Please read the following information concerning the study to be conducted.
I agree to participate voluntarily in a study being conducted by Teodora Pavlovic, Lisa Mask, Ph.D., and Fuschia M. Sirois, Ph.D. of the Department of Psychology at Bishop’s University, in Lennoxville, Québec. This research is made in fulfillment of the Psychology Honors Program of Bishop’s University.
The purpose of the study is to examine the relationship between men’s physical self-perceptions, their personality, and their health and well-being. As a participant in this study, I will be asked to complete an anonymous online survey that includes general questions about myself, my attitudes, how I feel about my body, and my well-being. Participation in this research requires only one testing session in which I am asked to complete an online survey. The survey will take approximately 30 to 45 minutes to complete, although individual completion times may vary according to computer systems. After submitting my survey, I will be given the option to enter in a draw for one of three prepaid 50$ Visa cards. If I choose to enter the draw I will have to send an email to the researchers following the instructions outlined at the end of the survey. Should I choose to enter the draw, the e-mail I will provide will not be linked to my survey.
I am aware at all times that my participation in this research project is completely voluntary. I do not have to respond to any questions that make me uncomfortable. I also have the right to withdraw from this project, at any time without incurring any negative consequences before I click the “Submit Survey” button at the end of the survey.
Several steps will be taken to ensure the confidentiality of the survey data submitted. All incoming surveys will be stored on a secure server and will only be accessible to the researchers. The electronic data file will be stored on a password protected computer in the Health and Well-Being Laboratory at Bishop’s University to ensure privacy.
The time and date of submission will be the only identyfing information attached to the survey. Such information is used solely for the purpose of excluding duplicate submissions. All data collected will be kept strictly confidential and is the property of the researchers and will be used strictly for the above-mentioned project. However, the data from this project may also be used by the researchers for subsequent studies, but only after receiving approval from the Research Ethics Board of Bishop’s University.
I am also aware that the data collected for this research is anonymous. The information collected over the course of this research project may be published in scientific/academic journals or shared with other persons during scientific discussions. However, any reports of this study will contain information that reflects group results and not information about specific individuals. If I wish to receive a copy of the results when available, I may contact the researchers below. The data will be retained for a period of 5 years in the Health and Well-Being Lab following its publication as per the guidelines set forth by the Canadian and American Psychological Associations. After this time period, the data will be disposed of in a secure manner (e.g. electronically deleted).
The potential risks and inconveniences associated with participating in the study are minimal. It is possible that some individuals might feel some mild discomfort, sadness or anger when completing the survey as some of the questions can be quite personal. However, I do not have to answer any question with which I am not comfortable and I may withdraw from the study at any time prior to clicking the “submit survey” button. In the event that I experience some mild loss in self-esteem and wish to discuss these issues further, a list of local and provincial resources will be provided at the end of the survey.
The potential direct benefits from my participation in this study are that I may gain insight on my physical self-perceptions and how they relate to my personality and my health and well-being. The results of this study will also advance knowledge given that this field of study is fairly recent.
Teodora Pavlovic can be reached at firstname.lastname@example.org. Dr. Lisa Mask can be reached at 819-822-9600, ext. 2843, or by email at email@example.com. Dr. Sirois can be reached at (819) 822-9600, ext.2790 or by email at firstname.lastname@example.org. The University’s Research Ethics Board approved this project on January 17th, 2014. If participants have any concerns regarding this project, they may contact Dr. Andrea Drumheller, Chair of the Research Ethics Board for Undergraduate Students, at 819-822-9600, ext. 2442, or by e-mail at email@example.com, or Dr. Miles Turnbull, Vice-Principal Academic at 819-822-9600, ext. 2227, or by e-mail at firstname.lastname@example.org.
I agree to participate in this project and have made this decision based on the information I have received about it. I have read and understand the terms of the present consent form and I accept its stipulations. I understand that by completing and submitting this electronic survey I am giving my consent to participate in this study according to the terms outlined above.
Please print a copy of this page for your personal records.