Primary Survey Consent Form

Please read this form and accept or decline at the bottom of the page.

University of Calgary


Name of Researcher, Faculty, Department, Telephone & Email:
Dr. Ryan Henry, Faculty of Science, Assistant Professor, Computer Science, +1(403) 210-6307 , ryan.henry@ucalgary.ca


Title of Project:
Personal and Financial Impacts and Improvements of COVID 19 on Canadian Households

Sponsor:
University of Calgary


This consent form, a copy of which has been given to you, is only part of the process of informed consent. If you want more details about something mentioned here, or information not included here, you should feel free to ask. Please take the time to read this carefully and to understand any accompanying information.

The University of Calgary Conjoint Faculties Research Ethics Board has approved this research study.

Ethics ID REB20-1301

Participation is completely voluntary and anonymous.

Purpose of the Study:

We are collecting information on how COVID 19 has effected Canadians mental, physical and financial welfare. By gathering this data we hope to be able to provide insight into which social programs will need increased resources to continue serving Canadians.

What Will I Be Asked To Do?

You will be asked a series of short answer and multiple choice questions about your general financial, mental and home situation during COVID 19. Questions will range from multiple choice, to satisfaction, to selecting applicable items from a list. You will be asked about your income and financial situation before and during COVID, as well as question about which government relief programs, if any, you have accessed. You will be asked some broad questions about past drug / substance use as it relates to your drug / substance use during COVID. You will be asked a multiple choice based overview of how you feel your mental and physical health has been during COVID, including how it has effected some aspects of your life such as the cleanliness of your home and your relationships with the people that you live with.
The Survey is expected to take between 5 and 7 minutes of committed time. You may choose to withdraw from the survey at any time as well as withdraw your information with one week of filling out this survey.
There will be an optional 3 to 5 minute follow up portion of this survey immediately following your completion of the primary survey. Payment is contingent on completion of this follow up survey. Participation in the follow up section is completely voluntary and you may choose to stop at any point during the follow up. You may also choose to withdraw your information from the follow up at any point up until one week following your completion of this survey. Upon completion of the follow up survey, you will be give a unique identifying code. This code with correspond with your data from the survey. Only you will have access to this code. In the event that you wish to withdraw your data, You will need to present this unique code to the researchers so that they can remove the associated answers from the database. Since this code is the only identifier that could link you to the answers you provided, you will be unable to withdraw your information without it.
You have the option to refuse participation in any and all aspects of this study.

What Type of Personal Information Will Be Collected?

No personal identifying information will be collected in this study, and all participants shall remain anonymous.


Are there Risks or Benefits if I Participate?

There are no physical risks to that would not be otherwise be possible and or probable while normally operating ones computer. Mental or emotional risks include potential moderate emotional distress pertaining to increased awareness of your current financial situation or increased self analysis of your past or current drug habits.

If you are feeling emotionally distressed at any point during or after this study with regards to your substance use, we suggest following this link to the government of Canada website where they maintain a list of crisis help numbers.
https://www.canada.ca/en/health-canada/services/substance-use/get-help/get-help-problematic-substance-use.html

If you are feeling emotionally distressed at any point during or after this study with regards to your financial situation, you can follow this link to the Canadian CERB forms to apply for financial aid.
https://www.canada.ca/en/services/benefits/ei/cerb-application.html

Because all of the data we collect is fully anonymized, we cannot be compelled by any law enforcement agency to disclose information that could be linked to any survey participant.
Full payment for this survey is dependent upon your completion of the follow up portion of the survey.


What Happens to the Information I Provide?

No one except the researcher and his research assistants will be allowed to see or hear any of the answers to the questionnaire. There are no names on the questionnaire. Only group information will be summarized for any presentation or publication of results. No investigation that will risk the de-anonymization of your answers will be done by the researcher or his assistants. The questionnaires are kept in an encrypted and secured hard drive, and protected with multi factor authentication known only to the researcher.. The anonymous data will be stored for five years on a computer disk, at which time, it will be permanently erased.


By selecting “I Consent” you are consenting to participate in this research study
By selecting “I Decline” you are declining to consent to participate in this research study

Questions/Concerns
If you have any further questions or want clarification regarding this research and/or your participation, please contact:
Dr. Ryan Henry
Faculty of Science
+1(403) 210-6307 , ryan.henry@ucalgary.ca

If you have any concerns about the way you’ve been treated as a participant, please contact the Research Ethics Analyst, Research Services Office, University of Calgary at 403.220.6289 or 403.220.8640; email cfreb@ucalgary.ca. A copy of this consent form has been given to you to keep for your records and reference. The investigator has kept a copy of the consent form.