California State University Fullerton

Research Study Consent Form
Study Title: Examining Students Experiences Serving as Physical Activity Coaches
Protocol Number:   HSR-18-19-116
Researchers:   Kathleen S. Wilson, Department of Kinesiology, 657-278-8329, kswilson@fullerton.edu

You are being asked to take part in a research study carried out by Dr. Kathleen Wilson, a faculty member in the Department of Kinesiology. This consent form explains the research study and your part in it if you decide to join the study.  Please read the form carefully, taking as much time as you need.  Ask the researcher to explain anything you don’t understand via phone or email listed above. You can decide not to join the study. If you join the study, you can change your mind later or quit at any time by not submitting the questionnaire.  There will be no penalty or loss of services or benefits if you decide to not take part in the study. 
 
What is this study about? 
This research study is being conducted to explore the effects of Kinesiology students promoting physical activity in the local parks. Kinesiology students are at various parks talking with residents about physical activity. We are seeking input from residents on their experience with our students.  
 
You are being asked to take part because you have talked with one of our Kinesiology students at a park.  Taking part in the study will take about 5-10 minutes of your time by completing a brief questionnaire.  You cannot take part in this study if you are under 18 years of age.  
 
What will I be asked to do if I am in this study? 
If you take part in the study, you will be asked to complete a brief questionnaire about your experiences talking with our students. This questionnaire will take you about 5-10 minutes to complete. You are asked to mail the questionnaire in the attached stamped envelope or complete an online version of the questionnaire. You can also return it to our students at the parks in a sealed envelope. You will be asked questions about your interaction with our students, as well as thoughts and behaviors about health and physical activity.
 
Are there any benefits to me if I am in this study?
 There is no direct benefit to you from being in this study. Your participation in this study will help us evaluate and improve our students’ experiences in the park and may help others in the future. 
 
Are there any risks to me if I am in this study?
 The potential risks from taking part in this study are possible discomfort from answering some questions. If this does occur, please feel free to skip any questions that make you feel uncomfortable.

Will my information be kept anonymous or confidential?
The data for this study are being collected anonymously.  Neither the researcher(s) nor anyone else will be able to link data to you. The results of this study may be published or presented at professional meetings, but the identities of all research participants will remain anonymous
 
The data for this study will be kept for a minimum of 3 years after the completion of the study. However, the data may be kept indefinitely to allow for future publications evaluating this program over time and future educational use such as an example dataset for classes.
 
Are there any costs or payments for being in this study?
 There will be no costs to you for taking part in this study.
 You will not receive money or any other form of compensation for taking part in this study.
 
Who can I talk to if I have questions?
 If you have questions about this study or the information in this form, please contact the researcher, Dr. Kathleen Wilson, kswilson@fullerton.edu, 657-278-8329. If you have questions about your rights as a research participant, or would like to report a concern or complaint about this study, please contact the Institutional Review Board at 657-278-7719, or e-mail irb@fullerton.edu
 
What are my rights as a research study volunteer?
 Your participation in this research study is completely voluntary.  You may choose not to be a part of this study.  There will be no penalty to you if you choose not to take part.  You may choose not to answer specific questions or to stop participating at any time. 
 
What does submitting the questionnaire attached to this consent form mean?
 Your submission of the questionnaire (online or by mail) means that:
  • You understand the information given to you in this form
  • You have been able to ask the researcher questions and state any concerns via phone or email provided
  • The researcher has responded to your questions and concerns
  • You believe you understand the research study and the potential benefits and risks that are involved.
 
Statement of Consent
I have carefully read and/or I have had the terms used in this consent form and their significance explained to me.  By returning the questionnaire including with this form by mail or online, I agree that I am at least 18 years of age and agree to participate in this project.  I may keep this copy of the consent form.