions and Contact Numbers
If you have questions about this research, you may contact Dennis Nabembezi, the Study Coordinator on telephone number: 0772 568 359 or you may visit him at the study offices located at Uganda Research Initiative, Mbarara, Plot 11-13, Lower Circular Road.
If you have questions about your rights as a research subject, you may call Emmanuel Kyagaba, Chairman of the Institutional Ethical Review Committee of Mbarara University of Science and Technology on telephone number: 485 21387.
Signatures
I have fully explained to the participant the nature and purpose of the procedures described above and the risks involved in participating in this study. I have asked if any questions have arisen regarding the procedures and I have answered these questions to the best of my ability.
____________________________ _____________
Investigator Date
I have read/been read this information and understood the purpose of the study. I have had the opportunity to ask questions, and questions that I have asked have been answered to my satisfaction. I consent to participate in this study and understand that I have the right to withdraw from the study at any time.
____________________________ ______________
Participant Date
I agree to have the interview audio-recorded _______Yes _______No