Cochlear Implant Survey (Patients)

Explanation of Research

TITLE OF RESEARCH: Survey of Educational/Social/Vocational Outcomes of Pediatric Cochlear Implant Users   Protocol 120326006

FOR PATIENTS:  

Dr. Audie Woolley wants to ask you some questions about how well you have done with your cochlear implant in school, in daily life, and at work.  This is a research study.  If you agree to participate, please click on the link below and complete the online survey form.  Completion of the questionnaire should take approximately 20 minutes.

We would like to have questions answered for all patients who have a cochlear implant.  We are asking about 300 patients and/or their families to participate in this study.

Your participation is voluntary.  By answering the questions and returning the questionnaire, you are allowing us to use your answers for our research study.  There is no cost to you for participation in this study.  We will be correlating your answers with clinical information obtained from your chart here at Children’s of Alabama.  Although the risk is very small, there is no guarantee that any personal data you submit over the internet cannot be intercepted by a third party.

To thank you for participating in this study, once we have received the completed survey from you, we will mail you a gift bag valued at approximately $10.00.

The results of this study may not help you directly.  The study may help us to know how well children with cochlear implants do in school, their daily lives, and at work.  This will help us in pre-operative counseling with parents about expectations after receiving a cochlear implant. 

It is your choice whether or not to complete the questionnaire.  You may choose not to answer any of the questions.  There will be no penalty if you decide not to participate in the study.  Dr. Woolley and the HEAR Center will continue to see you as we have in the past, and your care will not be affected.

When the study is done, and we look at the results, we will not use your name or any private identifiable information you may have given us.  Your responses will be kept completely confidential.

If you have any questions, concerns, or complaints about the research, please contact Dr. Audie Woolley at 205-939-6615.  He will be glad to answer any of your questions.  You may also call the Office of the Institutional Review Board (OIRB) at the University of Alabama Birmingham 205-934-3789 or 1-800-822-8816.  If calling the toll-free number, press the option for “all other calls” or for an operator, and ask for extension 4-3789.  Regular hours for the OIRB are 8:00 a.m. to 5:00 p.m. CT, Monday through Friday.  You may also call this number in the event the research staff cannot be reached or you wish to talk to someone else. 

Thank you immensely for your time and participation,

Dr. Woolley and associates

FOR PATIENTS:  click here to complete the Cochlear Implant survey