Online Consent Form for Participation in Research

Title of Investigation: Intergenerational Medication Assistance for Older Adults
Principle Investigator: Ann M. Steffen, Ph.D., Associate Professor, University of Missouri-St. Louis
Co-Investigator: Melanie VanDyke, Ph.D., St. Louis College of Pharmacy

You are invited to participate in this online research study. We want to improve our understanding of the experiences and challenges of women who help aging family members (parents, in-laws, grandparents) or close older friends manage their medications. If you decide to participate in this study, you will be asked to complete a series of questionnaires. This survey will take about 20-30 minutes for you to complete and should be taken using a laptop or computer (not a smartphone).

By participating in this study, there may be a risk that you could feel uncomfortable when answering some of the questions considered personal or sensitive in nature. If you would like help with these or any other issues, information about programs and services will be provided at the end of the survey.

Participation in this research is likely to benefit the field of health education by helping us understand which factors are linked to medication-related hassles and concerns. Through this research, we hope to improve ways to support family members and close friends in their care of older adults.

Confidentiality will be fully maintained in this study. At no point in the actual survey will you be asked for your name or other identifying information. We will, however, have your name and mailing address if you request a gift card at the conclusion of your survey. We are very careful in how we handle your confidential survey responses, including using a secure https website for data collection. Once the data are downloaded to our project office, your responses are stored separately from your name and address. All information you provide will be combined with the data from other respondents and reported in publications as group level data. All data will be stored electronically, will be password protected, and will be destroyed after 5 years. Your participation in this study is completely voluntary. You are free to withdraw your consent and remove yourself from participation in this study at any time without penalty of any kind.

For those who are eligible to complete the full survey, you can enter a separate online site at the end of the survey to request a $20 gift card as a thank you for your efforts.

All participants are welcome to receive a copy of the results of this research following its completion. Participants are also welcome to a copy of this consent form. For these purposes or for any other information regarding this research study and/or your rights as a research participant, you may contact the primary investigator, Dr. Ann M. Steffen at, or 314-516-4395.

The Institutional Review Board of University of Missouri-St. Louis has reviewed and approved this study. (UMSL Protocol #500663). The Institutional Review Board of St. Louis College of Pharmacy has also reviewed and approved this study (STLCOP Protocol # 201239). If you have questions and you would like to speak with a representative of the UMSL Institutional Review Board, you may contact: UMSL Institutional Review Board, 314-516-5399;

As you complete this survey, please note that you will NOT be able to exit the survey and re-enter at a later time. Thus, if you need to take a short break while filling it out, leave the survey window open.

There is a possibility that your responses could be viewed someone else if you have survey up on your screen and leave the computer terminal before finishing. If you need to leave the computer, don't close down the survey; simply minimize the internet screen so that others will not see it.
I have read the informed consent form and understand and agree to all of the stated terms, and am prepared to spend 30 minutes now to complete it.