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CONSENT TO PARTICIPATE IN
NON-BIOMEDICAL RESEARCH

Action Path

You or your child are asked to participate in a research study conducted by Erhardt Graeff, a PhD student at the Media Lab at the Massachusetts Institute of Technology (M.I.T.). Results will contribute to research publications by Erhardt Graeff and to ongoing development of the Action Path app. You or your child was selected as a possible participant in this study because membership in a local organization. You should read the information below, and ask questions about anything you do not understand, before deciding whether or not to participate.

PARTICIPATION AND WITHDRAWAL
Your or your child’s participation in this study is completely voluntary and you are free to choose whether to be in it or not. If you choose to be in this study, you may subsequently withdraw from it at any time without penalty or consequences of any kind. The investigator may withdraw you from this research if circumstances arise which warrant doing so.

PURPOSE OF THE STUDY
This study looks at how technologies can support community action.

PROCEDURES
If you volunteer to participate in this study, we would ask you or your child do some or all of the following things:

Take a short survey; Use a smartphone app called Action Path; and Participate in a short intervew. These will all be undertaken in or around your community. Interviews will be done at the location of your local organization. Interviews will last less than 30 minutes.

The app (Action Path) will send you push notifications, ask you to take short walks to visit locations in your community, and then ask you to complete a short task in the app. Data will be collected during your use of the smartphone app, including your location while using the app and anything that you input into the app.

POTENTIAL RISKS AND DISCOMFORTS
No risks or discomforts are forseeable.

POTENTIAL BENEFITS
Potential benefits of participating in this research include learning new things about your community.

PAYMENT FOR PARTICIPATION
You will not be paid for participation in this study.

CONFIDENTIALITY
Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law.

Data collected from app usage will be connected to personal accounts, which may contain personally identifiable information. Your activity on the app may be viewed by other users of the app. However, access to the servers where app data are stored will be restricted to primary researchers and only connected to survey and interview data through subject number codes. Personally identifiable information will be stored separately from that research data, and all data will be digitally locked with a password, which only primary researchers will have. Any quotes used in publications will be given pseudonymous names.

Audio recordings of interviews will be collected to assist with research. Recordings will be transcribed and then the original recording will be destroyed one year after the study’s completion.

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please feel free to contact Erhardt Graeff at [email protected] or 1-717-919-3145, or Ethan Zuckerman at [email protected] or 1-617-253-3962.

EMERGENCY CARE AND COMPENSATION FOR INJURY
If you feel you or your child have suffered an injury, which may include emotional trauma, as a result of participating in this study, please contact the person in charge of the study as soon as possible.

In the event you or your child suffer such an injury, M.I.T. may provide itself, or arrange for the provision of, emergency transport or medical treatment, including emergency treatment and follow-up care, as needed, or reimbursement for such medical services. M.I.T. does not provide any other form of compensation for injury. In any case, neither the offer to provide medical assistance, nor the actual provision of medical services shall be considered an admission of fault or acceptance of liability. Questions regarding this policy may be directed to MIT’s Insurance Office, (617) 253-2823. Your insurance carrier may be billed for the cost of emergency transport or medical treatment, if such services are determined not to be directly related to your participation in this study.

RIGHTS OF RESEARCH SUBJECTS
You and your child are not waiving any legal claims, rights or remedies because of your participation in this research study. If you feel you have been treated unfairly, or you have questions regarding your rights as a research subject, you may contact the Chairman of the Committee on the Use of Humans as Experimental Subjects, M.I.T., Room E25-143B, 77 Massachusetts Ave, Cambridge, MA 02139, phone 1-617-253 6787.

I understand the procedures described above. My questions have been answered to my satisfaction, and I agree to participate in this study.

[I UNDERSTAND] button

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