Dear Research Participant:
You are being asked to participate in a research study. Before you
give your consent to volunteer, it is important that you read the
following information and ask as many questions as necessary to be
sure that you understand what you will be asked to do.
Investigators: Eric (Jeng-Liang)
Hwang, Ph.D., OTR/L, Research Supervisor and Asst. Professor,
Department of Occupational Therapy, California State University
Dominguez Hills, 310-423-2217
Irina Silchuk, OTS
Heidi Spearman, OTS
Tammy Useman, OTS
Purpose of the Study: The purpose
of this study is to determine whether the gender of the spousal
caregiver of a stroke survivor presents differences in the
perceptions of caregiver burden. The study will specifically seek to
learn if there a gender difference in the perceived burden of caring
for a spouse with a stroke; and if so, do male and female spousal
caregivers differ in what they perceive as contributing factors to
their burden.
Description of the Study: You will be asked to complete a survey by
checking your response in the appropriate box for each question
under the following categories: strongly disagree, disagree,
neutral, agree, and strongly agree. The information obtained from
these questionnaires will be used to determine if there is a
difference in perceived burden of caregivers by gender. If you
choose not to participate after completing the survey, you may
contact the researchers to have your survey excluded. In the
questionnaire you will be asked questions similar to the following:
• Caring for my spouse interferes with my social life.
• I feel that I lack the skills and knowledge to care for my spouse.
Risks or Discomforts: Because of the personal nature of the
questions that will be presented to you in the survey, you may
experience unpleasant memories. If you begin to feel uncomfortable,
you may discontinue participation at any time, either temporarily or
permanently. Your withdrawal will not affect your relationships with
the researchers, CSUDH, or your support group.
Benefits of the Study: The results of the research study may help
benefit the profession of occupational therapy by advancing
caregiving support services; there is no guarantee, however, that
you will directly receive any benefits from participating in this
study.
Confidentiality: The completed survey will be received in a secured
mail box, or retrieved from the on-line website and printed in a
private location by the researchers. Signatures and agreement on the
consent form will be kept strictly confidential and the survey
documents will be stored by the researchers in a locked safe. Only
the researchers will have a key and access to this information to be
used strictly for study purposes. Confidentiality will be maintained
to the extent allowed by law. These records will be kept for
approximately one year and destroyed (erased and shredded).
Incentives to Participate: None
Voluntary Nature of Participation: Participation in this study is
voluntary. Your choice of whether or not to participate will not
influence your future relations with California State University,
Dominguez Hills. If you decide to participate, you are free to
withdraw your consent and to stop your participation at any time
without penalty or loss of benefits to which you are entitled.
Questions about the Study: If you have any questions about this
study or your rights as a participant, you may call the investigator
Eric (Jeng-Liang) Hwang, Ph.D., OTR/L, 310-243-2217, or the
Institutional Review Board for the Protection of Human Subjects at
CSUDH, 310-243-3756.
By signing below or, if submitting electronically, clicking the
continue button, you are indicating that you have read the
information in this document and agree to be in the study. You are
also indicating that you have been told that you can change your
mind and withdraw your consent at any time and have been provided
with a copy of this consent form. By signing this consent form you
are not giving up any of your legal rights.
