• CONSENT TO PARTICIPATE IN A RESEARCH STUDY

    Valparaiso University
  • TITLE OF STUDY 

    Assessing Knowledge Change after Completion of an Online Learning Module on Back Pain and Injury in Industrial Workers


    PRINCIPAL INVESTIGATOR/RESEARCHER

    Scarlet R. Spain

    College of Nursing and Health Professions

    836 Laporte Avenue, Valparaiso, IN 46383

    (219)741-2585

    scarletspainfnp@gmail.com

     

    SUMMARY 

    The project will include education regarding back pain and back pain prevention focused for workers in heavy industrial settings. The project will consist of a prerecorded online learning module and completion of an evaluation of the educational session. This project is only available for participant’s aged 18 years of age and above. Participants confirm that they are age 18 years and up by this signing consent. 


    PURPOSE OF STUDY 

    You are being asked to take part in a research study. You are being selected to participate based on self-designation of performing “heavy, industrial work.” Before you decide to participate in this study, it is important that you understand why the research is being done and what it will involve. Please read the following information carefully.  If anything is unclear or you need more information, please ask the researcher.


    The purpose of this study is to measure knowledge change after completion of an online module. 


    STUDY PROCEDURES OR STEPS

    - This study will consist of completing a consent and demographic form, viewing the online module, and completion of a post participation evaluation. 
    - Time required is approximately 1 hour, Scarlet R. Spain will keep data and may follow up after completion for 1 to 2 years. 
    - It is unknown how many participants will be in this study. 

    RISKS AND DISCOMFORTS

    There are no physical or other known risks to participating in the study.

     

    BENEFITS

    The information provided will provide current best practice evidence regarding back pain prevention for workers in heavy, industrial settings. 

     

    CONFIDENTIALITY 

    Although the information and answers I give will be used and reported by the Principal Investigator, my name and other facts that would identify me will be kept strictly confidential. I understand that Scarlet R. Spain may contact me in the future at the contact information given below to follow up on project outcomes. Data files and sensitive data be kept secure in an electronic environment in a secured electronic file that only the research team members have access to. Only the Principal Investigator and their collaborator(s) will have access to the data.

     

    FUTURE USE OF YOUR DATA

    Your data will be kept confidential as described above.  Your data will be used by the Principal Investigator and research team members or collaborators who are involved with this study.  This collaboration may include researchers outside of Valparaiso University. De-identified data from this study may be shared with the research community at large to advance science and health. We will remove or code any personal information that could identify you before files are shared with other researchers to ensure that, by current scientific standards and known methods, no one will be able to identify you from the information we share. Despite these measures, we cannot guarantee the anonymity of your personal data.


    If you do not agree with this use of your data, you may voluntarily withdraw from the study at any time.  

     

    CONTACT INFORMATION 

    If you have questions at any time about this study, or you experience adverse effects because of participating in this study, you may contact the researcher whose contact information is provided on the first page. If you have questions regarding your rights as a research participant, or if problems arise that you do not feel you can discuss with the principal investigator, please contact the Valparaiso University Institutional Review Board at valpoirb@valpo.edu or 219-464-5798. 


    VOLUNTARY PARTICIPATION

    Your participation in this study is voluntary. It is up to you to decide whether to participate in this study. If you decide to take part in this study, you will be asked to sign a consent form. After you sign the consent form, you are still free to withdraw at any time and without giving a reason. Withdrawing from this study will not affect your relationship with the researcher, if any. If you withdraw from the study before data collection is completed, your data will be returned to you or destroyed. You may decline to answer any or all questions and you may terminate your involvement at any time if you choose. Scarlet R. Spain may terminate participant’s participation if the participant is deemed not applicable to study due to job duties. Scarlet R. Spain may also terminate participant’s participation at any time if aggressive or condescending behavior is noted. 

     

    *Participants may obtain a copy of the consent form per formal request to Scarlet R. Spain.

  • CONSENT FORM


    CONSENT FOR PARTICIPATING IN THE RESEARCH STUDY

    I have read and I understand the information provided and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost.  I understand that I will be given a copy of this consent form.  I voluntarily agree to take part in this study. 

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  • Back Pain Online Learning Module Demographic Form

  • Please indicate job classification for STRENGTH LEVELS as listed below (as defined by U.S. Bureau of Labor Statistics (source: U.S. Bureau of Labor Statistics, (ND), Occupational requirements survey. https://www.bls.gov/ors/factsheet/strength.htm)

     

    * Duration levels are used to calculate the amount of time spent lifting or carrying. There are four duration
    levels in relation to a job’s workday schedule: seldom (up to 2 percent), occasional (2 percent to 1/3), frequent
    (1/3 to 2/3), and constant (2/3 or more).


    1.    Sedentary work (e.g minimal movement, minimal lifting etc)
    2.    Light work (e.g. occasional lifting 11-25 lbs, frequently 1-10 lbs)
    3.    Medium work (e.g. occasional lifting 26-50 lbs, frequently 11-25 lbs)
    4.    Heavy work (e.g. occasional lifting 51-100 lbs, frequently 26-50 lbs)
    5.    Very heavy work (e.g. occasional lifting >100 lbs,  frequently >50 lbs)

  • Back Pain Online Learning Module Presentation

  • Video Presentation

    Next, watch this entire educational video.

  • Back Pain Online Learning Module Evaluation Form

  • Rate each statement (Questions 1-20) from 1 to 5  using the scale: 

    1= strongly disagree

    2= disagree

    3= neutral

    4= agree

    5= strongly agree

  • Give a short response (Questions 11- 12).

  • Should be Empty: