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UNIVERSITY OF NEVADA, RENO
STATEMENT REGARDING RESEARCH STUDY

TITLE OF STUDY: Health Disparities and the Diverse Patient
INVESTIGATOR: 775-784-1533
PROTOCOL NUMBER: E04/05-090

PURPOSE
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.


PARTICIPANTS
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.

 

PROCEDURES

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.

 

RISKS
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 this survey.

 

BENEFITS
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.

 

CONFIDENTIALITY
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.

 

COSTS/COMPENSATION
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 study.

 

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.

 

QUESTIONS
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.

 

(May/12/2005 version.)

 

 


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