Swimmer's Itch Case Rate Study Information and Informed Consent Form
Study
Information. The goal of this project is to use simple online reporting
of water use and any resulting SI to determine the rate of SI per water
use. We seek to make it convenient for
lakeside resident volunteers to report water usage and whether they and any in
their party contracted swimmer’s itch as a result. The
study is funded by the Higgins Lake Swimmer’s Itch Organization (HLSIO) and has generated excellent and useful data.
Please read
the study participation risks and the informed consent form below, and sign the
form if you are willing to participate.
Risks to participation in this study. There is little risk in participation besides having to
disclose that you or household member have experienced SI. All data will be anonymized before analysis. You are not expected to alter your
swimming behaviors or time in the water for this study. Simply use the lake as
you would normally. The only difference is that you will take 1-2 minutes each
time someone in your household uses the lake and you will record whether or
not they got swimmer’s itch.
If you have questions at any time about this study, you
should feel free to contact Dr. Randy DeJong of Calvin University by email at rdejong@calvin.edu or by phone at
616.617.7090.
You have the right to withdraw from this study at any
time. To do so, simply contact the investigator as indicated above.
To ensure your rights as a research participant have been
safeguarded, this study and this form have been reviewed by the Calvin University Institutional
Review Board (IRB).
Signature
of informed consent. By signing below, I agree to be a part of this study during
which I will complete an online form for each day a member or a guest of my
household enters the water of Higgins Lake.
I understand that I may not receive any direct benefits from
participation in this research, other than contributing to knowledge about
swimmer’s itch at Higgins Lake and the effectiveness of control. Others may
benefit from the same.
I understand that I will provide my name, address, and
contact info at this sign-up, but that selection of a 4-digit PIN will allow me
to enter all my reports quickly and without including my name. I understand
that all data will be anonymized before analysis and I consent to the data
being used in reports to the lake association and/or in a published scientific paper.
All identifying data will be destroyed after the analysis is complete.
I have read the information provided
above: 1) Study Information and Risks, and 2) this Informed Consent Form.
I understand that I have the right
to withdraw from this study at any time. To do so, simply contact the
investigator: Dr. Randy DeJong of Calvin University by email at rdejong@calvin.edu.
By signing my name below, I am indicating my intent to participate and my informed consent to the use of the resulting data.