0929-1050 Consent Form - English

OMB Control No. 0920-1050

Exp. Date 06/30/2025

The public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-1050).

FOCUS GROUP CONSENT FORM

STUDY TITLE: Audience Testing to inform Essentials for Parenting Toddlers and Preschoolers Content refresh

SPONSOR: Centers for Disease Control and Prevention

WHAT ARE YOU BEING ASKED TO DO?

We are asking you to be part of a focus group discussion. This is part of a research study that will inform the creation of web and video content put forth by the Centers for Disease Control and Prevention (CDC). The purpose of this discussion is to get your thoughts and opinions on concepts related to parenting toddlers and preschoolers.

WHAT WILL YOU BE DOING?

A focus group is a special group discussion. We will meet with a small group of people like yourself (about 6 to 8 individuals) in a private Zoom meeting to talk about this topic. We will ask you what you think about several different concepts related to parenting toddlers and preschoolers. We will use this information to refine and improve web and video content about parenting techniques for toddlers and preschoolers.

We will record what people say so that we do not miss what is being said. We will also take notes. We will destroy the recordings and notes as soon as we finish working on our materials and messages. Our job is to:

• Ask you questions,

• Keep the group focused on the topic we want to discuss, and

• Make sure we don’t run out of time.

We really want you to feel free to talk together as a group. If everyone is talking about the questions we asked, we will just listen to your ideas and take notes. This discussion will take about an hour to complete.

DO YOU HAVE TO DO THIS?

You do not have to be part of this group discussion. It is your choice. Your participation in this focus group is voluntary. You can say that you don’t want to be in the focus group and that is fine. You are also free to stop participating at any time. It is important to us that you feel okay answering the questions honestly. You do not have to answer any questions you do not want to answer.

HOW WILL YOUR PRIVACY BE PROTECTED?

To protect your privacy, we will not ask you to share your full name and we will not write down your name in any of the notes we take.

We value your participation in this focus group. We also understand that you may not be okay telling the entire group what you think out loud. In these cases, if you prefer, you can write down your ideas or thoughts and share them as a private message in the Zoom chat box with the person leading the discussion. No one else will see these private messages except the study team. We will review all private messages sent to us via private Zoom chats after the focus group and record them in a password protected drive with other study materials. We will destroy our notes and recording when we finish working on our content.

WHAT ARE THE RISKS?

There may be some risks from participating in this study. Because you will be speaking with us in a group, there is the possibility that other participants in the group will tell other people you were part of this discussion. They may repeat what you said during the focus group to other people. To minimize this risk, at the beginning of the discussion, we will ask everyone in the group to not share anything from the discussion with anyone after the discussion ends. We hope you will feel comfortable being open and honest in your responses to our questions. However, you may leave the meeting at any time, and you do not have to answer any questions you do not want to.

ARE THERE ANY BENEFITS TO BEING IN THIS GROUP?

There are no direct benefits to being in this study. However, you may benefit from knowing your contributions to this discussion could help improve public messaging about parenting toddlers and preschoolers.

WILL YOU RECEIVE PAYMENT?

We will give you a $40 token of appreciation after we finish the discussion to thank you for your time, effort, and contributions.

WHAT WILL BE DONE WITH THE RESULTS OF THIS FOCUS GROUP?

We will review information from the focus group to refine and improve current web content and inform the creation of future products or materials that provide strategies for parenting toddlers and preschoolers, such as webpages, videos, and other tools.

OTHER INFORMATION

Please keep a copy of this information sheet for your records. If you have any questions or concerns about this study, you may contact [PI NAME] at [PHONE NUMBER] or via email at [EMAIL ADDRESS]. The study team is also willing to answer any questions or concerns you might have right now or after the discussion.

Please answer yes or no to the following statements:

___ I understand the information that has been provided to me and voluntarily agree to take part in this focus group discussion.

___ I know that I have a choice to be in this focus group discussion or not, and can stop participating at any time during the discussion.