P2 011 informed consent and GDPR
KDA Marktforschung GmbH
Telefon: +49 69 973077-0
Telefax: +49 69 973077-20
INFORMED CONSENT TO TAKE PART IN A RESEARCH STUDY
TITLE OF STUDY: Diabetes App (P2 011)
INVESTIGATOR: KDA Marktforschung GmbH
SUB-INVESTIGATOR: Acumen Fieldwork
SPONSOR: Roche Diabetes Care GmbH
You are being asked to participate in a research study. It is important that you read the following explanation of the proposed procedures. A member of the study staff will explain the study procedures to you and answer any questions that you may have about the study or the consent form. When you think you understand the study, you will then be asked if you agree to take part. If you agree, you will be asked to sign this consent form. You will be given a signed and dated copy of this consent form for your record.
Your participation in this research study is voluntary. You may quit the study at any time without harming any future medical care or losing any benefits to which you are entitled.
To conduct this study and to fulfill this informed consent, we store your contact details (name, address, potentially your phone number and email address) and the answers you have given in the interview. The storing and transferring of your contact details and the personal data contained in this informed consent via e-mail, streaming, data transfer and postal services within the UK and to Germany also serves to document your services and the compensation that you received and informs you of the purpose and the study procedure.
Purpose: The purpose of this study is to evaluate an app for diabetes management. The manufacturer wants to understand if the design will be safe and easy to use and will best meet the needs of the intended app users like you. The study will be conducted between 20th February and 3rd March 2023 in Stockport and London.
Procedure: Your total participation in the study will be up to 120 minutes. You will be asked to complete a series of tasks focusing on the usage of the app and then questions about your handling experience will be asked.
PLEASE NOTE CAREFULLY: You will not be asked to simulate an injection against your own body, or to inject yourself or others.
Answer a series of questions about your experience with the app.
You do not have to answer every question or complete every task. However, we would like you to do your very best to complete every task and question.
Confidential Research: This study is confidential. That means that only members of the research team, the study sponsor, its collaborators in the research study, and their affiliates, representatives, and agents (including laboratories and other third-party contractors working in connection with the study), have access to the information you gave. Any information you provide will be kept strictly confidential: your name will not be associated with this information instead a unique identification number will be assigned to each participant as a means of identification. During our analysis, and in any reports or other presentations of this research, your data will be identified with that number only.
Compensation: You will be compensated for your time and will receive a monetary honorarium for completing your assigned test session. Compensation is dependent on your role and time commitment for your test session. Based on participation of up to 120 minutes, you will be compensated £120 for full participation in the study.
Risks: The test is performed non-invasively, which means that you do not need to administer an injection. The tasks are performed in the presence of a moderator, therefore there is no danger.
Benefits: As a research participant, you will not benefit directly from this research.
Alternatives to Participation: Since this study is not intended to provide any therapeutic or other health-related benefit, your alternative is to not participate in this study.
Costs: There are no direct costs for your participation in this study.
Data Privacy: During the sign-up process and possibly during your study session you have provided personal data, and possibly will provide more personal data, about your age, medical conditions, experience with injections, etc. This information is secured to protect your privacy. The sponsor needs your data to assess the tested app and to show that the study observations were valid and accurate, for example when the results of this study are presented to regulatory authorities. At any time during or after the study you are entitled (allowed) to see, correct and limit access to your personal data. According to the GDPR regulations, the video recording and the informed consent will be kept for 10 years and will be deleted no later than 10.5 years after your participation.
Future Use and Retention: The data collected during this study will be stored with other documents for the development of the app that you will be testing. Your data and some of the background information you gave us (such as age and information about your diabetes) will only be labeled with your participant number. The study facilitator will remove all personal information that you provided and its connection to your participant number after the study report is finalized. After that, the study data will be considered anonymous because it will not be possible to connect the data with your name and therefore is not subject to data protection anymore.
The study facilitator will keep your name and contact information in case an issue arises so that they can follow up with you afterwards if needed, but they will not keep a record of what your participant number was.
Audio and Video Recording: A video-recording of the interview is made for analysis and control purposes. You may decide not to give permission for audio and video-recording of your session. In that case, you will not be able to participate in the study. This is because the study personnel would not be able to collect the data needed to evaluate the app.
If you do allow the study personnel to audio and videotape your session, these recordings may be used by the study personnel for later review and analysis (if necessary). Your comments will be transcribed and the recordings will be labeled with the date of the session and your participant number only (not your name).
The video recording will be forwarded to external contractors and technical service providers of KDA for data analysis and video editing within the UK and to Germany. The recording will be digitally stored on (a) password-protected computer(s).
Termination of Your Participation: The study facilitator or the study sponsor can take you off the research study if:
You may choose to withdraw your consent to allow the study facilitator and study sponsor to use your personal data for the purposes of the study as described above either during the study session or after the study session is over.
Study Contact: If you have any further concerns, complaints, or questions, you may contact the Principal Investigator at:
KDA Marktforschung GmbH Christiane Farnbacher
Bruchstr. 5, 60594, Frankfurt, Germany.
phone: +49 69 973077 26
I agree to the aforementioned terms:
Volunteer's Statement for Study P2 011 between KDA Marktforschung GmbH and
I understand that my participation in this research project is voluntary.
If I have any questions about my rights as a research subject in this study, I may contact
Christiane Farnbacher, phone: +49 69 973077 26
By signing this form, I have not waived any of my legal rights. I have read the above information. I agree to participate in this study as described above. I will be given a copy of this signed and dated form for my own records:
The General Data Protection Regulation we informed you in detail to what purpose KDA collects, records or transfers your data. The company responsible for data processing is
KDA Marktforschung GmbH Bruchstr. 5
60594 Frankfurt, Germany
Under the General Data Protection Regulation, you have the rights to:
I agree in the processing of my personal data as described above. I am aware that I can choose not to answer individual questions, and that withdraw this consent at any time:
Non Disclosure Agreement
Non-Disclosure: You agree that you will not disclose to any person (third party), or use for your own benefit, any confidential ideas, concepts, designs, or any information relating to any products or potential products, methods, client identities, business leads and relationships, intellectual property of various kinds, or other confidential information of the Study Sponsor, which may be disclosed to you in the course of this study.
Inventions, Discoveries, and Improvements: You agree that any input that you provide during the course of the study can be freely employed by the Study Sponsor with no restrictions. You further agree that all inventions, improvements, or discoveries, whether patentable or un-patentable, made, devised, or discovered by you during the course of this study, as well as all data generated during the course of the study and any copyright or other rights in such data or inventions will become the property of the Study Sponsor and will remain its sole and exclusive property, and further that you shall not acquire any rights in such data or material by your participation in the study.
I agree to these terms:
In accordance with GDPR Art. 6 Section 1a, and Art. 9 Section 2a
In accordance with GDPR Art. 6 Section 1b
In accordance with GDPR Art. 6 Section 1c, Art. 9 Section 2g
In accordance with GDPR Art. 28
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Document Name: P2 011 informed consent and GDPR
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