Eastern Connecticut State University Informed Consent Form: Participant's Printed Name

Eastern Connecticut State University
Informed Consent Form
Title of Project: A Quantitative Study of Video Games for Potential Health Care Improvement
Principal Student Investigator: John Cabuyaban
Faculty Mentor: Dr. Anita Lee
Participant’s Printed Name: _______________________________
Introduction
I welcome you to take part my research study “Improving Therapy and Rehabilitation with a
Gaming approach.” I want this study to improve therapy and rehabilitation methods due to them
being too tedious/unmotivating. Taking part of this study is completely your choice and
voluntary. Any questions or information should be for me alone. This will take a little bit more
of your time so make sure that there a little saved up for this study. If you decided to participate,
please sign this form to show that you want to take part.
Section 1. Purpose of the Research
The purpose of this research is to make therapy and rehabilitation better for patients. Therapy
sessions from experience show that there is a need of an update for these methods. Some of these
methods are effective, however, there are efficient and more stimulating ways to make therapy
and rehabilitation better. If there is even a sign of improvement through these methods for better
results in physical, mental, or cognitive recovery, then these activities should be applied to
modern day health care. Stress level will be measured to determine if games really are positive or
negative change for health care change.

Section 2. Procedures
You will participate in two questionnaires. One will determine how much gaming is in
relationship to time and stress. It will be a good reflection on life and will have good information
on health care reformation. The second questionnaire will determine what kind of gamer you are.
For those that play lots of games, this will show how there can be a game for everyone to enjoy
with minimal stress or how the most casual gamer can play any game they want and have no
stress at all. There is a game for everyone and finding the majority will help with types of games
to apply in a health care environment.
Section 3. Time Duration of the Procedures and Study
If you agree to take part of this study, you will engage in an activity for 3 activities. When the
activity is completed, please message me at the end of the session for results.
Section 4. Discomforts and Risks
Since this is a study on video games, be sure to take the necessary pre-cautions before engaging
in said activity.
Section 5. Potential Benefits
While this is a study on video games, having the mental stability is important to have in these
current times of COVID-19. Being able to access this form of therapy at your own home is an
amazing form of self-therapy. For physical video games, weight loss, muscle gain, stamina
improvement, and most importantly dexterity of limbs (arms and legs) are amazing ways to
apply to therapy and rehabilitation. Current methods are slower and less engaging, so with these
methods being relatively cheaper to the gear hospitals currently have, installing video game like
methods with technology can be applied.
Section 6. Statement of Confidentiality

6a. Privacy and confidentiality measures:
All research records that are reviewed, stored, and analyzed at Eastern Connecticut State
University will be kept in Microsoft Forms. It will be deleted after three months. Your data
collected for research will be labeled with a code name, initials, and a code for what type of
activity you did. Any data gathered will be deleted within 30 days upon study completion. In the
event of any publication or presentation resulting from the research, no personally identifiable
information will be shared.
Section 7. Costs for Participation
No cost will be required from the participants.
Section 8. Compensation for Participation
No compensation will be offered to participants.
Section 9. Research Funding
The research study has no funding.
Section 10. Voluntary Participation
Taking part in this study is completely voluntary. If you choose to take part in this research you
will be required to, schedule yourself to fit this research, commit to long hours of gameplay for
multiple days, checking in after every week to me, and filling out any forms given. You do not
have to participate in this study. You have the right to stop at any point in time of the study and
there will be no penalty for quitting. I will take you out of the research study without your
permission. These reasons may be, not following instructions, having late check-ins, or having a
suspicion of faking a task.

Section 11. Contact Information for Questions or Concerns
Information about this Study: If you have questions about your participation in this study,
or if you would like to receive a summary of the study results, please contact John Cabuyaban
at cabuyabanj@myeasternct.edu or my faculty mentor, Dr. Anita Lee at Leean@easternct.edu.
Your rights as a research participant: If you have questions about your rights as a research
participant, please contact Dr. Melanie Evans Keyes, Chair, Committee on the Use of Human
Subjects in Research at
Eastern Connecticut State University (Phone: 860-465-0070; Email: CUHSR@easternct.edu).
Consent Statement: Please initial the following statements and sign to indicate your
willingness to participate.
_____ I have been given the opportunity to ask questions about the research;
_____ I have received answers concerning areas I did not understand;
_____ I willingly consent to participate in this research;
_____ I understand that I will receive a copy of this consent form;
_____ I am 18 years old or above on the date I sign this form.
________________________________________________________________
Signature of Participant Date
___________________________________________________
Printed Name of Participant

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Eastern Connecticut State University

Informed Consent Form

Principal Student Investigator: John Cabuyaban

Faculty Mentor: Dr. Anita Lee

Participant’s Printed Name: _______________________________

Section 1. Purpose of the Research

negative change for health care change.

to apply in a health care environment.

Section 3. Time Duration of the Procedures and Study

Section 4. Discomforts and Risks

Section 5. Potential Benefits

methods with technology can be applied.

Section 6. Statement of Confidentiality

information will be shared.

Section 7. Costs for Participation

No cost will be required from the participants.

Section 8. Compensation for Participation

No compensation will be offered to participants.

Section 9. Research Funding

The research study has no funding.

Section 10. Voluntary Participation

suspicion of faking a task.

at cabuyabanj@myeasternct.edu or my faculty mentor, Dr. Anita Lee at Leean@easternct.edu.

Eastern Connecticut State University (Phone: 860-465-0070; Email: CUHSR@easternct.edu).

_____ I have received answers concerning areas I did not understand;

_____ I willingly consent to participate in this research;

_____ I understand that I will receive a copy of this consent form;

_____ I am 18 years old or above on the date I sign this form.

Signature of Participant Date

Printed Name of Participant

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