YOUTH CONSENT FORM

Title of Study: ANTI-RACISM ACTION PROGRAM – Youth Program

Researchers
Principal Investigator: Bonnie McIntosh, MBA, MPH, BA Community Health, CHES®
Co-Investigator: Korede Adepitan, Licensed Registered Practical Nurse
Co-Investigator: Olusola Atoyebi, MS Computer Science, BS Computer Science

Study Sponsoring Organization: The Islamic Society of Markham

Before you agree to participate in this research survey it is important that you read and understand this consent form. This form gives you all the information that we think you will need to know in order to decide if you want to participate in this study. If you have any questions after you read through this form, ask Bonnie McIntosh (the Principal Investigator) directly or via email. You should not sign this form until you are sure you understand everything in this form.

What is Bonnie’s Contact Information? Bonnie McIntosh, MBA, MPH, BA Community Health, CHES® Principal Consultant of ACE Community Health, University of Windsor, EPICentre, ACE Community Health, 2455 Wyandotte Street West, 2nd Floor, Windsor, ON N9B 3B3, Canada, Phone: 1-800-958-9ACE ext.710, Email: mbonnie@acechealth.com

This is What this Study is About: We would like to understand your knowledge, behaviours, and attitudes around anti-racism that you gained while in the ARAP program. The results from this study will be used to better advise the planning, implementation, and evaluation of the ARAP Program.

How is this Study Being Done? We would like you to take part in this interview and survey online. It is expected that 15 - 20 people will take part in the interview and roughly less than 30 people will participate in the survey. If you choose to partake you can review the information in this form at your leisure and electronically sign the consent form and submit it through this link provided to you within 7 days. During the interview and survey, you do not have to answer any questions that you do not want to, and you are free to skip any questions that you want to. This interview will take approximately 30 – 45 minutes to complete. The survey will take approximately 15 minutes to complete. If you choose to participate, you are asked to consent to be surveyed and interviewed twice by electronically signing the consent form and submitting it through the link provided to you within 7 days.

The Types of Questions that will be Asked are: (1) Did the program offer training and resources around awareness, knowledge, and behaviours with anti-racism? and (2) What impact did the training and resources around awareness, knowledge, and behaviours with anti-racism have?

Voluntary Participation and Withdrawal: Your choice to participate will be protected. You can skip any questions that you don’t want to answer, and you can change your mind during the interview or survey process by clicking “Cancel” while taking the survey or saying “I don’t want to do take this interview” while taking the interview. If you are less than 18 years of age, then your consent along with your parent/guardian consent is required, but you will have the last say. This means that if your parent/guardian consents to you taking part in this study, but you choose not to, then you don’t have to take part in this study. If you are 18 years of age or older then parent/guardian consent is not required.

Your Other Choice to Participation: Your other choice to participation is to not partake in the interview and survey at any time without any consequences. Also, an individuals’ choice to participate will not have any influence on their relationship with the University of Windsor, ACE Community Health, the Anti-Racism Action Program Youth Program or the Islamic Society of Markham either now or in the future.

What are the Potential Risks and Discomforts for Partaking Part in the Study: This project is considered to have no more than minimal psychological, social, or security risk. The study team does not expect any risk greater than that experienced in your routine daily activities.

What Steps are Taken to Decrease the Risks and Discomforts? To minimize your minimal risk, the information you disclose will be kept completely confidential; this includes your name, telephone number, and address or any other information that can identify you personally. Your information will be stored and managed securely. Also, you are free to skip any questions without any penalty that they do not want to answer in the interview and survey. Participants are free to withdraw from the study at any time before their data is submitted and for any reason without any penalty.

What’s the Potential Benefit for Taking Part in the Study? There is no direct benefit to you for taking part in this study. Although you may not get direct benefit from your participation, you may benefit from gaining education, awareness, and knowledge about how to promote diversity, and counter anti-racism, hate and bias. Also, others may benefit from the knowledge gained in this study; we hope that the results of this study will help to improve this anti-racism program.

Getting the Results: The results of this study may be made available after the study is completed and the findings are available for release through the Scholarship at UWindsor website available at: https://scholar.uwindsor.ca/research-result-summaries/. Your individual research results will not be returned to you.

Potential Costs of Participation and Payment to you: While taking part in this study, you will not be reimbursed or be compensated for any expenses. You will not incur costs as a result of your participation in these interview and survey.

Your Confidentiality: Every effort will be made to protect your confidentiality using procedures in place to protect your identity. Your answers will be reported as a group, and you will not be identified in any reports/publications on this study. Your data will only be used for analysis purposes. Records will be kept confidential to the extent provided by law. However, government officials responsible for monitoring this study may inspect these records. Your records will have a study number and will not be identified by name. All electronic data will be stored on a secure computer that is password protected. The research team will have access to your results for 5 years. All data collected will be stored and locked in a secure place that only the researchers will have access to. When data is no longer maintained, electronic files and backup media will be destroyed in a manner appropriate for the media to ensure privacy.

By signing this form, you are authorizing your consent to participate in this interview and survey.

Who can you contact if you have more questions about this study? If you have any questions about the nature or findings of this study, you may contact Bonnie McIntosh, MBA, MPH, BA Community Health, CHES® Principal Consultant of ACE Community Health, University of Windsor, EPICentre, ACE Community Health, 2455 Wyandotte Street West, 2nd Floor, Windsor, ON N9B 3B3, Canada, Phone: 1-800-958-9ACE ext.710, Email: mbonnie@acechealth.com

Click HERE, then START, then NEXT
to Sign and Date the Consent Form

SIGNATURE OF RESEARCH PARTICIPANT:

I understand the information provided for the study Anti-Racism Action Program as described herein. My questions have been answered to my satisfaction, and I agree to participate in this study. I have been given a copy of this form.

_________________________________________________________
Type the Name of the Participant in Textbook

___________________
Date

SIGNATURE OF INVESTIGATOR
These are the terms under which I will conduct research

_____________________________________
Signature of Investigator

AUGUST 4, 2021
Date

You've reached the end of the book

Read again

Made with Book Creator