Informed Consent
You are invited to participate in a research study conducted by Rebecca Linger, Ph.D., from the University of Charleston School of Pharmacy in collaboration with the West Virginia Drug Intervention Institute. We hope to learn the perceptions individuals hold about medication safety and perceived stigmas towards substance misuse. You were selected as a possible participant in this study because you are a university student in West Virginia.
If you decide to participate, you will receive education on the SmartRx University program. As part of this education, you will be given a pre-education event survey to establish your baseline beliefs regarding medication safety and substance misuse. At the end of the education event, you will be given a post-survey to determine if your attitudes and beliefs have altered due to your participation.
There are no significant risks to you by participating in our survey, however, some questions may cause you to remember unpleasant events in your past. The data we obtain will help us to revise our education program and allow us to present the issues facing today’s university students regarding medication safety and substance misuses. However, I cannot guarantee that you personally will receive any benefits from this research.
Any information that is obtained in connection with this study that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. Subject identities will be kept confidential by downloading the survey information with the identity code that is assigned in our learning management system. No other disclosure of your personal information will be done by this project.
Your participation is voluntary. Your decision whether or not to participate will not affect your relationship with your university. If you decide to participate, you are free to withdraw your consent and discontinue participation at any time without penalty.
Propriety Information and Material Clause
By participating in this training, you agree to practice confidentiality and nondisclosure of the program. You hereby acknowledge and agree to the following:
- Not use, disclose, or in any way reveal or disseminate to unauthorized parties or individuals any information about the program materials or documents, technology or software, or the delivery mechanisms (in person or virtually) used with the SmartRx University Medication Safety and Responsibility Program.
- Not to share any of the program’s intellectual property (i.e.: the creations of the mind, any literary or artistic works or designs).
- Not to divulge trade or technology secrets of the SmartRx University Medication Safety and Responsibility Program.
- Not to share the SmartRx University Medication Safety and Responsibility Program, in part or in whole, without the consent of the WV DII.
- Only use the materials, documents, and information of the SmartRx University Medication Safety and Responsibility Program under the direction of the WV DII.
If you have questions regarding your rights as a research subject, contact Dr. Rebecca Linger, Chair, University of Charleston, Institutional Review Board, phone, 304-357-4998; email: [email protected].
By agreeing to the terms and conditions and participating in this program, I confirm that I have read and understood the information provided above. I willingly agree to participate and may withdraw my consent at any time and discontinue participation without penalty. I also understand that I may receive a copy of this informed consent upon request.