Research Request Submission

Research Project Details

Research Project Title (in full; no abbreviations)*

Description of the Study*

Please keep your description brief (300 words or less).

Relevance to family medicine:*

Please describe how this project is relevant to the day-to-day family medicine community practice. (300 words or less)

Design & Methodology*

Provide brief details on your design and methodology.

Survey/Questionnaire

Qualitative

Quantitative

Other

If you selected "other" to the question above please describe your methodology:*

Population for Recruitment*

Select the primary audience you are recruiting to this project.

Impact on Practice – What is being asked, and what is the best estimation of time that would be required of the family physicians and/or other members of the healthcare team in the clinic?*

Please be clear and concise in your description of what is being asked of the participating physicians (e.g. participate in a survey, hang posters in waiting area and distribute project information brochures to patients, become involved as a sentinel practice, etc.) 

Will participants be compensated for their time?*

Yes

No

If yes, what is the compensation?*

Principal Investigator

Name*

Email Address*

Affiliation*

Is the Principal Investigator a family physician?*

Co-Investigator Name

(If applicable)

Name

Email Address

Affiliation

Is the Co-Investigator a family physician?

Please describe how family physicians were engaged to help create the research question for this project.*

Please keep your description brief (250 words or less).

At what stage of this project were family physicians engaged?

(e.g. at the very beginning to help shape the research question)

Does this project receive financial or in-kind support from a for-profit company/organization?*

If yes, please provide us with the name of the organization(s):*

Does this project receive financial or in-kind support from a not-for-profit organization?*

If yes, please provide us with the name of the funding organization(s):*

Is this project self-funded by the researchers?*

Has this project received approval from a Health Research Ethics Board (HREB)?*

If YES, please provide us with the name of the HREB and project #:*

If No, is this project pending HREB approval?* *

If HREB approval is not being sought, please tell us why and provide the ARECCI score achieved*

Please keep your answer brief (200 words or less).

When does this project begin, and when is it predicted to end?*

Do you agree to share research findings with the ACFP?

Please provide us with the url for the website for this project, or the survey link

NOTE: Approved listings are subject to an active website or survey link containing project information being available. The ACFP webpages will not serve as the primary host for dissemination of information on your project, or key findings.

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Email*

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Family Medicine and Primary Care Research

Expectations

Submit Research Posting Request Form

Research Project Details

Principal Investigator

Co-Investigator Name

Alberta College of Family Physicians