Official Use Only

Protocol number

OFFICE OF RESEARCH, INNOVATION AND DEVELOPMENT

Ethics Committee for the Humanities (ECH)
GUARDIAN /PARENTAL PROTOCOL CONSENT FORM

HOW TO USE THIS CONSENT FORM:

This document is the standard ECH-approved template to assist you with designing a written
informed consent form. You may adapt the template as you see fit but remember that the document
must address the participant directly, have some information about each heading, and include the
UG logo at the top. Please write in SIMPLE, NON-TECHNICAL language.

The text written in [RED] is for guidance only and should be removed before finalising the
document. Answers provided under each heading should be in paragraph format and not
bulleted. Also, this information box should be deleted before the document is finalised.

Section A- BACKGROUND INFORMATION

Title of Study: Parental Characteristics and Involvement in Predicting
Neurocognitive and Academic abilities in Children in Low-middle
Income SettingThe title must be consistent on the proposal and all
other documents
Principal Investigator: Ezekiel Nii Tettey Antieye AddyFor students and researchers, state
the lead person’s name
Certified Protocol
Number

Section B– CONSENT TO PARTICIPATE IN RESEARCH

General Information about Research

This study seeks to examine the role of parental characteristics and involvement can impact a
child’s intelligence and academic abilities in a public basic school within a low-middle income
environment in Ghana. Environmental factors such a parents’ level of education and socio-
economic status has been identified to have an impact on intelligence and academic abilities but
the extent of influence is unclear especially low-middle income communities.

The time required to complete the study may take up to forty-five (45) minutes.

Your role in the study will be to respond to a battery of cognitive tests and set of scales in a
questionnaire that assesses intelligence and academic abilities.

Revised – October 2023

 State clearly the purpose of the study in simple words (avoid the use of jargon and technical
language. Remember the consent form is for the participant – please do not copy and paste from
your research proposal).

 Indicate the expected duration that will be required of participants in the study.
 Give a description of the procedures/methods to be followed and the identification of any
experimental procedures and what the participant(s) is supposed to do.

Benefits/Risks of the study

Child-participants will be able to know their cognitive profile through the battery of tests
administered and parent-participants will also know their type of approach to parenting. There will
be no considerable risk associated with your participation in the study. Also, participants will
contribute to further development of intervention programmes for parents. Indicate specifically the
benefits and risks associated with the study.

However, the administration of test instruments may cause a psychological strain due to the
duration and to reduce psychological strain, participants will be encouraged to take periodic breaks
to reduce fatigue in the course of the administration of tests. Also, participants will be provided
with counselling when necessary.

Include all physical, social, and psychological risks and benefits anticipated. (State the direct
benefits to child-participants that could be expected from their participation in the study. If the
participants will not benefit directly, clearly state this fact. Also, state (realistically) the potential
benefits, if any, to society expected from this study.)

Indicate any hazards to participants and what steps will be taken to minimize the risks to protect
the child-participant (e.g., referral for counselling or therapy, etc.)

Confidentiality

 Describe the extent to which confidentiality of records identifying the participants will be
maintained.
 Indicate all groups that may have direct access to the research records at any particular
time; thus, by signing or thumbprinting a written consent form, the participant or their
representative is authorizing such access.

Compensation

 State clearly if there are any compensation packages either in cash or kind available for the
child and/or parent who participate in the study.
 The exact amount or gift to be given must be clearly spelt out.
 The conditions for receiving the package and when it will be made should also be indicated
(a token of appreciation should be given at the end of the study).

Withdrawal from Study

 State that the child and parent participation is voluntary and participants may withdraw at
any time without penalty.
 More specifically, state that the participant will not be adversely affected if he/she declines
to participate or later withdraws from the study.
Revised – October 2023
  Assure that the participant or the participant's legal representative will be
informed promptly if information becomes available that may be relevant to the
 participant's willingness to continue participating in the study or withdraw from the study.
Any circumstances and/or reasons under which participation may be terminated should be
stated clearly.

Contact for Additional Information

 Provide contact details of persons assigned to respond to questions about the research and
respond to cases of research-related injury.
 Names, Institutional affiliation, addresses, e-mail and telephone numbers (including mobile
numbers) should be made accessible to all participants.
 If you have any questions about your rights as a research participant in this study you may
contact the Administrator of the Ethics Committee for Humanities, ISSER, University of
Ghana at [email protected] or 0+0233- 303-294-0531.

Section C- PARTICIPANT AGREEMENT

"I have read or have had someone read all of the above, asked questions, received answers
regarding my child’s participation in this study, and am willing to give consent for me, my
child/ward to participate in this study. I will not have waived any of my rights by signing this
consent form. Upon signing this consent form, I will receive a copy for my personal records."

________________________________________________

Name of Participant

_________________________________________________ _______________________

Signature or mark of Participant Date

If participant can neither read nor understand the form themselves, a witness must sign
here:

I was present while the benefits, risks, and procedures were read to the volunteer. All questions
were answered and the volunteer has agreed to take part in the research.

_________________________________________________

Name of witness

Revised – October 2023

________________________________________________ _______________________

Signature of witness / Mark Date

I certify that the nature and purpose, the potential benefits, and possible risks associated with
participating in this research have been explained to the above individual.

__________________________________________________

Name of Person who Obtained Consent

___________________________________________ ______________________

Signature of Person Who Obtained Consent Date

Revised – October 2023