Consent for Telephone Interview

NSAL: National Survey of American Life

UNIVERSITY OF MICHIGAN

TELEPHONE CONSENT TO BE PART OF A RESEARCH STUDY

Title of the Project:       National Survey of American Life: 25 Year Follow-Up

Hello, my name is __________ and I am calling from the University of Michigan.

Purpose of the study

I am calling to ask you to participate in a research study, the National Survey of American Life: 25 Year Follow Up because you were a participant in the National Survey of American Life (NSAL) in 2001-2003. This study is funded by the National Institutes of Health. The purpose of this study is to understand how factors such as social support, mental health and wellbeing, physical health conditions, neighborhood environments, and stressful life events relate to the risk of dementia and other health and functional challenges as people age.

Dr. Briana Mezuk is the researcher in charge of this study.

What participation involves

  • If you choose to participate,
    • A member of our study team will conduct an interview with you by telephone. This interview is expected to take two hours.
    • During the interview, you will also complete some memory and problem-solving tasks that assess brain health. This part of the interview will be audio recorded for research purposes. You can still participate if you do not want to be recorded.

Information about study risks and benefits

  • There is no direct benefit to you for participating.
  • There is no cost to you for participating in this study.
  • There are a few risks and discomforts related to participation. Some questions might be upsetting because they ask about personal information related to your health, family, and wellbeing. You can skip any questions you do not wish to answer.
  • While we take very stringent security measures, there is a very small risk of loss of confidentiality in the information that you provide.
  • For your participation in this study, you will receive $40.

Protecting and sharing research information

  • There are reasons why information about you may be used or seen by the researchers or others during or after this study. For example, University, government officials, study sponsors or funders, auditors, and/or the Institutional Review Board may need the information to make sure that the study is done in a safe and proper manner.
  • We plan to publish the results of this study. We will not include any information that would identify you, and that includes information that could be combined to identify you. Your privacy will be protected, and your research records will remain confidential.
  • We use strict methods to protect your data and identity. The study team will retain your identifying information, such as your name and address, and this information will be stored separately from your study data and kept confidential. All information will be kept on secure, encrypted University of Michigan servers and your name will be replaced with a study ID number.
  • Because this study provides some payment for participating, we must provide your name and address to the University of Michigan finance department for record keeping purposes. If and only if you receive payments of greater than $400, in total, from participating in studies conducted by the University of Michigan during the calendar year, the finance department will also require your Social Security Number for tax reporting purposes. This study will not ask for your Social Security Number under any other circumstances. If you do not wish to provide your Social Security Number, you may continue to participate in research studies, but you will not be able to receive additional payment for the remainder of the calendar year.
  • Once the study is done, we may use your information and research audio recordings for future research studies. This future research may be similar to this study or completely different. We will not ask for your additional permission for these studies. Even in future research, we will not share information that could be used or combined to identify you.
  • In addition to everything we will do to protect your confidentiality, this study holds a Certificate of Confidentiality from the National Institutes of Health. This means that we cannot release or use information, documents, or samples that may identify you in any action or suit except as described below. This protection includes federal, state, or local civil, criminal, administrative, legislative, or other legal proceedings. An example of a situation in which the Certificate would apply would be a court subpoena for research records. There are some important things that you need to know:
    • The Certificate does not stop reporting or information-sharing that you agreed to in this consent document. For example, we may share information with appropriate authorities if we think you may harm yourself or others.  We may also share your information with other researchers, but not your audio recordings.
    • The Certificate does not stop reporting that federal, state, or local laws require. Some examples are laws that require reporting of child or elder abuse.
    • The Certificate cannot be used to stop a sponsoring United States federal or state government agency from checking records or evaluating programs.
    • The Certificate of Confidentiality does not stop you from personally releasing information about your involvement in this research if you wish.
    • More information about Certificates of Confidentiality and the protections they provide is available online at https://grants.nih.gov/policy/humansubjects/coc.htm
  • If you tell us or we learn something that makes us believe that you or others have been or may be abused, neglected, or exploited, we may, and in some cases must, report that information to the appropriate agencies.

The researchers may reach out to you in the future about taking part in another study. You can decide when you are contacted if you want to participate.

Taking part in this research project is voluntary. You do not have to participate and you can stop at any time. Parts of the interview may be recorded for quality control purposes. You can decline recording if you wish to do so.

Contact information

I’d like to give you three phone numbers to write down. If you have questions about this study in the future, you can contact the NSAL study team at 800-759-7947. If you have questions or concerns about your rights as a research participant, you can call the University of Michigan Institutional Review Board at (866) 936-0933 or email [email protected]. You can also contact the University of Michigan Compliance Hotline at 1-866-990-0111.

Do you have any questions about the study? 

Do you agree to participate?

Do you agree to recording parts of your survey for research purposes?

You can still participate if you decline audio recording.