Informed Consent

PROJECT TITLE

Just-in-Time Incentives (JITI) to Promote Fruit and Vegetable Redemption among WIC Participants

INTRODUCTION

The purpose of this form is to give you information that may affect your decision of whether to say YES or NO to participation in this research, and to record the consent of those who say YES. This experiment is a part of the study of Just-in-Time Incentives (JITI) to Promote Fruit and Vegetable Redemption among WIC Participants.

RESPONSIBLE PROJECT INVESTIGATORS

  • Qi Zhang, Ph.D., Associate Professor, School of Community and Environmental Health

DESCRIPTION OF RESEARCH STUDY

The purpose of this study is to test the effectiveness of sending text messages to participating families of the WIC program, to determine if these messages would change their redemption behaviors of WIC benefits on fruit and vegetables. If you agree to participate in this study, you will be receiving one text message per week for 12 weeks that remind you of your WIC benefits on fruit and vegetables.

INCLUSION CRITERIA

You are eligible for participating in this project only when you have children enrolled in the WIC program; you are the primary shopper for fruit and vegetables for your family; and your household receives fruit and vegetable benefits from the WIC program.

RISKS AND BENEFITS

RISKS:  We do not anticipate any risks of your participation in this study other than those encountered in day-to-day life.

BENEFITS: There are no direct benefits to participating in this study.

COSTS AND PAYMENTS

We will provide a $20 gift card for your participation in this study.

NEW INFORMATION

If the researchers find new information during this study that would reasonably change your decision about participating, then this will be shared with you.

CONFIDENTIALITY

The records of this study will be kept strictly confidential. All personal identifiable information will be kept in the investigators’ office or password-protected computers. All reports that we make public will only have the summary statistics from the data analyses and will not include any personal identification information.

WITHDRAWAL PRIVILEGE

Your participation is completely voluntary. If you decide not to take part, it will not affect your eligibility for WIC. If you decide to take part, you are free to withdraw at any time.

COMPENSATION FOR ILLNESS AND INJURY

If you say YES, then your consent in this document does not waive any of your legal rights.  However, in the event of injury or illness arising from this study, neither Old Dominion University nor the researchers are able to give you any money, insurance coverage, free medical care, or any other compensation for such injury.  In the event that you suffer injury as a result of participation in this research project, you may contact Dr. Qi Zhang the responsible project investigator at 757-683-6870, Dr. Tancy Vandecar-Burdin, the current IRB chair at 757-683‑3802 at Old Dominion University (tvandeca@odu.edu), or the Old Dominion University Office of Research at 757-683-3460, all of whom will be glad to review the matter with you.

VOLUNTARY CONSENT

By signing this form, you are saying several things.  You are saying that you have read this form or have had it read to you, that you are satisfied that you understand this form, the research study, and its risks and benefits.  The researchers should have answered any questions you may have had about the research.  If you have any questions arising later on, researcher staff will be available to answer them:

  • Dr. Qi Zhang: qzhang@odu.edu or 757-683-6870
  • Dr. Chuanyi Tang:  ctang@odu.edu or 757-683-4400
  • Dr. Yuzhong Shen: yshen@odu.edu, or 757-683-6366.

If at any time you feel pressured to participate, or if you have any questions about your rights or this form, then you should call Dr. Tancy Vandecar-Burdin, the current IRB chair, at 757‑683‑3802, or the Old Dominion University Office of Research, at 757‑683‑3460.

And importantly, by entering your contact information, your cell phone number, and your WIC family number, you are telling the researcher YES, that you agree to participate in this study.  You can print a copy for your records.

If you agree, please give the following information as the CONSENT to be enrolled in this study (All information will be kept confidential and be used only for research purpose, If you have any questions in the process, feel free to contact Dr. Harry Zhang at 757-656-6652 or email him (qzhang@odu.edu) and he will assist you).

    Last Name (required)

    Your First Name (required)

    Date (required)

    WIC Family ID #

    (It is the number on your WIC card sleeves and NOT your 16 digit EBT card number.)
    F-

    jiti

    Cell Phone Number (required)

    Email (required)

    Street Address (required)

    City (required)

    State (required)

    Zip Code (required)

    If you do not want to give the consent on the website, you can choose one of these ways to give your consent:

    1. Email your consent or text your consent to Dr. Harry Zhang (qzhang@odu.edu; 773-401-4576) with all the required information above (Last Name, First Name, WIC Family ID, Cell Phone Number, Email) and the following statement: “I have read the informed consent and understand the consent form, the research study, and its risks and benefits. I agree to participate in “Just-in-Time Incentives (JITI) to Promote Fruit and Vegetable Redemption among WIC Participants” voluntarily.“ OR

    2. Print this webpage, sign it and dated, and then mail the signed form to “Dr. Harry Zhang, Room 1016, 1014 W 46th Street, School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529”.

    How would you like to receive your $20 gift certificate? (required)
    Amazon Gift CertificateMailed Walmart Gift Certificate

    Once we have received your consent document and completed sending the text messages to you, you will receive your $20 gift certificate. You have the choice of an electronic Amazon gift card or a Walmart gift card.  The Amazon gift card will be sent to your email or the Walmart gift card will be mailed to you through the United States Postal Service.

    If you have any questions, feel free to contact Dr. Harry Zhang at 773-401-4576 or email him (qzhang@odu.edu).

    Thanks for your interested in JITI research study!