? 
Informed Consent Agreement
Please read this
consent agreement carefully before you decide to participate in the study.
Purpose of the
research study: The
object of this study is to establish the community needs of the Tibetan refugee
population in urban and rural refugee centers with regard to tuberculosis, a
disease that has a very high incidence among Tibetans.
What you will do in
the study: You
will be answering a series of basic questions on tuberculosis and its place in
your Center. These questions will test your general knowledge of the disease,
the community role in control and treatment of the disease, etc. The questions
will not be extremely personal or risky; however, it will ask you if you are
currently diagnosed with TB. Therefore, if at any time you feel uncomfortable
with the question, you can skip the question or stop the interview/survey. You
will not be photographed, videotaped, audio-taped, or identified in any form.
We request your age, gender, and place of birth; however, if you do not feel
comfortable giving out that information, you may opt to not answer.
Time required: The study will
require about 20 minutes of your time.
Risks: There are no anticipated
risks in this study.
Benefits: There are no direct benefits to you for participating
in this research study. The study may
help us understand the challenges that face your community in combating
tuberculosis. Through this, we hope to derive a list of most important needs of
your community as groundwork for possible future endeavors to assist the
community with these initiatives.
Confidentiality:
Participants
will not be required to give their name or any other identifying information.
Participants can even opt out of giving their age, gender, and birthplace
(India, Tibet, Nepal, other) information, although they will be requested to
offer this information. Participants will be a part of one-on-one confidential
interview with the principal investigator, who will be the only one that will
ever have access to the raw data. Participants will not be tagged for later
identification in any way, and there will be no video recordings, audio
recordings, or any other purposeful method of identification.
The
information that you give in the study will be anonymous. Your name will not be collected or linked to
the data.
Voluntary
participation: Your
participation in the study is completely voluntary.
Right to withdraw
from the study: You
have the right to withdraw from the study at any time without penalty.
How to withdraw from
the study:
If
you want to withdraw from the study, you may tell the interviewer to stop the
interview and destroy the notes that have already been taken. If you feel
uncomfortable with the survey and wish to withdraw it, you may let the
investigator know your wishes, and the investigator will destroy the survey in
front of you. Please let the investigator know of your withdrawal instead of
simply not turning in the survey.
Payment: You will receive no
payment for participating in the study.