TRG# 200507383 E> Date Approved: 05/27/2009 N ask ‘Valid Un: 07/05/2010 PUBLIGOUCY ENTER. March 2009 Evaluation of Public Engagement Project on Pandemic Influenza Purpose of the Researct ‘Thank you for agreeing to participate in this project which aims to understand how people can be better informed about public policy issues.. You must have reached the age of majority in your state to participate inthis study. ‘The Public Engagement Project on Pandemic Influenza is intended to bring people into the discussion about pandemic influenza and related public health issues. You are participating in this project for one of three reasons: 1. You are amember of a community taking part in this project as a participant. 2. You are an expert on such topics as public health, influenza, ethics and public engagement and agreed to participate as an expert or observer. 3. Your work with the U.S. Department of Health and Human Services or other federal, state, or local governmental agencies involved in making decisions or analyzing public health policies. ‘A survey may be given to you to get information about your opinions and knowledge about this topic, Research associated with the project will explore whether and how the views of participants change as a result of thinking about and discussing an issue. Procedures: ‘You willbe given two surveys asking your knowledge and opinions. The survey's will each take about 15 minutes to complete, Therefore, the minimum time commitment is 30 minutes (two surveys at 15 minutes each). ‘You may also have the opportunity fo attend a focus group meeting or paxticipate in a phone interview that will take no longer than one hour. With your permission, the focus group or phone interview will be audio recorded ‘The maximumn time commitment is one hour and thirty minutes (two surveys at 15 minutes each, and either a focus group or interview of about one hour), Risks and/or Discomforts: ‘There are no major risks we know of that result from taking part in this research, Benefits: ‘You may find that participating inthis research will be an enjoyable and educational experience, as it will allow ‘you to consider and discuss today’s topic and learn more about it. Participation in this study will give you the opportunity to add to the body of knowledge regarding what people ‘think about issues affecting public health. You will also be helping the researchers learn what happens to people's opinions when given additional information and the chance to participate in discussions. Confidentiality: Any information obtained during this research will be kept saictly confidentiad. Data will be kept in locked cabinet in the investigator's office and within secure, protected files on a computer, The information obtained in this study may be published in scientific journals or presented at scientific meetings, but the data will be reported as aggregated data. In other words, everyone’s answers will be grouped together, and there will be no way your ‘answers could be linked to you. 2185 Centennial Mall South, Suite 41 Lincoln, NE 68688-0228 (402) 472.5678 1 FAX (402) 472-5678 | Ema: ponsbraska.edu | htp:/ppeebraska.oduline¥ 200507383.6 | Date Approved. 05/27/2008 "valid Un 07/05/2010 Your responses on the surveys will be confidential. Although confidentiality. palariateeateepsetasst ~~ process, it will be protected to the full extent allowed by law. You can skip any questions you would rather not answer, and you are free to end your participation in the project at any point Compensation ‘There will be no compensation specifically for completing the surveys or taking part in focus groups or interviews. Some sites may offer compensation for participating in the discussions apart from the research parts of survey completion, focus groups, or interviews Opportunity to Ask Questions: Yeu may 1sk any questions concering this research and have those questions answered befere ageing to participate in or during the study. You may direct questions to Mark DeKrraai, the primary investigator, a (402) 472-1496 or mdckraai@nebraska.edy, or to Denise Bulling, secondary investigator, at (402) 472-1509 or loulling@ncbraska edu, Please contact the investigator ‘+ ifyou want to voice concems or complaints about the esearch, + inthe event of a research related injury Please contact the University of Nebraske-Lincoin Institutional Review Board at (402) 472-6965 forthe following reasons ‘© you wish to talk to someone other than the research staff to obtain answers to que asa research pacicipan, to voice concems or complaints about the research, to provide input concerning the research process, + inthe event the study staff eould not be reached yas about your rights ‘Freedom to Withdraw: ‘You are free to decide not to participate in this study or to withdraw at any time without adversely affecting your relationship with the University of Nebraska, or any other associated entities. Your decision will not result in any Joss or benefits to which you are otherwise entitled. Consent, Right to Receive a Copy: You are voluntarily making « decision whether to participate in this study. Your signature certifies that you have decided to participate having read and understood the information presented. If you request, you will be given 2 ‘copy of this consent for you to keep. Signature: Signature of Rvearch Paicpant Dare Please supply an E-mail address and/or phone number that you can be reached at if you wish to be contacted for an interview in the next two weeks, First name (please print) ‘Your E-mail address Your daytime phone number 1 Check if you agree to be audio taped during the interview or focus group. 218 Centennial Mall Sout, Sule 401 Linon, NE €BS88-0228 (402) 472-5678 | FAX 202) 472.5879 | Emalt ppo@nebraska.edu / Rtpslppc nebraska edu! carter eur: Unive Nae inn Une et Nba Mad Coker hte at On, Ue of tat Kay