University of Wisconsin – Milwaukee
Consent to Participate in Online Survey Research
Study Title: Patient Web Portal Experience
Person Responsible for Research: Priya Nambisan
Study Description: The purpose of this research study is to understand and evaluate health consumer’s experience in a patient web portal. Approximately 250 – 300 subjects will participate in this study. If you agree to participate, you will be asked to complete an online survey that will take approximately 15 minutes to complete. The questions will ask about your experience in a patient portal. A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection. Examples of such patient portals include ‘MyAurora’ of Aurora healthcare and ‘MyChart’ of Froedtert and ProHealth Care.
Risks / Benefits: Risks to participants are considered minimal. There are no personally identifying questions in the survey. Collection of data and survey responses using the internet involves the same risks that a person would encounter in everyday use of the internet, such as breach of confidentiality. While the researchers have taken every reasonable step to protect your confidentiality, there is always the possibility of interception or hacking of the data by third parties that is not under the control of the research team.
There will be no costs for participating. Benefits of participating include an opportunity to participate in a raffle. As a token of our appreciation, we will provide $15 Amazon Gift Cards to 20 randomly-selected respondents out of every 200 respondents who fill out the survey before December 15th midnight. At the end of the survey, there will be a link that will take you to a different page, not connected to the survey, where you can enter your email address, if you wish to participate in the raffle. This is a separate page from the survey and it is not linked to your survey – so, the survey remains completely anonymous. The email address is being collected for the sole purpose of sending the Amazon gift card, and is not part of the survey. Participating in this raffle do not require you to complete the survey, it is open to everyone – pl. send me an email (firstname.lastname@example.org) if you would like to participate in the raffle.
Limits to Confidentiality
Identifying information such as your name, email address, and the Internet Protocol (IP) address of this computer will not be asked or available to the researchers. Data will be retained on the Qualtrics website server for a year and will be deleted by the research staff after this time. However, data may exist on backups or server logs beyond the timeframe of this research project. Data transferred from the survey site will be saved on a password protected computer for another year. Only the PI will have access to the data collected by this study. However, the Institutional Review Board at UW-Milwaukee or appropriate federal agencies like the Office for Human Research Protections may review this study’s records.
Voluntary Participation: Your participation in this study is voluntary. You may choose to not answer any of the questions or withdraw from this study at any time without penalty. Your decision will not change any present or future relationship with the University of Wisconsin Milwaukee.
Who do I contact for questions about the study: For more information about the study or study procedures, contact Dr. Priya Nambisan at email@example.com
Who do I contact for questions about my rights or complaints towards my treatment as a research subject? Contact the UWM IRB at 414-229-3173 or firstname.lastname@example.org
Research Subject’s Consent to Participate in Research:
By entering this survey, you are indicating that you have read the consent form, you are age 18 or older and that you voluntarily agree to participate in this research study.
Please click on this link below: