Consent to Be a Research Subject REFRAME
Orientation: Healthy Relationships California (HRC) is working with Jonathan Jarvis, Ph.D., at Brigham Young University to explore how the R3 Academy for Couples benefits couples. We are happy to have you join our R3 Academy for Couples and contribute to our knowledge of how to best help couples thrive in their relationships.
Procedures: Once you agree to participate in this research study, here is what will occur:
1) Applicant Characteristics Survey: You will be contacted to complete a survey asking general questions about your demographics. The survey questions will be read to you over the phone by an HRC staff member. This survey will take approximately 25-30 minutes to complete.
2) Entrance Survey: You also will be given a survey asking general questions about your relationship with your child or children and your partner/co-parent. The survey questions will be read to you over the phone by an HRC staff member. This survey will take approximately 25-30 minutes to complete.
3) R3 Academy Program: During the next six or 12 weeks, depending upon the format of your program, you will have the opportunity to participate in the R3 Academy for Couples.
4) Exit Survey: At the conclusion of the R3 Academy for Couples, you will be contacted to complete the same questions you were asked on the Entrance survey, in order to gauge how the program affected you and your relationship. The survey questions will be read to you over the phone by an HRC staff member and will take approximately 25-30 minutes to complete.
5) Follow-up Survey: Approximately four months after the last class session, you will be contacted once more to complete the Exit survey again in order to gauge if the program continues to benefit you. This time the survey link will be emailed to you for you to complete on your own. The survey questions will be read to you over the phone by an HRC staff member and will take approximately 25-30 minutes to complete.
Benefits of the R3 Academy for Couples: Our hope and expectation is that through your participation in the R3 Academy for Couples, your relationship with your partner will be more satisfying, including your communication, problem solving, and ease in dealing with difficult emotions.
1) Attendance: Your completion of the R3 Academy for Couples can bring financial rewards. By completing 90% of the R3 Academy for Couples sessions (at least 22 out of 24 hours), you will be eligible to receive a $50 merchant gift card. In addition, if you complete 90% of the R3 Academy for Couples you are eligible to receive access to two free supplemental courses, Raising World Class Kids™ and Parenting in the Digital Age. During the R3 Academy for Couples you will be given up to two make-up opportunities if you miss a session, to facilitate reaching the 90% attendance threshold.
2) Survey Participation: If you participate in both the Entrance survey and Exit survey, you will be eligible for a $25 merchant gift card, which will be distributed following the Exit survey. If you participate in both the Entrance and Exit surveys, you will be invited to complete a Follow-up survey and will be eligible for an additional $25 gift card by participating in that survey. All incentives are earned individually, so you and your partner both will receive them if you both qualify.
Participation: Participation in this research study is completely voluntary. You have the right to withdraw at any time or refuse to participate entirely.
Risks/Discomforts: It is possible that you may be uncomfortable answering one or more of the survey questions. If so, you can refuse to answer that question or stop the survey altogether.
Confidentiality: Your survey data will be kept confidential at all times. Data collection and access will be limited to approved personnel trained in data usage and security requirements. Storage will be in a computer file on password protected computers. Identifying information will not be linked to your surveys and we will never use your name or personally identifiable information in any of the reports generated from this data.
Data Archival: As required by our federal grant, anonymized data will be archived with the Inter-university Consortium for Political and Social Research (ICPSR) after we complete our research. The data will not include your name, address, date of birth, phone number, or any other personal information or ID numbers that could identify you. Archiving this data provides other researchers with the opportunity to learn about how relationship education benefits people like you. By signing this form, you are giving us permission to share your anonymized survey data with other researchers.
Questions about the Research: Please direct any questions about the study to Jonathan Jarvis, Ph.D. Phone: (801) 422-4240; Email: email@example.com; Mailing address: 2031 JFSB, Provo, UT, 84602
Questions about Your Rights as a Research Participant: If you have any questions about your rights as a research subject or complaints regarding this research study, or you are unable to reach the research staff, you may contact a person independent of the research team at the Biomedical Research Alliance of New York (BRANY) Institutional Review Board at 516-318-6877. Questions, concerns or complaints about research can also be registered with the
*1. Statement of Consent: I have read, understand, and will receive a copy of the above consent, and I choose of my own free will to participate in this study.
You will receive a chance to indicate your preference during the initial processes.