UNDERSTANDING GRIEF AFTER SUICIDE
My name is
Michael Aguilar, a researcher at The University of Akron. This is a consent
form for research participation. It contains important information about this
study and what to expect if you decide to participate.
participation is voluntary.
consider the information carefully. Feel free to ask questions before making
your decision whether or not to participate. If you decide to participate, you
will be asked to indicate your consent by selecting "yes" from a
drop-down menu. If you decide not to participate after reading this form,
simply select "no" or exit your browser.
You are asked
to participate in this study because we are interested in the grief experience
of individuals who have lost a friend, family member, or loved one to suicide.
will complete an on-line survey.
Duration: Completing the survey will take a total
of 20-30 minutes.
You may leave
the study at any time. If you decide to stop participating in the study, there
will be no penalty to you, and you will not lose any benefits to which you are
otherwise entitled. Your decision will not affect your future relationship with
The University of Akron.
breach of confidentiality is possible with Internet data collection, the risk
is minimal. You will not be required to enter your name during the study. Only
if you are interested in entering the raffle drawing will you provide an e-mail
address for contact information. Your E-mail addresses could only immediately
identify you if the e-mail address includes your full name. The security of the
data cannot be guaranteed until the researchers receive the data from the
software company. Once the researchers receive the data, the confidentiality of
the data will be guaranteed. Because the software company requires a log-in ID
and password to access the data sets, only the researcher will have access to
this information. It is expected that in the case of breach of confidentiality,
the harm/discomfort would be minimal and the long-term consequences would be
psychological stress could result from answering the questionnaires regarding
the death of a friend, family member, or loved one, it is expected that such
distress would be minimal and transient. The likelihood of persistent
psychological stress resulting from answering the questionnaires is would be
minimal and long-term consequences are unlikely.
unlikely event that taking this survey causes you distress, please contact
Suicide Prevention Lifeline: 1-800-273-8255
will be kept strictly confidential. If you provide an email address, it will be
kept in a locked file cabinet to which only Michael Aguilar has access. This
email address will be kept separate from the data set, so your email address
will never be tied with your responses. Once individuals are selected to win
one of three $50 Visa Gift Cards, this identifying information will be
shredded. Your responses will be kept separate from identifying information
and will be kept on Michael Aguilar’s personal computer hard drive which is
password protected and to which only he has access. Regarding the precautions
taken with the on-line software company, the Qualtrics software is password
protected. Accordingly, only he will have access to the data via the software
company. No data will be obtained from private records, audiotaping or
is NOT affiliated with facebook.com or twitter.com, as this project is an
If you desire,
you will be directed to another page upon completion of the survey where you can
provide your email address. Doing so will enter you into a raffle to win one of
three $50 Visa Gift Cards. We will use your email address to contact you if you
are the winner of this gift.
You may refuse
to participate in this study without penalty or loss of benefits to which you
are otherwise entitled. If you are a student or employee at The University of
Akron, your decision will not affect your grades or employment status.
If you choose
to participate in the study, you may discontinue participation at any time
without penalty. An Institutional Review Board responsible for human subjects
research at The University of Akron reviewed this research project and found it
to be acceptable, according to applicable regulations and University policies
designed to protect the rights and welfare of participants in research.
concerns, or complaints about the study you may contact Michael Aguilar at
email@example.com or Dr. Ronald Levant at firstname.lastname@example.org.
To receive a copy of the results of this study please contact Michael Aguilar at email@example.com
For questions about
your rights as a participant in this study or to discuss other study-related
concerns or complaints with someone who is not part of the research team, you
may contact Ms. Sharon McWhorter at firstname.lastname@example.org or 330.972.8311.
I have read
(or someone has read to me) this form and I am aware that I am being asked to
participate in a research study. I have had the opportunity to ask questions
and have had them answered to my satisfaction. I voluntarily agree to
participate in this study.
Please print a
copy of this form for your records.
If you agree with the above please indicate your agreement by selecting
to continue with the study.