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UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
CONSENT TO BE IN RESEARCH
 
Study Title: Antenatal Insomnia Detection and Treatment
 
This is a research study, and you do not have to take part.  This form explains the study.  If you have any questions, you may contact study researcher Dr. Jennifer Felder, from the UCSF Department of Psychiatry.  Her contact information is at the end of this form.
 
You are being asked to take part in this study because you are pregnant.
 
In this study, the researchers are doing a survey to learn more about sleep difficulties during pregnancy and how health care providers help pregnant women who have difficulty sleeping. This study is funded by the UCSF Preterm Birth Initiative post-doctoral fellowship program, through a gift from Mark and Lynne Benioff, and the Bill and Melinda Gates Foundation.  About 10,000 people will participate in this study.
 
What will happen if I take part in this study?
If you agree to be in this study, you will complete an online survey. The survey asks about your sleep, whether you have discussed your sleep with your doctor, and steps you may have taken to improve your sleep. It will take you less than 10 minutes to complete this survey.

Are there any risks to me or my privacy?
The online survey is anonymous, so your name will not be associated with your survey responses.  Some of the survey questions may make you feel uncomfortable.  You are free to skip any question.

Are there benefits?
There is no benefit to you.  The survey results will be used for research.

Can I say “No”?
Yes, you do not have to complete the survey.  If you choose not to be in this study you will not lose any of your regular benefits, and you can still receive medical care from UCSF.

Are there any payments or costs?
You will be entered into a raffle to win one of ten $50 gift cards.
 
Who can answer my questions about the study?
You can talk with the study researcher about any questions, concerns, or complaints you have about this study.  Contact the study researcher, Jennifer Felder, PhD at (415) 476-7014.

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 Institutional Review Board at 415-476-1814.  


CONSENT

PARTICIPATION IN RESEARCH IS VOLUNTARY.
 

Click here to download a copy of this consent form.