Informed Consent

San Francisco State University

Inform ed Consent to Participate in Research

(WOMEN’S PERCEIVED SUPPORT COMPARED WITH WEIGHT LOSS BEHAVIOR CHANGES (DIET AND ACTIVITY))

A. PU RPO SE AND BACK GROU ND

The purpose o f this research is to learn more about the social support Bay Area women perceive along with behavior changes being made for weight loss. The researcher, Alicia C onnor, is a graduate student at San Francisco State University conducting research for a m aster’s degree thesis in the Consumer and Family Studies/ Dietetics Departm ent. You are being asked to participate in this study because you are a resident o f the Bay Area and are a woman in the age range o f 25-45 years old, premenopausal, overweight, and either you have recently lost weight or currently would like to lose weight.

B. PRO CED URES

If you agree to participate in this research, the following will occur:

• The focus group will take place in a designated classroom in Burk Hall at San Francisco State University.

• There will be 6-10 women in each focus group.

• The focus group sessions will take place June 3rd-5th either 12-2pm o r 6 -8 p m or June 6lh from 12-2pm.

• You will be volunteering for one focus group session.

• You will fill out a questionnaire that will take approxim ately 5-10 minutes about behavior changes you are currently making for weight loss o r weight maintenance. The attached questionnaire contains questions about eating and activity behaviors as well as personal information.

• You will participate in a group discussion about social support you have experienced for weight loss or weight maintenance; the discussion will take approximately 60 minutes.

• Halfway through the discussion you will be asked if you want a 5-minute break. • The researcher’s advisor will be taking notes during the discussion.

• The focus group will be audio recorded to ensure accuracy in reporting your statements. • After the discussion, a raffle drawing will take place for 2 gift cards worth $25 each. • If you did not win the raffle you will be offered a healthy cooking resource. • Total time comm itm ent will be no longer than 2 hours.

C. R IS K S

• There is a risk o f loss o f privacy. However, no names or identities will be used in any published reports o f the research. Only the researcher and faculty advisor will have access to the research data. There is a risk o f discomfort or anxiety due to the nature o f the questions asked; however, you may answ er only those questions you choose to answer, and may stop participation in the research at any time. The researcher will begin the focus group by asking each participant to verbally agree to the importance o f privacy and that the information discussed during the focus group will remain confidential and will not be discussed outside o f the room. You will be offered a handout with contact information for counseling services in San Francisco.

D. CO NFID EN TIA LITY

The research data will be locked safely in the faculty advisor’s file cabinet on campus and only the researcher, the researcher’s advisor, and the transcriber o f the audio recordings will have access to the data Data collected will not include your name, but number identifiers instead. The audio recordings.

Research Title: (WOMEN'S PERCEIVED SUPPORT COMPARED WITH WEIGHT LOSS BEHAVIOR CHANGES (DIET AND ACTIVITY))

Researcher's Name: Alicia Connor

questionnaires, signed consent forms, and other documents will be stored at least three years after the research study has ended. Information related to the research will be stored in encrypted files on a com puter at San Francisco State University to further protect the data.

E. D IR E C T B E N E F IT S

There will be no direct benefits to you. F. C O S T S

There will be no cost to you for participating in this research. G . C O M P E N S A T IO N

At the end o f the focus group session, you will be entered in a raffle. The prizes include tw o (2) $25 gift cards. At the end o f each focus group the names o f the participants will be included in a drawing and a third party will be responsible for drawing the two winning names and the gift cards will be handed out before the participants leave. For the rest o f the participants that did not get a gift card, they may pick out a healthy cooking resource that was donated.

H. A L T E R N A T IV E S

The alternative is not to participate in the research. L. Q U E S T IO N S

You have spoken with Alicia Connor, about this study and have had your questions answered. If you have any further questions about the study, you may contact the researcher by email at aconnor@ sfsu.edu or you may contact the researcher’s advisor. Professor Gretchen G eorge at glgeorge@ sfsu.edu.

Questions about your rights as a study participant, or comm ents or com plaints about the study, may also be addressed to the Human and Animal Protections at (415) 338-1093 or protocol@ sfsu.edu.

J. C O N S E N T

You have been given a copy o f this consent form to keep.

PARTIC IPA TIO N IN THIS RESEARCH IS VO LUN TARY . You are free to decline to participate in this research, or to withdraw your participation at any point, without penalty. Your decision whether or not to participate in this research will have no influence on you r present or future status at San Francisco State University.

S ig n a tu re ____________________________________ D a te :______ Research Participant

S ig n atu re ____________________________________ D a te :______ Researcher