GRADUATE SCHOOL RESEARCH STUDY:

Doctoral Dissertation on:

MEASURING DISTRESS IN PATIENTS WITH MORBID OBESITY IN THE UNITED STATES OF AMERICA: A REPLICATION OF THE OBESITY ADJUSTMENT SURVEY USING ON-LINE PATIENTS WHO ARE INVOLVED WITH BARIATRIC SURGERY

CONSENT FORM

Background: This is a request for your participation in a doctoral research study. This consent form consists of an agreement to participate in a study and is part of a dissertation and research study being conducted under the supervision of Dr. John Darland. Supervised research is a condition for completing the dissertation and is one of the degree requirements of the PhD. Degree program. This study is a quantitative inquiry into the experiences of individuals who live with morbid obesity. The opinions of people who share this common struggle are very important and could provide helpful information in the development of more effective ways of offering support, treatment, and aftercare to this disease. Incentives for participation can not be provided, but it is hoped that this study will offer information about stressors in the lives of people with obesity and will improve the decision-making process in deciding which candidates may be good surgical risks.

Participant Selection: Participation in this study is voluntary and has four criteria including 1) ages 18-80 years, 2) United States citizen, 3) at least a 6th grade education, and 4) not a current patient in a mental health hospital. By taking the time to fill out this consent form, you will be agreeing to participate in this study. All participants in this study who are interested in bariatric surgery have been offered the option of participating, because they have had at least some involvement in an Internet obesity support web-site. People who have involvement with an Internet chat-line, designed to offer support with obesity and weight reduction surgery are also eligible to participate.

Risk/Benefit: There are few risks associated with this study and therefore, there will not be much greater harm than in everyday life. However, measuring distress may be especially emotional in some cases. In the case of physical, psychological, and/or legal harms associated with the survey, confidentiality may need to be breached. Participants may contact me and will be referred to their nearest physician, mental health professional or legal consultant. Questionnaires will otherwise remain confidential, the two answer sheets will be kept apart, and any possible misuse of the information will be prohibited. The benefits which may be reasonably expected to result from this study are gaining knowledge regarding the assessment, treatment, and aftercare processes involved with bariatric surgery and allowing the results to benefit others. We can not and do not guarantee or promise that you will personally receive any benefit/s from your participation.

Voluntary: Your participation in this research is entirely voluntary. You may discontinue your participation in this study at any time and for any reason without negative consequences. Please be aware that your opinions are important and respected.

Purpose: This research focuses on ways of providing assessment, treatment, and aftercare for people thinking about and/or having bariatric surgery. By accessing this web-site and fitting within the four criteria, you meet the standards for being part of the research project.

Confidentiality: Information from the research process is confidential. A computer program will receive the information and code your responses. Not even the researcher/s will be provided with any identifying information regarding you, unless you choose to be in communication with us. No agency, surgeon, or other specific items that can be traced back to you will be named. Be aware that your participation in this research is entirely voluntary, and the choice of answering particular questions is your prerogative. Your wishes will be respected at all times during this process. The web-site will be password protected, the answers will be securely stored, and the results will be accurately reported. Confidentiality may be limited in some individual cases, such as in extreme emotional emergencies, or where individual states have laws limiting or affecting confidentiality. This study will comply with the dictates of law. Upon completion of this project, the computer program will be backed up to a CD, the CD will be secured in a locked fireproof safe in the researcher’s office, and only the researcher has access to the safe and computer.

If you choose to assist with this research, it will take about 10-15 minutes of your time to complete. There are two questionnaires to complete 1) the Obesity Adjustment Survey/Short Form (OAS) and 2) demographical/background information. The OAS is a valid and reliable instrument and asks 20 questions dealing with individual experiences related to obesity. Your responses will be agreement on a Likert-like scale (1 not at all true – 5 extremely true). The other questions deal with background information.

Questions: For questions and/or concerns, please contact the investigator at smsmith333@msn.com or 320-492-0327. Also feel free to contact the supervisor of this research project at John.Darland@Capella.edu or at 1-888-CAPELLA. This study has been approved by Capella University’s Institutional Review Board for the Protection of Human Participants. You may also contact Capella University’s IRB in care of AliceYick-Flanagan@Capella.edu or at 1-888-CAPELLA ext. 5377.

I look forward to your participation. Thank you for your willingness to participate.
Please complete the statement of consent that serves as an indication of your willingness to participate in this study.

Sincerely;
Susan M. Smith, PhD. Candidate
Capella University