UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
CONSENT TO PARTICIPATE IN SCREENING FOR A RESEARCH STUDY
Study Title: Research on Expecting Moms and Sleep Therapy (REST)
This is a screening survey used to determine eligibility for a research study about improving sleep during pregnancy. Study researcher Dr. Jennifer Felder, from the UCSF Department of Psychiatry, is available to explain this survey to you. Her contact information is at the end of this form.
How many people will take part in this study?
Up to 5,000 women will complete this screening survey.
What will happen if I take part in screening for this research study?
If you decide to complete this screening survey, you will next be asked to complete online questionnaires. The questionnaires ask about your pregnancy, sleep, mental health history, and symptoms of sad mood and anxiety, as well as demographics such as your age and race/ethnicity. If you are eligible after the screening, you will be asked to provide your contact information, and then you will view an additional consent form describing the study procedures for the research study about improving sleep during pregnancy.
Can I stop being in the study?
Yes. Answering these screening questions is voluntary and you can stop at anytime.
Will information about me be kept private?
We will do our best to protect the information we collect from you. Information that identifies you will be kept secure. The completed surveys will be kept secure and separate from information that identifies you. Only a small number of researchers will have direct access to completed surveys. If this study is published or presented at scientific meetings, names and other information that might identify you will not be used.
What are my rights if I take part in this study?
Taking part in this study is your choice. You may choose either to take part or not to take part in the study. If you decide to take part in this study, you may leave the study at any time. No matter what decision you make, there will be no penalty to you in any way. You will not lose any of your regular benefits, and you can still get your care from our institution the way you usually do.
Who can answer my questions about the study?
You can talk to the researchers about any questions, concerns, or complaints you have about this study. Contact Dr. Jennifer Felder at (415) 476-7014 or Rest.Study@ucsf.edu.
If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Office of the Committee on Human Research at 415-476-1814.
PARTICIPATION IN RESEARCH IS VOLUNTARY. You have the right to decline to be in this study, or to withdraw from it at any point without penalty or loss of benefits to which you are otherwise entitled