Consent form for Parkinson's Disease Support Groups

1. Appendix I­Consent Form
PhotoVoice CONSENT FORM
You are invited to participate in a PhotoVoice research project that will use pictures to describe how
Parkinson’s affects your daily life. You were selected because you belong to a Parkinson’s support
group. Please read this form and ask any questions you may have before agreeing to be in the project.
Joyce (the researcher), will talk to you about what the PhotoVoice project is and will give you time to ask
questions.
Study Purpose
The purpose of this project is to see if Photovoice (taking pictures, sharing the pictures and talking about
them) will be helpful within your support group to enhance discussions and to assist in identifying coping
strategies for all who are living with Parkinson’s disease or living with a family member who has
Parkinson’s disease. Photovoice has been found to be an effective therapeutic intervention in other
settings as it leads to visual evidence (the picture) and triggers thoughts and discussion.
Study Procedures
If you agree to join this project, you will be asked to do the following:
Joyce (the researcher) will meet with your support group to go over the information about the Photovoice
project. You will be instructed to take pictures associated with identified questions related to how
Parkinson’s disease affects your life. At the following meeting you will bring back 3­5 pictures that you
have taken based on the question that the facilitator instructed you to take pictures about. During your
support group meeting you will share your pictures and stories. You will do this for 3 support group
meetings in a row. Following the 3rd
meeting Joyce will return to the group to talk about the process,
answer any questions, and administer a questionnaire/survey on whether or not you found the Photovoice
project helpful. At any time you can choose not to be a part of the project or to share any of the pictures
you have taken.
You will be asked to take pictures with your own camera, cell phone, or ipad. If you do not own a
camera, one can be loaned to you for the project by the researcher. You will be asked to develop your 3­5
pictures to bring to the three support group meetings. Twenty dollars cash will be given to the facilitator
to assist with the development of the pictures.
You will receive a worksheet to document your pictures and to remind you of why you took the picture.
Risks of Study Participation
The PhotoVoice Project has the following risks.
It is important to make sure you are safe when taking your pictures.
You may be uncomfortable because you will be taking pictures of things that are personal to you. You
may be uncomfortable with describing the pictures within your support group. You can choose not to
discuss any of your pictures.

2.
If at any time, you feel you want to withdraw from the project, you are free to do so.
Benefits of Study Participation
The direct benefit will be discussing the pictures within a supportive environment that may allow
opportunity to share feelings and promote healing. Photovoice gives you a opportunity to share your story
through your pictures.
The indirect benefits would include incorporating the Photovoice intervention within support groups to
facilitate discussion, sharing and healing. The pictures and stories that the participants are willing to
share with the public will increase knowledge and understanding about the effects of Parkinson’s disease
on individuals and families.
Compensation
There will be no monetary compensation for your time or for the project.
Confidentiality
Any gathered information will be kept in a safe locked file. Your name will not be on any information or
pictures. In any publications or presentations, it will not include any information that will make it
possible to identify who you are.
Voluntary Nature of the PhotoVoice Project
You can choose to be in the PhotoVoice project or not. If you decide to be in the project, you can stop at
any time.
Contacts and Questions
The Project researcher/investigator is Joyce Bredesen. She teaches nursing at Metropolitan State
University. You can call her on her cell phone at 763­360­5947 if you have any questions or concerns. If
you have any other questions or concerns regarding this project and would like to talk to someone other
than Joyce, you can contact Dr. Ann Leja, Dean, at Metropolitan State University at (651) 793­1368. A
copy of the consent form will be maintained in a locked file cabinet at Metropolitan State University.
Statement of Consent
I have read the above information. I have asked questions and have received answers. I consent to
participate in the study.
Print name:_______________________________________________
Signature of participant: __________________________________________Date: ________________
Signature of Investigator: ________________________________________ Date: ________________
*Are you willing to share selected pictures and stories with the researcher (Joyce) for publication or
to share at a public forum to increase understanding of what it is like living with Parkinson’s
disease or with someone who has Parkinson’s disease? If yes, please sign again on the line below:
_____________________________________________________________Date:______________
Signature to share pictures and stories