AUTHORIZATION TO PARTICIPATE IN RESEARCH PROJECT
Consent is hereby given to participate in the study titled: Development and Evaluation of the Pediatric Diabetes Routines Questionnaire
Purpose: There is a need to look at routines that are specific to children with diabetes. The primary goal of this project is to develop a measure of diabetes specific routines in children and adolescents, the Pediatric Diabetes Routines Questionnaire. This measure will be developed to assess the aspects of diabetes management that are routine in nature. Additionally, this study will evaluate the reliability and validity of this new measure.
Description of Study: Parents of children with diabetes 5 to 17 years old will participate in the completion of questionnaires. Participants will complete an online survey that includes a form gathering family information and measures of diabetes specific routines, your child’s general daily routines, your family rituals, your supportive/non supportive behaviors related to your child’s diabetes, your child’s diabetes adherence, and your child’s behavior. Participants will be asked if they would be willing to complete the questionnaire on diabetes-specific routines again in two weeks for the purpose of temporal stability.
Exclusion Criteria: To participate in this study, your child/adolescent must be between the ages of 5 and 17, must have been diagnosed with diabetes more than 6 months ago, must not be diagnosed with another chronic illness, and/or must not be diagnosed with mental retardation or an autism spectrum disorder. If you are not sure if you are eligible, but would like to participate, please call or email the principal investigator, Jessica Pierce at (954) 815-5481 or jessica.s.pierce@usm.edu
Benefits: Upon completion of all questionnaires, participants will be entered into a drawing for a $50 gift certificate to Walmart. There is a one in 50 chance that you will win.
Risks: Your participation is voluntary. There is little risk associated with completing the study, although some parents may find it mildly distressing to report on their child’s diabetes management. If you find answering such questions distressing, you may stop at any time, although your responses will not be usable in the study if they are incomplete. If you continue to feel distressed about these and would like to seek mental health services, please contact a local mental healthcare provider in your area. A list of local healthcare providers in your area can be obtained through the National Mental Health Association, Department of Education for Licensing of Mental Health Professionals, or your Primary Care Physician.
Confidentiality: All efforts will be made to protect participant’s privacy and to maintain the confidentiality of the information acquired through this project. Responses will be stored with any identifying information in a separate database from the responses collected.
Subject's Assurance: Whereas no assurance can be made concerning results that may be obtained (since results from investigational studies cannot be predicted) the researcher will take every precaution consistent with the best scientific practice. Participation inthis project is completely voluntary, and subjects may withdraw from this study at any time without penalty, prejudice, or loss of benefits. Questions concerning the research should be directed to Jessica Pierce at (954) 815-5481 or Dr. Sara Jordan at (601) 266-4587. This project and consent form have been reviewed by the Institutional Review Board, which ensures that research projects involving human subjects follow federal regulations. Any questions or concerns about rights as a research subject should be directed to the Chair of the Institutional Review Board, The University of Southern Mississippi, 118 College Drive #5147, Hattiesburg, MS 39406-0001, (601) 266-6820. An unsigned copy of this form will be available to print for the participant.
By clicking BEGIN SURVEY, I consent to participate in this study.
