Sickle Cell Disease Eradication Initiative

Consent Form for Online Surveys

You are invited to participate in a web-based online survey on Sickle Cell Disease Eradication. This is a research project being conducted by Sickle Cell Disease Eradication Initiative (SCDEI), a Community Based Organisation in Damaturu, Yobe-State Nigeria.  It should take approximately 5 minutes to complete.

PARTICIPATION
Your participation in this survey is voluntary. You may refuse to take part in the research or exit the survey at any time without penalty. You are free to decline to answer any particular question you do not wish to answer for any reason.

BENEFITS
You will receive no direct benefits from participating in this research study. However, your responses may help us learn more about the burden of sickle cell disease and its eradication strategies.

RISKS

There are no foreseeable risks involved in participating in this study other than those encountered in day-to-day life.

CONFIDENTIALITY
Your survey answers will be sent to a link at https://kobo.humanitarianresponse.info/  where data will be stored in a password protected electronic format. Kobo Toolbox does not collect sensitive identifying information such as your BVN or password. Therefore, your responses will remain anonymous and secured. No one will be able to identify you or your answers, and no one will know whether or not you participated in the study.

CONTACT
If you have questions at any time about the study or the procedures, you may contact the Principal Investigator, Dr Aliyu Usman Muhammad via phone at +2348067510125 or via email at sicklecelleradication@gmail.com.

ELECTRONIC CONSENT:

Please select your choice below. You may print a copy of this consent form for your records.

Clicking on the “Agree” button indicates that

  • You have read the above information
  • You voluntarily agree to participate
  • You are 18 years of age or older