2021 Central Ohio Regional Assessment on Aging

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[ Consent ]

Study Title: Central Ohio Needs Assessment on Aging

Katie White, MSW, Director, Age Friendly Columbus, Ohio State University, College of Social Work Holly Dabelko-Schoeny, PhD, Ohio State University, College of Social Work

City of Columbus

This is a consent form for research participation.
It contains important information about this study and what to expect if you decide to participate.

Your participation is voluntary.
Please consider the information carefully.

The purpose of this study is to: (1) assess needs of older adults in central Ohio (2) understand the preferences and values of older adults in central Ohio (3) identify areas of opportunity for governments and organizations in central Ohio to better serve older adults.

Participants are asked to complete the attached survey and return it using the prepaid envelope.

The survey will take approximately 30 minutes to complete.

Risks and Benefits:
The risks from taking part in this study are minimal and do not exceed those posed by routine daily activities. Participation may benefit efforts that aim to improve the resources, built environments, and social environments in your community.

Efforts will be made to keep your study-related information confidential. All data provided to the research team will be deidentified. However, there may be circumstances where this information must be released. For example, personal information regarding your participation in this study may be disclosed if required by state law. Also, your records may be reviewed by the following groups (as applicable to the research):

  • Office for Human Research Protections or other federal, state, or international regulatory agencies
  • The sponsor, if any, or agency supporting the study
  • The Ohio State University Institutional Review Board or Office of Responsible Research Practices

No incentives will be provided.

Participant Rights:
If you feel uncomfortable with any questions, you can skip those questions or withdraw from the study at any time without penalty or loss of benefits to which you are otherwise entitled. Your decision will not affect your future relationship with The Ohio State University. By signing this form, you do not give up any personal legal rights you may have as a participant in this study. This study has been determined exempt from IRB review.

Future Research:
Your de-identified information may be used or shared with other researchers without your additional informed consent.

Contacts and Questions:
For questions, concerns, or complaints about the study, or you feel you have been harmed as a result of study participation, you may contact Katie White at (614) 549-7980. For questions about your rights as a participant in this study or to discuss other study-related concerns or complaints with someone who is not part of the research team, you may contact Ms. Sandra Meadows in the Office of Responsible Research Practices at 1-800-678-6251.

Signing the Consent Form:
I have read (or someone has read to me) this form and I am aware that I am being asked to participate in a research study. I have had the opportunity to ask questions and have had them answered to my satisfaction. I voluntarily agree to participate in this study. Please print or save this screen if you want to be able to access the information later.

Agreement to Participate:
If you would like to take the survey, please begin.