Survey from PI

{IRB #}

Research investigators may use or adapt the following sample survey to obtain feedback from study participants to support quality improvement of human subject protection practices and the informed consent process. REDCap electronic data capture tool is available for UK researchers to use to set up a secure, web-based version of the survey. Information is available at http://www.ccts.uky.edu/ccts/RedCap

Human Subject Protection: Sample Research Participant Satisfaction Survey

(Investigator name) is seeking your opinion on your experience participating in his/her recent research study. The following survey includes 15 questions and should take around 10 to 15 minutes for you to complete. You are free to answer all, some, or none of the questions and you may write additional comments at the end of the survey.

Dr. (Investigator name) will use the information you provide to learn how to better protect and inform research participants. Every effort will be made to prevent anyone who is not on the research team from knowing that you gave us this information, or what the information is. You will not be treated differently by Dr. (Investigator name) because of answers you give to the questions in this survey, or if you decide not to answer the questions in this survey.

If you have concerns about your experience in the research, or want to talk to someone about your rights as a volunteer in the research, please call the Office of Research Integrity at 859-257-9428, or toll free at 1-866-400-9428 during the following hours 8:00 am-12:00 pm or 1:00 pm-5:00 pm. Thank you!

1. / Did you know that you participated in a research study? / Yes / No / Not
Sure
2. / Do you remember signing a consent form to take part in a research study? / Yes / No / Not
Sure / Not Applicable
3. / Do you feel like you were provided with enough information to make a decision about whether to take part in the research study? / Yes / No / Not
Sure
4. / Which one of the statements listed below best describes your options if you chose to quit the research study? Circle the correct answer.
a.  You could drop out at any time and for any reason.
b.  You could only drop out of the research study if Dr. (Investigator name) let you drop out.
c.  I'm not sure what the policy was for dropping out of the research study.
d.  Other:
5. / Who reviewed the consent form with you?
Study Coordinator/Nurse/Staff
Researcher / Study Doctor
Student
No one
Other:
Not applicable
Unsure
6. / Did anyone on the research staff pressure you to sign the consent form? / Yes / No / Not
Sure / No
Opinion
7. / Did the consent form or the research staff tell you about possible risks, discomforts, or inconveniences expected from being in the study? / Yes / No / Not
Sure / Not Applicable
8. / Did the consent form or the research staff tell you about possible alternatives to being in the study such as other non-research treatments or options? / Yes / No / Not
Sure / Not Applicable
9. / Did you have enough time to read and
ask questions about the consent form? / Yes / No / Not
Sure / Not Applicable
10. / Were all of your questions answered by the research staff? / Yes / No / Not
Sure / Not Applicable
11. / Did the research staff give you a copy of the consent form after you signed it? / Yes / No / Not
Sure / Not Applicable
12. / Did you know that participating in the research study was voluntary and that you didn't have to take part in the study if you didn't want to? / Yes / No / Not
Sure / No
Opinion
13. / Do you think the study staff would have treated you differently if you had stopped the study early? / Yes / No / Not
Sure / No
Opinion
14. / Did you know who to call on the research staff if you had questions or concerns during and after the study? / Yes / No / Not
Sure / No
Opinion
15. / Did you know you could call the University of Kentucky Office of Research Integrity if you had questions or concerns about your rights as a research participant? / Yes / No / Not
Sure / No
Opinion
If you have any additional comments or questions, list them below:

J:\Master Outreach Documents\Survival Handbook\O - Quality Improvement\Research-Participant-Satisfaction-Survey.doc

August 2014 UK Quality Improvement Program

2