Informed Consent Form

The History, Attitudes, and Barriers of Primary Care Providers Practicing in the Northeast in Referring Patients to Registered Dietitian Nutritionists for Chronic Diseases


You are invited to be in a research study about the relationship between two healthcare professionals; primary care providers (PCPs) and registered dietitian nutritionists (RDs/RDNs). You were chosen as a possible participant because you are a primary care provider (PCP) in the Northeastern region of the United States and are a member of the Rhode Island Society of Osteopathic Physicians (RIOSPS), Connecticut Osteopathic Medical Society (COMS), Massachusetts Osteopathic Society (MOS), New York State Association of Family Physicians (NYSAFP), New Hampshire Nurse Practitioner Association (NHNPA), or ProHealth Physicians Inc. organization. Please read this form and ask any questions you may have before agreeing to take part in this study.

This study is being conducted by Laura Niederer, an undergraduate Honors student at Marywood University.

Purpose - What the Study is About

The purpose of this study is to assess the history, attitudes, and barriers of PCPs in utilizing RDs/RDNs as part of an interdisciplinary healthcare team in an outpatient setting. This study will specifically target PCPs' referring patients to RDs/RDNs for the prevention, management, and treatment of the specific chronic diseases of obesity, type 2 diabetes, hypertension, and hyperlipidemia.

Procedures - What You Will Be Asked to Do

If you agree to be in this study, you will be asked to complete this online survey via REDCap which should take you approximately ten minutes to complete. The survey will include a ten question demographic section followed by eight questions within the Provider History, Provider Attitudes, and Provider Barriers sections.

Risks and Benefits

The risk in this study is no greater than the risks experienced in daily life or activities.

The benefit of this study is to enhance the general knowledge of professional relations between PCPs and RDs/RDNs in an outpatient setting concerning the prevention, management, and treatment of specific chronic diseases.


You will not receive an incentive for taking part in this study.


The records of this study will be kept private and will be de-identified. Information used in any written or presented report will not make it possible to identify you. Only the researcher and the research advisor will have access to the research records. Data pertaining to ProHealth Physicians Inc. in Connecticut will be de-identified and shared with that agency. Records will be kept on a password protected computer for three years. Then they will be deleted. While it is understood that no computer transmission can be perfectly secure, reasonable efforts will be made to protect the confidentiality of your transmission of the survey information.

Taking Part is Voluntary

Your participation is voluntary. Your decision to participate or not participate will not affect your current or future relations with the investigator. It will not affect your relations with Marywood University or your affiliation with your statewide organization, association or employer. You may withdraw at any time without penalty or loss of benefits to which you are entitled. To withdraw, close the survey window located in the upper right corner of the screen. If you withdraw by closing the survey window, no data will be recorded.

Contacts and Questions

The investigator conducting this study is Laura Niederer.

You may ask questions now or later. If you have questions later, you may contact the researcher at or (609) 613-0508 or her research advisor, Jessica Bodzio, at or (570) 340 -6079.

If you have questions related to the rights of research participants or research-related injuries (where applicable), please contact Ms. Courene M. Loftus, MPA, CIP, Marywood University’s Director of Human Participants Protection and Research Compliance, at (570) 961-4782 or

Statement of Consent

I have read the above information. I have asked questions and have
received answers. I consent to participate in this study.

By proceeding to the first question, I acknowledge that I have read and understood the above and consent to participate in this study.

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