Date:

Dear Sir or Madam:

 
We are undertaking a study titled, Readiness to Interprofessional Learning within the
Omani Context that aims to build vital information in the integration of
interprofessional practice and education into the higher education system of Oman. 
 
We are writing to ask if you could spare the time to answer this web-based design
survey. This survey will last approximately 15 to 20 minutes. 
 
The information you provide will remain confidential and this questionnaire is
anonymous. Any information allowing identification will be destroyed.

In addition, if you wish, the name of your institution and those individuals will be
changed.

Your participation in this study is entirely voluntary. You may refuse to participate
without any penalty. If you decide not to participate, you can refuse at any time to
answer a question or even terminate the questionnaire. If you would find it useful, I
am happy to provide you with a summary of the findings.

Should you have any inquiries, my email address is cptuppal@up.edu.ph and my

phone number is 00-968-913-10-550.

If you have other colleagues who may be interested in being part of this study as
participants, please send to them the link https://www.surveymonkey.com/r/
 

Yours sincerely,
 
 
 PACKET INFORMATION

You are invited to take part in a study on  Sexual Education Implementation and
Sexual Health Among Health Science Students. Whether or not you take part is your
choice.  If you don’t want to take part, you don’t have to give a reason, and it won’t
affect the care you receive.  If you do want to take part now, but change your mind
later, you can pull out of the study at any time.  

This Participant Information Sheet will help you decide if you’d like to take part.  It
sets out why we are doing the study, what your participation would involve, what the
benefits and risks to you might be, and what would happen after the study ends.  We
will go through this information with you and answer any questions you may have.

You do not have to decide today whether you will participate in this study. Before you
decide you may want to talk about the study with other people, such as family,
friends, or healthcare providers.  Feel free to do this.

If you agree to take part in this study, you will be asked to sign the Consent Form on
the last page of this document.  You will be given a copy of both the Participant
Information Sheet and the Consent Form to keep.

This document is four (4) pages long, including the Consent Form. Please make sure
you have read and understood all the pages.
 Respondent Information and Certificate of Consent Form

Research Title :
Sexual Education Implementation and Sexual Health Among Health Science Students

Researchers: :
Molvizar, Izobelle Marie P.
Flores Avilene
Lubo, Kizziah Ira Mhe T.
Odon, Crystal Joy V.
Pajar, Andre Rafael C.
Reposo, Nicolas Antonio E.

This Informed Consent Form has two parts:

þ Information Sheet (to share information about the research with you)
þ Certificate of Consent (for signatures if you agree to take part)

You will be given a copy of the full Informed Consent Form

PART I. RESPONDENT’S INFORMATION SHEET

a. Purpose of the Study

The study will determine the instructional leadership of the nursing
administrators and clinical instructors, the implementation of the outcomes-
based education in the nursing curriculum and the challenges encountered by
the administrators and clinical instructors in improving the passing rate in the
nursing licensure examination during the fourth quarter of 2019. The findings
of the study will serve as bases for a proposed development plan.

b. How will the present study be conducted?

This study will be conducted after the approval of the ethics committee of the
university. Informed consent will be taken from all the research subjects who
are to participate in the study. A record form will be provided for each
respondent.

There will be screening for inclusion and exclusion criteria, presentation about
the study, and informed consent.

c. What is the nature and extent of involvement of research respondents?

You will be involved in the administration of the survey questionnaire that will
take 30 to 60 minutes. An interview will be conducted that will take 2 to 3
hours.
d. Risks and Inconveniences

Will there be discomfort or risks?

There are no discomforts or risks involved during the course of the study.

e. Possible Benefits for the Respondents

What benefits can the respondents expect?

There will be no cost or remunerations involved during the study.

f. Compensation

Will there be reimbursement for travel expenses? Compensation for loss of

income?

There will be no reimbursements of any kind.

g. Provision for Injury or Related Illness

Will the respondent be given free treatment in case of injury or illness incurred
as a result of participating in the study?

Untoward incidents related to the study shall be taken care of by the

investigator.

h. Contact Person

Who is the person knowledgeable about the research and rights of the
respondent? How can he/she be contacted?

The investigator/s for this study is/are Molvizar, Izobelle Marie P., Flores
Avilene, Lubo, Kizziah Ira Mhe T., Odon, Crystal Joy V., Pajar, Andre Rafael
C., Reposo, Nicolas Antonio E. of St. Dominic College of Asia, Bacoor City
Cavite.
Mobile Number: +639060918806
Email Address:
izobellemarie.molvizar@sdca.edu.ph
avilene.flores@sdca.edu.ph
iramhe.lubo@sdca.edu.ph
crystaljoy.odon@sdca.edu.ph
andrerafael.pajar@sdca.edu.ph
nicolasantonio.reposo@sdca.edu.ph

i. Specimen Handling
 Specimen handling / Is any specimen collected from the study that will be
retained?

The study did not involve retaining tissue samples for genetic studies. No
specimen will be retained.

j. Voluntariness of Participation

Is the respondent free of any coercion in participating?

You are always free to decide for yourself. You will be managed accordingly
whether you agree or refuse to participate.

Shall the parties refuse to participate?

If you refuse to participate, you can still avail of the services due from the
same institution.

Is there assurance that the respondent can withdraw anytime without affecting
treatment/care due him/her?

Will be no different in terms of service if you join or refuse to participate on

this study.

k. Confidentiality

Is there a statement that describes the measures that will be taken to keep and
ensure the confidentiality of the respondent’s records?
All information shall remain confidential. The interview schedules shall be
kept in a data storage room so that only the investigator shall have access of
it. There will be no identifying information in the electronic form and the data
cannot be traced back to a specific respondent.

l. Privacy of the Respondent’s Data

During the subsequent follow up, you will be informed for the result of this
interview.

PART II. CERTIFICATE OF CONSENT

I have read and understood the above information and had been allowed to consider
and ask questions on the information regarding the involvement in this study. I have
spoken directly to my doctor who has answered to my satisfaction all my questions. I
have received a copy of this Respondent’s Information and Informed Consent Form.

I am (please check)
 [] volunteering myself to participate in the study
[] not participating in the study

Respondent’s Signature:

_________________________________ _____________________
PRINTED NAME OVER SIGNATURE DATE

Researcher’s Signature:

I, the undersigned, certify that to the best of my knowledge, the person signing this
consent form has read the above information sheet fully, that this has been carefully
explained to him/her, and that he/she clearly understands the nature, risks, and
benefits of his/her participation in this study.

A COPY OF THIS Informed Consent Form has been given to the respondent.

________________ __________________
Researcher