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Conducting a Participatory Situation Analysis of.pdf - Global HIV ...

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Appendix I: Example Consent Forms<br />

Example Consent Form #1<br />

Oral Informed Consent for Guardians<br />

(Zambia SCOPE Project)<br />

Introduction:<br />

“My name is …. I’m working for SCOPE. We’re interviewing children between the ages <strong>of</strong> 6 and 12 years here in<br />

[name <strong>of</strong> city, region, or site] in order to find out what their experiences are as orphans and vulnerable children. Are<br />

there any children living in this household who have lost either their mother or father? Have any <strong>of</strong> these children<br />

been interviewed in the past few weeks [or other appropriate time period] for this study?” IF THE RESPONDENT<br />

STATES THAT A CHILD IN THE HOUSEHOLD HAS BEEN INTERVIEWED BEFORE, DO NOT INTER-<br />

VIEW ANYONE IN THIS HOUSEHOLD AGAIN. Explain to them that you cannot interview them a second<br />

time; thank them; and end the interview. If they have not been interviewed before, continue.<br />

Confidentiality and Consent:<br />

“I’m going to ask the child some personal questions that some people may find difficult to answer. The answers are<br />

completely confidential, and the name <strong>of</strong> the child will not be written on this form and will never be used in connection<br />

with any <strong>of</strong> the information provided. The child does not have to answer any questions that he or she does not<br />

want to answer, and may end this interview at any time he or she wants. We would greatly appreciate your help in<br />

responding to this interview. The interview will take about 10 minutes. Would you be willing to let one <strong>of</strong> the children<br />

participate?”<br />

“I would also like to ask you a few questions about your life and the lives <strong>of</strong> your children. We are asking these questions<br />

so that we can understand the situation better and be able to develop support programs for you and your family.<br />

The questions for you will take only about 10 minutes. Would you be willing to participate?”<br />

Signature <strong>of</strong> Interviewer _____________________ Date___________<br />

(certifying that informed consent has been given verbally by respondent)<br />

Signature <strong>of</strong> Interviewer _____________________ Date___________<br />

(certifying that informed consent has been given verbally by respondent)<br />

<strong>Conducting</strong> a <strong>Situation</strong> <strong>Analysis</strong> <strong>of</strong><br />

Orphans and Vulnerable Children Affected by <strong>HIV</strong>/AIDS<br />

197

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