Researcher Intake Form

Researcher support and training

In research, intake forms play a pivotal role in collecting standardized and accurate information from participants. These forms streamline the process, ensure consistent information collection, and help patient partners prepare for studies. Intake forms also enhance privacy compliance, mitigate potential risks, and save valuable time during our matching process. By maintaining records, intake forms provide a reference for tracking changes over time and adapting patient partner research strategies. Digital accessibility enables remote participants to contribute, making intake forms indispensable tools for modern researchers. This form is mandatory for all research team in the CHF Alliance

Section 1
Perspectives on Patient Partnership and Empowerment Form

Section 2
Patient Engagement in Alliance Governance and Themes Form

Section 3
Research Project Intake Form

Perspectives on Patient Partnership and Empowerment Form

In lay terms, provide a high-level description of the planned engagement activities.

How will patient engagement support and advance the project/initiatives. Please be as specific as possible.

When you think about your patients or patient partners in research, what key characteristics come to mind?

When you think about your patients or patient partners in research, who is the most involved with their own HF healthcare and services?

What kinds of patients do you think may be best positioned to participate in the planned research activities?

Are there specific experiences (e,g., type of HF), characteristics (e.g., sex or gender), or knowledge (e.g., experience of particular health system services) that you feel is important to the planned engagement activities?

Total number of patient partners you wish to be involved in this project (Note: depending on the project, it is advisable to have two or more patient representatives involved in a single project).

Please consider the level of engagement you expect. You may identify the level of engagement planned (e.g., Inform, Consult, Involve, Collaborate, & Empower) by using the International Association of Public Participation (IAP2) spectrum as a guide

Are there patients that may experience challenges in engaging in their healthcare? Are these perspectives important to your planned research?

Do you perceive any barriers to patient engagement in the planned activities (e.g., Physical Space, Washroom accessibility for mobility aids, Cognitive processing needs, Differentiated instruction options, Sensory needs, Fine/gross motor requirements)? What kinds of supports might be valuable to support participation?

Will participants be able to engage in both National languages? Will other languages be supported?

Is the planned scope regional, provincial, national or international? Please describe if any travel is required and what activities will be offered remotely

Does the patient partner need to be in a relatively stable state of health at the time of engagement?

How do you plan to evaluate the success of this engagement opportunity? You may consider using tools , such as the Public and Patient Engagement Evaluation Tool (PPEET)).

How will patient partner contributions be recognized? Please indicate initial thoughts on authorship, recognizing contributions, and compensation.

Patient Engagement in Alliance Governance and Themes Form

Committee/Theme name

Primary Contact(s)

In lay terms, provide a high-level description of the committee/theme and key functions within the Alliance

Are other stakeholders/knowledge users engaged in the committee/theme? If so, please provide an overview (e.g., healthcare providers, decision-makers, policy-makers, researchers).

Please indicate your plans regarding patient partner compensation.

What types of activities will the patient partner be responsible for within the planned activities?

Are there specific timelines or commitments that are expected of patient partners? Consider hours per month/days per year.

Research Project Intake Form

Project/Initiative Name

Project Lead/Primary Contact(s)

In lay terms, provide a high-level description of the project, data collection methods, and the desired outputs/outcomes. 4-6 PowerPoint slides may also be used if available.

Who is the primary audience for the project outputs?

Has your project received ethics approval? If so, by which institution?

Please indicate your project funding source if there are funds from outside the base Alliance funding. Please indicate your plans regarding patient partner compensation.

What types of activities will the patient partner be responsible for within the research project?

Are there specific project timelines that require increased input from patient partners? Please be as specific as possible. Consider hours per month/days per year.

HeartLife Hub

Researcher Intake Form

Researcher support and training

Section 1
Perspectives on Patient Partnership and Empowerment Form

Section 2
Patient Engagement in Alliance Governance and Themes Form

Section 3
Research Project Intake Form

Perspectives on Patient Partnership and Empowerment Form

Patient Engagement in Alliance Governance and Themes Form

Research Project Intake Form

Heartlife Hub

HeartLife Hub

Researcher Intake Form

Researcher support and training

Section 1 Perspectives on Patient Partnership and Empowerment Form

Section 2Patient Engagement in Alliance Governance and Themes Form

Section 3 Research Project Intake Form

Perspectives on Patient Partnership and Empowerment Form

Patient Engagement in Alliance Governance and Themes Form

Research Project Intake Form

Heartlife Hub

Section 1
Perspectives on Patient Partnership and Empowerment Form

Section 2
Patient Engagement in Alliance Governance and Themes Form

Section 3
Research Project Intake Form