Technology Support for Clean Eating: Participation Agreement Form
Dear participant,
You are being asked to be a volunteer in a research study.

Purpose:
The purpose of this study is to understand how people use computer technology during juice fasts, cleanses or phases of ‘clean eating.’ We also want to know how your use of technology for diet has changed over time. Eventually, we want to design technology to better support clean eating. We expect to enroll 20 people in this study.

Exclusion/Inclusion Criteria:
Participants in this study must have at some point started a juice, smoothie, or other ‘clean eating’ diet. Participants must be 18 or older.

Procedures:
If you decide to be in this study, we will interview you. We will contact you to schedule an interview. The interview may take place on the Georgia Tech campus or at a place of your choosing. You may also choose to conduct the interview over the phone. The interview should last about 40 minutes. It will last no more than 60 minutes. With your permission, we will audio record the interview. Remember, you may stop at any time.

Risks or Discomforts:
The risks involved are no greater than those involved in daily activities such as talking about food and diet.

Benefits:
You are not likely to benefit from joining this study. We hope that what we learn will someday help others better manage their diets through technology.

Compensation to You:
There is no compensation for participation.

Confidentiality:
The following procedures will be followed to keep your personal information confidential in this study:

The data we collect about you will be kept private to the extent allowed by law. To protect your privacy, your records will be kept under a code number rather than by name. Your records will be kept in locked files. Only study staff will be allowed to look at them.

With your permission, we will audio record the interview. We will transcribe the audio. The transcription will not contain your name. It will use your code number instead. As soon as the transcripts have been produced, the audio will be deleted.
Your name and any other fact that might point to you will not appear when results of this study are presented or published. Your privacy will be protected to the extent allowed by law. To make sure that this research is being carried out in the proper way, the Georgia Institute of Technology IRB may review study records. The Office of Human Research Protections and/or the Food and Drug Administration may also look over study records during required reviews.

Costs to You:
There are no costs to you, other than your time, for being in this study.

In Case of Injury/Harm:
If you are injured as a result of being in this study, please contact Professor Elizabeth Mynatt, at telephone (404) 894-4728. Neither the Principal Investigator nor Georgia Institute of Technology has made provision for payment of costs associated with any injury resulting from participation in this study.

Participant Rights:
• Your participation in this study is voluntary. You do not have to be in this study if you don't want to be.
• You have the right to change your mind and leave the study at any time without giving any reason and without penalty.
• Any new information that may make you change your mind about being in this study will be given to you.
• You will be given a copy of this consent form to keep.
• You do not waive any of your legal rights by signing this consent form.

Questions about the Study:
If you have any questions about the study, you may contact Professor Elizabeth Mynatt at telephone (404) 894-4728) or mynatt @ gatech.edu.

Questions about Your Rights as a Research Participant:
If you have any questions about your rights as a research participant, you may contact Ms. Melanie Clark, Georgia Institute of Technology Office of Research Integrity Assurance, at (404) 894-6942.
If you choose YES below, it means that you have read (or have had read to you) the information given in this consent form, and you would like to be a volunteer in this study.

Thanks,
Elizabeth Mynatt, Andrew Miller, Jessica Pater

Sign in to Google to save your progress. Learn more
Your name *
Your email address *
Do you agree to participate? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy