Long COVID Survey Informed Consent

Paige Haberkorn

Informed Consent Form

Exploring Vocational Rehabilitation Professionals beliefs about Long COVID IRB NCR224526

Principal Investigator: Dr. Kenneth C. Hergenrather, CRC
(202) 994-1334
Sponsor: U.S. Department of Education

Introduction

Dr. Kenneth Hergenrather CRC of the George Washington University (GW) Center for Rehabilitation Counseling Research and Education (CRCRE) invites you to participate in a web-based electronic anonymous research survey in a research survey study. It is funded by the U.S. Department of Education Rehabilitation Services Administration. You are being asked if you want to take part in this study because you are a vocational rehabilitation professional who voluntarily signed up for the GW CRCRE Center for Innovative Training in Vocational Rehabilitation (CIT-VR) email listing. Please read this form and ask me any questions that will help you decide if you want to be in the research study. Taking part is in this study by completing the survey is completely voluntary and even if you decide you want to, you can quit at any time. Your decision to take part, withdraw, or not take part, in this survey research study will not affect the services or benefits provided to you by the George Washington University, the Center for Rehabilitation Counseling Research and Education, or the Center for Innovative Training in Vocational Rehabilitation You must be at least 18 years old to take part in this study.

Purpose

The research study is a survey from which to explore Vocational Rehabilitation Professionals’ beliefs about Long Covid. The information will be used to inform Vocational Rehabilitation Professional practice through preparing manuscripts and proposals to be submitted to professional vocational rehabilitation journals and conferences.

Procedures

The total amount of time you will spend in this study is 20 minutes once you have accessed the survey. Any information obtained in connection with this research study will remain anonymous, meaning that no one will be able to identify your responses as yours.

Risks and Confidentiality

The study has the following risks:

  • You may feel some emotional stress/discomfort answering the survey questions.
  • You are free to skip any questions or stop taking the survey at any point.
  • If you feel the need to talk to someone about the emotions you are feeling while completing the survey, please contact Dr. Kenneth Hergenrather (email: hergenkc@gwu.edu | phone: (202) 994-1334) who will provide you with contact information of professional services.
  • Information about Long COVID can be located on the Centers for Disease Control and Prevention website.

There is a small chance that someone not on our research team could find out that you took part in the study or somehow connect your name with the information we collect about you, however the following steps are being taken to reduce this risk: the survey is anonymous, identifiable data is not collected, all data will be destroyed at the end of the study period on 31 March 2024.

The records of this study will be kept private. In any published articles or presentations, we will not include any information that will make it possible to identify you as a subject. Your unidentifiable survey responses for the study may be reviewed by the U.S. Department of Education Rehabilitation Services Administration and by departments of the University responsible for overseeing research safety and compliance.

Benefits

Taking part in this research will not help you directly, however the benefit to society will be a better understanding of the vocational rehabilitation professionals’ beliefs toward Long COVID.

Compensation

Completing the survey is required to receive 1 continuing education unit (CUE) from the Commission on Rehabilitation Counseling Certification and to enter a drawing for a $75 Amazon gift card.

When you have completed the survey, you will find a link to click on to go to another page to provide your information to receive 1 CRC CEU and a link to enter your email address in the drawing for a $75 Amazon gift card.

Questions

Talk to the research team if you have questions, concerns, complaints, or think you have been harmed. You can contact the Principal Investigator listed on the front of this form at (202) 994-1334. For questions regarding your rights as a participant in human research call the GWU Office of Human Research at 202-994-2715.

Documentation of Consent

Your consent is implied if you proceed with the survey.
Complete the Long COVID Survey