SELF CONSENT

I have been invited to take part in a research study titled:   Exploring the impact of poorly managed chronic pain on the health and wellness of adults within the community setting

This study is being conducted by                    , who can be contacted at:

I understand that my participation is voluntary and that I can refuse to participate or stop taking part any time without giving any reason and without facing any penalty.  Additionally, I have the right to request the return, removal, or destruction of any information relating to me or my participation: SELF CONSENT.

PURPOSE OF STUDY

I understand that the purpose of the study is to:  Explore the impact of insufficient chronic pain management on the quality of life and mental wellness of adults within the community setting.

PROCEDURES

I understand that if I volunteer to take part in this study, I will be asked to:

• Provide information on my history of chronic pain and the measures taken to address the pain.
• Provide information on my healthcare-seeking behavior for the management of chronic pain.
• Provide information on the factors that may have been contributing to the poor management of chronic pain.
• Explain how chronic pain has affected my physical, social, and psychological wellness.

BENEFITS

I understand that the benefits I may gain from participation include:

• Contribute to the growing knowledge of quality improvement in chronic pain care. The insights obtained from my responses will be used to provide recommendations on improving the delivery of chronic pain care.
• Inform the need for addressing societal factors that play a role in poor management of pain. As Tata et al. (2024) report, a combination of environmental and personal factors interplays in poorly managed chronic pain. Personal factors, such as poor health literacy, alongside environmental factors, such as poor access to health care, are a reason for insufficient pain management for people living in remote areas.

RISKS

I understand that the risks, discomforts, or stresses I may face during participation include:

• Having to provide personal health information. Personal health information is one of the sensitive topics in the care environment and research. By accepting to participate in this study, I acknowledge that I will have to share information on my physical and psychological wellness with the investigator.
• Psychological distress that is related to having to give information on the perceived suffering and stress attributable to chronic pain. This may include emotions triggered by having to recount past experiences.

CONFIDENTIALITY

I understand that the only people who will know that I am a research subject are members of the research team.  No individually-identifiable information about me, or provided by me during the study will be shared with others except when necessary to protect the rights and welfare of myself and others (for example, if I am injured and need emergency care, if the provided information concerns suicide, homicide, or child abuse, or if revealing the information is required by law).

FURTHER QUESTIONS

I understand that any further questions that I have, now or during the course of the study can be directed to the researcher (                                                           ).

Additionally, I understand that questions or problems regarding my rights as a research participant can be addressed to Dr. Jessica Hillyer, Institutional Review Board Director of Compliance and Training, South University, 7700 W. Parmer Ln., Austin, TX 78729;

jhillyer@southuniversity.edu; 512-516-8779.

My signature below indicates that the researchers have satisfactorily answered all of my current questions about this study and that I understand the purpose, procedures, benefits, and risks described above.  I have also been offered a copy of this form to keep for my own records.

Participant Printed Name

 

Signature of Participant                                                                     Date (mm/dd/yyyy)

 

Signature of Principal Investigator                                        Date (mm/dd/yyyy)

References

Tata, T. K., Ohene, L. A., Dzansi, G. A., & Aziato, L. (2024). Factors influencing nurses’ pain assessment and management of road traffic casualties: A qualitative study at a military hospital in Ghana. BMC Emergency Medicine, 24(1). https://doi.org/10.1186/s12873-024-01016-8

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

I have been invited to take part in a research study titled:

This study is being conducted by_ j who can be contacted at:

I understand that my participation is voluntary and that I can refuse to participate or stop taking part any time without giving any reason and without facing any penalty. Additionally, I have the right to request the return, removal, or destruction of any information relating to me or my participation.

PURPOSE OF STUDY
I understand that the purpose of the study is to:

PROCEDURES
I understand that if I volunteer to take part in this study, I will be asked to:

BENEFITS
I understand that the benefits I may gain from participation include:

RISKS
I understand that the risks, discomforts, or stresses I may face during participation include:

CONFIDENTIALITY
I understand that the only people who will know that I am a research subject are members of the research team. No individually–identifiable Information about me, or provided by me during the study will be shared with others except when necessary to protect the rights and welfare of myself and others (for example, if I am Injured and need emergency care, if the provided information concerns suicide, homicide, or child abuse, or if revealing the Information is required by law).

FURTHER QUESTIONS
I understand that anyfurther questions that I have, now or during the course of the study can be

directed to the researcher (	)
Additionally, I understand that questions or problems regarding my rights as a research participant
can be addressed to Dr. Training,	‘Institutional Review Board Director of Compliance and

My signature below indicates that the researchers have satisfactorily answered all of my current questions about this study and that I understand the purpose, procedures, benefits, and risks described above. I have also been offered a copy of this form to keep for my own records.

Participant Printed Name

Signature of Participant Date (mm/dd/^XKJ

Signature of Principal Investigator Date {mm/dd / yxyy)