Consent information for eligibility & full questionnaire
We ask that you read this form and ask any questions you may have before agreeing to take the eligibility survey.
What the project is about: The purpose of this research project is to learn more about how people recover from self-injury.
What we will ask you to do: We will first ask you to answer a few background and demographic questions to determine if you are eligible to participate in the full survey. If you are determined to be eligible to participate you will be directed to the second part of the survey. Here you will be presented with several statements related to self-injury behavior. We will ask you to rate these statements based on your experience with self-injury.
Risks and benefits of participating in the research project: Self-injury is a topic that people often find
difficult to talk about. This survey will explore sensitive issues that may cause negative thoughts or feelings for you. Please keep in mind, you may choose to not answer a question or questions and may stop the survey at any time. In addition, we will also provide you with a list of resources to save at the end of the survey. There are no direct personal benefits to participating in this study. However, your involvement is part of a larger research study which will contribute to a greater understanding of how individuals recovery from self-injury. In addition, findings from this research will help guide the
development of practices for treatment providers.
Taking part is voluntary: Taking part in this eligibility survey is voluntary.
Your responses are confidential: The records of this project will be kept private, including your responses to eligibility questions within this survey.
Compensation: Those who are eligible and who agree to participate in the survey will receive a $7.00
“thank you” gift. In order to receive this compensation you must submit your e-mail at the end of the survey. There is no other contact information requested in this survey, and we will only use the e-mail to send the compensation and will delete it immediately after this is sent.
Length of time to complete survey/s: The eligibility portion of this survey will take less than 5 minutes to complete and will ask demographic and screening questions to determine your eligibility to participate in the full survey. If eligible, the second part of the survey will take 15-30 minutes to complete.
If you have questions: Please ask any questions you have now, before you indicate your consent to participate. You can reach the study coordinator, Kaylee Kruzan, at firstname.lastname@example.org or the Cornell Research Program for Self-injury and Recovery staff at 607- 255-6179. If you have questions later, you may contact the Cornell University researcher responsible for this project, Janis Whitlock, by email at email@example.com or by calling 607-254- 2894. If you have any questions or concerns regarding your rights as a participant in this study, you may contact the Institutional Review Board (IRB) at (firstname.lastname@example.org) or 607-255-5138 or access their website at http://www.irb.cornell.edu. You may also report your concerns or complaints anonymously through Ethicspoint (www.hotline.cornell.edu) or by calling toll free at 1-866-293-3077. Ethicspoint is an independent organization that serves as a liaison between the University and the person bringing the complaint so that anonymity can be ensured.
Please note: By hitting on the "I consent" button below you are indicating your consent to take this survey.
Statement of Consent: If you agree to participate in this survey, please indicate this below: