Consent form - Swinburne University of Technology

March 2014
Dear Colleague
Invitation to take part in a study of the effects of ‘You the Man’ Program on adult audiences
This invitation has been sent to you by the local organiser of the ‘You the Man’ Program, and is
being sent to all those who have registered their attendance for the forthcoming program.
As you may know, the ‘You the Man’ Program is a theatre-based program for bystander
engagement and violence prevention. It has been successfully used in the United States for over
10 years, with positive effects on knowledge attitudes and behaviour in the short, medium and
longer term. Now that we have an Australian version of the program being used in Victoria, we
think it is important to investigate the short effects of the Program within the settings it is now
being used. This study will look at its short term effects.
The attached plain language statement gives you information about how you can take part in this
study. If you have any questions, please feel free to contact me by phone or email.
Thank you for taking the time to consider this invitation.
Yours sincerely
Professor Ann Taket
Chair in Health and Social Exclusion
Director, Centre for Health through Action on Social Exclusion
Deakin University CRICOS Provider Code: 00113B
School of Health and Social Development
Faculty of Health
Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125
Tel 03 9244 3798 Fax 03 9244 6261 email [email protected] www.deakin.edu.au/health/chase
PLAIN LANGUAGE STATEMENT AND CONSENT FORM
TO: Participants in ‘You the Man’ Program
Plain Language Statement
Date: March 2014
Full Project Title: Effects of ‘You the Man’ program on adult audiences
Principal Researcher: Professor Ann Taket
Other Researcher(s): Professor Beth Crisp
Adjunct Professor Cathy Plourde (University of New England, US)
We are providing you with this plain language statement and consent form so you can make
an informed decision about whether you would like to participate in the project or not. The
statement is 5 pages long. If you have any questions about any aspects of the project, you
can contact Prof Ann Taket (contact details are given on page 5).
1. Purpose and background
‘You the Man’ (YTM) is an American theatre-based program for bystander engagement and
violence prevention. YTM has been in use in the US since 2002, in a variety of settings:
secondary school (grades 9 to 12), tertiary education, workplaces and communities. Data
from an ongoing longitudinal study in secondary schools in the US has shown that the
intervention positively affects knowledge, attitudes and behaviour in the short, medium and
longer term. Now that we have an Australian version of the program being used in Victoria,
we think it is important to investigate the effects of the Program within the settings where it
is now being used. This study has been designed to explore its short-term effects.
You have been provided with this invitation to take part since you are one of the people who
have registered to attend the YTM Program. To protect your privacy, your details have not
been shared with Professor Taket, and she will not know you have been invited to
participate unless you contact her yourself.
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
Page 1 of 5
If, after reading this information, you decide you want to take part in the study, in order to
protect your confidentiality, you need to return the completed consent form, if applicable,
to Professor Taket directly.
2. Methods
The study will be based on two sources of data. The first source is surveys completed by
participants in the YTM Program, one survey completed before attending the Program and
the other around one month after attendance. These surveys are completed anonymously
to protect privacy and ensure confidentiality. The second data source is focus group
discussions, held at some point in the three months following attendance at YTM. You can
choose to participate in the surveys and/or the focus groups. If you want to participate in
the surveys you follow the instructions sent to you by the local coordinator with this
invitation pack, you do not need to fill in a consent form, completion of the survey is taken
as consent to participate. If you want to participate in a focus group discussion, you should
fill in the attached consent form and return it to Prof Taket.
3. What participation in the project would mean for you
If you want to complete the survey, you can do so at a time and place convenient to you.
If you want to participate in a focus group discussion, you need to return the completed
consent form, and then, in the three months following your attendance at YTM one of the
research team will contact you, using the method you have specified on the form, to discuss
possible dates for attending a focus group. These will be arranged locally to the YTM
program venue, and will only be held if there are at least eight people who wish to attend.
The focus groups will be conducted by Prof Taket and one of the researchers from Deakin
University on her team. The focus group will be between one and two hours in length, and
refreshments will be provided. The discussion will be digitally recorded. From the recording
a transcript will be produced, the research team will then anonymise any personally
identifying details to protect your confidentiality.
4. Potential benefits to participants and the wider community;
The expected benefits of the study are an increased understanding of the effects of the YTM
program for adult audiences in Victoria. The study will also enable early identification of any
implementation challenges or problems with the implementation of the YTM Program.
These can then be addressed, which should result in improvements in the final outcomes
and greater success in violence prevention. Besides this community benefit, it is quite
possible that participants will receive personal satisfaction from contributing to this process.
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
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5. Potential risks to participants
The risk of discomfort occurring during participation in this research, through survey
completion is low given that personal experiences are not the topic of discussion.
Participants are free to omit any questions they do not wish to answer in the survey.
In the focus group discussions, talking about dating violence, domestic abuse and sexual
coercion can be difficult. These conversations may cause some people to feel uncomfortable
or upset. All those attending a focus group discussion will be given a list of local resources
that they can use at any time. At the start of each discussion, it will be emphasised that
participants are free to leave at any time and do not have to answer all of the questions.
There may be additional unforseen or unknown risks.
6. How privacy and confidentiality will be protected
Completed consent forms are returned directly to Professor Taket, and will be stored
securely in a locked filing cabinet. Contact details will be available to members of the
research team so that they can contact participants to arrange the focus groups, and they
will keep these details confidential, with storage only on password protected computers.
Recordings of focus groups will be stored on password protected computers. We will use a
commercial agency to produce transcripts, and this agency is bound by strict confidentiality
procedures. Before analysis, all transcripts will be anonymised by the research team,
removing any information that might identify participants. All focus group transcripts will be
held on password protected computers.
Once the project is completed, the interview information will be stored at Deakin University
in a locked storage area for a period of six years. The information will then be destroyed in
line with Deakin’s procedures. The procedures are compliant with the Victorian Privacy Act.
It will not be possible to identify any participant in any of the project reports and other
documents. We will make sure that any information that might identify a person has been
removed from the data before it is published or reported.
7. Results of project
We will share what we learn from the project with others in different ways, to suit the needs
of the audience. We will produce reports, conference and academic papers. We might also
share the project findings at meetings and in workshops.
Results of the project will be available for download from part of Deakin University website
www.deakin.edu.au/health/CHASE and can also be requested by contacting Prof. Ann Taket
at [email protected].
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
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8. How the research will be monitored
The progress of the research will be monitored by the lead investigator on an ongoing basis.
Annual reports will be submitted as part of the Deakin research governance process.
9. Payments to participants
There are no payments for participation in this project.
10. Financial or other relevant declarations of interests of researchers, sponsors and
institutions
This research is funded through internal University research resources held by Prof. Ann
Taket.
11. Participation is Voluntary
Participation in this research project is voluntary. If you do not want to take part you do not
have to. If you decide to take part and later change your mind, you can drop out of the
project at any stage.
Your decision to take part, or take part and then withdraw, will not affect any other
relationship you may have with Deakin University.
Before you make your decision, you can ask any questions you have about this project.
If you wish to complete the pre-survey you can then do so as soon as you like. The link to the
post-survey will be sent to everyone who attended the YTM program approximately one
month after attendance (this is so that individuals can opt into the research process at a
later stage if they wish), you can complete the pre-survey at your convenience.
If you wish to participate in a focus group discussion you should only sign the Consent Form
after you have had a chance to ask your questions and have received satisfactory answers.
Once we have received your consent form, we will send you a copy to keep. If you decide to
drop out of this project later, please let us know by completing and returning the
Withdrawal of Consent Form included with this information. There are no special
requirements linked to withdrawing.
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
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12. Ethical Guidelines
This project will be carried out according to the National Statement on Ethical Conduct in
Human Research (2007) produced by the National Health and Medical Research Council of
Australia. This statement has been developed to protect the interests of people who agree
to participate in human research studies.
The project has been approved by the Human Research Ethics Committee of Deakin
University
13. Complaints
If you have any complaints about any aspect of the project, the way it is being conducted or
any questions about your rights as a research participant, then you may contact:
The Manager, Research Integrity, Deakin University, 221 Burwood Highway, Burwood
Victoria 3125, Telephone: 9251 7129, [email protected]
Please quote project number HEAG-H 139_2013.
14. Any questions?
If you have any questions about the information contained in this statement, or about the
project that we are inviting you to participate in, please feel free to contact Professor Ann
Taket. Her contact details are below. If you want to maintain your confidentiality while
asking your questions, you can do so by using the phone.
Researcher contact details:
Professor Ann Taket
School of Health & Social Development
Deakin University Melbourne Burwood Campus
221 Burwood Highway
Burwood
VIC 3125
Phone:
03 9244 3798
Fax
03 9244 6261
Email
[email protected]
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
Page 5 of 5
PLAIN LANGUAGE STATEMENT AND CONSENT FORM
TO: Participants in ‘You the Man’ Program
Consent Form for focus group participation
Date: March 2014
Full Project Title: Effects of ‘You the Man’ program on adult audiences
Reference Number: HEAG-H 139_2013
I have read, and I understand, the attached Plain Language Statement.
I freely agree to participate in this project according to the conditions in the Plain Language
Statement.
I have been given a copy of the Plain Language Statement and Consent Form to keep.
The researcher has agreed not to reveal my identity and personal details, including where
information about this project is published, or presented in any public form.
I agree to participate in a focus group and I understand that this will be recorded.
Participant’s Name (printed) ……………………………………………………………………
Signature ………………………………………………………
Date …………………………
Please give us contact details for how you would like us to contact you to discuss focus group
arrangements:
Phone/mobile
Email
Please return to:
Professor Ann Taket, Reply Paid 60208, School of Health & Social Development, Deakin
University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125
Alternatively if you wish you may scan the form and return by email to
[email protected]
Plain Language Statement & Consent Form to Participants
HEAG-H 139_2013: version 2: 13 September 2013
Page 1 of 1

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