University of Hawai'i
Parent/Guardian Consent for their Child to Participate in a Research Project
Allison Tsuchida, Principal Investigator

Student Athlete Concussion Knowledge and Attitude Needs Assessment and Effectiveness of the BrainSpace Program

Aloha! My name is Allison Tsuchida and I am requesting your permission for your child to participate in my research project. I am a faculty member at the University of Hawai'i at Manoa (UHM), in the Department of Kinesiology and Rehabilitation Science (KRS). The purpose of my project is to understand the knowledge and attitudes toward sport related concussions in Hawaii amongst student athletes ages 15 to 18 years old, in order to create an effective concussion education program. Your child's participation in this project will fulfill his/her concussion education as required by law (Act 262).

Taking part in this study is your choice.

You can choose to allow or not to allow your child to take part in this study. I also will ask your child to agree to participate in this project. You or your child also can change your mind at any time. If you stop being a part of the study, there will be no penalty or loss to you. I assure you that your child's participation or non-participation in my research project will not impact his or her grades, class standing, status on the athletic team, or relationship with your child's school.

What will happen if I decide to take part in this study?

Initially, your child will be asked to take an online survey. Survey questions will be answered using a 7-point scale. Completion of the survey will take approximately 5 to 10 minutes. After the survey, your child will be asked to watch a short video. There will be another survey after the video, and this takes about 5 minutes to complete.

What are the risks and benefits of taking part in this study?

I believe there is little risk to your child for participating in this research project. Your child may become stressed or uncomfortable answering any of the survey questions. If your child does become stressed or uncomfortable, he or she can take a break and continue once they are comfortable. Your child can also stop taking the survey or withdraw from the project altogether. This program fulfills the annual requirement of a mandatory concussion education set forth by Hawaii Concussion Law Act 262. The results of this project may be published in a journal article and also help improve the effectiveness of concussion education program.

Confidentiality and Privacy

I will keep all study data secure in a locked filing cabinet in a locked office/encrypted on a password protected computer. Only my co-investigators and I will have access to the information. Other agencies that have legal permission have the right to review research records. The University of Hawai'i Human Studies Program has the right to review research records for this study.

Questions?

If you have any questions about this study, please call or email me at 808.956.9057 or artsuchi@hawaii.edu You may contact the UH Human Studies Program at 808.956.5007 or uhirb@hawaii.edu to discuss problems, concerns and questions, obtain information, or offer input with an informed individual who is unaffiliated with the specific research protocol. Please visit http://go.hawaii.edu/jRd for more information on your rights as a research participant.