UKZN HUMANITIES AND SOCIAL SCIENCES RESEARCH ETHICS COMMITTEE (HSSREC)
INFORMED CONSENT
Information Sheet and Consent to Participate in Research Dear Sir/Miss/Madam
My name is Mbuso Zulu from department of Population Studies at the University of KwaZulu- Natal. My mobile number is 072 649 8799 and my email address is [email protected] You are being invited to consider taking part in a study about dietary practices among the elderly in a rural setting in KwaZulu-Natal. The aim and purpose of this research is to find out whether foods that is, eaten by the elderly has contributing factors to non-communicable diseases in their lives. The study is expected to enroll 24 people in Turton. It will involve the following procedures: a group discussion. The duration of your participation if you choose to enroll and remain in the study is expected to be 2hours. The study is not funded.
The study will not involve risks and/or discomforts. We hope that the study will create the following benefits:
Broaden the participant’s knowledge about dietary practices causes for non- communicable diseases.
The participants will understand the benefits of healthy diet.
The elders will potential cues to action in adopting a healthy diet.
This study has been ethically reviewed and approved by the UKZN Humanities and Social Sciences Research Ethics Committee (approval number_____).
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In the event of any problems or concerns/questions you may contact the researcher at 072 649 8799 or email address [email protected] or the UKZN Humanities & Social Sciences Research Ethics Committee, contact details as follows:
HUMANITIES & SOCIAL SCIENCES RESEARCH ETHICS ADMINISTRATION Research Office, Westville Campus
Govan Mbeki Building
Private Bag X 54001
Durban 4000
KwaZulu-Natal, SOUTH AFRICA Tel: 27 31 2604557- Fax: 27 31 2604609 Email: [email protected]
The participation criteria on this study is on voluntary bases. If the participants feel that somehow are no longer comfortable to participate in the study, they have the right to withdraw from the study at any time. The participants will not be liable for any penalties in the event of refusal/withdrawal from the study. However, participants will be required to notify the researcher about their withdrawal privately. The researcher does not intend to terminate any participant from the study, at any given circumstances.
There are no incentives or reimbursements for participation in the study will be given to the participants. Only refreshments will be served during the tea break.
The information disclosed by the participants in the study session will remain personal and confidential. Their names will remain anonymous at any given point in time. The digital recordings and electronic transcripts will be kept in a password protected folder on my memory stick. The hard copies will be locked in a filing cabinet. No identifying information (such as consent forms) will be kept with the digital or hard copies. On completion of the project, the research data (notes, audio records etc.) will be stored in the supervisor’s office for five years after which it will be permanently destroyed.
--- CONSENT
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I (Name) have been informed about the study entitled (provide details) by (provide name of researcher/fieldworker).
I understand the purpose and procedures of the study (add these again if appropriate).
I have been given an opportunity to answer questions about the study and have had answers to my satisfaction.
I declare that my participation in this study is entirely voluntary and that I may withdraw at any time without affecting any of the benefits that I usually am entitled to.
If I have any further questions/concerns or queries related to the study I understand that I may contact the researcher at (provide details).
If I have any questions or concerns about my rights as a study participant, or if I am concerned about an aspect of the study or the researchers then I may contact:
HUMANITIES & SOCIAL SCIENCES RESEARCH ETHICS ADMINISTRATION Research Office, Westville Campus
Govan Mbeki Building
Private Bag X 54001
Durban 4000
KwaZulu-Natal, SOUTH AFRICA Tel: 27 31 2604557 - Fax: 27 31 2604609 Email: [email protected]
Additional consent, where applicable I hereby provide consent to:
Audio-record my interview / focus group discussion YES Video-record my interview / focus group discussion NO
Use of my photographs for research purposes NO
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____________________ ____________________
Signature of Participant Date
____________________ _____________________
Signature of Witness Date (Where applicable)
____________________ _____________________
Signature of Translator Date (Where applicable)
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UKZN HUMANITIES AND SOCIAL SCIENCES RESEARCH ETHICS COMMITTEE (HSSREC)
Informed Consent (IsiZulu)
Incwadi yesivulelwano socwaningo Mnumzane/Nkasikazi/Nkosazana
Igama lami ngingu Maxwell Mbuso Zulu, ngingumfundi waseNyuvesi yakwaZulu-Natali.
Inombolo yokuba umfundi kanye nekheli ithi: 9407655. Inombolo yami yocingo ithi: 072 649 8799. Uyamenywa ukuba uhlanganyele nami ocwaningeni olumaqondana nesihloko esithi:
Umthelela wendlela okudliwa ngayo ekubeni yimbangela yezifo ezingalaphekiyo, maqondana nabantu abadala (ogogo nomkhulu) abahlala ezindaweni zasemakhaya esifundazweni saKwa Zulu-Natal.
Lolucwaningo luzoba nenani labantu abangu 24 endaweni yaseNyangwini. Indlela oluzoqhutshwa ngayo: INgxoxo ngokwamaqoqo (group discussions). Lamaqoqo azohlukaniswa kabili, abantu abangu 12 iqoqo ngalinye. Isikhathi sengxoxo sizoba amahora amabili. Lengxoxo izobe ihambisana nokuphendula imibuzo, ezobe ibuzwa umcwaningi maqondana nesihloko. Lolucwaningo aluxhasangwa ngezimali. Ngiyabonga ukuthi uvume ukuba yingxenye yalolu cwaningo. Inhloso yemibuzo ukuthi Kobe nengxoxo phakathi kwethu, ngizocela ukhululeke ukuzwakalisa imibono yakho ngokuphelele. Ngicela imvume yokuba ngiqophe inkulumo yethu. Engikutholayo kulolu daba esikhuluma ngalo ngizokusebenzisa ukubhala umbiko.
Kulideleke ukuba lolucwaningo:
• Luthuthukise ulwazi maqondana nendlela yokudla eyimbangela yezifo ezingalaphekiyo.
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• Labo abayingxenye yocwaningo bazoqonda ukuthi ukudla ngokunempilo kusiza kanganani.
• Ogogo nomkhulu bazofunda ukuba badle ngendlela enempilo.
Lolu cwaningo lusingethwe nguDokotela Kerry Vermmak ngaphansi kwesikole seBuilt Environment and Development Studies eNyuvesi yakwaZulu-Natali lapho ngifunda khona.
Yimi ozobe enza ucwaningo, uma unemibuzo ungabuza:
Isikole seBuilt Environment and Development Studies, eNyuvesi yakwaZulu Natali, Howard College, eThekwini. Imininigwane yami ukuze ngithinteke ungathumela umyalezo wombani kuleli kheli: [email protected].
Uma udinga ulwazi oludlulele ungathinta: HUMANITIES & SOCIAL SCIENCES RESEARCH ETHICS ADMINISTRATION
KwaZulu-Natal, SOUTH AFRICA
Tel: 27 31 2604557- Fax: 27 31 2604609 Email: [email protected].
Ngaphambi kokuba siqale ngithanda ukugcizelela ukuthi ukuvuma kwakho ube ingxenye yocwaningo kukuwena. Esikukhulumayo kuphakathi kwethu, igama neminingwane yakho ngeke idalulwe.
Ayikho inkokhelo noma ingozi ekubeni ingxenye yalolu phenyo. Ungahoxa noma inini futhi uvumelekile ukungaphenduli enye yemibuzo uma ungakhululekile. Ungabuza noma imiphi imibuzo noma inini.
Ngicela usayine isivumelwano ngenzansi.
Mina ……….. (Igama) ngiyakuqinikisekisa ukuthi ngiyifundile futhi ngayiqondisisa imibandela ethulwa NGU: Mbuso Zulu mayelana nocwaningo lwakhe.
Nginalo ithuba lokubuza imibuzo futhi ngiyagculiseka ngezimpendulo ezibekiwe. Nginalo ulwazi lokukhetha ukuba inkulumo iqoshwe.
Nginalo ulwazi ukuthi ngingahoxa noma inini.
Ngiyaqonda ukuthi awukho umnikelo engizowuthola kulolu cwaningo
YEBO CHA Ngineminyaka engaphezulu kuka-18 futhi ngivumelekile
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Ngiyavuma ukuzibandakanya kulolu cwaningo
Ngiyavuma ukuba inkulumo iqoshwe Igama __________________________________________________
Isiginesha __________________________________________________
Usuku __________________________________________________
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