INFORMED CONSENT

STUDY TITLE: Determining the Role of Occupational Therapy in Public Libraries for Addressing Community Health

RESEARCHERS (PI):
Dr. Karla Reese, DHSc, OTR/L
Department of Occupational Therapy
College of Health
2121 Euclid Avenue, HS 103, Cleveland, OH 44115-2214
216-687-3661
k.reese@csuohio.edu

Claire Bruening
Occupational Therapy Doctorate Student
2121 Euclid Avenue, HS 101, Cleveland, OH 44115-2214
(216) 687-2493
c.e.bruening@vikes.csuohio.edu

WHY ARE WE DOING THIS STUDY?
We want to understand how families are using their local libraries. We want to learn what barriers may prevent participation, what areas of need are not currently being addressed by libraries and determine if there is room for occupational therapists to meet needs. This study is looking for people who live in the United States, are over 18 years old, take care of at least one child between the ages of 0 and 12, and have a membership to a local library.

WHAT WILL I BE ASKED TO DO IF I AGREE TO TAKE PART IN THIS STUDY? This survey will ask questions about your social and economic background, what programs are available at your local library, which programs you participate in, and what factors affect your library engagement. The survey will take about 10 minutes.

Your answers are private. We will not use your name in our work. All information will be kept on a password protected computer account. Only the researchers can access it. All data will be kept for 3 years then deleted.

RISKS:
The risks are very low, similar to everyday life. Some participants may feel emotional in responding to questions about family makeup and responsibilities. If this happens during the survey, they can choose to stop at any time without any consequences.

Anytime you share information online there are risks. We’re using a secure system to collect this data, Qualtrics, but we can’t completely eliminate this risk.
Breach of confidentiality: There is a chance your data could be seen by someone who shouldn’t have access to it. We’re minimizing this risk in the following ways:
 o Data is anonymous.
 o We’ll store all electronic data on a password-protected, encrypted Qualtrics account. All data will be deleted after 3 years.

BENEFITS:
There is no personal benefit to you.

YOUR CHOICES:
You can choose to join the study or not. There is no penalty if you say no. If you say yes, you agree to participate, and your answers can be used for research.

You can choose to stop the survey or skip non-required questions at any time for any reason. There will be no penalty for stopping the survey or skipping questions.

CONTACTS:
If you have questions now or later, contact Dr. Reese at 216-687-3661, or Claire Bruening at (440) 478-7835.

I understand that if I have any questions about my rights as a research subject, I can contact the Cleveland State University Institutional Review Board at (216) 687-3624.

CHECK OF UNDERSTANDING:
By selecting “Yes” below, I agree to participate in this study and understand that information collected by this survey will be used for research purposes.