SUBJECT INFORMATION AND CONSENT FORM

“LifeChart Data Collection”

 

Principal Investigator:
Dr. Michael Krausz, MD, PhD
Department of Psychiatry, UBC
Contact Phone Number: 604-827-3685         

Research Coordinator:                                
Erika Neilson
Department of Psychiatry, UBC
Contact Phone Number: 604-827-4364

Research Team:
Nicole Gehring
Department of Psychiatry, UBC
Contact Phone Number: 604-827-4381

Marissa Mar
Department of Psychiatry, UBC
Contact Phone Number: 604-827-3796

                                               

Purpose: 

In using our website, WalkAlong (www.walkalong.ca), we will be collecting data on your use of the site, including the data that you enter into our online tool the LifeChart. This information will be collected anonymously and will be collected only for research purposes.

Your participation is voluntary: 

Your participation is entirely voluntary – it is up to you to decide whether or not to take part in this study.  Before you decide, it is important that you understand what this research involves.  This consent form will tell you about the study and your involvement.

If you decide to participate, you will be asked to sign this consent form by clicking I agree.  You are free to withdraw at any time, and may choose not to participate at all, without giving any reasons for your decision and without any negative consequences.

Please take time to read the following information carefully. If you have any questions, feel free to ask any of our research staff at the contact phone numbers listed above.

 

Who can take part in this study? 

You can participate in this study if you are above the age of 16 and have access to a device that can connect to the internet, in order to access our website.

Who cannot take part in this study? 

Those under the age of 16 may not be included in the study or do not have access to a device with internet may not partake in the study.

 

Study procedures: 

If you decide to take part in this study, then we will collect the data that you enter into the website on an ongoing basis. Whenever you log into the website walkalong.ca, the data you enter into the LifeChart will be stored alongside the initial questions you answer during the sign up process.   

 

Compensation: 

Your participation is voluntary and you will not be given any monetary compensation for your participation.

 

Potential benefits: 

You may not directly benefit from your participation in this study. However, you will be contributing to the development of an online mental health portal that has been tailored to your needs based on the responses you give us today. We hope that you may find the assessments, information, and resources that you receive off the website useful to you.

 

Risks or discomfort: 

The LifeChart will ask questions around your current emotional and physical state. This may bring up feelings of anxiety or emotional discomfort. If at any time you are feeling too uncomfortable, you may stop at any time.

 

Confidentiality: 

We will respect your confidentiality throughout the study. We will keep your identity confidential during and after the study. Personal identifiers, such as those identify you by name or e-mail will be stored on password secured computers that will not be allowed to leave the investigator’s office. We will not release or publish any information you provide or disclose during the study without your specific consent to the disclosure. All information gathered from this survey will remain completely anonymous.

 

Contact for information about the study: 

If you have any questions or want more information about this study, please contact Erika Neilson, Research Coordinator, at the phone number listed above.

If you have any questions or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the University of British Columbia Office of Research Ethics by e-mail RSIL@ors.ubc.ca or by phone at 604-822-8598 (Toll Free: 1-877-822-8598).

 

The Study: “LifeChart Data Collection”

Subject consent to participate: 

By clicking “I agree” at the end of this document you consent to participating in this project. This statement certifies the following:

 

  • I have read and understood the subject information and consent form.
  • I have had sufficient time to consider the information provided and to ask guidance if necessary.
  • I have had the opportunity to ask questions and have had satisfactory responses to my questions.
  • I understand that all of the information collected will be kept confidential and that the result will only be used for scientific objectives.
  • I understand that my participation in this study is voluntary and that I am completely free to refuse to participate or to withdraw from this study at any time.
  • I understand that I am not waiving any of my legal rights as a result of signing this consent form.
  • I understand that there is no guarantee that this study will provide any benefits to me.
  • I have read this form and I freely consent to participate in this study.
  • I understand that I will receive a copy of this consent form if requested.

 

You should know that you have the right to see the results prior to their being published. A copy of the informed consent will be given to you if requested. By signing this form you are stating that you are 16 years of age or over, you understand the above information and you consent to participate in this study.