Anzahl traumatischer Lebensereignistypen
3 2
1 0
HSCL Depressivität Summenwert
60
50
40
30
20
10
Type II/III Type I nicht beschnitten
FGM Typ
Seite 1
VII. Untersuchungsset
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Consent Form Interview – Participant
My name is !... This is !..., s/he will be our interpreter. The organizations I am working with are a NGO called vivo and the University of Konstanz in Germany.
I would like to learn more about what has happened to you, what you have experienced and how you feel about it today. The information collected will help to understand how people respond to violent, stressful, or sad experiences they have undergone in the past and how it influences their daily lives now. By participating in this study you will contribute a lot to our work and I am very grateful for that. Thank you.
The Interview consists of three parts. First, there will be short memory game. Then, I will ask you some questions about your life experiences and your current well-being. In the end I would like to know how your body deals with the stressful events you have experienced in the past. Actually, the body, if under stress, releases chemicals that circulate through the bloodstream modifying the functioning of many organs. These chemicals can also be found in hair and as our hair grow, store the information of how much of these chemicals had been released across time. Therefore we would like to obtain a sample of your hair and conduct a corresponding analysis.
The interview will take about two to three hours. The interpreter and I will keep all of your responses strictly confidential. Your answers will not allow to identify you later on. The results may be published for scientific purposes and cannot be reconstructed on the basis of the published data.
For participating in this study you will receive 50 Birr, yet there will be no further financial or other direct benefit.
Your participation is voluntary and you may refuse to answer any question. Whether you participate or not will neither affect you or your family in any way, nor be communicated to EGLDAM or any other international organization.
Do you have any questions? You may ask questions about this study at any time.
I have read the consent form to the participant and the participant agreed to take part in the study:
________________________________
(interviewer’s signature)
I agree to take part in this study: ________________________________
(participant’s signature)
Professional Confidentiality Agreement – Interpreter
The interpreter Mrs ... is herewith declaring to be advised by Mrs ..., vivo international andUniversity of Konstanz, of the professional confidentiality of the impending interview.
She understands, that all information provided by the interviewee during this study are strictly bound to professional discretion and must not be passed on to third parties.
________________________________
(interpreter’s signature)
________________________________
(place, date)
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