Weight Feedback Study Consent Form

Thank your for your interest in this study. Please click the button below to confirm your consent.

Research Project Title:Weight Feedback Study.

Date of IRB Approval:September 18, 2008 Protocol #2008P-000300

Principal Investigator: Julia Braverman, PhD, Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Clinical Informatics

Study description We are conducting a study on the use of personal feedback for effective weight management. If you agree to participate in the study you will be asked to answer questions about your personality as well as reactions to graphs depicting weight measures over time. Your answers are anonymous. The study will take up to 10 minute of your time.

Benefits: No direct benefit is expected, however your participation may help the investigators better understand the role of feedback to improved weight management.

Any questions? If you have questions or concerns about this study please e-mail the principal investigator at jbraver1@bidmc.harvard.edu or you may contact the Human Subject Protection Program at 617-667-0469.

Please read the full consent form.

STUDY DESCRIPTION: We are conducting a study on the use of personal feedback for effective weight management. If you agree to participate in the study you will be asked to answer questions about your personality as well as reactions to graphs depicting weight measures over time. PURPOSE: The purpose of this study is to explore the role of feedback in weight management. The study is designed to look at how to create the most useful feedback to increase one's motivation to reach personal goals. WHAT HAPPENS IN THIS RESEARCH STUDY: If you choose to participate you will be #1042 of approximately 100 subjects to be asked to participate. Participants will be asked to answer several questions regarding their demographic information and their personality. They will also be shown a graphical representation of weight measures and asked for their reaction and impressions of the graphs. The research study is being conducted by Julia Braverman in the Division of Clinical Informatics at Beth Israel Deaconess Medical Center. The study will take up to 10 minute of your time. To minimize any confidentiality risks associated with participating, we will keep your responses to all the surveys anonymous BENEFITS: There is no direct benefit to you for participating in the study. It will not cost you anything to participate in the study. You will not be compensated for your time to complete the survey Participating in this study is entirely voluntary. By completing the study you are giving your consent to the researcher to use your responses for the research study. You may end your participation at any time. If at any point during the survey you decide that you no longer wish to participate, your responses will be deleted. The deletion will be done manually by the researcher at the end of data collection. If you have questions or concerns about this study please e-mail the principal investigator at jbraver1@bidmc.harvard.edu or you may contact the Human Subject Protection Program at 617-667-0469. IF RESEARCH RESULTS ARE PUBLISHED OR USED TO TEACH OTHERS The results of this research study may be published in a medical book or journal, or used to teach others. However, yourname or other identifying information will not be used for these purposes without your specific permission.

Authorization: I have read this form and any questions I had regarding this project have been answered. I give my consent to participate in the project described above. Its general purposes, the particulars of involvement and possible hazards and inconveniences have been explained to my satisfaction.