Family Kitchen, Ventura County
Adult Consent – Read First

Adult Consent – Read First

California State University, Northridge


Cooking Matters, Ventura County WIC

You are being asked to participate in a research study. Rachel Kimmel, Graduate Student Research Coordinator, is doing a study conducted by Dr. Dena Herman as part of the requirements for the M.S degree in Human Nutrition, Department of Family and Consumer Sciences. Participation in this study is completely voluntary.  Please read the information below and ask questions about anything that you do not understand before deciding if you want to participate.  A researcher listed below will be available to answer your questions.


Dr. Dena Herman
Department of Family and Consumer Sciences
18111 Nordhoff St.
Northridge, CA 91330

Graduate Student Research Coordinator: Rachel Kimmel 
Department of Family and Consumer Sciences
18111 Nordhoff St.
Northridge, CA 91330


The purpose of this research study is to assess the feasibility of delivering an online cooking education program to WIC participants and assess the impact of the program on healthy eating practices.    


Inclusion Requirements

You are eligible to participate in this study if you: 1) Speak English or Spanish; 2) Are a current Ventura County WIC client or a participant in the Ventura County Comprehensive Perinatal Services Program; and 3) Are pregnant, breastfeeding, postpartum or a parent of a child up to the age of 5 years. 

Time Commitment 

This study will involve approximately 30 minutes of your time for the pre-recorded education session and 30 minutes of your time for the optional live/online session over the course of 6 months.


The following procedures will occur: If you are interested in participating in this program, you will receive a link to a website that will have all of the information for the cooking education program, including the recorded lessons and dates/times for the optional live/online cooking education class. When you first access the website, you will be asked to complete this consent form. Afterwards, you will have access to a pre-survey to complete over your phone or computer about your access to healthy food and shopping habits prior to viewing the cooking education recording. Once you complete the pre-recorded education lesson, you will be asked to complete a post-survey on your phone or computer about what you have learned. If you would prefer, we can also call you to complete the pre- and post-surveys on the phone together. If you would like, you can then join in a live/online cooking education class where you will receive free food delivered to your home to be used for the cooking class. We will ask you to complete a post survey following the live cooking education class to understand your experience.


The possible risks and/or discomforts associated with the procedures described in this study include: minor psychological and physical risks. Some participants may feel embarrassed about answering certain questions, admitting that they do not have the financial resources to purchase healthier foods or be surprised to find out that the lifestyle they have been living to date may not be all that healthy. Boredom, fatigue, or frustration may occur with the use of online technology. There are minor physical risks involved in participating in the pre-recorded online and “live” online cooking education classes, such as burns or cuts from using a knife. To minimize risks, there will be a food safety guide before the start of the cooking class to cover food safety and knife skills. Research staff will be available via telephone or email to help participants with technological difficulties. Also, validated survey instruments will be used to ensure survey questions are appropriate for the intended audience. This study involves no more than minimal risk. There are no known harms or discomforts associated with this study beyond those encountered in normal daily life. 

If you choose to participate, you are not anticipated to require any care as a consequence of this study, but if you do require care, you may contact Ventura County Behavioral Health (1-866-998-2243). In case of minor kitchen injury, you may contact Ventura County Academic Family Medical Center, Urgent Care Clinic (3291 Loma Vista Road Building 340, Suite 101 Ventura, CA 93003, Tel: 805-652-6500).  


Subject Benefits

The possible benefits you may experience from the procedures described in this study include increased knowledge and confidence about how to shop for healthy foods on a budget, learn new cooking skills, and improve healthy eating practices. 

Benefits to Others or Society

The results of this study may possibly provide an increase in healthy eating practices among family members of those who participate in the study. Also, the results of this study may lead to an improvement in the WIC nutrition education program to include the Cooking Matters topics on a regular basis, reaching more WIC participants. 


The only alternative to participation in this study is not to participate.


Compensation for Participation 

If you participate in the Cooking Matters online, pre-recorded lesson, this will meet your nutrition education requirement for the month to get your WIC benefits. To receive credit, you will need to provide the research team your WIC ID number and they will give it to Ventura County WIC upon completion of the pre-recorded lesson. 

If you choose to participate in the Cooking Matters live, online education lesson, you will receive a free package of food delivered to your home to be used during the live, online cooking lesson. This will also meet your nutrition education requirement for the month to get your WIC benefits. To receive credit, you will need to provide the research team your WIC ID number and they will give it to Ventura County WIC upon completion. Also, upon completion of the live, online cooking class, you may receive a gift certificate in the amount of $5. 


There is no cost to you for participation in this study. 


You will not be reimbursed for any out-of-pocket expenses, such as parking or transportation fees. Expenses associated with medical or counseling services that arise from your participation in this study will not be reimbursed. 


You are free to withdraw from this study at any time. If you decide to withdraw from this study you should notify the research team immediately. The research team may also end your participation in this study if you do not follow instructions, miss scheduled visits, or if your safety and welfare are at risk.


Subject Identifiable Data 

All identifiable information that will be collected about you will be removed and replaced with a code. A list linking the code and your identifiable information will be kept separate from the research data. Home address information collected for the purpose of delivering the free food packages will be safely discarded at the completion of the study. 

Data Storage 

All research data will be stored electronically on a secure network with password protection.

Data Access  

The researcher and graduate student research coordinator named on the first page of this form will have access to your study records. Other research personnel (example, graduate students) will only have access to de-identified research data including, demographic, dietary, and lifestyle information. Any information derived from this research project that personally identifies you will not be voluntarily released or disclosed without your separate consent, except as specifically required by law. Publications and/or presentations that result from this study will not include identifiable information about you.

Data Retention 

Research materials (example, consent forms, questionnaires) gathered in this study will be kept in storage for 5 years following termination of the study. After this time, the materials will be disposed of in a way that ensures that participant identities will not be revealed. 

Mandated Reporting

Under California law, the researchers are required to report known or reasonably suspected incidents of abuse or neglect of a child, dependent adult or elder, including, but not limited to, physical, sexual, emotional, and financial abuse or neglect.  If any researcher has or is given such information in the course of conducting this study, she may be required to report it to the authorities. 


If you have any comments, concerns, or questions regarding the conduct of this research please contact the research team listed on the first page of this form.

If you have concerns or complaints about the research study, research team, or questions about your rights as a research participant, please contact the Research and Sponsored Programs office, 18111 Nordhoff Street, California State University, Northridge, Northridge, CA 91330-8232, by phone at (818) 677-2901 or email at


You should not sign this form unless you have read it and been given a copy of it to keep.  Participation in this study is voluntary.  You may refuse to answer any question or discontinue your involvement at any time without penalty or loss of benefits to which you might otherwise be entitled. Your decision will not affect your relationship with California State University, Northridge. Participation in the study will not affect your relationship with Ventura County WIC or the services that you receive. Your signature below indicates that you have read the information in this consent form and have had a chance to ask any questions that you have about the study.