APPENDIX A Informed Consent Form

IRB# 664282-V4- March 2017 March 2017

Dear Parents,

We are conducting a study involving the impact of family and day camp on your child’s motivation to manage his or her diabetes. To conduct this study we need the participation of youth that are involved with diabetes camp for the summer of 2017. The attached

“Consent/Permission for Child’s Participation” form describes the study and asks your permission for you and your child to participate.

Please carefully read the attached “Consent/Permission for Child’s Participation” form. It provides important information for you and your child. If you have any questions pertaining to the attached form or to the research study, please feel free to contact Dr. Eddie Hill at the number below.

After reviewing the attached information, please return a signed copy (at camp) or with your application of the “Consent/ Permission for Child’s Participation” form to Dr. Eddie Hill or your child’s camp counselor if you (and your child) are willing to participate in the study. Additional copies of the form for your records will be available at camp. Even when you give consent, your child will be able to participate only if he/she is willing to do so.

We thank you in advance for taking the time to consider you and your child’s participation in this study.

Sincerely, Eddie Hill

Dr. Eddie Hill, CPRP Assistant Professor Old Dominion University

Human Movement Sciences Dept.

Student Recreation Center, Room 2019 Norfolk, Va 23529-0196 Ph - 757-683-4881 Fx - 757-683-4270 [email protected] http://www.odu.edu/~ehill www.odu.edu/recreation IRB# 664282-V4- March 2017 CONSENT/PERMISSION FOR CHILD’S PARTICIPATION DOCUMENT

The purposes of this form are to provide information that may affect decisions regarding you and your child’s participation and to record the consent of those who are willing to participate in this study.

TITLE OF RESEARCH: Motivation for Diabetes Management in a Recreation Setting: Examining the Impact of Family Camp

RESEARCHER: Dr. Eddie Hill (Responsible Project Investigator), Assistant Professor, Old Dominion University

Takeyra Collins, Doctoral Student, Old Dominion University DESCRIPTION OF RESEARCH STUDY: Diabetes camps have long been considered beneficial to participants. The camp experience also allowed youth to meet others who are coping with the similar daily struggles. Camp offers adolescents the opportunities to share common experiences, form meaningful friendships, and make decisions about behaviors that impact their diabetes. Through this study, we hope to determine the role that motivation plays in diabetes management at family residential and day camps.

If you decide to participate in this study, you will be asked to complete a 5-10 minute survey twice and your child three times. Parents will be asked to complete this survey once while at camp and once by mail/on-line. Approximately 100 campers will be asked to complete this survey twice while at camp and once by mail/on-line. Your and your child’s participation will take approximately 20 minutes of your time.

EXCLUSIONARY CRITERIA: In order for your child to participate in this study, your child must be diagnosed with diabetes and participated in diabetes camp during 2017.

RISKS: There could be a risk of loss of confidentiality and distress in responding to the surveys as items are brought up for consideration. There will be camp counselors available to address any distress or concerns that the participants may express.

BENEFITS: There are no direct benefits to your child for participating in this study. However, the main benefit to you is that you will receive a summary of results about how camp impacts motivation of diabetes management.

COSTS AND PAYMENTS: The researcher are unable to give you or your child any payment for participating in this study.

NEW INFORMATION: You will be contacted if new information is discovered that would reasonably change your decision about your or your child’s participation in this study.

CONFIDENTIALITY: Participants will be assigned a code number so that your child’s name will not be attached to his or her responses. Only researcher involved in the study or in a professional review of the study will have access to data sheets. All data and participant information will be kept in a locked and secure location.

WITHDRAWAL PRIVILEGE: Your and your child’s participation in this study is completely voluntary. It is all right to refuse your and your child’s participation. Even if you agree now, you and your child may withdraw from the study at any time, but still, remain at camp. In addition, your child may withdraw at any time if he or she so chooses.

COMPENSATION FOR ILLNESS AND INJURY: Agreeing to your and your child’s participation does not waive any of your legal rights. However, in the event of harm arising from this study, neither Old Dominion University nor the researcher are able to give you any money, insurance coverage, free medical care, or any other compensation. In the event that your child suffers harm as a result of participation in this research project, you may contact Dr. Eddie Hill at (757) 683-4881 or Dr. Tancy Vandecar-Burdin, Chair of the Institutional Review Board at (757) 683-3802.

VOLUNTARY CONSENT: By signing this form, you are saying 1) that you have read this form or have had it read to you, and 2) that you are satisfied you understand this form, the research study, and its risks and benefits. The researcher will be happy to answer any questions you have about the research. If you have any questions, please feel free to contact Dr. Eddie Hill at (757) 683-4881 or Dr. Tancy Vandecar-Burdin, at (757) 683-3802.

If at any time you [or your child] feel pressured to participate, or if you have any questions about your rights or this form, please call the Old Dominion University Office of Research (757-683- 3460).

Note: By signing below, you are telling the researcher YES, that you [and will allow your child] to participate in this study. Please keep one copy of this form for your records. Your child’s name (please print): ______________________________

Your name (please print): ______________________________

Relationship to child (please check one): Parent: _____ Legal Guardian: ____ Your Signature: ______________________________

Date: ______________________________

INVESTIGATOR’S STATEMENT: I certify that this form includes all information concerning the study relevant to the protection of the rights of the participants, including the nature and purpose of this research, benefits, risks, costs, and any experimental procedures. I have described the rights and protections afforded to human research participants and have done nothing to pressure, coerce, or falsely entice the parent to allowing this child to participate. I am available to answer the parent’s questions and have encouraged him/her to ask additional questions at any time during the course of the study.

APPENDIX B

RASP-M Parent Version (Pre-test)

The following items relate to your opinions of your child and his/her personal characteristics. Please read each statement and indicate the extent to which you agree or disagree with each one. There are no right or wrong answers, so please be as honest as possible!

MY CHILD…