Site Consent Form
**The purpose of this consent form is to request approval to contact and recruit early intervention occupational therapists within your organization in order to conduct the research described below.
Title of Research: Early Intervention and Nutrition Education: Occupational Therapists’ Perspective
IRB#: 828691-1
Principal Investigator(s): Erin Horting B.S., MOTS, Caitlin Moffit B.S., MOTS, Jordan Nowacki B.S., MOTS
Purpose of Research:
The purpose of this study is to investigate occupational therapists’ knowledge about nutrition. Also, the aim of the research is to determine how nutritional information is used within feeding and mealtime within early intervention treatment plans.
Procedures:
Initial data for this research will be collected using the online survey monkey tool. Once participants have completed the survey, their answers will be analyzed. Statistical tests will be performed to determine both common answers and correlation between questions. Survey responses will then be used to guide a focus group on the research topic.
Risks, Benefits, and Compensation:
No risks are anticipated from participating in this study. There are no benefits for participating in this study nor is there any compensation for participating in this study.
Confidentiality:
Participation in this study is anonymous, and no identifying information will be gathered about participants. If participants share any personally identifying information in an open-ended question, it will be kept confidential based on the discretion of the researchers. The results of this research will be published in the form of a graduate paper and will be presented at Elizabethtown College. Additionally, the research may be published in a professional journal or presented at professional meetings. Participating in this study is strictly voluntary. Refusal to participate will involve no penalty. Participants can withdraw from the study at any time.
Contacts and Questions:
If participants have any questions concerning the research project, they may contact (Erin Horting at ; Caitlin Moffit at ; Jordan Nowacki at ; Kerri Hample ). Should participants have any questions about their rights as a participant in this research, they may contact the Elizabethtown College Institutional Review Board at (717) 361-3740 or the IRB submission coordinator at .
Statement of Consent:
I am in the position of authority to approve this study
I have read the above information. I have asked questions and received answers. My organization is willing to participate in this study.
A copy of this consent form has been provided to me.
Name of Site ______
Site Representative Name (Printed) ______Date ______
Site Representative Signature ______Date ______
Investigator Signature______Date ______