Informed Consent Statement
Impacts on Access to Dental Care on Oral Health
You are invited to participate in this research study that will be investigating the accessibility that Ontarians have to dental care and the affects it has on their oral health. I am conducting this research project for my Undergraduate Honors Thesis for Wilfrid Laurier University that is to be supervised by Dr. Sean Doherty.
In this study, dentist locations will be mapped for all of Ontario to determine dentist concentration relative to the population of municipalities. Oral health surveys will then be distributed to citizens in strategic municipalities to gauge their oral health through a short survey. This will allow for the study to correlate oral heath to accessibility to dentists.
The survey should take less than 10 minutes to complete. You have been randomly selected from this municipality to participate in this short study due to the fact that you live in an area with preferable. In this research there will be over 1000 participants from around Ontario participating in the study on oral health. Participants over the age of 18 will be asked to participate in the study and disclose their full postal codes for the study.
Participants will be asked to complete a survey inquiring about their oral health and proximity to oral care centers. Some questions in the survey might cover sensitive topics regarding your oral health and past oral care. You will be required to complete a short 10-minute survey for your participation in this study.
This study could improve and bring trusted dental care to all parts of Ontario. The research being conducted will be able to improve access to oral care to all Ontarians while improving the current level of dental care in all municipalities.
Participants personal and health information will be kept confidential through anonymous surveys. The information collected will not disclose participants association with any particular survey. This will be assured by using identification numbers only. The researchers stated above will only have access the data collected. Once the project has been completed, the data will be in the hands of the university and possibly will be published in an academic journal. The data collected will be held indefinitely in an encrypted file. The data will be encrypted at all times with a strong password, and stored on the researcherís computers. The data might be used in a future project but participants will be notified prior to their inclusion in any such study.
If you have questions at any time about the study or procedures you may contact the researcher, Mark Gera at email@example.com or his supervisor Dr. Doherty at firstname.lastname@example.org or (519) 884-0710, ext. 2044. This project has been reviewed and approved by the University Research Ethics Board. If you feel you have not been treated according to the descriptions in this form, or your rights as a participant in research have been violated during the course of this project, you may contact Dr. Robert Basso, Chair, University Research Ethics Board, Wilfrid Laurier University, (519) 884-1970 ext. 5225 or email@example.com
Your participation in this study is voluntary; you may decline to participate without penalty. If you decide to participate, you may withdraw from the study at any time without penalty. If you withdraw from the study, every attempt will be made to remove your data from the study, and have it destroyed. You have the right to omit any question(s) you choose.
Feedback and Publication
The research being conducted is for an Undergraduate Honors Thesis and all results will be accessible through Wilfrid Laurier University. The results of the research will be available upon completion in May 2015. You may contact the researcher if you would like a written executive summary of the results at the conclusion of the study. The information and data provided will be kept indefinitely for this research project for reference purposes.
I have read and understand the above information. By pressing the button below, I am consenting to participate, and will be directed to the survey site.