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Galasso I. Precision Medicine for Whom? Public Health Outputs from "Genomics England" and "All of Us" to Make Up for Upstream and Downstream Exclusion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:71-85. [PMID: 36876959 DOI: 10.1080/15265161.2023.2180108] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current "diversity and inclusion" efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from benefitting from precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion.
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Shahrier S, Gaydarska H, Takashima K, Yoshizawa G, Minari J. A conceptual analysis of public opinion regarding genome research in Japan. Front Genet 2023; 14:1170794. [PMID: 38098474 PMCID: PMC10720899 DOI: 10.3389/fgene.2023.1170794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
In the 20 years since the completion of the Human Genome Project, the gap between scientific development and public understanding of genome research has been widening. While genome research has been increasingly utilized for social and clinical purposes in a multifaceted manner, this has resulted in an increase in the potential risks associated with genomic data. In this context, our study aims to consider the nature of public perceptions of genome research, primarily by using as a case study the results of previous public surveys relevant to donations for social benefits in Japan. We explored certain types of awareness, attitude, and intention (A-A-I) in such surveys and discussed the resultant key findings through the cultural transmission framework. Reframing the public's response toward genome research based on A-A-I analysis and behavioral science may contribute to developing more systematic communication approaches with the public. With a view to establishing such approaches, our perspective suggests some new insights to discuss the science-society gap in genome research internationally.
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Affiliation(s)
- Shibly Shahrier
- Teesside University International Business School, Teesside University, Tees Valley, United Kingdom
| | - Hristina Gaydarska
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, Kyoto, Japan
| | - Kayo Takashima
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, Kyoto, Japan
| | - Go Yoshizawa
- Innovation System Research Center, Kwansei Gakuin University, Nishinomiya, Hyogo, Japan
| | - Jusaku Minari
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, Kyoto, Japan
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3
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Galasso I, Geiger S. Genetic research and the collective good: participants as leaders to reconcile individual and public interests. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108867. [PMID: 37673669 DOI: 10.1136/jme-2022-108867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
This paper problematises the notions of public or common good as weighed against individual sovereignty in the context of medical research by focusing on genetic research. We propose the notion of collective good as the good of the particular collective in which the research was conducted. We conducted documentary and interview-based research with participant representatives and research leaders concerned with participant involvement in leading genetic research projects and around two recent genetic data controversies: the case of the UK Wellcome Sanger Institute, accused of planning unauthorised commercialisation of African DNA samples, and the case of the company Genuity Science, which planned genetic research on brain tumour samples in Ireland with no explicit patient consent. We advocate for greater specificity in circumscribing the collective to which genetic research relates and for greater efforts in including representatives of this collective as research coleaders in order to enable a more inclusive framing of the good arising from such research. Such community-based participant cogovernance and coleadership in genetic research is vital especially when minorities or vulnerable groups are involved, and it centrally requires community capacity building to help collectives articulate their own notions of the collective good.
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Affiliation(s)
- Ilaria Galasso
- School of Business, UCD, Dublin, Ireland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
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4
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Shim JK, Foti N, Vasquez E, Fullerton SM, Bentz M, Jeske M, Lee SSJ. Community Engagement in Precision Medicine Research: Organizational Practices and Their Impacts for Equity. AJOB Empir Bioeth 2023; 14:185-196. [PMID: 37126431 PMCID: PMC10615663 DOI: 10.1080/23294515.2023.2201478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal. METHODS Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for. RESULTS We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability. CONCLUSIONS Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in "pantomime community engagement." This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process.
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Affiliation(s)
- Janet K Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Emily Vasquez
- Department of Sociology, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Stephanie M Fullerton
- Department of Bioethics & Humanities, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Melanie Jeske
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
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5
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Uvere EO, Nichols M, Ojebuyi BR, Isah SY, Calys-Tagoe B, Jenkins C, Obiako R, Owolabi L, Akpalu A, Sarfo FS, Ogunronbi O, Adigun M, Fakunle GA, Hamzat B, Laryea R, Uthman B, Akinyemi JO, Adeleye O, Melikam L, Balogun O, Sule A, Adeniyi S, Asibey SO, Oguike W, Olorunsogbon O, Singh A, Titiloye MA, Musbahu R, Wahab KW, Kalaria RN, Jegede AS, Owolabi MO, Ovbiagele B, Arulogun OS, Akinyemi RO. Capacity-Building for Stroke Genomic Research Data Collection: The African Neurobiobank Ethical, Legal, and Social Implications Project Experience. Biopreserv Biobank 2023; 21:158-165. [PMID: 35759418 PMCID: PMC10125390 DOI: 10.1089/bio.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The fields of stroke genomics, biobanking, and precision medicine are rapidly expanding in sub-Saharan Africa. However, the ethical, legal, and social implications (ELSI) of emerging neurobiobanking and genomic data resources are unclear in an emerging African scientific landscape with unique cultural, linguistic, and belief systems. Objective: This article documents capacity-building experiences of researchers during the development, pretesting, and validation of data collection instruments of the African Neurobiobank for Precision Stroke Medicine-(ELSI) Project. Methods: The African Neurobiobank for Precision Stroke Medicine-ELSI project is a transnational, multicenter project implemented across seven sites in Ghana and Nigeria. Guided by the Community-Based Participatory Research framework, we conducted three workshops with key stakeholders to review the study protocol, ensure uniformity in implementation; pretest, harmonize, and integrate context-specific feedback to ensure validity and adaptability of data collection instruments. Workshop impact was assessed using an open-ended questionnaire, which included questions on experience with participation in any of the workshops, building capacity in Genetic and Genomic Research (GGR), level of preparedness toward GGR, the genomic mini-dictionary developed by the team, and its impact in enhancing understanding in GGR. Data were analyzed qualitatively using a thematic framework approach. Results: Findings revealed the usefulness of the workshop in improving participants' knowledge and capacity toward GGR implementation. It further identified local, context-specific concerns regarding quality data collection, the need to develop culturally acceptable, genomic/biobanking data collection tools, and a mini-dictionary. Participants-reported perceptions were that the mini-dictionary enhanced understanding, participation, and data collection in GGR. Overall, participants reported increased preparedness and interest in participating in GGR. Conclusion: Capacity-building is a necessary step toward ELSI-related genomic research implementation in African countries where scholarship of ELSI of genomics research is emerging. Our findings may be useful to the design and implementation of ELSI-GGR projects in other African countries.
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Affiliation(s)
- Ezinne O. Uvere
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michelle Nichols
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Babatunde R. Ojebuyi
- Department of Communication and Language Arts, University of Ibadan, Ibadan, Nigeria
| | | | | | - Carolyn Jenkins
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olumayowa Ogunronbi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Muyiwa Adigun
- Department of Law, University of Ibadan, Ibadan, Nigeria
| | | | - Bello Hamzat
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | - Babatunde Uthman
- Department of Epidemiology & Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Osi Adeleye
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lois Melikam
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olubukola Balogun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Abdullateef Sule
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Shadrack O. Asibey
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Olorunyomi Olorunsogbon
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Musibau A. Titiloye
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rabiu Musbahu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kolawole W. Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele S. Jegede
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O. Owolabi
- Department of Medicine, University of Ibadan, Ibadan. Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San Francisco, California, USA
| | - Oyedunni S. Arulogun
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus O. Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Akyüz K, Goisauf M, Chassang G, Kozera Ł, Mežinska S, Tzortzatou-Nanopoulou O, Mayrhofer MT. Post-identifiability in changing sociotechnological genomic data environments. BIOSOCIETIES 2023:1-28. [PMID: 37359141 PMCID: PMC10042674 DOI: 10.1057/s41292-023-00299-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 03/30/2023]
Abstract
Data practices in biomedical research often rely on standards that build on normative assumptions regarding privacy and involve 'ethics work.' In an increasingly datafied research environment, identifiability gains a new temporal and spatial dimension, especially in regard to genomic data. In this paper, we analyze how genomic identifiability is considered as a specific data issue in a recent controversial case: publication of the genome sequence of the HeLa cell line. Considering developments in the sociotechnological and data environment, such as big data, biomedical, recreational, and research uses of genomics, our analysis highlights what it means to be (re-)identifiable in the postgenomic era. By showing how the risk of genomic identifiability is not a specificity of the HeLa controversy, but rather a systematic data issue, we argue that a new conceptualization is needed. With the notion of post-identifiability as a sociotechnological situation, we show how past assumptions and ideas about future possibilities come together in the case of genomic identifiability. We conclude by discussing how kinship, temporality, and openness are subject to renewed negotiations along with the changing understandings and expectations of identifiability and status of genomic data.
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Affiliation(s)
- Kaya Akyüz
- Department of Science and Technology Studies, University of Vienna, Universitätsstraße 7/Stiege II/6, Stock (NIG), 1010 Vienna, Austria
- BBMRI-ERIC, Graz, Austria
| | - Melanie Goisauf
- Department of Science and Technology Studies, University of Vienna, Universitätsstraße 7/Stiege II/6, Stock (NIG), 1010 Vienna, Austria
- BBMRI-ERIC, Graz, Austria
| | - Gauthier Chassang
- CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Plateforme GenoToul Societal “Ethique et Biosciences”, Toulouse, France
| | | | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
- BBMRI.LV, Riga, Latvia
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7
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Atkins R, Kelly TA, Johnson S, Deatrick JA, Wunnenberg M, Joseph PV, Pudasainee-Kapri S, Gage G, Pontes NMH, Cresse N, Williams W. Beliefs and willingness towards participating in genetic testing for depression in low-income and racial/ethnic minority mothers at-risk. Arch Psychiatr Nurs 2022; 41:153-165. [PMID: 36428043 PMCID: PMC11036348 DOI: 10.1016/j.apnu.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression. DESIGN A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness. FINDINGS Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %). CONTROL Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %). CONCLUSIONS Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.
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Affiliation(s)
- Rahshida Atkins
- The College of New Jersey, School of Nursing and Health Sciences, 2000 Pennington Road, Room 113, Ewing, NJ 08102, USA.
| | - Terri-Ann Kelly
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Shanda Johnson
- New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ 07305, USA.
| | - Janet A Deatrick
- The University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA, USA.
| | - Mary Wunnenberg
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Paule V Joseph
- Section of Sensory Science and Metabolism (SenSMet), National Institute on Alcohol Abuse and Alcoholism & National Institute of Nursing Research, National Institutes of Health, Bethesda, MD.
| | - Sangita Pudasainee-Kapri
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Gale Gage
- Essex County College, Division of Nursing & Health Sciences, 303 University Avenue, Newark, NJ 07102, USA
| | - Nancy M H Pontes
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Nancy Cresse
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
| | - Wanda Williams
- Rutgers The State University of New Jersey School of Nursing-Camden, 530 Federal Street, Camden, NJ 08102, USA.
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8
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Ewing AT, Turner AD, Sakyi KS, Elmi A, Towson M, Slade JL, Dobs AS, Ford JG, Erby LH. Amplifying Their Voices: Advice, Guidance, and Perceived Value of Cancer Biobanking Research Among an Older, Diverse Cohort. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:683-693. [PMID: 32975747 DOI: 10.1007/s13187-020-01869-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
The use of biobanks may accelerate scientists' chances of developing cures and treatments that are tailored to individuals' biological makeup-a function of the precision medicine movement. However, given the underrepresentation of certain populations in biobanks, the benefits of these resources may not be equitable for all groups, including older, multi-ethnic populations. The objective of this study was to better understand older, multi-ethnic populations' (1) perceptions of the value of cancer biobanking research, (2) study design preferences, and (3) guidance on ways to promote and increase participation. This study was designed using a community-based participatory research (CBPR) approach and involved eight FGDs with 67 older (65-74 years old) black and white residents from Baltimore City and Prince George's County, MD. FGDs lasted between 90 and 120 min, and participants received a $25 Target gift card for their participation. Analysis involved an inductive approach in which we went through a series of open and axial coding techniques to generate themes and subthemes. Multiple themes emerged from the FGDs for the development of future cancer-related biobanking research including (1) expectations/anticipated benefits, (2) biobanking design preferences, and (3) ways to optimize participation. Overall, most participants were willing to provide biospecimens and favored cancer-related biobank. To increase participation of older, diverse participants in biobanking protocols, researchers need to engage older, diverse persons as consultants in order to better understand the value of biobanking research to individuals from the various populations. Scientists should also incorporate suggestions from the community on garnering trust and increasing comfort with study design.
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Affiliation(s)
- Altovise T Ewing
- Global Health Equity and Population Science, Roche Genentech, 1 DNA Way, South San Francisco, CA, 94404, USA.
| | - Arlener D Turner
- Department of Psychiatry, Center for Sleep and Brain Health, New York University School of Medicine, New York, NY, USA
| | - Kwame S Sakyi
- Public and Environment Wellness Department, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Ahmed Elmi
- All of Us Research Program, National Institutes of Health (NIH), Rockville, MD, USA
| | - Michele Towson
- Maxwell Enterprises, 211 East Lombard Street, Baltimore, MD, #300, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, P.O. Box 250, Upper Marlboro, MD, USA
| | - Adrian S Dobs
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Lori H Erby
- Department of Health Behavior, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Kikut A, Sanyal M, Vaughn M, Ridley-Merriweather KE, Head K, Salowe R, Lomax-Reese S, Lewis M, Ross AG, Cui QN, Addis V, Sankar PS, Miller-Ellis E, O’Brien JM. Learning from Black/African American Participants: Applying the Integrated Behavioral Model to Assess Recruitment Strategies for a Glaucoma Genetic Study. HEALTH COMMUNICATION 2022; 37:515-524. [PMID: 33345602 PMCID: PMC8213868 DOI: 10.1080/10410236.2020.1853897] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The underrepresentation of African American (AA) participants in medical research perpetuates racial health disparities in the United States. Open-ended phone interviews were conducted with 50 AA adults from Philadelphia who had previously participated in a genetic study of glaucoma that included complimentary ophthalmic screenings. Recruitment for the genetic study was done in partnership with a Black-owned radio station. Thematic analysis of interview transcripts, guided by the integrated behavior model (IBM), identified self-reported motivations for participating in this care-focused and community-promoted research program. Findings revealed that decisions to enroll were influenced by strong instrumental attitudes regarding learning more about personal health and contributing to future care options for others. Notable normative influences that factored into participants' decisions to enroll in the study included hearing about the study from a respected community media outlet, friends, and family. About one-third of respondents discussed past and current racial discrimination in medical research as an important sociocultural frame within which they thought about participation, suggesting that experiential attitudes play a continuing role in AA's decisions to enroll in medical research studies. Medical researchers seeking to recruit AA participants should collaborate with community partners, combine enrollment opportunities with access to health services, and emphasize the potential for new research to mitigate racial inequalities.
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Affiliation(s)
- Ava Kikut
- Annenberg School for Communication, University of
Pennsylvania, Philadelphia, PA, USA
| | - Mohima Sanyal
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Marquis Vaughn
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | | | - Katharine Head
- Department of Communication Studies, Indiana
University–Purdue University Indianapolis, IN, USA
| | - Rebecca Salowe
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ahmara G. Ross
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N. Cui
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi S. Sankar
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Joan M. O’Brien
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
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10
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Grewe ME, Khalil L, Felder K, Goldstein KM, McNeil RB, Sims KJ, Provenzale D, Voils CI. Gulf War Era Veterans' perspectives on research: a qualitative study. Life Sci 2021; 287:120113. [PMID: 34728229 DOI: 10.1016/j.lfs.2021.120113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
AIMS Many veterans of the 1990-1991 Gulf War Era (GWE) have experienced poorly understood health issues. In response to challenges recruiting this population for research, we conducted focus groups and semi-structured phone interviews with GWE veterans and subject matter experts (SMEs) to explore GWE veterans' perceptions about research. MAIN METHODS Transcribed discussions were content-analyzed. Participants discussed research-related motivators and barriers identified among other populations, and nuances that may be specific to GWE veterans. KEY FINDINGS Examples of motivating factors included: seeking answers about causes of and treatment for health issues; helping oneself; and helping other veterans. Examples of barriers included: distrust and dissatisfaction with federal entities; lack of research follow-through; and concerns about privacy and confidentiality. SIGNIFICANCE Researchers can use this information to better address GWE veterans' concerns and motivate them to participate in research. Inclusion of GWE veterans in research will allow researchers and clinicians to better understand and address health issues affecting this population.
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Affiliation(s)
- Mary E Grewe
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Lara Khalil
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Kristina Felder
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Karen M Goldstein
- Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina, United States of America; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rebecca B McNeil
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America; Center for Clinical Research Network Coordination, Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina, United States of America
| | - Kellie J Sims
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America.
| | - Dawn Provenzale
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America; Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina, United States of America; Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, Madison, WI, United States of America; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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11
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Passmore SR, Jamison AM, Abdelwadoud M, Rogers TB, Wiggan M, Mullins DC, Thomas SB. Use of a Qualitative Story Deck to Create Scenarios and Uncover Factors Associated with African American Participation in Genomics Research. FIELD METHODS 2021; 33:159-174. [PMID: 34326707 PMCID: PMC8318208 DOI: 10.1177/1525822x20982089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To gain a complex understanding of willingness to participate in genomics research among African Americans, we developed a technique specifically suited to studying decision making in a relaxed social setting. The "Qualitative Story Deck," (QSD) is a gamified, structured elicitation technique that allows for the spontaneous creation of scenarios with variable attributes. We used the QSD to create research scenarios that varied on four details (race/ethnicity of the researcher; research goal; biospecimen requested; and institutional affiliation). Participants created scenarios by randomly choosing cards from these categories and provided: (1) a judgement about their willingness to participate in the research project represented; and (2) their thought process in reaching a decision. The QSD has applicability to topics involving decision making or in cases where it would be beneficial to provide vignettes with alternate attributes. Additional benefits include: rapid establishment of rapport and engagement and the facilitation of discussion of little known or sensitive topics.
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12
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Galbraith-Gyan KV, Ramanadhan S, Viswanath K. Community Stakeholders' Perspectives on Introducing Human Papillomavirus Vaccination and Biobanking Evidence-Based Programs Within Medically Underserved Communities: A Community-Engaged Approach. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 41:315-323. [PMID: 32664800 PMCID: PMC9376934 DOI: 10.1177/0272684x20942071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE We explored the perspectives of program coordinators and community leaders from Community-based-organizations (CBOs) and Faith-based-organizations (FBOs) to determine how information on human papillomavirus (HPV) vaccination and biobanking is understood and supported within medically underserved communities, and identified strategies for introducing evidence-based programs (EBP) on HPV vaccination and biobanking within underserved communities. METHODS The EPIS framework guided discussions in four focus groups with program coordinators (n = 27) and one-on-one interviews with community leaders (n = 15) from CBOs and FBOs. RESULTS Participants reported that community members were aware of HPV vaccination but did not know of the link between HPV infection and cancers. Awareness for biobanking was low. HPV vaccination and biobanking were not priority health concerns among community members due to other health issues. However, HPV vaccination and biobanking were considered sensitive health topics. For HPV vaccination, sensitivity was due to concerns that HPV vaccination promoted sex among adolescents, while for biobanking, sensitivity was due to historical abuses of people of color by the medical community. Participants reported that program coordinators' awareness of HPV vaccination and biobanking depended on their organizations' mission. Neither were considered a priority health concern due to lack of funding. Few EBP were available on HPV vaccination and biobanking. Recommendations on culturally-appropriate strategies for engaging community members on HPV vaccination and biobanking EBP are discussed. CONCLUSION Given the promise of HPV vaccination and the Precision Medicine Initiative to reduce cancer disparities, findings elucidate factors to be considered when implementing EBP on HPV vaccination and biobanking into medically underserved communities.
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Affiliation(s)
- Kayoll V Galbraith-Gyan
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Kasisomayajula Viswanath
- Lee Kum Kee Professor of Health Communication, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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13
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Amendola LM, Golden-Grant K, Scollon S. Scaling Genetic Counseling in the Genomics Era. Annu Rev Genomics Hum Genet 2021; 22:339-355. [PMID: 33722076 DOI: 10.1146/annurev-genom-110320-121752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The development of massively parallel sequencing-based genomic sequencing tests has increased genetic test availability and access. The field and practice of genetic counseling have adapted in response to this paradigm-shifting technology and the subsequent transition to practicing genomic medicine. While the key elements defining genetic counseling remain relevant, genetic counseling service delivery models and practice settings have evolved. Genetic counselors are addressing the challenges of direct-to-consumer and consumer-driven genetic testing, and genetic counseling training programs are responding to the ongoing increased demand for genetic counseling services across a broadening range of contexts. The need to diversify both the patient and participant groups with access to genetic information, as well as the field of genetic counseling, is at the forefront of research and training program initiatives. Genetic counselors are key stakeholders in the genomics era, and their contributions are essential to effectively and equitably deliver precision medicine.
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Affiliation(s)
- Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Katie Golden-Grant
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA;
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14
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Eliciting Willingness and Beliefs towards Participation in Genetic Psychiatric Testing in Black/African American Mothers at Risk for Depression. Behav Sci (Basel) 2020; 10:bs10120181. [PMID: 33256064 PMCID: PMC7760786 DOI: 10.3390/bs10120181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Black/African American women are at high risk for depression, yet are underrepresented in psychiatric genetic research for depression prevention and treatment. Little is known about the factors that influence participation in genetic testing for Black/African American women at risk. The purpose of this study was to elicit the beliefs that underlie participation in genetic testing for depression in Black/African American mothers, a subgroup at high risk. Willingness to participate in genetic testing procedures was also determined. A qualitative, descriptive design was employed. Exactly 19 mothers aged 21–42 completed open-ended questionnaires. Directed content and descriptive analyses of the text were conducted based on the Theory of Planned Behavior. Salient beliefs included: behavioral advantages—diagnosing/detecting depression (31.6%), finding cure/treatment (21.1%); disadvantages—not finding follow-up treatment/help (21.1%); salient referents, who approves—family members (47.4%), agencies/organizations (26.3%); who disapproves—church associates (21.1%). Control beliefs included: barriers—unpleasant/difficult testing procedures (42.1%), limited knowledge about the purpose of testing (26.3%); facilitator—a convenient location (21.1%). Most mothers (89.5%) indicated willingness to participate in testing. Interventions can target families, address barriers, emphasize future benefits, and use convenient locations and community-based participatory research methods. Policies can address social determinants of participation to increase inclusion of these mothers in psychiatric genetic research.
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15
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Griesemer I, Staley BS, Lightfoot AF, Bain L, Byrd D, Conway C, Grant TL, Leach B, Milko L, Mollison L, Porter N, Reid S, Smith G, Waltz M, Berg JS, Rini C, O'Daniel JM. Engaging community stakeholders in research on best practices for clinical genomic sequencing. Per Med 2020; 17:435-444. [PMID: 33026293 PMCID: PMC7938705 DOI: 10.2217/pme-2020-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: Maximizing the utility and equity of genomic sequencing integration in clinical care requires engaging patients, their families, and communities. The NCGENES 2 study explores the impact of engagement between clinicians and caregivers of children with undiagnosed conditions in the context of a diagnostic genomic sequencing study. Methods: A Community Consult Team (CCT) of diverse parents and advocates for children with genetic and/or neurodevelopmental conditions was formed. Results: Early and consistent engagement with the CCT resulted in adaptations to study protocol and materials relevant to this unique study population. Discussion: This study demonstrates valuable contributions of community stakeholders to inform the implementation of translational genomics research for diverse participants.
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Affiliation(s)
- Ida Griesemer
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill NC, USA
| | - Brooke S Staley
- Department of Epidemiology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Derrick Byrd
- Parent/Advocate, Family Resource Center South Atlantic, Raleigh, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | - Tracey L Grant
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Laura Milko
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Lonna Mollison
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Sharron Reid
- Parent/Advocate, Wake County Sickle Cell Support Group, Raleigh, NC, USA
| | | | - Margaret Waltz
- Department of Social Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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16
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Hussain SB, Quittner AL, Brown M, Li-Rosi AM. Understanding access to genomics in an ethnically diverse south Florida population: A comparison of demographics in odyssey and rapid whole genome sequencing programs. J Genet Couns 2020; 29:553-561. [PMID: 32277851 DOI: 10.1002/jgc4.1281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022]
Abstract
Advances in genomic medicine have evolved to include rapid whole genome sequencing (rWGS) in pediatric intensive care settings. Traditionally, genetic testing was conducted in outpatient clinics, with stepwise genetic testing occurring over several years. This delayed the time to diagnosis, making it more difficult to include underrepresented groups, such as those who identify as Black and Latinx. National genetic sequencing programs have also struggled to engage these participants in their studies, leading to a significant disparity in access to new genetic technologies. The purpose of our study was to compare the demographic characteristics of families enrolled in both an Odyssey Program (N = 46), defined as outpatients in the Genetics Clinic who have had prior genetic testing, and a newly implemented rWGS (N = 52) sequencing program. Despite living in a large, ethnically diverse city, our results indicated that parents in the Odyssey program differed significantly from parents in the rWGS program in level of education, family income, and insurance status. For example, 71.5% of parents in the diagnostic Odyssey program had a college or advanced degree, whereas 42% of parents in the rWGS program had this level of education. Family income and insurance also differed, with 48.6% of families in the Odyssey program earning $100,000 or more versus 28.2% in rWGS; 56% of parents in the Odyssey program had private insurance with 26% on Medicaid whereas only 23% of parents in rWGS had private insurance, with the vast majority of children on Medicaid (69%). Thus, our Odyssey program illustrates some of the common pitfalls in implementing genomic testing in an ethnically diverse community, including lack of referrals, travel to outpatient visits, and a cultural mismatch with providers. The successful enrollment of underrepresented groups in the rWGS program demonstrates that given the opportunity to participate in genetic testing, families are interested and aware of the potential benefits of this testing for their child. As genomic sequencing transitions from outpatient to inpatient settings, an opportunity arises to close the health disparity gap. Recommendations for implementing rWGS in pediatric, intensive care settings that address the common barriers faced by underrepresented families are discussed.
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Affiliation(s)
- Saida B Hussain
- Research Institute, Nicklaus Children's Hospital, Miami, FL, USA
| | | | - Marilyn Brown
- Research Institute, Nicklaus Children's Hospital, Miami, FL, USA
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17
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Hudson M, Garrison NA, Sterling R, Caron NR, Fox K, Yracheta J, Anderson J, Wilcox P, Arbour L, Brown A, Taualii M, Kukutai T, Haring R, Te Aika B, Baynam GS, Dearden PK, Chagné D, Malhi RS, Garba I, Tiffin N, Bolnick D, Stott M, Rolleston AK, Ballantyne LL, Lovett R, David-Chavez D, Martinez A, Sporle A, Walter M, Reading J, Carroll SR. Rights, interests and expectations: Indigenous perspectives on unrestricted access to genomic data. Nat Rev Genet 2020; 21:377-384. [DOI: 10.1038/s41576-020-0228-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
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18
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McKinney LP, Gerbi GB, Caplan LS, Claridy MD, Rivers BM. Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection. J Genet Couns 2020; 29:494-504. [PMID: 32103577 DOI: 10.1002/jgc4.1228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.
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Affiliation(s)
- Lawrence P McKinney
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gemechu B Gerbi
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Lee S Caplan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mechelle D Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brian M Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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19
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Passmore SR, Jamison AM, Hancock GR, Abdelwadoud M, Mullins CD, Rogers TB, Thomas SB. "I'm a Little More Trusting": Components of Trustworthiness in the Decision to Participate in Genomics Research for African Americans. Public Health Genomics 2020; 22:215-226. [PMID: 31955173 PMCID: PMC7037806 DOI: 10.1159/000505271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/08/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Susan Racine Passmore
- Collaborative Center for Health Equity, University of Wisconsin, Madison, Wisconsin, USA,
| | - Amelia M Jamison
- Center for Health Equity, University of Maryland, College Park, Maryland, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA
| | - Taylor B Rogers
- Department of Health Policy and Management, University of California, Los Angeles, California, USA
| | - Stephen B Thomas
- Department of Health Policy and Management, University of Maryland, College Park, Maryland, USA
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20
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Sirisena ND, Dissanayake VHW. Strategies for Genomic Medicine Education in Low- and Middle-Income Countries. Front Genet 2019; 10:944. [PMID: 31649727 PMCID: PMC6791921 DOI: 10.3389/fgene.2019.00944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/05/2019] [Indexed: 01/04/2023] Open
Affiliation(s)
- Nirmala D Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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21
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Scherr CL, Ramesh S, Marshall-Fricker C, Perera MA. A Review of African Americans' Beliefs and Attitudes About Genomic Studies: Opportunities for Message Design. Front Genet 2019; 10:548. [PMID: 31258547 PMCID: PMC6587098 DOI: 10.3389/fgene.2019.00548] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
Precision Medicine, the practice of targeting prevention and therapies according to an individual’s lifestyle, environment or genetics, holds promise to improve population health outcomes. Within precision medicine, pharmacogenomics (PGX) uses an individual’s genome to determine drug response and dosing to tailor therapy. Most PGX studies have been conducted in European populations, but African Americans have greater genetic variation when compared with most populations. Failure to include African Americans in PGX studies may lead to increased health disparities. PGX studies focused on patients of African American descent are needed to identify relevant population specific genetic predictors of drug responses. Recruitment is one barrier to African American participation in PGX. Addressing recruitment challenges is a significant, yet potentially low-cost solution to improve patient accrual and retention. Limited literature exists about African American participation in PGX research, but studies have explored barriers and facilitators among African American participation in genomic studies more broadly. This paper synthesizes the existing literature and extrapolates these findings to PGX studies, with a particular focus on opportunities for message design. Findings from this review can provide guidance for future PGX study recruitment.
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Affiliation(s)
- Courtney L Scherr
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Sanjana Ramesh
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Charlotte Marshall-Fricker
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL, United States
| | - Minoli A Perera
- Department of Pharmacology, Center for Pharmacogenomics, Feinberg School of Medicine, Chicago, IL, United States
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22
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Menon U, Cohn E, Downs CA, Gephart SM, Redwine L. Precision health research and implementation reviewed through the conNECT framework. Nurs Outlook 2019; 67:302-310. [PMID: 31280842 DOI: 10.1016/j.outlook.2019.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Precision health is a population-based approach that incorporates big-data strategies to understand the complex interactions between biological, environmental, lifestyle, and psychosocial factors that influence health. PURPOSE A promising tool to facilitate precision health research and its dissemination is the ConNECT Framework. METHODS Here, we discuss the relationship of the five broad and synergistic principles within the ConNECT Framework as they may apply to nursing science research: (1) Integrating Context, (2) Fostering a Norm of Inclusion, (3) Ensuring Equitable Diffusion of Innovations, (4) Harnessing Communication Technology, and (5) Prioritizing Specialized Training. DISCUSSION/CONCLUSION The principles within this framework can be used by nurse scientists and educators to guide and disseminate precision health research.
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Affiliation(s)
- Usha Menon
- College of Nursing, University of South Florida, Tampa, FL.
| | | | - Charles A Downs
- School of Nursing & Health Studies, University of Miami, Miami, FL
| | | | - Laura Redwine
- College of Nursing, University of South Florida, Tampa, FL
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23
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Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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24
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Williams JK, Feero WG, Veenstra DL, Starkweather A, Cashion AK. Considerations in initiating genomic screening programs in health care systems. Nurs Outlook 2018; 66:570-575. [PMID: 30093136 DOI: 10.1016/j.outlook.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/12/2018] [Accepted: 06/17/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Janet K Williams
- College of Nursing, The University of Iowa, Iowa City, IA; American Academy of Nursing, Washington D.C..
| | | | | | - Angela Starkweather
- American Academy of Nursing, Washington D.C.; School of Nursing, University of Connecticut, Storrs, CT
| | - Ann K Cashion
- American Academy of Nursing, Washington D.C.; National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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25
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Sabatello M, Callier S, Garrison NA, Cohn EG. Trust, Precision Medicine Research, and Equitable Participation of Underserved Populations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:34-36. [PMID: 29621444 PMCID: PMC5890957 DOI: 10.1080/15265161.2018.1431328] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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26
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Sirisena ND, Dissanayake VHW. Focusing attention on ancestral diversity within genomics research: a potential means for promoting equity in the provision of genomics based healthcare services in developing countries. J Community Genet 2017; 8:275-281. [PMID: 28699077 DOI: 10.1007/s12687-017-0311-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/08/2017] [Indexed: 12/01/2022] Open
Abstract
Although we are well into the second decade after the completion of the International Human Genome Project, genomic research has failed to fully represent the diverse ancestry of global populations. The resultant healthcare challenges faced by populations underrepresented in genomic research needs to be tackled by the global scientific community. In this paper, we address several major factors which have contributed to the existing health disparity and put forward a combination of scientific and political interventions needed to bring about a change that will ensure all global populations benefit equally from the advances made in genomic medicine and research.
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Affiliation(s)
- Nirmala D Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka.
| | - Vajira H W Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka
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Cohn EG, Hamilton N, Larson EL, Williams JK. Self-reported race and ethnicity of US biobank participants compared to the US Census. J Community Genet 2017; 8:229-238. [PMID: 28623623 PMCID: PMC5496846 DOI: 10.1007/s12687-017-0308-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/11/2017] [Indexed: 12/17/2022] Open
Abstract
Precision medicine envisions a future of effective diagnosis, treatment, and prevention grounded in precise understandings of the genetic and environmental determinants of disease. Given that the original genome-wide association studies represented a predominately European White population, and that diversity in genomic studies must account for genetic variation both within and across racial categories, new research studies are at a heightened risk for inadequate representation. Currently biological samples are being made available for sequencing in biobanks across the USA, but the diversity of those samples is unknown. The aims of this study were to describe the types of recruitment and enrollment materials used by US biobanks and the diversity of the samples contained within their collection. Biobank websites and brochures were evaluated for reading level, health literacy, and factors known to encourage the recruitment of minorities, such as showing pictures of diverse populations. Biobank managers were surveyed by mail on the methods and materials used for enrollment, recruitment, consent, and the self-reported race/ethnicity of biobank participants. From 51 US biobanks (68% response rate), recruitment and enrollment materials were in English only, and most of the websites and brochures exceeded a fifth-grade reading level. When compared to the 2015 US Census, self-reported race/ethnicity of participants was not significantly different for Whites (61%) and blacks (13%). The percentages were significantly lower for Hispanics and Latinos (18 vs. 7%, p = 0.00) and Hawaiian/Pacific Islanders (0.2 vs. 0.01%; p = 0.01) and higher for Asians (13 vs. 5%, p = 0.01). Materials for recruitment predominantly in English may limit participation by underrepresented populations.
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Affiliation(s)
- Elizabeth Gross Cohn
- School of Nursing, Columbia University, New York, NY, USA.
- Adelphi University, Garden City, NY, USA.
| | - Nalo Hamilton
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
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Murtagh MJ, Minion JT, Turner A, Wilson RC, Blell M, Ochieng C, Murtagh B, Roberts S, Butters OW, Burton PR. The ECOUTER methodology for stakeholder engagement in translational research. BMC Med Ethics 2017; 18:24. [PMID: 28376776 PMCID: PMC5379503 DOI: 10.1186/s12910-017-0167-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes (as a patient or member of the public). Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others (the many 'publics' of engagement) brings them closer to the research but also brings the research closer to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. METHODS In practice, engagement faces numerous challenges and is often time-consuming, expensive and 'thorny' work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER (Employing COnceptUal schema for policy and Translation Engagement in Research) methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, "How could it be otherwise?" ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of 'keeping open' the possible considerations that might emerge and including reflexive use of qualitative analytic methods. RESULTS This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to 'open up' engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: (1) engagement and knowledge exchange; (2) analysis of mindmap contributions; (3) development of a conceptual schema (i.e. a map of concepts and their relationship); and (4) feedback, refinement and development of recommendations. CONCLUSION ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it.
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Affiliation(s)
- Madeleine J. Murtagh
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Centre for Policy, Ethics and Life Sciences (PEALS), Newcastle University, Newcastle, UK
| | - Joel T. Minion
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew Turner
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rebecca C. Wilson
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mwenza Blell
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Cynthia Ochieng
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Barnaby Murtagh
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Urban Cow Productions, London, UK
| | - Stephanie Roberts
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Oliver W. Butters
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul R Burton
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Development and validation of the biobanking attitudes and knowledge survey-Spanish (BANKS-SP). J Community Genet 2016; 7:303-314. [PMID: 27627979 DOI: 10.1007/s12687-016-0280-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/22/2016] [Indexed: 10/21/2022] Open
Abstract
Few research studies with non-English-speaking audiences have been conducted to explore community members' views on biospecimen donation and banking, and no validated Spanish-language multi-scale instruments exist to measure community perspectives on biobanking. This study describes the development and psychometric properties of the Biobanking Attitudes aNd Knowledge Survey-Spanish (BANKS-SP). The BANKS was translated into Spanish using the Brislin method of translation. Draft BANKS-SP items were refined through cognitive interviews, and psychometric properties were assessed in a sample of 85 Spanish-speaking individuals recruited at various community events in a three county area in central west Florida, USA. The final BANKS-SP includes three scales: attitudes, knowledge, and self-efficacy; as well as three single items, which evaluated receptivity and intention to donate a biospecimen for research. The final Cronbach's alpha coefficients for the two scales that use a Likert response format indicated adequate internal consistency (attitudes, α = .79; self-efficacy, α = .91). Intention to donate blood and intention to donate urine were positively correlated with attitudes, self-efficacy, and receptivity to learning more about biobanking (all p's < .001). BANKS-SP-Knowledge was not statistically significantly correlated with other BANKS-SP scales or single items measuring intention to donate a biospecimen for research and receptivity for learning more about biospecimen research. The BANKS-SP attitudes and self-efficacy scales show evidence of satisfactory reliability and validity. Additional research should be conducted with larger samples to assess the BANKS-SP instrument's reliability and validity. A valid and reliable Spanish-language instrument measuring Spanish-speaking community members' views about biobanking may help researchers evaluate relevant communication interventions to enhance understanding, intention, and actual biospecimen donation among this population.
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Underhill M, Jones T, Habin K. Disparities in Cancer Genetic Risk Assessment and Testing. Oncol Nurs Forum 2016; 43:519-23. [DOI: 10.1188/16.onf.519-523] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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