Online Survey Consent Form
Study Title: Prevalence of Bullying and Incivility in Occupational Therapy Fieldwork Settings
 
Co-Principal Investigators: Edwin Myers, OTD, OTR/L, ATP, RA(FL); Kaitlyn Cremer, OTD, MOT, OTR/L
Co-Investigator(s): Cameron Gehrke, OTS; Rachel Kohler, OTS; Megan Sloboda, OTS

   You are invited to participate in a research study conducted through Florida Gulf Coast University. You must be age 18 or older to participate in the study. Your participation in this study is voluntary. The University requires that we obtain your signed consent to participate in this study. This study is being conducted by students as part of their degree from Florida Gulf Coast University.

   Refusal to join the study will not affect any future services you may be eligible to receive from the University.

Study Summary
The purpose of this study is to identify the prevalence and effects of bullying and incivility in occupational therapy fieldwork settings. The information we learn from this study may help us increase awareness of the effects of incivility and bullying to the occupational therapy profession.

Participants in this study will complete a 10-minute survey about their exposure to bullying and/or incivility in occupational therapy fieldwork settings. Participants will have the opportunity to participate in a follow-up semi-structured interview about their experience with bullying and/or incivility in occupational therapy fieldwork settings upon completion of the survey.

There is a risk of minimal emotional discomfort upon recalling negative experiences.

If you are interested in learning more about this study, please continue to read below and ask the researcher any questions you have to help you understand the study.
 
Invitation to Participate in Study
   We are asking you to take part in the study because you have identified yourself as an occupational therapist, certified occupational therapy assistant, occupational therapy student, or certified occupational therapy assistant student.
 
Description of your Involvement
   If you agree to be part of the research study, you will be asked to complete an online survey about bullying and incivility in occupational therapy fieldwork settings.  We expect the survey will take about 10 minutes to complete.  The survey cannot be completed in more than one session.
 
Benefits of Participation
   We do not expect this study to benefit you.
 
Risks and Discomforts of Participation
      Your participation will be kept anonymous. However, working with email or the internet has the risk of compromising privacy, confidentiality, and/or anonymity. Despite this possibility, the risks to your physical, emotional, social, professional, or financial well-being are considered to be 'less than minimal’ by completing the survey.
 
Compensation for Participation
   You will not be paid to take part in this study.
 
Confidentiality
   If you join the study, we will make every effort keep your information confidential and secure by storing all information on a password-protected computer in a secure location, and destroying audio recordings after analysis. However, despite these safeguards, there is the possibility of hacking or other security breaches that could compromise the confidentiality of the information you provide. Thus, it is important to remember that you are free to decline to answer any question that makes you uncomfortable for any reason.
   We will not release information about you unless you authorize us to do so or unless we are required to do so by law.  If results of this study are published or presented at a professional meeting, no information will be included that would make it possible to identify you as a study participant.
   It is possible that organizations responsible for making sure the research is done safely and properly such as the university, and government offices may need to see the information you provide.

Storage and Future Use of Data
   Your information will not be used or distributed for future research studies even if your identifiers are removed from the information you provided for this study.
 
Voluntary Nature of Study
   Participating in this study is completely voluntary.  Refusal to join the study will not affect any future services you may be eligible to receive from the University. You can choose to not answer an individual question or you may skip any section of the survey by clicking “Next” at the bottom of the survey page to move to the next question.
   If you choose to join the study, you can leave it at any time with no penalty.
 
Contact Information for the Study Team
   We do not foresee any medical problems from participating in this study.  However, if you believe you experienced a research related injury, please contact Edwin Myers at (239) 590-7551. 
If you have any questions about this study, please contact Edwin Myers at (239) 590-7551.
 
Contact Information for Questions about Your Rights as a Research Participant
   If you have any questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Human Subjects Institutional Review Board through research@fgcu.edu .
 
Statement:
   I have read or had read to me the preceding information describing this study. All of my questions have been answered to my satisfaction. I am 18 years of age or older and freely consent to participate in the study. My decision to participate or to decline participating in this study is completely voluntary.  I understand that I am free to withdraw from the study at any time. I am aware of my option to not answer to any questions I choose. 
   I understand that it is not possible to identify all potential risks I believe that reasonable steps have been taken to minimize both the known and potential but unknown risks.  The submission of the completed survey is my informed consent to participate in the study.
   If you would like a copy of the consent form, print a copy before continuing.
 
 
Instructions on how to signify study participation
By clicking the “Next” button below you are consenting to participate in this research survey.
 
If you do not wish to participate, click the “x’ in the top corner of your browser to exit.
Thank you for your time.
Edwin Myers, Kaitlyn Cremer, Cameron Gehrke, Rachel Kohler, Megan Sloboda