Research Participant Information & Consent Form - Adults [pdf]

UNIVERSITY OF WISCONSIN-MADISONResearch Participant Information and Consent FormAdult Consent FormTitle of the Study: Assessing Math Comprehension of 9 - 18 Year Olds After Using ProblemSolving ImageryPrincipal Investigator: Jessica Hirsch (phone: 608-265-4312) (email: jrhirsch2@ls.wisc.edu)DESCRIPTION OF THE RESEARCHYou are invited to participate in a research study that evaluates how children understand mathproblems.You have been asked to participate because you are enrolled in the Madison Public SchoolDistrict and are taking a math course.The purpose of the research is to understand if visualizing how to solve a math problem beforestarting to solve it helps students succeed in math.The research will be conducted in the clinical cognitive lab at the Waissman Center.WHAT WILL MY PARTICIPATION INVOLVE?If you decide to participate in this research, you will need to come to the clinical cognitive lab atthe Waisman Center for an evaluation. During the evaluation, we will randomize you into one oftwo groups:1. A group that has the visual imagery intervention, and2. A control group that does not use visual imagery interventionIf you are randomized to the visual imagery group, we will show a five minute video of a childsolving math problems. We will then give you 10 math problems to solve. Your progress will betimed.If you are randomized to the control group, you will not view any video. We will ask you to solvethe same 10 math problems as those who were randomized to the visual imagery group. Yourprogress will be timed.In total, you will be asked to complete 10 math problems one time. Participation will lastapproximately 30 minutes.This study will include 50 other students.We would like to video tape you while you are solving the math problems. We will use the videotape to identify any common themes that you exhibit while struggling with a math problem. Onlythe research staff will see the video recordings. The tapes will be kept for The tapes will bedestroyed as soon as they have been reviewed. before they are destroyed.

ARE THERE ANY RISKS TO ME?We don't anticipate any risks to you from participation in this study. You may feel a littlefrustrated while trying to work out the math problems, but if that happens, you can stop at anytime. You can also skip some or all of the math problems.ARE THERE ANY BENEFITS TO ME?We don't expect any direct benefits to you from participating in this study.WILL I BE COMPENSATED FOR MY PARTICIPATION?You will receive a $10 iTunes Gift card for participating in this study.If you do not complete the study, you will receive nothing.HOW WILL MY CONFIDENTIALITY BE PROTECTED?While there will probably be publications as a result of this study, your name will not be used.Only group characteristics will be published. The data collected will only be shared withmembers of the research team.WHOM SHOULD I CONTACT IF I HAVE QUESTIONS?You may ask any questions about the research at any time. If you have questions about theresearch after you leave today you should contact the Principal Investigator, Jessica Hirsch, at608-265-4312.If you are not satisfied with response of research team, have more questions, or want to talk withsomeone about your rights as a research participant, you should contact the Education Researchand Social & Behavioral Science IRB Office at 608-263-2320.Your participation is completely voluntary. If you begin participation and change your mind youmay end your participation at any time without penalty.Your signature indicates that you have read this consent form, had an opportunity to ask anyquestions about your participation in this research and voluntarily consent to participate. You willreceive a copy of this form for your records.Signature_________________________________________________________________Name of Participant (please print)___________________________Date__________________