Consent form - Immunization experience

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Ministry of Health is working with Ministry of Citizens’ Services’ Government Digital Experience (GDX) Division to improve the immunization service experience. We are taking a human-centered design approach to this work. This includes:

 
  • Talking to people about their immunization service experience (user experience) to identify people’s immunization-related needs  
  • Enhancing the existing (digital) booking and scheduling product and creating artefacts (journey map, system map)
  • Drafting recommendations to inform decision-making processes

 

Recordings and transcripts

 

To help analyze the results of the research, during the interview or workshop the interviewers may take: 

  • Notes 
  • Audio or video recordings 
  • Photographs

Your name and any other personal identification are not associated with the recordings. The recordings may be used for training or evaluation purposes. 

 

The recordings are not used for any purpose other than those described in this form, or otherwise permitted by law.  

 

All recordings, transcripts and notes are stored during the project and then securely disposed of as transitory records in accordance with the Information Management Act and related policies. 

 

Confidentiality

 

Your confidentiality will be respected. We will de-identify all notes. Please do not name yourself or others in audio or video recordings. You can choose not to be recorded. 

 

When individuals’ stories and experiences are recorded, confidential personal information may be shared during the interview or workshop. In compliance with the Freedom of Information and Protection of Privacy Act, all personal information will be protected using appropriate security controls. 

 

Notification of collection

 

This information is collected by the Ministry of Citizens’ Services - GDX under section 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act. This information will be used for the purpose of assisting analysis in the project described above. It may be used for training or evaluation purposes.  

 

Should you have any questions about the collection of this personal information, please contact:  Elizabeth Wrightson (Design Research Team Lead), elizabeth.wrightson@gov.bc.ca – Phone: 778-678-6912

I agree to being audio taped for the purposes described.
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I agree to screen-capture recording for the purposes described.
Please select an option
I agree to being photographed for the purposes described.
Please select an option
I agree to being videotaped for the purposes described.
Please select an option

I understand the following:
  • I have read and understood the Participant Consent form;
  • I have had the opportunity to ask questions and have had satisfactory responses to my questions; 
  • I have the option to receive a dated and signed copy of this form. 
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Please provide a valid email address
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We'd like to provide you with a gift card to thank you for taking the time to participate in this research. 

 

If you want, after the session you will receive an electronic gift card by email from a company called Virtual Incentives. You can choose the type of gift card you want. You can get the gift card even if you don’t complete the session.  

Notice of Collection

 

For the purpose of delivering and confirming that you have received your e-Gift card, your personal information is collected through Virtual Incentives under section 26(c) and section 26 (e) of the Freedom of Information and Protection of Privacy Act. Please be aware that your IP address, email address and e-Gift details will be collected by Virtual Incentives. This information will be stored and may be accessed outside of Canada.  

 

If you do not consent to register your e-Gift card through Virtual Incentives, the project team can offer you a physical card. 

 

By selecting "yes" you are consenting to your personal information (IP address, email address and e-Gift details) being stored and/or potentially accessed outside Canada. Your consent is effective as soon as you submit.  

 

If you have any questions about the collection, use or disclosure of your personal information, please contact: Elizabeth Wrightson (Design Research Team Lead), elizabeth.wrightson@gov.bc.ca – Phone: 778-678-6912

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