Columbia University Medical Center Consent Form to Participate in a Research Study
Please read the information below regarding the study. By continuing to the survey, you are indicating that you are at least 18 years old, have read this form, and agree to participate in research.
1. Title of research study and general information
Study title: Study of healthcare behavior of aviation personnel
Study number: IRB-AAAV0213
Participation duration: The survey is expected to take approximately 3-5 minutes to complete.
Anticipated number of research participants at this site: This is a study of aviation personnel, and it is expected that 8,000 participants will participate overall.
2. Researchers' contact information
Principal Investigator: Sheng-Han Kuo, MD
Phone Number: (212) 305-2651
Co-Investigator: William R. Hoffman, MD
Study Coordinators: Nadia Amokrane and Pia Parekh
3. What information is on this form?
You are asked to participate in a research study conducted by Dr. Sheng-Han Kuo, H. Houston Merrit Assistant Professor of Neurology and Director of the Initiative for Columbia Ataxia and Tremor, and Dr. William R. Hoffman, Columbia University Irving Medical Center.
This form explains why we are doing this study and what you will be asked to do if you choose to be in this study. It also describes the way we (Researchers) would like to use and share information about you.
Please take the time to read this form. We will talk to you about taking part in this research study. You should ask us any questions you have about this form and about this research study.
You do not have to participate if you don't want to.
4. Why is this study being done?
Aviation personnel face unique challenges related to health and aeromedical screening. The current study aims to study the health behavior and healthcare preferences of air traffic controllers, flight attendants, and pilots to better understand how best to support their health.
5. What will I be asked to do if I choose to be in this study?
We will ask you to complete 1 survey. This survey is expected to take approximately 3-5 minutes to complete and requires no follow-up.
6. Are there any risks?
We do not think that there are any risks to taking part in this study. You may feel uncomfortable when answering questions about your experience. You can choose to skip questions if they make you uncomfortable.
No personally identifiable information will be gathered from the participants, so your answers cannot be tied back to you. You should not have any personal risk from completing the survey. In addition, the study team plans to protect your privacy, which is further described in section 8 of this consent form.
7. Are there any benefits?
There are no direct benefits to you by participating in this study. Your participation in this study will improve knowledge about healthcare seeking and avoidant behaviors in aviation safety sensitive personnel. This information can be used to advocate for better care for all aviation safety sensitive personnel.
8. What about my privacy?
Every effort will be made to keep your personal information confidential. No personal identifying information will be gathered from the participants, so you should incur no personal risk from completing the survey. The survey platform will be utilized in a manner to ensure responses are anonymous and the subjects will be able to skip any questions they do not want to answer and can stop the survey at any time. Survey responses will be completely anonymous and no protected health information will be gathered or saved. It will not be possible for you to submit any identifying information through the survey. All data will be saved in the secure Columbia University One Drive in a research folder, accessible only to investigators, research assistants, and biostatisticians. Since no information will be tied with any personally identifying information, there is no more than minimal risk to the participant. Data will be saved by a random number that includes the date of submission. Data will be accessible in the research folder or shared to investigators of this project through secure CUMC email. Investigators will not accept any survey answers by any means other than the anonymous survey.
9. Will I get paid or be given anything to take part in this study?
You will not receive any payment or other reward for taking part in this study.
10. Will I incur costs if I take part in this study?
There will be no costs to you for being in this study.
11. What are my rights if I take part in this study?
Taking part in this study is your choice. You may withdraw your consent at any time and discontinue participation in the study without penalty. You are not waiving any legal claims, rights, or remedies because of your participation in this study.
You can decide not to take part in or stop being in the study at any time. You may stop the survey halfway or choose only to answer partial questions.
12. Who can I call if I have questions?
If you have any questions about the research, please feel free to contact:
Principal Investigator, Sheng-Han Kuo, MD
(212) 305-2651
Neurological Institute at Columbia University
710 West 168th Street, New York, NY 10032
If you have any questions about your rights as a research participant, or if you have a concern about this study, you may contact the Institutional Review Board listed below.
Institutional Review Board
Columbia University Medical Center
154 Haven Avenue, 2nd Floor
New York, NY 10032
Telephone: (212) 305-5883
irboffice@columbia.edu