Page 1: PARTICIPANT CONSENT FORM & INFORMATION SHEET

This study will investigate how ethnicity, location and care approach impacts the health-related quality of life of patients with Endometriosis.

Participation in this study involves completing an online questionnaire along with answering some demographic questions. This should only take approximately 20 minutes.

If this interview survey has brought up feelings that are unwanted and you feel you need to talk to someone you can contact the Samaritans here www.samaritans.org or call 116 123 for free.

By sharing your experiences with us you will be helping Jodie Hughes and the University understand the care that you are receiving at present with regard to your endometriosis.

As this data is anonymised it will be kept indefinitely, there are no plans for this data to be shared with third parties.

At the end of the survey you will be asked if you are interested in participating in an additional interview, you can participate by contacting Jodie Hughes on hughesj9@roehampton.ac.uk.

Findings will be presented orally or as posters at research conferences, Health Science Research Centre meetings and other University of Roehampton events such as postgraduate conferences. Findings will also be presented as a written thesis and will be submitted to be published in scientific journals.      

Investigators contact details:         

Jodie Hughes

Department of Life Sciences

University of Roehampton

Whitelands College

Holybourne Ave

Roehampton

London

SW15 4JD

Hughesj9@roehampton.ac.uk

Jodie Hughes is willing to discuss any concerns that may arise as a result of participation.

Should I feel any emotional or physical discomfort due to the participation in this survey I will contact my GP in the first instance, contact local talking services, or contact a support group.

By consenting to complete this survey you are confirming that you have been informed about and understand the University’s Data Privacy Notice for Research Participants

The information you have provided will be treated in confidence by the researcher and your identity will be protected in the publication of any findings. The purpose of the research may change over time, and your data may be re-used for research projects by the University in the future. If this is the case, you will normally be provided with additional information about the new project.

Please note: if you have a concern about any aspect of your participation or any other queries please raise this with the investigator (or if the researcher is a student you can also contact the Director of Studies.) However, if you would like to contact an independent party please contact the Head of Department/ Director of School.

Supervisor contact details:

Dr Patrick Brady

Department of Life Sciences

University of Roehampton

Whitelands College

Holybourne Ave

Roehampton

London

SW15 4JD

p.brady@roehampton.ac.uk

020 8392 3258

Head of Department contact details:

Dr Caroline Ross

Department of Life Sciences

University of Roehampton

Whitelands College

Holybourne Ave

Roehampton

London

SW15 4JD

c.ross@roehampton.ac.uk

020 8392 3529

Should the Head of Department change over the lifecycle of the research project the new Head of Department will become the independent contact. Contact details for the new Head of Department can be obtained from the investigator.

Endometriosis South Coast is a great source of information and support surrounding the condition and can be found here www.endometriosissouthcoast.com

As well as Endometriosis UK

https://www.endometriosis-uk.org/

And Cysters

http://cysters.org/

 

I agree to take part in this research and am aware that I will not be able to withdraw from this survey once I have submitted my responses due to the anonymous nature of this survey. 
I understand that if I do withdraw, my data may not be erased but will only be used in an anonymised form as part of an aggregated dataset. 
I understand that the personal data collected from me during the course of the project will be used for the purposes outlined above in the public interest.