Behavioral Adult Consent

University of North Carolina-Chapel Hill Consent to Participate in a Research Study Adult Participants Social Behavioral Form ______

IRB Study #17-3082 Consent Form Version Date: 1/2/2018

Title of Study: The shaping of occupational choice by contextual factors

Principal Investigator: MaryBeth Gallagher PhD, OTR/L, Seminar Facilitator UNC-Chapel Hill Department: Allied Health/Occupational Science & Occupational Therapy UNC-Chapel Hill Phone number: 919-843-4464 Email Address: [email protected] Co-Investigators: Taylar Byrd, Giovanna Calloway, Michael Higgins, Rachael Perrin, Alexis Petteway, Leslie Riley, Jordyn Roberts, April Sawyer

Funding Source and/or Sponsor: N/A

Study Contact telephone number: Study Contact email: ______

What are some general things you should know about research studies? You are being asked to take part in a research study. To join the study is voluntary. You may refuse to join, or you may withdraw your consent to be in the study, for any reason, without penalty.

Research studies are designed to obtain new knowledge. This new information may help people in the future. You may not receive any direct benefit from being in the research study. There also may be risks to being in research studies. Details about this study are discussed below. It is important that you understand this information so that you can make an informed choice about being in this research study.

You will be given a copy of this consent form. You should ask the researchers named above, or staff members who may assist them, any questions you have about this study at any time.

Please note: This study has been reviewed by the Institutional Review Board at the University of North Carolina at Chapel Hill and has been determined to be exempt from further oversight of that Board. However, the investigators for this study feel that informed consent is still an important ethical step in social sciences research and so are using an informed consent process for the study.

What is the purpose of this study? Purpose: This research project will be completed by graduate students in partial fulfillment of requirements for the M.S. degree in Occupational Therapy. The project focuses on the exploration of how occupational choices, or preferences for action, are shaped by the contextual factors in which they are situated. That is, how does the experience of specific factors, like being homeless, a post 9/11 veteran, a sibling of a child with profound disabilities or contribute to the choices one makes about what to do everyday and how does this impact health and wellbeing?.

of 4 You are being asked to be in the study because you have certain characteristics or experiences that have shaped your occupational choices, as defined in this study.

Are there any reasons you should not be in this study? You should not be in this study if you are not willing or able to participate in an interview or focus group led by one of the co-investigators.

How many people will take part in this study? If you decide to be in this study, you will be one of approximately 25 people in this research study.

How long will your part in this study last? Your participation will include an individual interview or a focus group that will last 1-2 hours. The researcher that does your interview or focus group may contact you by phone or email after the interview/focus group if they have follow-up questions, but this should require no more than an additional 15-30 minutes of your time. The study will be completed by April 30, 2018, so your participation will end then if not earlier.

What will happen if you take part in the study? You will participate in a 1-2 hour individual interview or focus group (group interview) led by one of the people listed as co-investigators on the first page of this consent form. You will be asked questions about your experience of making occupational choices in relation to one of the following situations: preacher's kids, siblings of a child with profound disabilities, post 9/11 veterans, homeless people, minority women survivors of sexual assault, first generation college students, and black male college students.

Your interview or focus group will be audio recorded so that it can later be transcribed.

The person doing your interview or focus group may contact you after this interview/focus group has happened to clarify things you said or to ask some short additional questions. This may be done by email or on the phone and is just for the purpose of being as accurate as possible in understanding what people have said.

What are the possible benefits from being in this study? Research is designed to benefit society by gaining new knowledge. You may not benefit personally from being in this research study.

What are the possible risks or discomforts involved from being in this study? There are no known risks from participating in this study. However, there may be uncommon or previously unknown risks. You should report any problems to the researcher.

How will your privacy be protected? Your privacy will be protected in several ways.  Digital audio recordings will be moved immediately to a secure flash drive, and the recording file will be securely removed from the audio recording device.  Digital audio recordings will be stored on a secure flash drive and/or password protected, secure computer, and will not be accessible to anyone other than the researchers listed on the first page of this consent form.  Transcriptions of audio recordings will also be stored on a secure flash drive or password protected, secure computer.

of 4  Only the researchers (principle investigator and co-investigators) will know your identity unless you give specific permission to use your real name and/or photos of you.  Prior to the interview or focus group, you may choose an alias to use during the interview/focus group if you wish. In any case, only a first name will be used during the interview/focus group.  If you do not choose to use an alias for the interview/focus group, you will be given an alias that will be used in transcriptions and in any reports or publications about the study.  Transcription will be completed by an individual who has signed a confidentiality agreement to keep your identity private, and actual transcripts will only have aliases included as participant identifiers.  For those participating in focus groups, all focus group participants will be asked to keep the content of the focus group private.  Audio recordings will be destroyed after the study has ended.  Transcripts may remain in the possession of the PI for this study for up to 5 years, stored on a secure server in the School of Medicine at UNC-Chapel Hill.  Co-investigators will destroy all copies of audio or transcription data in their possession at the end of the study.

Although every effort will be made to keep research records private, there may be times when federal or state law requires the disclosure of such records, including personal information. This is very unlikely, but if disclosure is ever required, UNC-Chapel Hill will take steps allowable by law to protect the privacy of personal information. In some cases, your information in this research study could be reviewed by representatives of the University, research sponsors, or government agencies for purposes such as quality control or safety.

Permissions: Recording Check the line that best matches your choice: _____ OK to record me during the study _____ Not OK to record me during the study Name Check the line that best matches your choice: _____ OK to use my real name throughout the study and in reports/publications _____ Not OK to use my real name; please use an alias

Photos Check the line that best matches your choice: _____ OK to use photographs of me in reports/publications _____ Not OK to use photographs of me in reports/publications

What if you want to stop before your part in the study is complete? You can withdraw from this study at any time, without penalty. The investigators also have the right to stop your participation at any time. This could be because you have had an unexpected reaction, or have failed to follow instructions, or because the entire study has been stopped.

Will you receive anything for being in this study? You will not receive anything for taking part in this study.

of 4 Will it cost you anything to be in this study? There will be no costs for being in the study

What if you are a UNC student? You may choose not to be in the study or to stop being in the study before it is over at any time. This will not affect your class standing or grades at UNC-Chapel Hill. You will not be offered or receive any special consideration if you take part in this research.

What if you are a UNC employee?. Taking part in this research is not a part of your University duties, and refusing will not affect your job. You will not be offered or receive any special job-related consideration if you take part in this research.

What if you have questions about this study? You have the right to ask, and have answered, any questions you may have about this research. If you have questions, complaints, concerns, or if a research-related injury occurs, you should contact the researchers listed on the first page of this form.

What if you have questions about your rights as a research participant? All research on human volunteers is reviewed by a committee that works to protect your rights and welfare. If you have questions or concerns about your rights as a research subject, or if you would like to obtain information or offer input, you may contact the Institutional Review Board at 919-966-3113 or by email to [email protected]. ------

Title of Study: The shaping of occupational choice by contextual factors

Principal Investigator: MaryBeth Gallagher PhD, OTR/L

Participant’s Agreement:

I have read the information provided above. I have asked all the questions I have at this time. I voluntarily agree to participate in this research study.

______Signature of Research Participant Date

______Printed Name of Research Participant

______Signature of Research Team Member Obtaining Consent Date

______Printed Name of Research Team Member Obtaining Consent