Appendix 3: Informed Consent Form
The Informed Consent Form, used to recruit individual interview
and focus group participants, was approved by the Research and Ethics Committee
of the Montreal General Hospital, MUHC.
Health Education Project: Needs
- Linda Shohet, Principal investigator, Director, The Centre
for Literacy of Québec
- Denise Malo, Co-investigator, Montreal General Hospital
- Odette Langlais, Principal researcher
Health Canada has provided financial support for
We are a doing a study to improve health
education for patients at the Montreal General Hospital. We would like to
invite you to participate in this study. Your ideas about the kind of health
information that is given to patients will be very helpful to us. You can help
us understand how we can improve health education for patients.
This is a project of the Montreal General Hospital and The
Centre for Literacy of Québec. To improve patient education at the
hospital, we want to set up a Health Education Centre. This Centre will inform
patients and their families about their health and healthcare. It will:
- Give information and all kinds of classes and teaching for
patients and their families;
- Help health care workers communicate better with patients;
- Collect and give out information and findings about health
The first phase of the project is the Needs Assessment. Three
units in the hospital are participating: Dialysis, Pre-op Centre and Oncology
Hematology. We want to ask patients, caregivers, health care workers and
support staff about the health education needs of patients. We also want to ask
health care workers what are their needs as educators.
You are completely free to
participate or not. If you refuse to participate or decide to leave the study,
this will not affect in any way your health care or your benefits. We invite
you to participate in:
- An individual interview. You will spend about 30 minutes
with the researcher (only once). They will ask you about what you need in terms
of health information and health education. They will write down the answers.
AND / OR
- A small-group discussion of about one hour. You will discuss
patient health education with others.
your answers to the questions and what you say during the discussion is
strictly confidential. We will not write down your name on the questionnaire.
We will keep records in a safe location. The researcher will ask you questions
and collect information. He or she will not be able to help you with your
current health needs. If information is given to the researcher that should be
communicated to the health care worker (important information for the patient's
health), then verbal consent will be obtained from the patient or the caregiver
to communicate this to the health worker. The Research Ethic Committee of the
Montreal General Hospital may look at research records from this study. This is
to verify that the research is done in agreement with Montreal General Hospital
and the Montreal General Hospital Research regulations for research involving
Risks and Potential Benefits
There are no foreseen
risks for you to participate in this study. There are no immediate benefits
either. However, we hope to improve the way information is provided to patients
at the hospital in the medium to long term.
There is no compensation offered for
your participation in this study.
If you have questions about your
rights as a participant in this study, please contact Mr. Glen Fash, the
Representative of the Patient's Committee at (514) 937-6011, ext.2409. If you
have any questions regarding your participation in this research study, you
should contact Linda Shohet, principal investigator, Director, Centre for
Literacy of Québec at (514) 931-8731, ext.1411; Denise Malo,
co-investigator, Montreal General Hospital at (514) 937-6011, ext.4183; or
Odette Langlais, principal researcher, at (819) 827-9124.
A Steering Committee looks after this project. It is composed
of hospital staff, patient representatives, the Director of The Centre for
Literacy and a person from Health Canada. The Steering Committee has hired two
researchers to do the Needs Assessment: Odette Langlais and Charles Draper.
understand the information in this form.
I was able to ask questions and I
am satisfied with the answers.
I agree to participate in the Needs
I have been given a signed copy of the consent form.
not give up any of my legal rights by signing this form.
|Signed by Participant
|Signed by Researcher
| Signed by Witness/Translator