UOW Consumer and Community Research Network

UOW Consumer and Community Research Network - Researcher Sign Up Form

Form for researchers to engage with consumers in a project. Your information is collected in line with our privacy policy. For further information about UOW's commitment to protecting your privacy, please visit https://www.uow.edu.au/privacy/

If you:
- Find the form difficult to complete
- Prefer a paper copy
- Use assistive technology and need an alternative format, please contact us at: uowhi-network@uow.edu.au

We’re here to help and will do our best to meet your needs.

First name
Last name
Email address
Phone number
Affiliation or Employer

Affiliation or Employer UOW ISLHD Other affiliation/employer (please specify)
Employer - Other
What UOW campus is your research affiliated with?
Select the Health Innovations or Molecular Horizons Research Theme/s your project aligns with. You can select more than one option.

Select the Health Innovations or Molecular Horizons Research Theme/s your project aligns with. You can select more than one option. Chronic Disease Management, Aged Care and Ageing Antimicrobial Resistance Cancer Therapeutics Molecular Neuroscience and Neurodegeneration Nutrition, Food and Sustainability Mental Health and Cognition Cardiovascular Health Digital Health and Learning Health Systems Sport, Leisure and Prevention Primary Care and Health Services Research Indigenous Health and Wellbeing Rural Health, Equity and Cultural Diversity Unsure
Section 2: The following questions are to help us contact relevant consumers for your project
Please provide a summary (no more than 250 words) of your research project to distribute to consumers. This should include a plain language description of role and expectations, date(s), time(s) and location(s) of involvement, duration of project and any specific consumer demographics or lived experience you are interested in (i.e. eligibility criteria for consumer involvement).
Maximum of 250 words allowed. Currently Entered: 0 words.
Please select if any of the following are relevant eligibility criteria for consumers involved in your project.
You can select more than one option.

Please select if any of the following are relevant eligibility criteria for consumers involved in your project. You can select more than one option. Age Gender consumer uses to describe themselves Main language spoken at home Athlete or very physically active individual Aged Persons Carer Carer of person with disability or chronic illness Parent to a child under 18
Please specify the age range of consumers you are interested in.
You can select more than one option.

Please specify the age range of consumers you are interested in. You can select more than one option. Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75 or older All of the above
Are you interested in consumers whose sex records recorded at birth is:
You can select more than one option.

Are you interested in consumers whose sex records recorded at birth is: You can select more than one option. Female Male Intersex Other sex (please specify)
Sex - Other (please specify)
Are you interested in consumers who describe their gender as:
You can select more than one option.

Are you interested in consumers who describe their gender as: You can select more than one option. Man/Male Woman/Female Non-binary/genderqueer/gender-fluid Other gender (please specify)
Gender - Other (please specify)
Are you interested in consumers whose main language spoken at home is

Are you interested in consumers whose main language spoken at home is English Other language (please specify)
Lanugage - Other (please specify)
Please specify the specific health condition or lived experience(s) of interest.
You can select more than one option.

Please specify the specific health condition or lived experience(s) of interest. You can select more than one option. Heart disease (High Blood Pressure, Heart Attack, Heart Failure) Antimicrobial Resistance, Infections or use of Antibiotics Cancer (Solid tumours, Haematological Cancers) Bowel Conditions (Irritable Bowel Syndrome, Inflammatory Bowel Disease) Diabetes Lung Disease (Emphysema, Fibrosis) Chronic Kidney Disease Chronic pain Asthma Mental Illness (Depression, Anxiety or other diagnosed conditions) Cardiovascular disease (Stroke, Mini-stroke) Neurological disorders (Motor Neurone Disease, Multiple Sclerosis, Parkinson's Disease) Food Allergies and Intolerances Dementia or Cognitive Impairment Alcohol and other drug/substance use Lived experience of incarceration Other health condition(s) or lived experience(s) (please specify) Any or all of the above
Are you interested in Aboriginal and Torres Strait Islander consumers?

Are you interested in Aboriginal and Torres Strait Islander consumers? Yes, exclusively Yes, included within general population No
Health condition(s) or lived experience(s) - Other (please specify)
What is the role of the consumer in your project/research?
You can select more than one option.

What is the role of the consumer in your project/research? You can select more than one option. Informing – being informed by researchers. Information provided may be about health conditions, rights and responsibilities, health services or programs. This may be in the form of brochures, videos, community stalls or websites. Consulting – giving us feedback. This could be about services, experiences, resources or programs. Feedback may be via conversations, focus groups or surveys. Advising – providing advice about what is working and not working, and plans for the future. Topics may include research priorities and how to recruit participants and disseminate results via workshops or forums. Collaborating – being partners in shared decision making about your care and health services via committees, workshops, forums and working groups. Leading – working, learning and reflecting together to plan and deliver activities, resources or services. This can be referred to as ’consumer-led’. Participating in a study - trialling a new program, service, product or treatment type. This allows researchers to collect data on new ways to deliver health care or methods of treating certain health conditions. All of the above
What is the format of consumer involvement?
You can select more than one option.

What is the format of consumer involvement? You can select more than one option. Face to face Online Reviewing materials All of the above Other involvement (please specify)
Involvement - Other (please specify)
Please note the varying rates for reimbursement of consumers – see HCNSW link for remuneration and reimbursement guidelines:

https://hcnsw.org.au/training-resources/resources/remuneration-and-reimbursement-of-health-consumers/
Will the consumer be remunerated?

Will the consumer be remunerated? Yes No Unsure
What is the closing date for recruitment of this project? What is the closing date for recruitment of this project? / DD / MM YYYY
What strategies do you have in place to protect consumers?
You can select more than one option.

What strategies do you have in place to protect consumers? You can select more than one option. Key contact person to liaise with consumers Clear description of expectations for the consumer Overview of roles and responsibilities for the consumer Orientation and briefing for the consumer prior to engagement At least two consumers for each activity Remuneration of the consumer Debriefing / exit checklist from the project for the consumer Other consumer protection (please specify)
Consumer protection - Other (please specify)
How did you hear about the UOW Consumer and Community Research Network?
UOW's Privacy Policy

Please see the Privacy Policy available at:
https://www.uow.edu.au/privacy/
Do you agree to adhere to UOW's privacy policy?

Do you agree to adhere to UOW's privacy policy? Yes No
Would you be willing to be contacted to have your research published on relevant UOW web-pages, newsletters or in media releases?

Would you be willing to be contacted to have your research published on relevant UOW web-pages, newsletters or in media releases? Yes No
Data Collection Statement

The information you provide on this form will be used by the UOW Consumer and Community Research Network team to assess suitability of the project for consumer involvement, and to assist with sending your project to relevant consumers.

Your information is collected in line with our privacy policy. For further information about UOW's commitment to protecting your privacy, please visit: https://www.uow.edu.au/privacy/

UOW Consumer and Community Research Network - Researcher Sign Up Form

UOW Consumer and Community Research Network - Researcher Sign Up Form

Section 2: The following questions are to help us contact relevant consumers for your project

UOW's Privacy Policy

Data Collection Statement