Informed Consent for Project Evaluation

Purpose and Background

We are conducting an evaluation research study that is evaluating the progress and impact of the Infant Mortality CoIIN initiative’s activities. As part of the study, we are interested in learning stakeholders’ perceptions of the Infant Mortality CoIIN initiative, and what did or did not work well to reduce infant mortality, improve birth outcomes and address disparities. Your perspective will help us evaluate, suggest changes, and make recommendations to strengthen the efforts to improve infant mortality rates and birth outcomes during and after the initiative. The results from this study will be shared in a report and used to teach others.


We are interested in learning about your experience in this area. You will be asked to participate in up to three different activities (a 45 minute interview, a team self-reflection survey, and/or a 20-30 minute online survey) to share your experiences and perceptions of activities in the Infant Mortality CoIIN. With your permission, we will audio-record and take notes during interviews. 


We do not anticipate any risks associated with participating in the study. If any question asked makes you uncomfortable, you are always free to decline to answer or to discontinue participation at any time.


Participating in this study will give you an opportunity to add your ideas and opinions to recommendations around reducing infant mortality, reducing disparities, and this project.


The researchers for this study will protect the confidentiality of whatever you share with them, and no identifying information will be released to anyone. Outside of NICHQ staff, only the Allendale Investigational Review Board of RTA Inc. can access this confidential information. Information from this study will be used for research purposes and may be published; however, your name will not be used in any publications. Any interview audio-recordings will be destroyed after the final report is written. The IRB may decide to review the records made during this study.


There is no compensation for participating in this study.

Participation is Voluntary

You do not have to be in this study if you do not want to. If you volunteer to be in this study, you may withdraw from it at any time without consequences of any kind or loss of benefits to which you are otherwise entitled. 

Contact Information

If you have any questions regarding your rights as a participant in this study, please contact:

Allendale Institutional Review Board 

For any general inquiries or to report any harm from the study, please contact:

Rachel Levine, MS
Principal Investigator
NICHQ Senior Analyst