Consent Form

Project Title: Identifying Workplace Hazards and Accommodations for Practicing Orthotic & Prosthetic Clinicians and Technicians During Pregnancy

Principal Investigator: Sophia Mancini, Graduate Student

Faculty Advisor: Rebecca Spragg, Orthotics & Prosthetics Associate Professor and Program Coordinator

Purpose: The purpose of this research is to identify hazards in the Orthotics & Prosthetics (O&P) field and collect information on what accommodations may have been requested by female practitioners or technicians who worked during their pregnancy.

Study Procedures: Participation in this study involves completing an online survey. It should take between 10 and 20 minutes to complete the survey.

Types of Data Collected: We will ask questions about your pregnancy history, hazards you were exposed to in the workplace, and any accommodations that were made during your pregnancy. We will also ask for information about your age range during pregnancy.

Risks: The primary risk of participation in this study is a potential loss of confidentiality. Some of the survey questions are personal in nature and may make you feel uncomfortable. These include questions on pregnancy health, exposure, complications, and fertility. You do not have to answer any questions that make you uncomfortable or that you do not want to answer. You may stop the survey at any time even if you have not finished it. In the event that the survey causes you emotional distress or is upsetting to you in any way, psychological services through online counselors are available through betterhelp.com.

Benefits: Participation in this study will not provide any immediate benefits to you.  It is possible that the results of this study could be beneficial to you if you become pregnant in the future. Benefits to society include understanding workplace risks that are present and job accommodations that employees make in O&P during pregnancy.

Confidentiality: Your personal information (name, email) will not be collected for this study. The principal investigator and the research team will have access to the survey responses you provide for research purposes only. The results of this research may be published.

Compensation: There is no compensation for this study.

Contact Information: If you have any questions about the research, you can contact the Principal Investigator, Sophia Mancini at smancin2@emich.edu or by phone at 330-503-3159. You can also contact Sophia’s adviser, Rebecca Spragg, at rspragg@emich.edu or by phone at 734-487-0487.

For questions about your rights as a research subject, you can contact the Eastern Michigan University Office of Research Compliance at human.subjects@emich.edu or by phone at 734-487-3090.

Voluntary participation

Participation in this research study is your choice. You may refuse to participate at any time, even after signing this form, with no penalty or loss of benefits to which you are otherwise entitled. You may choose to leave the study at any time with no loss of benefits to which you are otherwise entitled. If you leave the study, the information you provided will be kept confidential. You can withdraw your consent by emailing the Principal Investigator listed above.

Statement of Consent

I have read this form. I have had an opportunity to ask questions and am satisfied with the answers I received. I click “continue” below to indicate my consent to participate in this research study.