Informed Consent for Screening
You are invited to take part in online screening for possible
participation in the research study titled "Cardiorespiratory fitness,
physical activity, and psychological effects of an acute bout of cycling
exercise in people with epilepsy.” The study will be conducted by Kristen Johnson,
a master’s student in the Department of Kinesiology at the University of
Georgia, under the direction of Patrick J. O’Connor, a professor in the
Department of Kinesiology at the University of Georgia.
participation is voluntary: You
can refuse to participate or stop taking part at any time without giving any
reason, and without penalty or loss of benefits to which you are otherwise
entitled. If you decide to withdraw from
the study, the information that can be identified as yours will be kept as part
of the study and may continue to be analyzed, unless you make a written request
to remove, return, or destroy the information. The decision to participate or
not participate in the study will not affect your grade or class standing.
of the research: The
purpose of you providing demographic, medical, and drug, information is to
determine whether you are eligible to participate in the research study.
for Participation: There
are no incentives for completing this screening. However, if you are eligible
to participate in the research study then you will have an opportunity to be
compensated for your participation at a rate of $10 per hour.
of Procedures: If you
volunteer for the screening, your participation will involve completing a
series of questions inquiring about demographics, epilepsy history, and medical
issues, and this will take about 10 minutes. If you are ineligible, you will
not be contacted by the researchers. Your screening data will be retained in an
online database for no more than one month. If you are eligible based on your
responses to the screening questions, you will be emailed about arranging a
date and time to visit the Exercise Psychology Lab in the Ramsey Center to
initiate participation in the study.
or potential health risks: There
are no expected discomforts or health risks associated with the screening. There
is a risk of loss of privacy if the information you provide is not secured;
measures to protect against this are described below. Society ultimately may
benefit by learning new information about the difference in psychological
outcomes between no exercise and moderate intensity exercise if you are
eligible and willing to complete the study.
Confidentiality: Any individually-identifiable information obtained
from the screening questionnaires will not be accessible to anyone other than Dr.
Patrick O’Connor, Ms. Kristen Johnson, and other members of the research team
unless otherwise required by law. Your information from this screening may be
combined with that from others and summarized in a published report but your
name would not be included in any report.
You may have a copy of any or all of the information obtained if you
request it. No more than one month after your data have been collected, your
records will be destroyed by deleting them from the computer file.
note that Internet communications are insecure and there is a limit to the
confidentiality that can be guaranteed due to the technology itself. If you are
not comfortable with the level of confidentiality provided by the Internet,
please feel free to print out a copy of the survey, fill it out by hand, and
mail it to us at the address given below, with no return address on the
envelope. Patrick J. O’Connor, Department of Kinesiology, University of
Georgia, 330 River Road, Athens, GA 30602-6554.
Kristen Johnson or Dr. Patrick O’Connor will be
happy to answer any further questions about the research, now or during the
course of the project. Kristen Johnson may be reached on her cell phone
(404-663-4417) or email (Kristen.email@example.com). Dr. O’Connor can be reached
by telephone in his office (706-542-4382) or by email (firstname.lastname@example.org). Additional questions or problems
regarding your rights as a research participant should be addressed to The
Chairperson, Institutional Review Board, University of Georgia, 609 Boyd
Graduate Studies Research Center, Athens, Georgia 30602-7411; Telephone (706)
542-3199; E-Mail Address: IRB@uga.edu