More than Tuskegee: understanding mistrust about research participation

Public perception of predictive cancer genetic testing and research in Oregon

The potential for using widespread genetic testing to inform health care has become a viable option, particularly for heritable cancers. Yet, little is known about how to effectively communicate the benefits and risks of both personal genetic testing and participation in biorepositories that aid scientific advancements. Nationwide efforts are engaging communities in large genetic studies to better estimate the population-wide prevalence of heritable cancers but have been met with hesitance or declination to participate in some communities. To successfully engage an Oregon population in longitudinal research that includes predictive genetic testing for pathogenic or likely pathogenic variants associated with an increased risk for cancer, researchers conducted 35 focus groups (two of which were held in Spanish) in 24 of Oregon's 36 counties to better understand knowledge and attitudes related to genetic testing and willingness to participate in longitudinal genetic research. A total of 203 adults (mean = 45.6 years; range 18-88), representing a range of education levels and prior knowledge of genetic research, participated in the focus groups. The majority (85%) of participants reported personal or family diagnoses of cancer (e.g., self, family, friends). A majority (87%) also reported a strong interest in cancer genetic testing and receiving genetic information about themselves. Nearly all focus groups (94%, 33 of 35 sites) included participant discussion citing their families (e.g., children, close relatives, and extended family members) as key motivators for participation in genetic research. For example, participants reported interest in increasing personal knowledge about their own and their families' cancer risks in order to respond proactively, if a pathogenic variant was found. While most focus groups (94%, 33 of 35 sites) included participant discussion describing barriers to predictive genetic, testing such as concerns about outcomes, the desire to learn about health risks in oneself mitigated or outweighed those fears for many participants. Other commonly reported concerns were related to potential mistrust of insurance companies, researchers, or institutions, or lack of knowledge about genetics, genetic testing, or genetic research. Participants, particularly in rural areas, highlighted critical factors for research recruitment, such as trust, personal interaction, public education about genetic research, and clear communication about study goals and processes. Our statewide findings reflect that public interest in predictive cancer genetic testing and cancer genetic research can surpass lack of knowledge of the complex topics, particularly when benefits for self and family are emphasized and when study considerations are well articulated.

Approach to High Volume Enrollment in Clinical Research: Experiences from an All of Us Research Program Site

Clinical trials and cohort studies are required to meet target recruitment of study participants within stipulated timelines, especially when the priority is to include populations traditionally unrepresented in biomedical research. By the third quarter of 2019, the University of Arizona‐Banner Health Provider Organization (UA‐Banner HPO) has enrolled > 30,000 core participants into the All of Us Research Program (AoURP), the research cohort of the Precision Medicine Initiative. The majority of enrolled participants meet the criteria for individuals under‐represented in biomedical research. The enrollment goals were calculated based on a target of 20,000 as set by the National Institutes of Health and our health provider organization achieved enrollment numbers between 17% and 86% above the targeted daily enrollment. We evaluated enrollment methods and challenges to enrollments encountered by the UA‐Banner Health Provider Organization into the AoURP. Challenges to enrollment centered around the need for high‐touch engagement methods, time investment necessary for stakeholder inclusion, and the use of purely digital enrollment methods especially in populations under‐represented in biomedical research. These challenges occurred at the level of the individual, provider, institutions, and community, and cumulatively impacted participant enrollment. Successful strategies for engagement and enrollment leveraged provider partners as advocates for the program. For high‐volume enrollment in clinical research, it is important to engage leaders in the healthcare setting, patient providers, and tailor engagement and enrollment to potential participant needs. We emphasize the need for precision engagement and enrollment methods tailored to individual needs.

Improving community participation in clinical and translational research: CTSA Sentinel Network proof of concept study

BACKGROUND

Research participation by members of racial or ethnic minority groups continues to be less than optimum resulting in difficulties to generalization of research findings. Community-engaged research that relies on a community health worker (CHW) model has been found effective in building trust in the community, thereby motivating people to participate in health research. The Sentinel Network study aimed at testing the feasibility of utilizing the CHW model to link community members to appropriate health research studies at each of the research sites.

METHODS

The study was conducted at six Clinical and Translational Science Award institutions (N = 2371) across the country; 733 (30.9%) of the participants were from the University of Florida, 525 (22.0%) were from Washington University in St. Louis, 421 (17.8%) were from the University of California, Davis, 288 (12.1%) were from the University of Michigan, Ann Arbor, 250 (10.5%) were from Rochester, and 154 (6.5%) from Albert Einstein College of Medicine. Trained CHWs from each of these sites conducted regular community outreach where they administered a Health Needs Assessment, provided medical and social referrals, and linked to eligible research studies at each of those sites. A 30-day follow-up assessment was developed to track utilization of services satisfaction with the services and research study participation.

RESULTS

A large majority of people, especially African Americans, expressed willingness to participate in research studies. The top two health concerns reported by participants were hypertension and diabetes.

CONCLUSION

Findings on the rate of navigation and enrollment in research from this study indicate the effectiveness of a hybrid CHW service and research model of directly engaging community members to encourage people to participate in research.

The Effect of Discrimination on Likelihood of Participation in a Clinical Trial

OBJECTIVES

Despite efforts to increase minority enrollment in research, racial disparities still exist, and a belief persists that minorities are inherently less likely to enroll in medical research. This lingering view may impact the manner in which studies are presented to minority patients. This study aimed to assess racial differences in reported discrimination while seeking medical care and likelihood to participate in a medical research study.

METHODS

844 residents were enrolled via convenience sampling, and asked to complete a survey designed to examine perceived discrimination while seeking healthcare and likelihood to participate (LoP) in a medical research study.

RESULTS

Participants who reported worse treatment than other races had lower mean LoP scores (53.7 ± 17.6) than participants who reported being treated the same as (61.1 ± 16.1) or better than (64.0 ± 15.0) other races (p < .001). There were no significant differences in mean LoP score by race/ethnicity. The interaction of race with discrimination had no significant effect on mean LoP (p = 0.8). There was a statistically significant association between race and discrimination (X² = 11.32, p = 0.023), although the majority of participants reported no discrimination.

CONCLUSION

Patient experiences in the medical arena may have an impact on their willingness to join a medical study. An effective strategy to increase minority participation in research may be to work with investigators and staff on implicit bias with regard to minority patients. Further research should focus on the impact of research staff interactions on an individual's decision-making process.

Comparison of US Federal and Foundation Funding of Research for Sickle Cell Disease and Cystic Fibrosis and Factors Associated With Research Productivity

IMPORTANCE

Sickle cell disease (SCD) and cystic fibrosis (CF) are severe autosomal recessive disorders associated with intermittent disease exacerbations that require hospitalizations, progressive chronic organ injury, and substantial premature mortality. Research funding is a limited resource and may contribute to health care disparities, especially for rare diseases that disproportionally affect economically disadvantaged groups.

OBJECTIVE

To compare disease-specific funding between SCD and CF and the association between funding and research productivity.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study examined federal and foundation funding, publications indexed in PubMed, clinical trials registered in ClinicalTrials.gov, and new drug approvals from January 1, 2008, to December 31, 2018, in an estimated US population of approximately 90 000 individuals with SCD and approximately 30 000 individuals with CF.

MAIN OUTCOMES AND MEASURES

Federal and foundation funding, publications indexed in PubMed, clinical trial registrations, and new drug approvals.

RESULTS

From 2008 through 2018, federal funding was greater per person with CF compared with SCD (mean [SD], $2807 [$175] vs $812 [$147]; P < .001). Foundation expenditures were greater for CF than for SCD (mean [SD], $7690 [$3974] vs $102 [$13.7]; P < .001). Significantly more research articles (mean [SD], 1594 [225] vs 926 [157]; P < .001) and US Food and Drug Administration drug approvals (4 vs 1) were found for CF compared with SCD, but the total number of clinical trials was similar (mean [SD], 27.3 [6.9] vs 23.8 [6.3]; P = .22).

CONCLUSIONS AND RELEVANCE

The findings show that disparities in funding between SCD and CF may be associated with decreased research productivity and novel drug development for SCD. Increased federal and foundation funding is needed for SCD and other diseases that disproportionately affect economically disadvantaged groups to address health care disparities.

Dissecting racial disparities in multiple myeloma

Multiple myeloma (MM) is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. MM progresses from the more common but often subclinical precursor states of monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) to overt MM. There are large racial disparities in all stages of the disease. Compared with Whites, Blacks have an increased MGUS and MM risk and higher mortality rate, and have not experienced the same survival gains over time. The roots of this disparity are likely multifactorial in nature. Comparisons of Black and White MGUS and MM patients suggest that differences in risk factors, biology, and clinical characteristics exist by race or ancestry, which may explain some of the observed disparity in MM. However, poor accrual of Black MGUS and MM patients in clinical and epidemiological studies has limited our understanding of this disparity and hindered its elimination. Disparities in MM survival also exist but appear to stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of disparities that exist at each stage of the MM disease continuum and facilitate their elimination.

At the Research-Clinical Interface: Returning Individual Genetic Results to Research Participants

Whether individual results of genetic research studies ought to be disclosed to study participants has been debated in recent decades. Previously, the prevailing expert view discouraged the return of individual research results to participants because of the potential lack of analytic validity, questionable clinical validity and medical actionability, and questions about whether it is the role of research to provide participants with their data. With additional knowledge of participant perspectives and shifting views about the benefits of research and respect for participants, current expert consensus is moving toward support of returning such results. Significant ethical controversies remain, and there are many practical questions left to address, including appropriate procedures for returning results and the potential burden to clinicians when patients seek guidance about the clinical implications of research results. In this review, we describe current views regarding the return of genetic research results, including controversies and practical challenges, and consider the application of these issues to research on apolipoprotein L1 (APOL1), a gene recently associated with health disparities in kidney disease. Although this case is unique, it illustrates the complexities involved in returning results and highlights remaining questions.

Lessons learned for recruitment and retention of low-income African Americans

Recruitment and retention of low-income African Americans in clinical trials is challenging. This paper reports recruitment and retention strategies that yielded high rates for both in a clinical trial pilot to improve hypertension self-management among low-income African Americans. The study successfully recruited 96.7% (59 of 61 participants) within a seven month period. Retention rates for the 1, 3, and 6-month post-baseline assessment visits were 91.5%, 88.1%, and 83.1%, respectively. Recruitment and retention strategies include two grounded in previous literature: a culturally sensitive and diverse research team and use of incentives. Four additional strategies were developed for this study to meet the needs of the study site and participants, which included: study site collaboration; ongoing communications; responding to the clinical environment; and addressing participants’ health literacy levels. A discussion of key recruitment and retention strategies and suggestions for future studies focused on low-income African American participants ensues.

Building bridges between a community and an academic medical center via community tours

Academic medical centers (AMCs) face challenges in conducting research among traditionally marginalized communities due to long-standing community mistrust. Evidence suggests that some AMC faculty and staff lack an understanding of the history of distrust and social determinants of health (SDH) affecting their communities. Wake Forest Clinical and Translational Science Institute Program in Community Engagement (PCE) aims to build bridges between communities and Wake Forest Baptist Health by equipping faculty, clinicians, administrators, and staff (FCAS) with a better understanding of SDH. The PCE collaborated with community partners to develop and implement community tours to improve cross-community AMC understanding and communication, enhance knowledge of SDH, and build awareness of community needs, priorities, and assets. Nine day-long tours have been conducted with 92 FCAS. Tours included routes through under-resourced neighborhoods and visits to community assets. Participant evaluations assessed program quality; 89% reported enhanced understanding of access-to-care barriers and how SDH affect health; 86% acknowledged the experience would improve future interactions with participants and patients; and 96% agreed they would recommend the tour to colleagues. This work supports the use of community tours as a strategy to improve cross-community AMC communication, build trust, and raise awareness of community needs, priorities, and assets.

"I'm a Little More Trusting": Components of Trustworthiness in the Decision to Participate in Genomics Research for African Americans

AIMS

This study sought to explore the decision to participate in genomics research for African American individuals. Our overall goal was to explore (1) the attributes that significantly contribute to willingness to participate in genomics research; (2) how these attributes are interpreted (what is their meaning?); (3) how trustworthiness is estimated in the decision to participate in research (i.e., what are the symbolic representations or heuristics of trustworthiness in decision-making?); and (4) how participants see factors to counterweigh each other.

METHODS

We sought a methodology that would afford exploration of the compensatory nature of decision-making where some choice attributes may be weighed differently than others as well as the use of heuristics (shortcuts to estimate key concepts in the mentally taxing task of decision-making) for concepts such as trustworthiness. We used a qualitative story deck to create hypothetical research scenarios with variable attributes (i.e., researcher race/ethnicity; institutional affiliation; research goal; and biospecimen requested) to determine how individuals find and interpret information to make decisions about research participation. These semi-structured interviews (n = 82) were conducted in African American barbershops in Baltimore City and Prince George's County, Maryland.

RESULTS

Quantitative and qualitative analysis was completed. Findings include that, even in the absence of interpersonal connection, trustworthiness can be communicated through multiple factors, such as (1) shared values with researchers and (2) familiarity. Conversely, (1) ambiguity, especially regarding the use of biospecimens, (2) negative reputations, and (3) perceptions of "hidden agendas" were associated with a lower willingness to participate. However, the alignment of participant and research goals was weighed more heavily in decisions than other factors.

CONCLUSION

This study finds that negatively assessed characteristics in research design do not result in automatic rejections of participation. Negative assessments can be mitigated by emphasizing the multiple factors that communicate trustworthiness in the consent process, which may improve rates of research participation.

Rigor in Qualitative Methods: An Evaluation of Strategies Among Underrepresented Rural Communities

Achieving rigor using selected criteria to determine trustworthiness using qualitative methods has been without critical evaluation. In this article, strategies such as prolonged engagement and thick, rich description; negative case analysis; peer review or briefing; clarifying researcher bias; member checking; and, investigator triangulation and intercoder reliability are evaluated for appropriateness among an African American Appalachian rural population. Achieving rigor using qualitative methods among participants living in rural communities is time intensive requiring attention to quality versus quantity of time spent in interviews, building trusting relationships, an awareness of interviewer bias and assumptions, and appropriately evaluated strategies that enhance validity. Strategies to achieve rigor in qualitative methods should not be used as a one size fits all approach as this practice might actually diminish rigor. Among underrepresented populations, strategies should be adapted or not used at all.

Clinical trial recruitment of adult African American smokers from economically disadvantaged urban communities

This investigation evaluated the effectiveness and challenges of multiple recruitment methods, described as proactive, reactive, and combination methods, among adult African American smokers (N = 527) from economically disadvantaged urban communities enrolled to test progressively reduced nicotine content investigational cigarettes. The study evaluated success using descriptive statistics to measure the volume of phone calls and percentage of eligible participants per method. Reactive and combination strategies effectively prompted participants to call about the study. Combination methods yielded the highest eligibility rates. Findings demonstrate the unique recruitment successes within this population across a range of recruitment methods and may inform improved methods to recruit and engage African Americans in clinical trials.

Cultural Narratives of Micronesian Islander Parent Leaders: Maternal and Children's Health, the School System, and the Role of Culture

Background: In Oregon in the United States' Pacific Northwest, Native Hawaiians/Pacific Islanders including Micronesian Islanders (MI) substantially grew by 68%; however, research is sparse. This is often due to data aggregation as Asian and Pacific Islanders and community members' reluctance and wariness to participate in research due to a history of unethical research in the Pacific. The MI community experienced miscarriages, stillbirths, and intellectual and developmental disabilities. Organizational MI community leaders expressed a need to explore the voices of MI parent leaders (MIPLs). The purpose of the community-based participatory qualitative descriptive pilot study was to explore the perceptions and experiences of MIPLs with maternal and children's health, the school system, and the influence of culture. Methods: A trained MI community health worker recruited eight MIPLs from an urban area of the Pacific northwest in the United States. A group level assessment included illustrative storytelling and is a participant-driven qualitative method that guided data collection and analysis with real-time involvement with MIPL. The discussions lasted for 90 minutes. MIPL shared stories by writing and drawing pictures onto the flip chart papers, transcribed main points, and analyzed the data with researchers. Researchers recorded field notes of the interactions. Researchers debriefed with MIPL to assure trustworthiness and credibility of the findings. Findings: MIPL are Compact of Free Association citizens. Their age ranged from 26 to 42 years, have lived in the United States an average of 12.63 years, and most reported having less than $15,000 total household income before taxes. Four main themes were identified: MI cultural identity, English language and MI culture disharmony, zero or delayed prenatal care, and uncertainty for the future of MI children who have disabilities or developmentally delayed as they progress through the school system. Conclusion: Health care providers including nurses and school officials need to have a culturally specific understanding of the MI community and must consider their needs, culture, and language barriers.

Building Safe Didactic Dialogues for Action Model: Mobilizing Community with Micronesian Islanders

Background: Despite mandates by the United States (U.S.) government to ensure the inclusion of women and minorities in federally funded research, communities of color continue to participate less frequently than non-Latinx Whites. There is limited research that examines maternal health outcomes and early childhood resources. Pacific Islanders (PI) have grown substantially in a county in the Pacific Northwest region of the U.S. (from 4,419 to 9,248, of which 52% are female). About 62.7% of PI women are not accessing prenatal care in the first trimester, and this is substantially higher than the national target of 22.1%. Researchers found that PI children are leaving school to take care of family obligations. The purpose of the educational innovative project, Building Safe Didactic Dialogues for Action model, was to respond to Micronesian Islanders (MI) parent leaders' need to feel safe and to build a close kinship to encourage dialogue about difficult topics regarding access and utilization of early education systems and prenatal/perinatal health for community-driven model for action planning and solutions. Approach: Popular education tenets were used in the project to be culturally sensitive to the human experience. The MI community health worker outreached to MI parent leaders in an urban area in the Pacific Northwest region of the U.S. Eight partners participated in this project: parent leaders from the MI community-at-large, community partners from the MI Community organization, and academic nurse researchers. Didactic dialogues lasted two hours per session for four. Topics included: collaborative agreements, MI parent leaders' identified needs and existing resources regarding preschool and immunization, parent-child relationship (stress and trauma, adverse childhood experiences), and MI experience regarding prenatal care access and postpartum depression. Group discussion on reflection was used to evaluate utility. Outcomes: Building Safe Didactic Dialogues for Action model was foundational via mobilizing community with MI, trust and rapport building, and engaging in a safe and courageous space for dialogues for action planning and solutions as community and academic partners as stakeholders. Conclusion: Many previously unspoken issues such as abuse, language, and cultural beliefs including barriers were openly shared among all partners. Dynamic thoughts towards identifying needs for change and then planning steps toward creating positive change created an atmosphere of empowerment for change.

Factors Associated with Lumbar Puncture Participation in Alzheimer's Disease Research

BACKGROUND

Cerebrospinal fluid (CSF) provides insight into the spectrum of Alzheimer's disease (AD) pathology. While lumbar punctures (LPs) for CSF collection are generally considered safe procedures, many participants remain hesitant to participate in research involving LPs.

OBJECTIVE

To explore factors associated with participant willingness to undergo a research LP at baseline and follow-up research study visit.

METHODS

We analyzed data from 700 participants with varying cognition (unimpaired, mild cognitive impairment, and dementia) in the Wisconsin Alzheimer's Disease Research Center. We evaluated the relationship of demographic variables (age, sex, race, ethnicity, and years of education) and clinical variables (waist-to-hip ratio, body mass index, AD parental history, cognitive diagnosis) on decision to undergo baseline LP1. We evaluated the relationship of prior LP1 experience (procedure success and adverse events) with the decision to undergo follow-up LP2. The strongest predictors were incorporated into regression models.

RESULTS

Over half of eligible participants opted into both baseline and follow-up LP. Participants who underwent LP1 had higher mean education than those who declined (p = 0.020). White participants were more likely to choose to undergo LP1 (p < 0.001); 33% of African American participants opted in compared to 65% of white participants. Controlling for age, education, and AD parental history, race was the only significant predictor for LP1 participation. Controlling for LP1 mild adverse events, successful LP1 predicted LP2 participation.

CONCLUSION

Race was the most important predictor of baseline LP participation, and successful prior LP was the most important predictor of follow-up LP participation.

Association of Fear and Mistrust with Stress Among Sheltered Homeless Adults and the Moderating Effects of Race and Sex

In shelter settings, homeless individuals often congregate and sleep in proximity to one another, with limited secure places for belongings: a living environment that may engender perceived vulnerability to victimization. Fear of victimization and mistrust of others in the shelter environment may result in greater stress, and racial minority residents and women may be particularly affected. Here, we aimed to examine the associations between fear, mistrust, and fear and mistrust, and stress among sheltered homeless adults, and explore moderation by race and sex. Data were from a convenience sample of adults from a homeless shelter in Dallas, TX (N = 225; 67% black; 27% women). Participants completed the fear and mistrust scale and the urban life stressors scale. Linear regressions were used to measure associations of fear, mistrust, and fear and mistrust with stress, adjusted for age, education, sex, race, history of schizophrenia/schizoaffective disorder, and discrimination. Moderation was assessed with interaction terms. Adjusted results indicated that fear, mistrust, fear and mistrust was positively associated with stress (p < 0.001). Race, but not sex, was a significant moderator of associations between fear and stress, whereby black adults with high levels of fear were more likely than white adults to experience high stress levels. Thus, although more research is needed, results suggest that interventions aimed at reducing fear of victimization may reduce stress for black adults. Given the association of stress with myriad undesirable health outcomes that can further exacerbate known health disparities, further work in this area is critical. Future research should investigate environmental sources of fear to provide further direction for interventions.

Association between enrollment factors and incident cognitive impairment in Blacks and Whites: Data from the Alzheimer's Disease Center

INTRODUCTION

We examined the influence of enrollment factors demonstrated to differ by race on incident mild cognitive impairment and dementia using Alzheimer's Disease Center data.

METHODS

Differences in rates of incident impairment between non-Latino Whites and Blacks (n = 12,242) were examined with age-at-progression survival models. Models included race, sex, education, source of recruitment, health factors, and family history of dementia.

RESULTS

No significant race differences in progression were observed in cognitively unimpaired participants. In those with mild cognitive impairment at baseline, Whites evidenced greater risk for progression than Blacks. Enrollment factors, for example, referral source, were significantly related to progression.

DISCUSSION

The finding that Blacks demonstrated lower rate of progression than Whites is contrary to the extant literature. Nested-regression analyses suggested that selection-related factors, differing by race, may account for these findings and influence our ability to accurately estimate risk for progression. It is potentially problematic to make racial comparisons using Alzheimer's Disease Center data sets.

Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida

Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff's circular and Tango's flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%-21% in high-risk clusters and by 9%-28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.

Utilizing Community-based Participatory Research Principles in a Safety-Net Hospital to Develop a Research Partnership

Research at safety-net hospitals may require additional planning to ensure the ethical conduct of research with vulnerable populations. This report discusses application of the principles of community-based participatory research and bioethics to establish a research partnership with a safety-net hospital in the southern U.S.

Recruitment and retention of underrepresented populations in Alzheimer's disease research: A systematic review

INTRODUCTION

Alzheimer's disease and related dementias (ADRD) disproportionately impact racial and ethnic minority and socioeconomically disadvantaged adults. Yet, these populations are significantly underrepresented in research.

METHODS

We systematically reviewed the literature for published reports describing recruitment and retention of individuals from underrepresented backgrounds in ADRD research or underrepresented participants' perspectives regarding ADRD research participation. Relevant evidence was synthesized and evaluated for quality.

RESULTS

We identified 22 eligible studies. Seven studies focused on recruitment/retention approaches, all of which included multifaceted efforts and at least one community outreach component. There was considerable heterogeneity in approaches used, specific activities and strategies, outcome measurement, and conclusions regarding effectiveness. Despite limited use of prospective evaluation strategies, most authors reported improvements in diverse representation in ADRD cohorts. Studies evaluating participant views focused largely on predetermined explanations of participation including attitudes, barriers/facilitators, education, trust, and religiosity. Across all studies, the strength of evidence was low.

DISCUSSION

Overall, the quantity and quality of available evidence to inform best practices in recruitment, retention, and inclusion of underrepresented populations in ADRD research are low. Further efforts to systematically evaluate the success of existing and emergent approaches will require improved methodological standards and uniform measures for evaluating recruitment, participation, and inclusivity.

Mistrust of Researchers Correlates with Stroke Knowledge among Minority Seniors in a Community Intervention Trial

BACKGROUND

Medical mistrust influences patients' treatment seeking, adherence, health behaviors, and minority participation in research studies. However, medical mistrust remains understudied within neurological diseases like stroke despite disproportionately affecting minority populations.

OBJECTIVE

This study examines the relationship of medical mistrust with stroke knowledge among Black, Latino, Korean, and Chinese-Americans.

METHODS

Subjects greater than 60 years were enrolled from senior centers to test a culturally-tailored educational curriculum around stroke risk reduction in a randomized controlled trial. A Trust Physician Scale and a modified Trust of Medical Researchers Scale measured medical mistrust. The Stroke Action Test instrument measured stroke knowledge, focusing on intent to call 911 appropriately when presented with stroke symptoms.

RESULTS

Of 225 subjects, 69.5% were female (n = 157) with an average age of 73.7 years (standard deviation 6.7). Blacks had highest trust scores of physicians relative to Latino/a, Korean or Chinese subjects (P< .05). In multivariable analysis, decreased stroke knowledge was associated with decreased researcher trust at baseline (<.05), but not physician trust, when controlling for covariates. Among Latino/a, Korean, and Chinese groups, mainstream acculturation reduced the association between researcher trust and stroke knowledge. A mediation model showed no evidence of physician trust mediating researcher trust.

CONCLUSIONS

Among minority seniors participating in a randomized controlled trial, decreased trust of researchers, not physicians, was associated with low baseline knowledge of stroke symptoms. Those least acculturated to US culture may be a particular focus for trust building intervention. Future studies should examine whether researcher mistrust is disproportionately preventing those with the largest knowledge gaps from participating in trials.

What The Health (WTH)?: Theorising Southern Black Feminisms in the US South

The everyday lived experiences of Southern Black American women in the United States (US) are rarely explicitly characterised in Black Feminisms' discourse. The lack of an active discourse surrounding the Southern Black women's identity is a glaring weakness in the broader discussion of feminism (Rushing, 2009; 2017). From Black women who historically worked as day workers, cleaning the homes of white families while their families fended for themselves, to the contemporary phenomena of home health care aid workers charged with cleaning and caring for individuals, often older and white, Southern Black women's ways of knowing have framed not only the civil rights movement (Emmons et al, 2013); but also contemporary social movements such as #SayHerName and the agency of digital social phenomena such as Black Twitter. Past social movements emphasised space and the meaningfulness of the South concerning civil rights, yet current discourse fails to integrate region and location in the narrative of these movements, thus missing opportunities to explore the "complexity and explanatory power" place contributes (Rushing, 2017:1). The proliferation of digital platforms such as podcasts, videos, social media stories focused on health demonstrate how Black women are reclaiming their health, and bringing others along with them. However, the theorisation of what we term Southern Black Feminisms, specifically as it relates to Black women's health, is lacking. This theoretical article, informed by qualitative and quantitative data from both authors' previous research, will build a profile for Southern Black women in the US, characterise Southern Black Feminisms and propose a Southern Black woman informed, evidence-based framework addressing health inequities among Southern Black women. The goal is to demonstrate how the experiences of everyday Black women in the US South and the Global South are connected, especially with African Diasporic women, and consider how potential alliances can contribute to collective resistance and action.

"We Don't Need a Swab in Our Mouth to Prove Who We Are": Identity, Resistance, and Adaptation of Genetic Ancestry Testing among Native American Communities

Genetic ancestry testing (GAT) provides a specific type of knowledge about ancestry not previously available to the general public, prompting questions about the conditions whereby genetic articulations of ancestry present opportunities to forge new identities and social ties but also new challenges to the maintenance of existing social structures and cultural identities. The opportunities and challenges posed by GAT are particularly significant for many indigenous communities-whose histories are shaped by traumatic interactions with colonial powers and Western science-and for whom new applications of GAT may undermine or usurp long-standing community values, systems of governance, and forms of relationality. We conducted 13 focus groups with 128 participants and six in-depth, semistructured interviews with a variety of community leaders examining the perceptions of GAT within indigenous communities across Oklahoma. Our interviews and focus groups suggest that participants-through the articulation of indigeneity as experiential and relational in nature and inherently distinct from genetic notions of ancestry-resist much of the challenge presented by GAT in usurping traditional forms of identity while at the same time recognizing the utility of the technology for tracing unknown ancestry and identifying health risks in the community.

Recruiting African Immigrant Women for Community-Based Cancer Prevention Studies: Lessons Learned from the AfroPap Study

Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) mobilizing African churches; (2) utilizing word of mouth through family and friends; (3) maximizing research team's cultural competence and gender concordance; (4) promoting altruism through health education; (5) ensuring confidentiality through the consenting and data collection processes; and (6) providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a "hard-to-reach" immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.

Understanding the decision to screen for lung cancer or not: A qualitative analysis

Background

Although new screening programmes with low‐dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening‐eligible persons' decisions to screen or not remain poorly understood.

Objective

To describe how current and former long‐term smokers explain their decisions regarding participation in lung cancer screening.

Design

Phone interviews using a semi‐structured interview guide were conducted to ask screening‐eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques.

Setting and participants

A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements.

Results

The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening‐eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x‐ray. A physician recommendation was a key influence on decisions to screen.

Discussion and conclusions

Education initiatives aimed at providers and long‐term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.

Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research

Background: Community and patient engagement in the healthcare system and biomedical research are prerequisites for eliminating health disparities. We conducted a “listening tour” to enhance our understanding of multilevel factors associated with community trust. Methods: Using community-based participatory research (CBPR) methods, we conducted a phenomenological qualitative study. “Town-hall” style discussions were held at nine sites across an urban, Midwestern city. We recruited adults (N = 130) via community networks, social media, flyers, and word-of-mouth. Demographic assessments were self-administered and listening tour sessions were conducted by trained moderators. Themes were framed within the social ecological model (SEM; intrapersonal, interpersonal, institutional, community, and policy levels). Results: Participants were mostly female (68%), African American (80%), had health coverage (97%) and were diagnosed with a chronic health condition (71%). The overarching theme was sociodemographic differences in distrust, such that African Americans and deaf/hearing impaired participants perceived disparities in healthcare, a lower quality of care, and skepticism about biomedical research, relative to Whites. Conclusions: The depth of distrust for healthcare providers, systems, and researchers in underserved communities remains strong and complex. Findings highlight the need to understand the lived experiences of community members, and how distrust is maintained. Multilevel interventions to increase trust and the accrual of underrepresented populations into clinical trials are needed.

Toward Affirming Therapy: What Sex Workers Want and Need From Mental Health Providers

Within the field of psychology, the development of a culture of competency both in training programs and, more specifically, related to working with historically underrepresented and underserved populations has been making significant progress. One group who has been neglected, however, consists of individuals who consensually work in the commercial sex trade industry (i.e., sex workers). The current Delphi study begins to address this gap. Using responses from eight sex workers to explore factors affecting disclosure of occupation to therapists, barriers and facilitators to receiving mental health care, and areas for educational growth among mental health professionals, the results reveal participants’ preference for therapists who take an affirming approach regarding their occupation (e.g., respecting the hard work, skill, and emotional labor) and do not assume that they are in therapy because of their work. Broadly, this article highlights the knowledge, skills, and attitudes sex workers believe comprise critical areas of competency for therapists working with this often-stigmatized population. Ultimately, these results can be used to advance competent, just, and effective therapy with this population.

Facilitators and barriers to successful recruitment into a large comparative effectiveness trial: a qualitative study

Background: Recruitment of participants into research studies, especially individuals from minority groups, is challenging; lack of diversity may lead to biased findings. Aim: To explore beliefs about research participation among individuals who were approached and eligible for the GRADE study. Methods: In-depth qualitative telephone interviews with randomized participants (n = 25) and eligible individuals who declined to enroll (n = 26). Results: Refusers and consenters differed in trust and perceptions of risk, benefits and burden of participation. Few participants understood how comparative effectiveness research differed from other types of trials; however, some features of comparative effectiveness research were perceived as lower risk. Conclusion: We identified facilitators and addressable barriers to participation in research studies.

National college health assessment sampling: Organizational barriers preventing black participation and organizational solutions for appropriate representation

Objective: This investigation longitudinally examined the participation of Black college students in the American College Health Association?s National College Health Assessment (ACHA-NCHA). Participants: All respondents to ACHA-NCHA from the years 2008, 2011, & 2014 were included in the analysis. Methods: This study compared the descriptive demographic student characteristics from the 2008, 2011, & 2014 ACHA-NCHA data to the National Center for Education Statistics (NCES) college enrollment for the corresponding years. Results: Despite constituting 14.5% of the total enrollment in 4-year universities and colleges from 2005 to 2013, Black students represented about 7% of the ACHA-NCHA respondents. Conclusion: Having a sample lacking valid representation of minorities can further lead to biased and flawed assumptions. Therefore, organizations such as ACHA should make concerted efforts to gather data that is reflective of national enrollment rates.

Outcomes of patient self-referral for the diagnosis of several rare inherited kidney diseases

Purpose

To evaluate self-referral from the Internet for genetic diagnosis of several rare inherited kidney diseases.

Methods

Retrospective study from 1996–2017 analyzing data from an academic referral center specializing in autosomal dominant tubulo-interstitial kidney disease (ADTKD). Individuals were referred by academic health care providers (HCPs) non-academic HCPs, or directly by patients/families.

Results

Over 21 years, there were 665 referrals, with 176(27%) directly from families, 269(40%) from academic HCPs, and 220(33%) from non-academic HCPs. 42(24%) of direct family referrals had positive genetic testing vs 73(27%) of families from academic HCPs and 55(25%) from non-academic HCPs (P=.72). 99% of direct family contacts were white and resided in zip code locations with a mean median income of $77,316±34,014 vs. US median income $49,445.

Conclusions

Undiagnosed families with Internet access bypassed their physicians and established direct contact with an academic center specializing in inherited kidney disease to achieve a diagnosis. Twenty-five per cent of all families diagnosed with ADTKD were the result of direct family referral and would otherwise have been un-diagnosed. If patients suspect a rare disorder that is un-diagnosed by their physicians, actively pursuing self-diagnosis using the Internet can be successful. Centers interested in rare disorders should consider improving direct access to families.

The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion

In recent years, the study of psychedelic science has resurfaced as scientists and therapists are again exploring its potential to treat an array of psychiatric conditions, such as depression, post-traumatic stress disorder, and addiction. The scientific progress and clinical promise of this movement owes much of its success to the history of indigenous healing practices; yet the work of indigenous people, ethnic and racial minorities, women, and other disenfranchised groups is often not supported or highlighted in the mainstream narrative of psychedelic medicine. This review addresses this issue directly: first, by highlighting the traditional role of psychedelic plants and briefly summarizing the history of psychedelic medicine; second, through exploring the historical and sociocultural factors that have contributed to unequal research participation and treatment, thereby limiting the opportunities for minorities who ought to be acknowledged for their contributions. Finally, this review provides recommendations for broadening the Western medical framework of healing to include a cultural focus and additional considerations for an inclusive approach to treatment development and dissemination for future studies.

Racial differences in two measures of trust in biomedical research

Objective:

Lack of trust toward medical research is a major barrier to research participation, particularly among some population groups. Valid measures of trust are needed to develop appropriate interventions. The study purpose was to compare two previously validated scales that measure trust in biomedical research – one developed by Hall et al. (H-TBR; 2006) and the other by Mainous et al. (M-TBR; 2006) – in relation to socio-demographic variables and attitudes toward research. Differences between Black and White respondents were explored.

Methods:

Two nearly identical surveys – one with H-TBR and the other with M-TBR – were systematically administered to a convenience sample. Internal consistency reliability of each scale was assessed. Associations were computed between scores on each scale with attitudes toward biomedical research and demographic variables (i.e., gender, age, race, and socioeconomic status). The difference between White and Black respondents on each TBR score while controlling for age, education, and race was also investigated.

Results:

A total of 2020 participants completed the H-TBR survey; 1957 completed the M-TBR survey. Mean item scores for M-TBR were higher (F = 56.05, p < 0.001) among Whites than Blacks. Whites also had higher mean item scores than Blacks on H-TBR (F = 7.09, p < 0.001). Both scales showed a strong association with participants’ perceived barriers to research (ps < 0.001) and significant, positive correlations with interest in research participation (ps < 0.001). Age and household income were positive predictors of TBR scores, but the effects of education differed.

Conclusions:

Both scales are internally consistent and show associations with attitudes toward research. Whites score higher than Blacks on both TBR scales, even while controlling for age and socioeconomic status.

Use of community forums to increase knowledge of HPV and cervical cancer in African American communities

Cervical cancer adversely impacts African American communities. While disparities in incidence remain unclear, communities continue to use forums to increase cervical cancer education. The purpose of this paper is to examine the efficacy of using community forums to increase human papillomavirus vaccine (HPVV) and cervical cancer knowledge in African American communities. This study is a one-group pretest-posttest study design using a 17-item questionnaire to collect data from 412 participants in diverse communities. Our analyses revealed perceived knowledge increased significantly after the forums for African American participants. For African Americans, perceived knowledge prior to the forums was explained by gender, access to care, and trust in clinical trials. After the forum, perceived knowledge was associated with access to care and trust in vaccines. Participants who had health insurance reported higher perceived HPV and cervical cancer knowledge and greater trust in vaccines. This study found community forums that address the cultural and historical context of research mistreatment related to HPVV development and include diverse racial/ethnic representation of stakeholders may be a useful strategy to increase HPVV, and cervical cancer knowledge in African American communities.

Measuring Trust in Medical Researchers: Adding Insights from Cognitive Interviews to Examine Agree-Disagree and Construct-Specific Survey Questions

While scales measuring subjective constructs historically rely on agree-disagree (AD) questions, recent research demonstrates that construct-specific (CS) questions clarify underlying response dimensions that AD questions leave implicit and CS questions often yield higher measures of data quality. Given acknowledged issues with AD questions and certain established advantages of CS items, the evidence for the superiority of CS questions is more mixed than one might expect. We build on previous investigations by using cognitive interviewing to deepen understanding of AD and CS response processing and potential sources of measurement error. We randomized 64 participants to receive an AD or CS version of a scale measuring trust in medical researchers. We examine several indicators of data quality and cognitive response processing including: reliability, concurrent validity, recency, response latencies, and indicators of response processing difficulties (e.g., uncodable answers). Overall, results indicate reliability is higher for the AD scale, neither scale is more valid, and the CS scale is more susceptible to recency effects for certain questions. Results for response latencies and behavioral indicators provide evidence that the CS questions promote deeper processing. Qualitative analysis reveals five sources of difficulties with response processing that shed light on under-examined reasons why AD and CS questions can produce different results, with CS not always yielding higher measures of data quality than AD.

Socioeconomic Status and Racial or Ethnic Differences in Participation: Web-Based Survey

Background

Web-based survey data collection has been widely used because of its advantages, although attaining and retaining participants can be challenging. There are several factors associated with successful Web-based survey participation; yet little is known regarding racial or ethnic and socioeconomic differences in the progress of a Web-based survey.

Objective

This study aimed to examine racial or ethnic and socioeconomic status (SES) differences in participation in a Web-based survey.

Methods

We conducted a secondary data analysis of a study dataset containing information on parents of preschool children. We used 2 phases of Web-based surveys: (1) screening questions including race or ethnicity information and (2) full survey with a consent form. Once potential participants submitted the screening questions, including their racial or ethnic information, the team sent the full survey link to potential participants who met study eligibility criteria. We calculated the proportion of racial or ethnic groups in each of the following areas: consent, partial survey completion, and total survey completion.

Results

A total of 487 participants (236 non-Hispanic white, 44 Hispanic, 137 black, and 70 Asian) completed initial screening questions, and a total of 458 participants met study eligibility criteria. Compared with black participants, non-Hispanic white and Asian participants were more likely to consent to participate in the study (odds ratio [OR] 1.73, 95% CI 1.08-2.78, P=.02; OR 2.07, 95% CI 1.04-4.13, P=.04, respectively). There was no racial or ethnic difference with respect to the completion of demographic questions or completion of a partial survey. Finally, compared with black participants, non-Hispanic white participants were more likely to complete the entire survey (OR 3.36, 95% CI 1.51-7.06, P<.001). With respect to SES, less educated non-Hispanic white participants were less likely to complete the survey compared with their counterparts with more education (OR 0.15, 95% CI 0.50-1.48, P<.001).

Conclusions

We found a significant difference among racial or ethnic groups as well as different education levels in Web-based survey participation. Survey researchers need to consider the SES and racial or ethnic differences in Web-based survey participation and develop strategies to address this bias in participation and completion in their research.

Successful recruitment and retention of diverse participants in a genomics clinical trial: a good invitation to a great party

PURPOSE

African ancestry (AA) individuals are inadequately included in translational genomics research, limiting generalizability of findings and benefits of genomic discoveries for populations already facing disproportionately poor health outcomes. We aimed to determine the impact of stakeholder-engaged strategies on recruitment and retention of AA adult patients into a clinical trial testing them for renal risk variants nearly exclusive to AAs.

METHODS

Our academic-clinical-community team developed ten key strategies that recognize AAs' barriers and facilitators for participation. Using electronic health records (EHRs), we identified potentially eligible patients. Recruiters reached out through letters, phone calls, and at medical visits.

RESULTS

Of 5481 AA patients reached, 51% were ineligible, 37% enrolled, 4% declined, 7% were undecided when enrollment finished. We retained 93% at 3-month and 88% at 12-month follow-up. Those enrolled are more likely female, seen at community sites, and reached through active strategies, than those who declined. Those retained are more likely female, health-literate, and older. While many patients have low income, low clinician trust, and perceive racism in health care, none of these attributes correlate with retention.

CONCLUSION

With robust stakeholder engagement, recruiters from patients' communities, and active approaches, we successfully recruited and retained AA patients into a genomic clinical trial.

Association of Health Literacy and Numeracy with Interest in Research Participation

BACKGROUND

There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills.

OBJECTIVE

To determine if health literacy and numeracy affect individuals' interest to participate in research studies.

DESIGN

Cross-sectional survey data were pooled from 3 large studies conducted in the Mid-South Clinical Data Research Network.

PARTICIPANTS

Adult patients enrolled in 1 of 3 Mid-South Clinical Data Research Network studies.

MAIN MEASURES

The survey domains included demographic items, the 3-item Brief Health Literacy Screen (range 3-15), and the 3-item Subjective Numeracy Scale (range 3-18). The outcome was a sum index measure of a 7-item instrument (range 7-21) assessing individuals' interest in participating in different types of research, including research that involves taking surveys, giving a blood sample, participating via phone or internet, taking an investigational medication, meeting at a local community center or school, including family, or staying overnight at a hospital.

KEY RESULTS

Respondents (N = 15,973) were predominately women (65.5%), White (81.4%), and middle aged (M = 52.8 years, SD = 16.5); 32.4% previously participated in research. Self-reported health literacy was relatively high (M = 13.5 out of 15, SD = 2.1), and subjective numeracy skills were somewhat lower (M = 14.3 out of 18, SD = 3.6). After adjustment for age, gender, race, income, education, and other characteristics, lower health literacy and numeracy skills were each independently associated with less interest in research participation (p < 0.001 for each). Prior research participation was associated with greater interest in future research participation (p < 0.001).

CONCLUSIONS

After adjustment for factors known to be predictive of interest, individuals with lower health literacy or numeracy scores were less interested in participating in research. Additional work is needed to elucidate reasons for this finding and to determine strategies to engage these populations.

Recruitment Techniques and Strategies in a Community-Based Colorectal Cancer Screening Study of Men and Women of African Ancestry

BACKGROUND

Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques.

OBJECTIVES

This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants.

METHODS

For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility.

RESULTS

Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05).

DISCUSSION

Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.

Concept Mapping: Engaging Urban Men to Understand Community Influences on Partner Violence Perpetration

Intimate partner violence (IPV) is a significant health concern rooted in community experiences and other social determinants. The purpose of this study is to understand community-based risk and protective factors of IPV perpetration through participatory research that engages men who use IPV. Secondarily, we assess the relative influence, as measured by ranking, of these factors regarding risk of IPV perpetration and stress. We conducted concept mapping with Baltimore men (n = 28), ages 18 and older, enrolled in an abuse intervention program (AIP), through partnership with a domestic violence agency. Concept mapping, a three-phase participatory process, generates ideas around an issue then visually presents impactful domains via multi-dimensional scaling and hierarchical clustering. Most participants were Black (87.5%) and 20-39 years old (75%). Seven key domains, or clusters, were established. "No hope for the future" was the greatest contributor to IPV perpetration. "Socioeconomic struggles" (i.e., lack of employment) and "life in Baltimore" (i.e., homicide) were most likely to result in stress. Emergent domains related to IPV perpetration and stress were ranked similarly, but with some nuance. Having good support systems (i.e., family, community centers) were felt to prevent IPV and reduce stress. This participant-driven process among a primarily young, Black sample of Baltimore men speaks to the influence of perceived social disempowerment and underlying trauma on intimate relationships and the potential for mitigation. Few studies have engaged men who use IPV through participatory research to understand the comprehensive dynamics of an impoverished, urban environment. Results provide direction for community-based intervention and prevention programming to increase self-efficacy, particularly among younger men, and to enact trauma-informed violence prevention policy from the perspectives of male IPV perpetrators.

Factors influencing parental trust in medical researchers for child and adolescent patients' clinical trial participation

Parental trust in medical researchers is a commonly cited barrier to their child's participation in clinical research. Yet, there is little understanding of factors influencing parental trust to be implemented in interventions to address their concerns. This study seeks to identify psychosocial and modifying factors influencing parental trust in medical researchers to improve child and adolescent patients clinical trial participation, and potentially their health outcomes. We conducted a cross-sectional study with 307 parents. Multiple ordinary linear (OLS) regression was conducted to determine: (1) psychosocial and modifying factors associated with parental trust; and (2) perceived advantages and disadvantages associated with parental trust. Parent's race (White) (β = .343, p < .001), higher education level (β = .409, p < .001), higher perceived advantages of adolescent clinical trials (β = .142, p < .001), and lower perceived disadvantages of adolescent clinical trials (β = -.337, p = .001) were the most significant predictors of higher levels of parental trust in medical researchers. Parents who were African American and had lower education levels expressed lower levels of trust in medical researchers. Education on the benefits of clinical trials could reduce parents' apprehension towards their child's participation in clinical trials. Results support the development of a clinical trial education program for parents to improve their trust in medical researchers.

Overcoming Barriers to Clinical Trial Enrollment

Clinical trials are imperative for testing novel cancer therapies, advancing the science of cancer care, and determining the best treatment strategies to enhance outcomes for patients with cancer. However, barriers to clinical trial enrollment contribute to low participation in cancer clinical trials. Many factors play a role in the persistently low rates of trial participation, including financial barriers, logistical concerns, and the lack of resources for patients and clinicians to support clinical trial enrollment and retention. Furthermore, restrictive eligibility criteria often result in the exclusion of certain patient populations, which thus adds to the widening disparities seen between patients who enroll in trials and those treated in routine practice. Moreover, additional factors, such as difficulty by patients and clinicians in coping with the uncertainty inherent to clinical trial participation, contribute to low trial enrollment and represent key components of the decision-making process. Specifically, patients and clinicians may struggle to assess the risk-benefit ratio and may incorrectly estimate the probability and severity of challenges associated with clinical trial participation, thus complicating the informed consent process. Importantly, research has increasingly focused on overcoming barriers to clinical trial enrollment. A promising solution involves the use of patient navigators to help enhance clinical trial recruitment, enrollment, and retention. Although clinical trials are essential for improving and prolonging the lives of patients with cancer, barriers exist that can impede trial enrollment; yet, efforts to recognize and address these barriers and enhance trial enrollment are being investigated.

Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men

The contribution of medical mistrust to healthcare utilization delays has gained increased public health attention. However, few studies examine these associations among African-American men, who delay preventive healthcare more often and report higher levels of medical mistrust than non-Hispanic White men. Additionally, studies rarely account for other factors reportedly working in tandem with medical mistrust to increase African-American men's preventive health screening delays (i.e., everyday racism and perceived racism in healthcare). We examined associations between medical mistrust, perceived racism in healthcare, everyday racism, and preventive health screening delays. Analyses were conducted using cross-sectional data from 610 African-American men aged 20 years and older recruited primarily from barbershops in four US regions (2003-2009). Independent variables were medical mistrust (MM), everyday racism (ER), and perceived racism in healthcare (PRH). Dependent variables were self-reported routine checkup, blood pressure screening, and cholesterol screening delays. Using multiple logistic regression and tests for mediation, we calculated odds ratios and 95% confidence intervals to assess associations between the independent and dependent variables. After final adjustment, African-American men with higher MM were significantly more likely to delay blood pressure screenings. Men with more frequent ER exposure were significantly more likely to delay routine checkups and blood pressure screenings. Higher levels of PRH were associated with a significant increased likelihood of delaying cholesterol screening. MM did not mediate associations between ER and screening delays. Increasing preventive health screening among African-American men requires addressing medical mistrust and racism in and outside healthcare institutions.

Towards a More Inclusive and Dynamic Understanding of Medical Mistrust Informed by Science

Mistrust of medical advances and the medical professions continues to persist, and is perhaps increasing. The popular press has documented the growing number of parents globally whose concerns around childhood vaccination, albeit based on faulty scientific information, has led to the anti-vax movement which has already resulted in outbreaks of measles in various parts of the U.S. In recent years, the AIDS Healthcare Foundation has increased speculation and mistrust with regard to the denialism of the effectiveness of pre-exposure prophylaxis (PrEP) to avert HIV infections, again based on misinformation. However, in other cases, medical mistrust reflects the very real historical and ongoing injustices experienced by socially and economically marginalized groups. Whether the genesis of the mistrust is based on fact or fallacy, the results may be similar. There are myriad negative consequences associated with medical mistrust, including lower utilization of healthcare and poorer management of health conditions. Mistrust is thought to provide a partial explanation for staggering health disparities, particularly among Black and African American people, and much of the public health and medical literature cites the infamous Tuskegee Study as a main catalyst for this persistent health-related mistrust among people of color and other groups who experience social and economic vulnerability. While mistrust is often referred to as a phenomenon existing within an individual or community, we must rethink this conceptualization and instead locate mistrust as a phenomenon created by and existing within a system that creates, sustains and reinforces racism, classism, homophobia and transphobia, and stigma. The purpose of this article is to briefly address the state of the medical mistrust literature, and to provide a summary of the articles included in this special issue on medical mistrust. Although the scholarship in this issue addresses diverse methodologies, outcomes and populations, they share a message: social inequality drives mistrust.

Assessing the Impacts and Ripple Effects of a Community-University Partnership: A Retrospective Roadmap

Each community-based participatory research (CBPR) partnership may incur "ripple effects" - impacts that happen outside the scope of planned projects. We used brainstorming and interviewing to create a roadmap that incorporated input from nine CBPR participants and five community/academic partners to retrospectively assess the ripple effects observed after five years of participatory research in one urban community. The resulting roadmap reflected a range of community impacts which we then divided into four key areas: impacts in the community (i.e., strategies, programs, and policies implemented by community partners), impacts on the CBPR team, impacts on individuals (participants and community members), and contributions to the field and the university. Our approach focused on observing what happened in the community that was directly or indirectly related to our partnership, process, products, and relationships. Much of the impact we observed reflected the synergy of sharing our research and community voice with responsive partners and stakeholders.

Does Discrimination Breed Mistrust? Examining the Role of Mediated and Non-Mediated Discrimination Experiences in Medical Mistrust

Medical mistrust is associated with a decreased likelihood of engaging in various health behaviors, including health utilization and preventive screening. Despite calls for research to address medical mistrust, few studies have explicitly delved into antecedents to medical mistrust. The current study a) examines the relationship between discrimination experiences and medical mistrust and b) experimentally tests the influence of mediated vicarious discrimination on reported levels of medical mistrust. Participants (N = 198) were randomly assigned to view news stories in one of four experimental conditions: no exposure, no discrimination control, implicit racial discrimination, and explicit racial discrimination. Results indicated prior personal and vicarious discrimination experiences were related to medical mistrust. Furthermore, exposure to mediated discrimination influenced medical mistrust in different ways for Black and White participants. Among Black participants, medical mistrust was significantly higher for those exposed to the implicit racial discrimination condition than the control condition. Marginal differences were found for White participants such that those exposed to both explicit and implicit racial discrimination conditions reported higher medical mistrust than those exposed to the control condition. Our findings are discussed in terms of the theoretical and practical implications for health communication scholars seeking to examine and influence health behaviors.

A Demographic Analysis of Racial/Ethnic Minority Enrollment Into HVTN Preventive Early Phase HIV Vaccine Clinical Trials Conducted in the United States, 2002-2016

OBJECTIVES

Racial/ethnic minority communities in the United States are overrepresented among new HIV diagnoses, yet their inclusion in preventive HIV vaccine clinical trials is inadequate. An analysis of enrollment demographic characteristics from US preventive HIV vaccine clinical trials from 1988 through 2002 showed that enrollment of racial/ethnic minority groups increased. We analyzed enrollment in preventive HIV vaccine clinical trials from 2002 through 2016 and compared our data with data from the previous study, described demographic characteristics of trial participants, and assessed how well this distribution reflected the racial/ethnic distribution of new HIV diagnoses in the United States.

METHODS

We examined data on demographic characteristics from 43 Phase 1 and Phase 2A preventive HIV vaccine clinical trials conducted in the United States and compared the results with those of the previous study. We also compared racial/ethnic distributions from 2011 through 2015 with Centers for Disease Control and Prevention data on the number of new HIV diagnoses during the same period.

RESULTS

Of 3469 participants, 1134 (32.7%) identified as a racial/ethnic minority, a 94% increase from the previous period (634/3731; 17.0%). Percentage annual enrollment of all racial/ethnic minority participants fluctuated from 17% to 53% from mid-2002 to 2016. Percentages of new HIV diagnoses among the general population were 1.9 to 2.9 times the percentage enrollment of black participants and 1.3 to 6.6 times the percentage enrollment of Hispanic/Latino participants in clinical trials for the same period.

CONCLUSIONS

Although enrollment of racial/ethnic minority groups into HIV vaccine clinical trials has increased, it is not proportional to the number of new HIV diagnoses among these groups. To enhance recruitment of racial/ethnic minority groups, the HIV Vaccine Trials Network has prioritized community partnerships and invested resources into staff training.

A systematic review of medical mistrust measures

OBJECTIVE

Medical mistrust is seen as a barrier to health promotion and addressing health disparities among marginalized populations. This study seeks to examine how medical mistrust has been measured as a step towards informing related health promotion efforts.

METHODS

A systematic review of medical mistrust scales was conducted using four major databases: PubMed, PsycINFO, ERIC, and Communication & Mass Media Complete. Databases were searched using the terms "medical mistrust scale" "medical mistrust" and "medical distrust."

RESULTS

The search returned 1595 non-duplicate citations; after inclusion and exclusion criteria were applied, 185 articles were retained and coded. Almost a quarter of studies used a single-item or a few items. Among validated scales, the Group-Based Medical Mistrust Scale, Medical Mistrust Index, and Health Care System Distrust Scale were most frequently used. There were important differences among these scales such as the object of mistrust (e.g., system, individual physician) and referent specificity (e.g., group). The measurement of medical mistrust varied by health topic and sample population.

CONCLUSION

These differences in scales and measurement should be considered in the context of intervention goals.

PRACTICE IMPLICATIONS

Researchers should be aware of differences in measures and choose appropriate measures for a given research question or intervention.