Skip to main content
. Author manuscript; available in PMC: 2018 Mar 12.
Published in final edited form as: J Empir Res Hum Res Ethics. 2014 Oct 2;9(5):1–7. doi: 10.1177/1556264614552627

Table 2.

Example of Simplified Paper-Based Consent Form.

You will be randomly assigned to one of three groups. This means that you or your health care provider cannot choose your group. Your assignment to a group is up to chance, like rolling dice.
Everyone will receive information on newborn screening. In addition, some mothers will view one or two 5-min videos near the end of their pregnancy.
  • Some mothers will view a video about newborn screening and a second video about leftover blood spots.

  • Other mothers will view a video about newborn screening only.

You will be asked to do a 15- to 20-min telephone survey 2 to 6 weeks after your due date. The survey is about your experiences, knowledge, and attitudes on newborn screening and leftover blood spots.
  • Some mothers will be asked if we can contact their partner to do a similar survey.

  • A few mothers will be asked for a telephone interview about their choices with newborn screening and leftover blood spots.