Share Your Story - ICU Survivor Photovoice Study

We recognize that there are aspects of critical illness recovery that can be difficult to articulate. If you are interested in sharing your own critical illness and recovery experience with our study team through the use of photography and an accompanying description of the visual representations of your experiences, we welcome you to do so below using the embedded form. Confidentiality of all communications will be strictly maintained to the extent desired by you, the contributor.

Your willingness to share your critical illness and recovery experience is greatly appreciated.

Form Instructions:

1. Please carefully consider your responses to the reflection questions. Responses cannot be saved before submission so please fill out the form below as completely as you can when you are ready to submit your photos and written reflections. Alternatively, you can download the reflection questions in this Word Document and then copy and paste your answers into the form below when you are ready: Share Your Story Word Document

2. The questions with a red asterisk require responses.

3. Please do not forget to press the “Submit” button at the end of the form or the information will be lost!

4. Consent*
I wish the account of my experience to be placed in the ICU Survival Photovoice Study archives. I understand it may be read by researchers, students, or others approved by the study team for use of the archives. NO IDENTIFYING PERSONAL INFORMATION will be given to anyone but our Research Manager who receives the submitted responses. That means that names and e-mails are strictly confidential. My photos and my reflection responses may be excerpted or used in full, or data may be drawn from it in conjunction with a Research Ethics Board approved study or project, including but not limited to lectures or educational programs, or part of a published article, or in a book. If you do not wish your experience to be used like this, then please let us know and tell us what use you would prefer. This can be done by e-mail or by check mark in the publishing consent box below. Your comfort in sharing your story with our study team is of the utmost importance to us.
I agree to the publishing consent terms.
Where to publish*
- Under no circumstances
- Website only
- Media, publication, book and website
- Please ask permission to use my photographs and responses in places other than the website.
How to publish*
- Anonymously (without my name)
- First Name and First Initial of Last Name
Name*
First
Email*
Reflect on the questions below and take photos in response to each question. Review your photographs and select one that you feel best represents your response to each question. You can then upload the chosen photo for each question. Please provide a description about how each photo represents your experience. The descriptions to each question on the form are limited to 250 words.
1. What was it like going from hospital back to home?
FileAccepted file types: jpg, jpeg, png, gif.Title
Description
2. What did you need at home to facilitate your recovery?
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Description
3. How did the experience affect your mental and emotional health?
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Description
4. How has this experience shaped your life?
FileAccepted file types: jpg, jpeg, png, gif.Title
Description
5. What is important for others to understand about life after a critical illness?
FileAccepted file types: jpg, jpeg, png, gif.Title
Description
Thank you for sharing!
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