Information and Informed Consent
Sponsor: National Institute on Disability and Rehabilitation Research
Investigator: Craig Ravesloot, Ph.D. Rural Institute on Disabilities, 52 corbin Hall, University of
Montana, Missoula, MT 59812
Special Instructions to potential participants: This information may contain words that are new to you.
If you read any words that are not clear to you, please call 1(888)268-2743 to speak with Craig Ravesloot
who can answer your questions.
Purpose: Thank you for your interest in this research project. We are hoping to learn about ways to
help people with medical problems develop and maintain healthful behavior.
Procedures: If you choose to participate in this program, you will be invited to use a health
promotion website that helps people develop healthful behaviors. You will be assigned to one of two groups.
Either you will use the website on your own, or you will be assigned to a chat group to help you use the
website materials. If you use the materials with a chat group, you will be assigned to a group of Internet
users who meet weekly for 60-90 minutes to "chat" about the materials on the website.
Risks/Discomforts: We do not anticipate any risks or discomforts to you from participating in this
research evaluation.
Alternative Services: There are alternatives to this program for improving health status including
consultation with a physical or occupational therapist, a physical trainer or wellness center. Your primary
healthcare provider may be able to help you as well.
Confidentiality: No information will be collected from you.
Compensation for Injury: Although we do not foresee any risk in taking part in this study, the following
liability statement is required in all University of Montana consent forms.
"In the event that you are injured as a result of this research you should individually seek appropriate medical
treatment. If the injury is caused by the negligence of the University or any of its employees, you may be
entitled to reimbursement or compensation pursuant tothe Comprehensive State Insurance Plan established by the
Department of Administration under the authority of M.C.A., Title 2, Chapter 9. In the event of a claim for
such injury, further information may be obtained from the University's Claims representative or University
Legal Counsel. (Reviewed by University Legal Counsel, July 6, 1993)"
If you have any questions, you may contact Craig Ravesloot, Rural Institute on Disabilities, 52 Corbin Hall,
University of Montana, Missoula, MT, 59812, 1(888)268-2743.
Participation in this program is entirely voluntary. You may refuse to participate or withdraw at any time.
By clicking yes below, you are consenting to participate in this study.
I understand this informed consent information.
I have been informed of all the risks and benefits involved in completing this research.
All my questions have been answered and I know that I can call Craig Ravesloot with any more questions I may have.
I voluntarily agree to take part in this study.