Running head: INFORMED CONSENT AND DEBRIEFING
Informed Consent and Debriefing
Grand Canyon University: PSY 550
January 27, 2021
INFORMED CONSENT AND DEBRIEFING FORM 2
Informed Consent and Debriefing Form
Research P
...
Running head: INFORMED CONSENT AND DEBRIEFING
Informed Consent and Debriefing
Grand Canyon University: PSY 550
January 27, 2021
INFORMED CONSENT AND DEBRIEFING FORM 2
Informed Consent and Debriefing Form
Research Participant Name:
Informed consent is a signed or verbal agreement in which participants state they are willing
to participate in a research study after being informed of all aspects of their role in
the study (Privitera, 2020).
Introduction
Extensive research has been devoted to study the impact of exercise on mental health and wellbeing for people experiencing a mental illness (Mazyarkin, Peleg, Golani, Sharony, Kremer &
Shamir, 2019). It is indisputable that regular physical exercise is crucial to health promotion,
disease prevention, and mental health (Klaperski, Koch, Hewel, Schempp & Muller, 2019). The
purpose of this consent form will provide pertinent information necessary for any participant
wanting to take part in this study.
Invitation
I am a Psychology Graduate Student at Grand Canyon University, inviting you
to participate in a research study of the impact of exercise on mental health and well-being.
Purpose
The purpose of the study will demonstrate the effects of physical activity on overall patient
mental health state and physiological fitness. Physical inactivity has been described as the
leading risk factor for global mortality, accounting for 27% of diabetes and 30% of ischemic
heart diseases (Mazyarkin, Peleg, Golani, Sharony, Kremer & Shamir, 2019).
Description of the Research Study
As a participant in this clinical study, the program will examine the effects of group-based
exercise programs for participants with chronic mental health. This study will involve 100
participants conducting physical exercise three times per week for 1 hour in small groups.
During and following the physical exercise program changes in psychiatric well-being, empathy,
and physiological fitness factor (e.g., fasting blood glucose, lipid profile, hemoglobin A1C, and
BMI) will be monitored.
Risks & Benefits
This study includes a small number of patients in each study group (6-10 participants). Exercise
is required for the study, participants who suffer from metabolic and cardiovascular diseases,
diabetes, obesity, and stroke will be screened and monitored. Duration of physical activity within
the groups will be 1 hour and does not factor in participant current nutrition and health lifestyle.
The benefits of the diverse groups may yield more significant health results and conclusions.
Providing evidence for the beneficial effect of physical exercise on mental health, leading to
healthy lifestyle modifications, improving overall health - physical and mental.
Confidentiality
All information obtained in this study is strictly confidential unless required by law. The results
of this research may be used in reports, presentations, and publications, but the researchers will
INFORMED CONSENT AND DEBRIEFING FORM 3
not identify you. In order to protect your privacy and identity, all records of your participation
will be given a group number that does not allow anyone (including the project staff) to
personally identify you. These records will be kept in a locked cabinet in a locked room where
they will remain for at least 3 years following the completion of this research study or until the
records can be safely destroyed (Privitera, 2019)
Compensation
Participation in the study will give the participants free medical labs and assessment of overall
health by a licensed physician and medical staff.
Questions & Contact Information
Please ask any questions you may have at this time. If you have questions following your
participation or if you feel you have been placed at risk as a participant in this research, they can
be answered by , phone#: (XXX)XXX-XXXX, or email @gcu.edu.
Disclaimer
Participation in this study is voluntary and participants can quit or withdraw from the study at
any time without penalty. Participants can refuse any portions of the study without withdrawing
from the entire study (Privitera, 2020).
Research Participant Signature:
Grand Canyon University Researcher Signature:
INFORMED CONSENT AND DEBRIEF
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