Focus Group/Interview consent form QA/QI projects – Sample

[UBC letterhead]

Optional: Letterhead of project lead’s department/unit

Project Title

Who is conducting the study?
[Name, title and contact information of project lead]

Who will be conducting and analysing the focus group/interview?
Focus groups/interviews will be conducted and analyzed by [Name, title and position of person in charge of conducting interviews/focus groups and analyzing the data].

Why are we conducting focus groups/interviews? [provide project description]
The goal of the focus group/interview is to [briefly and clearly explain why this is being done; what the goal of the study is]. Your participation and input during the focus group/interview will be used to [briefly and clearly describe what will be done with the data; what will be the output of the study; for example: “Anonymized data from this study may be published in academic research journals and may also be presented at scholarly conferences.”].

How is the study done?
[Name of person facilitating focus groups/interviews] will ask you and other focus group/interview participants a set of questions related to [topic for discussion during the session] and audio record the responses. The focus group/interview will take approximately [XX minutes] to complete. Your participation is voluntary and you may leave the focus group/interview at any time. Your responses will not impact your grade in the course and any identifying information that would compromise your anonymity will be removed from transcripts and reports. However, absolute anonymity cannot be guaranteed given that other focus group participants will be present [relevant for focus groups only]. Following the focus group/interview, you will have seven days to contact the facilitator to revise or omit anything you said.

What will happen to the data and study results?
Data will be securely stored on encrypted computers and shared between the researchers using a FIPPA and PIPEDA compliant (federal government mandated) tool. Instead of using names or any identifiable information (e.g. student numbers), codes will be used to protect the identity of the participants [if accurate]. The Principal Investigator will only have access to the anonymized data [if accurate]. The anonymized and analyzed results of this study will be available to participants and to the general public. The result may be shared via [what will be done with the results? What avenues of dissemination are you contemplating?] and contribute to improving the learning experience of future students. [If applicable] Aggregate data and/or anonymized quotes may also be shared publicly.

Questions?
If you have any questions or concerns, please contact [Name and contact information of person facilitating sessions]. You may choose to withdraw your participation at any time while the study is active without giving a reason and without any negative consequences.

Your signature indicates that you consent to participate in this study:

______________________________________    ______________
Participant Signature                                                                  Date
____________________________________________________
Printed Name of the Participant signing above