Interviewer: Read the consent statement below to
the interviewee prior to conducting the interview.
Hello! My name is
in coordination with (partners)
a working group is conducting an assessment on
policies, systems, and services related to SrH
and Hiv linkages. this information may help to
improve policies, programmes and services.
We would appreciate it if you could answer some
questions. However, your participation in this study
is voluntary and if you choose not to participate,
you will not be penalized in any way. if you agree to
participate and you change your mind later, you can
also ask me to stop the interview whenever you want.
if you participate, you will not benefit directly from
your participation. But your participation may
result in improved future sexual and reproductive
health and Hiv policies and services.
Your opinions and the information you give during the
interview will remain confidential. the questionnaire
will not have your name. this way, no one will be able
to know that i interviewed you or what you said.
finally, if you have any questions about this study
at a later time, you can call this phone number
Sample Consent Form
May i continue with the questions? ____ Yes ____ no
Informed Consent Interviewer: Read the consent statement below to the interviewee prior to conducting the interview. if you agree to participate and you change your mind later, you can also ask me to stop the interview whenever you want.