Wild Indigo (Baptisia tinctoria or Sophora tinctoria)1


Consent Form for Evaluation Questionnaire (Consumers/Growers)


WHAT IS THE PURPOSE OF THIS STUDY?
You are invited to participate in a research project to evaluate the educational materials produced for a project entitled Developing a Sustainable Medicinal Herbs Market for North Carolina, Project II. The purpose of the project was to develop information for health professionals, herb growers, and health consumers regarding the uses and safety of the medicinal herbs of economic significance to North Carolina farmers. You are being asked to participate because you are a current or potential herb grower or consumer.

The study is being conducted by Susan Gaylord, Ph.D., Director of the Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine CB #7200, Chapel Hill, NC 27599-7200 and her research assistant, Kim Faurot, a student in the Department of Health Behavior and Health education at the UNC School of Public Health. It is part of a larger study conducted by Jeanine Davis, Ph.D. at North Carolina State University.

WHAT WILL I BE ASKED TO DO? You will be asked to answer a few questions about your impression of the information sheets. We would like to know if we have provided too much information or too little and if the information is in a style you find acceptable. We anticipate that that you will need no more than five minutes to answer this survey questions.

WHAT ARE THE RISKS AND BENEFITS OF MY PARTICIPATION?
The risks associated with this study are minimal. You may feel embarrassed if asked to comment on a topic about which you know very little. The benefits which may reasonably be expected to result from this study include:
(1) You may learn information about specific herbs you may be able grow;

(2) You may learn where to find reliable information on herbs and herbal products.
Your decision whether or not to participate in this study should not affect your employment.
WILL I BE PAID? There is no compensation for filling out the brief questionnaire.
SUBJECT'S RIGHTS AND CONFIDENTIALITY: If you agree to participate in this study, please understand that your participation is voluntary (you do not have to do it). You have the right to withdraw your consent or stop your participation at any time without penalty. You have the right to refuse to answer particular questions.

To protect your privacy, you will not provide your name on the questionnaire. We ask for only your profession and county of residence.
All of the information you provide will be stored only with an identification number. Only Kim Faurot, Susan Gaylord, and the Grant Evaluator (Susan Siegel) will have access to the questionnaire responses. They will be stored in a locked cabinet in the office of the Grant Evaluator.
If you wish have any questions, contact Kim Faurot or Dr. Susan Gaylord at (919) 966-8586. You may call collect if you wish.
This study has been reviewed and approved by the Public Health Institutional Review Board on Research Involving Human Subjects. If you have questions about your rights as a study participant, or are dissatisfied at any time with any aspect of this study, you may contact -- anonymously, if you wish -- the Public Health Institutional Review Board, Office of Human Research Ethics, University of North Carolina at Chapel Hill, CB # 7400, Chapel Hill, NC 27599-7400, or by phone 919-966-3012. You may call collect.


You may print out and keep this fact sheet.

Please click here if you understand the above information and wish to fill out the questionnaire.