Informed Consent Template

Information Sheet

This consent form is for Single mothers in the City of San Fernando, La Union, who
have been invited to participate in a study entitled "This is How We Feel: Psychological
Distress faced by Single Mothers."

The Researchers: Sandra G. Lacanaria

Karyll Anne J. Ferrer
Arturo Consejo R. Galvan
Jee-Anne B. Jose
Angelica G. Loucillo
College: College of Arts and Sciences
Department: Psychology

This Informed Consent Form has two parts:

• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)

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

Part I: Information Sheet

Introduction

Greetings! The researchers are from the Bachelor of Science in Psychology students at
DMMMSU-MLUC, conducting a research study whereas “This is How we Feel: Psychological
Distress faced by Single Mothers”. This is to invite you to be part of this research study.
Before you decide to participate in this study, it is important that you understand why the
research is being done and what it will involve. Please read the following information
carefully. Please ask the researcher if there is anything that is not clear or if you need more
information.

Purpose of the research

This study aims to identify the Psychological Distress faced by Single Mothers, at the
same time, to contribute to the growing body of literature regarding the challenges and
coping strategies of single mothers, and to be able to suggest possible interventions for the
development or improvement of appropriate programs and policies that will ensure their
overall well-being. Once you decide to participate in this study, the researchers will ask you
questions that are only relevant to the study.

Type of Research Intervention

A Researcher-made interview guide will be used in the study to facilitate the efficient
and effective collection of your response. The study utilized the Researcher-made Interview
Guide, specifically a semi-structured interview guide to gather the data and responses of the
respondents.
Participant Selection

Single mothers of ages twenty-five (25) to sixty (60) years old, who are currently
residing in the City of San Fernando, La Union were chosen as the research study's target
participants and primary sources of data.

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Voluntary Participation

Participation in this study is completely voluntary. It is your choice whether or not to

participate in this study. If you choose to participate, you will be required to sign a consent
form. After signing the consent form, you retain the right to withdraw at any time and
without explanation. Your withdrawal from this study will have no effect on your relationship,
if any, with the researcher. If you withdraw from the study prior to the conclusion of data
collection, your data will be returned to you or deleted.

Procedures

A consent form will be presented to the participants before the interview begins. The
researchers will conduct interviews for the research to be successful. In an interview,
information will be gathered through interviews with respondents. For additional information,
researchers will ask follow-up questions to emphasize the research. A recorded and in-person
interview will be used to collect and transcribe the proof and evidence resulting from the
research conducted. This document will be written in order to better comprehend the results.
The one-on-one interviews will continue until the researchers had gathered all of the
necessary information from the respondents.

Duration

From the beginning of Data collection to the conclusion of the interview, a minimum
of twenty minutes and a maximum of forty-five minutes will pass.

Risks

This research study may cause the participant mental and emotional distress.
However, neither Physical nor Financial risks are present in this study.

You may decline to answer any or all questions and you may terminate your
involvement at any time if you choose.

Benefits

This study's participants may have a better understanding of themselves, allowing

them to experience and enhance their overall sense of well-being.

Reimbursements

Participants will receive in-kind compensations as a token of appreciation and as

reimbursement for their time.

Confidentiality

This research study will be conducted in consonance with the rules of behavior or ways
of doing research. As such, the researchers considered and reviewed the ethical problems
carefully and complied with the protocols of the institution. Furthermore, the researchers
observed the protection of the well-being of the human participants wherein there will be no
physical or emotional harm will happen to the participants. Hence, the participants’ personal
information will be sealed by the researchers with all honesty and dignity. Rest assured that
all information that will be gathered will be kept in utmost confidentiality.

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Sharing the Results

This study's participants will have access to the information that will be collected.
Thus, the researcher's contact information will be provided so that participants may request
the findings following the conclusion of the study. In addition, sharing research results with
participants has the potential to significantly enhance research, to the benefit of both
research teams and participant communities.

Right to Refuse or Withdraw

Participants may decide to stop being part of the research study at any time without
explanation. Participants have the right to ask that any data you answered or provided to that
point will be withdrawn or destroyed. Participants have the right to omit or refuse to answer
or respond to a question that is asked appropriately and without penalty. Participants may
raise concerns or questions regarding the study prior to the said research or to the
information sheet.

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Who to Contact

This proposal has been reviewed and approved by DMMMSU Research Ethics Committee,
which is a committee whose task it is to make sure that research participants are protected
from harm. If you wish to find about more about the Committee, contact:

Joel C. Estacio
Chair, DMMMSU REC
rec@dmmmsu.edu.ph

Do you know that you do not have to take part in this study if you do not wish to? You can
say No if you wish to? Do you know that you can ask me questions later, if you wish to? Do
you know that I have given the contact details of the person who can give you more
information about the study?

You can ask me any more questions about any part of the research study, if you wish to. Do
you have any questions? You can contact me through the following:

Sandra G. Lacanaria
Group Leader, Don Mariano Marcos Memorial State University- Mid La Union Campus
0997-527-1996

Part II: Certificate of Consent

I have read the foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions I have been asked have been
answered to my satisfaction. I consent voluntarily to be a participant in this study

Name of Participant: ____________________________________________

Signature of Participant: ____________________________________________

Date: ____________________________________________

Day/month/year

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If illiterate 1

I have witnessed the accurate reading of the consent form to the potential participant,
and the individual has had the opportunity to ask questions. I confirm that the individual
has given consent freely.

Name of witness ______________________________ Thumb print of participant

Signature of witness _________________________

Date _______________________________________

Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and to
the best of my ability made sure that the participant understands that the following will
be done:

1. __________________________________________________________________

2. __________________________________________________________________

3. __________________________________________________________________

I confirm that the participant was given an opportunity to ask questions about the
study, and all the questions asked by the participant have been answered correctly and to
the best of my ability. I confirm that the individual has not been coerced into giving
consent, and the consent has been given freely and voluntarily.

A copy of this ICF has been provided to the participant.

Name of Researcher/person taking the consent ________________________________

Signature of Researcher /person taking the consent _____________________________

Date ___________________________

Day/month/year

1
A literate witness must sign (if possible, this person should be selected by the participant and should have no connection to
the research team). Participants who are illiterate should include their thumb print as well.

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