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Consent to Take Part in a Human Research Study



Title of research study: Validation of NASA physical and neurobehavioral checklists

Investigator: Dr. Candice Alfano

Why am I being invited to take part in a research study?

We invite you to take part in a research study because you are aged 18 or older and have seen one of our study advertisements.

What should I know about a research study?

·         Someone will explain this research study to you.
·         Whether or not you take part is up to you.
·         You can choose not to take part.
·         You can agree to take part and later change your mind.
·         Your decision will not be held against you.
·         You can ask all the questions you want before you decide, and can ask questions at any time during the study.

Why is this research being done?

We have designed two questionnaires to help researchers investigate the emotional and physical changes that people may experience when they spend time in isolated, confined and extreme environments. Before this, we need to check the responses that people in everyday environments give to these questionnaires.

How long will the research last?

We expect that you will be in this research study for approximately 15 minutes.

How many people will be studied?

We expect to enroll about 1000 people in this research study.

What happens if I say yes, I want to be in this research?

If you decide to participate, you will be taken to a website which asks questions about the extent to which you currently experience different emotions and physical symptoms. The study only requires one session and will be conducted entirely via the internet.

What happens if I do not want to be in this research?

You can choose not to take part in the research and it will not be held against you. Choosing not to take part will involve no penalty or loss of benefit to which you are otherwise entitled.
If you are a University of Houston student, a decision to take part or not, or to withdraw from the research will have no effect on your grades or standing with the University of Houston.

What happens if I say yes, but I change my mind later?

You can leave the research at any time and it will not be held against you. To do this, you can simply close your internet browser.
If you stop being in the research, already collected data will be removed from the study record.

Is there any way being in this study could be bad for me?

There are no foreseeable risks related to the procedures conducted as part of this study. If you choose to take part and undergo a negative event you feel is related to the study, please inform your study team.


Will I get anything for being in this study?

If you are a University of Houston student, you may be eligible for course credit for participating. There are no other benefits or compensation associated with this study.

Will being in this study help me in any way?

There are no known benefits to you from your taking part in this research. However, possible benefits to others include better assessment of emotional and physical wellbeing in isolated, confined, and extreme environments, which may result in improved interventions for people who are experiencing difficulties in these situations.

What happens to the information collected for the research?

Your taking part in this project is anonymous, and information you provide cannot be linked to your identity. SONA ID will be collected for University of Houston students participating for course credit,  but will be deleted once credit has been authorized and prior to data analysis.
We may publish the results of this research. However, unless otherwise detailed in this document, we will keep your name and other identifying information confidential.

Can I be removed from the research without my OK?

The person in charge of the research study can remove you from the research study without your approval. Possible reasons for removal include indications of non-genuine responding (e.g. a response time that is so fast that the participant could not have read all of the questions).

Who can I talk to?

If you have questions, concerns, or complaints, or think the research has hurt you, you should talk to the research team and ask for Dr. Alfano at (713) 743-8611 or
This research has been reviewed and approved by the University of Houston Institutional Review Board (IRB). You may also talk to them at (713) 743-9204 or if:
·         Your questions, concerns, or complaints are not being answered by the research team.
·         You cannot reach the research team.
·         You want to talk to someone besides the research team.
·         You have questions about your rights as a research subject.
·         You want to get information or provide input about this research.
If you would like a copy of this form for your records, please click here: Letter of consent NASA Validation Study

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