Fear of Falling, Physical Activity Volume and Stage of Motivational Readiness to Change Physical Activity Behaviour in Late Midlife Adults
Today is:
Online Letter of Information and Consent Form
Purpose of the Survey
We are conducting a survey for adults living on Prince Edward Island aged 50 to 70. This study will survey about eighty people. This survey is available online or as a paper survey. The goal of the study is to find out more about physical activity, interest in increasing physical activity, and fear of falling in this age group. The results will guide nursing care of older adults. If you are 50 to 70 years of age (born between 1946 and 1966) and live on Prince Edward Island, you are eligible for this survey.
Who is doing the research?
Valerie Abd-El-Aziz, graduate student at the UPEI School of Nursing, is leading this study.
What will you be asked to do?
If you decide to take part, you are asked to complete this online survey. The survey is completely voluntary. You may skip any question that you do not wish to answer and you may exit the survey at any time without penalty. Once you submit your survey, you will not be able to withdraw your information. However, if you do not wish to continue, your survey information will be destroyed, and your information will not be included in the data analysis or report. You may print any part of this survey, including this information page and the consent form below. This survey will take about 20 minutes.
Who will have access to your information?
We are not collecting your name or other identifying information of study participants. Only the researchers will have access to the survey answers. Your answers will be coded and put in a secure computer program. The results of this survey will be presented at conferences. The results will also be submitted to academic and professional journals. The student will also do public presentations about this study.
What are the risks?
Some of the questions may seem personal and you may be uncomfortable sharing this information with us. If you are concerned about any of the information we have asked you about, contact your doctor or nurse practitioner.
What are the benefits?
You will be helping the researchers learn more about falls prevention, and help nursing care in adults aged 50 to 70.
How can I ask questions?
This survey has been reviewed by the Ethics Review Board of the University of Prince Edward Island as part of our research study. You may contact the Research Ethics Board at (902) 620-5104 or by email at reb@upei.ca if you have any concerns.
If you need to ask questions about the research or would like to discuss your participation in the research, you may contact me - Valerie Abd-El-Aziz,
Master of Nursing Candidate,
School of Nursing, UPEI,
219 Health Sciences Bldg.,
(902) 620-5206,
vabdelaziz@upei.ca
or my research Supervisor - Gloria McInnis-Perry,
Associate Professor,
School of Nursing, UPEI,
220 Health Sciences Bldg.,
(902) 628-4301,
gjmcinnis@upei.ca
If you decide to take part in this study, please read carefully, then click on the link below. Reviewing this next information is necessary to participate in the survey.
Consent Form
I have read and understood the information provided above for the Falls Prevention Research Study “Fear of Falling, Physical Activity Volume and Stage of Motivational Readiness to Change Physical Activity Behaviour in Late Midlife Adults”. I consent to be part of this study. I have been provided a contact number of the researcher. I have been invited to ask questions about the study or my participation in the study.
I understand that I can print any part of this survey for my records, including the information sheet and this consent form. I understand that I may withdraw from the study at any time and there will be no negative impact on me from withdrawing from the study. I understand that I may refuse to answer any question. I understand that if I decide not to be part of the study, my survey information will be destroyed.
My answers will be published as part of a summary of all the survey findings. I understand that a written summary of the findings will be available through written reports and presented at conferences. The reports will also be submitted to academic and professional journals. I understand that the student will also do public presentations about this study.
I may obtain my personal results or a summary of the results of this study by contacting the researcher listed above.
I understand that the information will be kept confidential within the limits of the law. All information will be stored on a USB stick with a secured password. Only the researcher and the research team will be able to use this information. After 5 years, the information will be destroyed.
I understand that I may contact the Research Ethics Board at (902) 620-5104, or by email at reb@upei.ca if I have any concerns about the ethical conduct of this study.
If you agree with the above statements, and consent to be part of this research, click below.
