UNIVERSITY OF NEVADA, RENO
STATEMENT REGARDING RESEARCH STUDY
TITLE OF STUDY: Health Disparities and the Diverse
PROTOCOL NUMBER: E04/05-090
You are being asked to participate in a research study
is to determine whether a poor health care outcome or
poor health care access is perceived by individuals to
be due to their race, ethnicity, religion, disability,
gender, language and other factors.
You are being asked to participate because you are over
the age of 18 and are literate in English. Since the
survey will be anonymous, it will not be possible to
identify you from the survey answers.
Paper Pencil Survey: If you choose to participate,
you will complete an anonymous paper pencil survey, fold
it and drop it in a sealed box marked “drop box” by the
front desk. The survey asks questions about your
satisfaction with your medical care.
Web based Survey: If you are participating in a web
based survey, then you will complete an anonymous
on-line survey and when ready to submit, just click on
the submit button. The survey asks questions about your
satisfaction with your medical care.
There are no risks to you since this is an anonymous
survey that is asking you to share your thoughts and
beliefs. No one will be able to tell who gave what
answer. We have no way of knowing who participated in
There may be no direct benefits to you as a participant
in this study. However, we hope to determine whether a
poor health care outcome or poor access to health care
is perceived by individuals to be due to their race,
ethnicity, religion, disability (excluding mental
disabilities), gender, language and other factors.
The Investigator is the owner of all data collected. You
are not required to answer all questions.
Your identity will be protected to the extent allowed by
law. You will not be personally identified in any
reports or publications that may result from this study.
For the online version of this survey, cookies will not
be placed on your computer. IP addresses will not be
stored, displayed or collected. Email addresses or
contact information will not be solicited, required or
requested. The server is owned by the Investigator. The
server resides behind a hardware based firewall. Access
to server requires username and a password
authentication and is periodically changed. After the
study concludes, the on-line surveys will be stored for
3 years after publication and remain in the possession
of the PI and then subsequently deleted.
Paper pencil surveys will not have any identifying
information and will be stored with the investigator.
You are not required to answer all questions. Data may
be shared with the investigator’s faculty advisor. After
the study concludes, the surveys will be stored for 3
years after publication and remain in the possession of
the investigator and then subsequently shredded.
There will be no cost to you nor will you be compensated
for participating in this study.
The University of Nevada may not provide compensation
or free medical care for an unanticipated injury
sustained as a result of participating in this research
RIGHT TO REFUSE OR WITHDRAW
You may refuse to participate or withdraw from the study
at anytime without penalty. There will be no negative
impact on your medical care or employment. If the study
design or use of the data is to be changed, you will be
so informed via an updated poster being placed at the
facility where you take the survey. You will be told of
any significant new findings developed during the course
of this study, which may relate to your willingness to
continue participation via poster notification at the
facility where you take the survey.
If you have any questions, please ask us. If you have
additional questions later, contact
(775) 784-1533 or email survey@PhysiciansLounge.com.
You may report (anonymously, if you so choose) any
complaints or comments regarding the manner in which
this study is being conducted to the University of
Nevada, Reno Social Behavioral Institutional Review
Board at (775) 327-2368 or by addressing a letter to the
Chair of the Board, c/o UNR Office of Human Research
Protection, 205 Ross Hall / 331, University of Nevada,
Reno, Reno, NV 89557.