Impact of participant incentives and direct and snowball sampling on survey response rate in an ethnically diverse community: results from a pilot study of physical activity and the built environment

Participant Bias in Community-Based Physical Activity Research: A Consistent Limitation?

Physical activity is a beneficial, yet complex, health behavior. To ensure more people experience the benefits of physical activity, we develop and test interventions to promote physical activity and its associated benefits. Nevertheless, we continue to see certain groups of people who choose not to, or are unable to, take part in research, resulting in "recruitment bias." In fact, we (and others) are seemingly missing large segments of people and are doing little to promote physical activity research to equity-deserving populations. So, how can we better address recruitment bias in the physical activity research we conduct? Based on our experience, we have identified 5 broad, interrelated, and applicable strategies to enhance recruitment and engagement within physical activity interventions: (1) gain trust, (2) increase community support and participation, (3) consider alternative approaches and designs, (4) rethink recruitment strategies, and (5) incentivize participants. While we recognize there is still a long way to go, and there are broader community and societal issues underlying recruitment to research, we hope this commentary prompts researchers to consider what they can do to try to address the ever-present limitation of "recruitment bias" and support greater participation among equity-deserving groups.

Differences in the surgical treatment of adult and pediatric brachial plexus injuries among peripheral nerve surgeons

OBJECTIVES

Peripheral nerve surgeons disagree on the optimal timing and treatment of brachial plexus injuries (BPI). This study aims to survey peripheral nerve surgeons on their management of BPI, including disagreement.

METHODS

Surgeons responded to a case-based survey involving traumatic and birth injuries leading to BPI involving the upper and lower trunks, and pre- and post-ganglionic injuries.

RESULTS

Out of 255 invited surgeons, 154 participated, with specialties of Neurosurgery (33.7%), Plastic surgery (32.5%), and Orthopedics (32.5%). For the adult C5-6 avulsion injury, 97.4% agreed they would operate. There was 46.2% disagreement regarding the pediatric upper trunk neuroma-in-continuity case, and similar disagreement (50.0%) was recorded on exploring the brachial plexus for a pediatric lower trunk injury case. High percentages of surgeons were more likely to explore the plexus, such as at upper BPI. Also, most participants reported nerve transfer for the upper and lower trunk avulsion injuries, but there was 55.6% disagreement regarding nerve transfer for the infant with the upper trunk neuroma-in-continuity. Among those elected to perform nerve transfer, most (70.0%-84.5%) would perform an accessory-to-suprascapular nerve transfer for upper BPI, while brachialis-to-anterior interosseous and supinator branch of the radial nerve-to-posterior interosseous were preferred for lower BPI (30.0%-55.9%).

CONCLUSIONS

Substantial disagreement exists among peripheral nerve surgeons in managing adult and pediatric BPI. In adult BPI, most prefer to operate at the time of the presentation and perform extensive nerve transfers. The accessory-suprascapular transfer was recommended for upper BPI, while brachialis and radial nerves were preferred for lower BPI. The most significant disagreements exist in operation and nerve transfer for pediatric upper BPI and brachial plexus explorations. Geography, specialty, and operative volume contribute to the differences seen.

Testing Vicarious Experiences as Antecedents of Medical Mistrust: A Survey of Black and White Americans

In response to recent calls to examine medical mistrust antecedents, the present study investigated the influence of negative healthcare (personal, vicarious interpersonal, vicarious media) and racial discrimination (personal, vicarious interpersonal, vicarious media) experiences on medical mistrust, and whether these relationships were mediated by perceived racism and perceived financial corruption in healthcare. Multigroup structural equation modeling was utilized to test the model using a cross-sectional survey of Black and White adults. Personal negative healthcare experiences and vicarious media racial discrimination experiences were directly related to medical mistrust for Black and White participants. Additionally, personal negative healthcare experiences exerted indirect effects through both perceived racism in healthcare and perceived financial corruption in healthcare. Vicarious media racial discrimination experiences exerted indirect effects through perceived financial corruption for both Black and White participants and through perceived racism for Black participants. Finally, both types of vicarious interpersonal experiences and racial discrimination experiences exerted indirect effects through perceived racism for White participants. The findings have implications for medical mistrust scholarship going forward. It is necessary to acknowledge the role vicarious experiences plays in medical mistrust antecedents, which may include recognizing the impact of news depictions of racial discrimination on patients' behaviors. Additionally, there is a need to further investigate the role of perceived financial corruption in healthcare in medical mistrust.

Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam

Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects.

Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic

Background

COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs).

Objectives

This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic.

Methods

An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively.

Results

The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group.

Conclusion

This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.

"Are people thinking I'm a vector…because I'm fat?": Cisgender experiences of body, eating, and identity during COVID-19

While a range of studies have shown the negative impact of COVID-19 on disordered eating and body image, few have engaged with how identity and social context interact with these domains. The current study used inductive codebook thematic analysis to understand experiences of body and eating during the pandemic among a diverse (sub)clinical sample of individuals with self-reported disordered eating. We interviewed 31 cisgender participants (18/31 Black Indigenous People of Color (BIPOC), 24/31 women) with a history of disordered eating (diagnosed and undiagnosed). Five themes were identified: Body Surveillance and Dissatisfaction, Movement and Intake Fixation, Food Scarcity and Resource Concerns, Changes in Visibility of Body and Eating, and Bodies Are Vulnerable. We examined the extent to which themes pertained to certain identities over others. Notably, BIPOC, large-bodied, queer participants more commonly spoke to body vulnerability than White, small/medium-bodied, straight participants. BIPOC and large-bodied participants also particularly spoke to feeling relief from discrimination as social distancing and mask wearing reduced their public visibility. Participants related these themes to changed body and eating experiences that spanned distress and resilience. Our analysis offers insight into multifaceted and contextual impacts of COVID-19 on experiences of body, eating, and identity.

How can I Be as attractive as a Fitness YouTuber in the era of COVID-19? The impact of digital attributes on flow experience, satisfaction, and behavioral intention

In the past decade, the social media platform has dramatically changed individuals’ daily activities in real life and on the Internet, including shopping, socialization, entertainment, study, and even health and fitness. In the era of COVID-19, particularly, consumers tend to rely more on digital attributes of social media platforms for their decision-making process by reducing the physical touchpoint. Responding to this ongoing trend, this study investigates how fitness YouTube channel attributes and fitness YouTuber attributes influence flow experience, satisfaction, and behavioral intention of YouTubers who work out at home via a fitness YouTube channel during the COVID-19 pandemic. Based on the social media literature and the cognitive appraisal theory, this research formulates a research model that specifies the influence of three dimensions of fitness YouTube channel attributes (i.e., social interaction, information quality, and visual content) and three dimensions of fitness YouTuber attributes (i.e., social attractiveness, physical attractiveness, and attitude homophily) on flow experience, YouTube channel satisfaction, and behavioral intention in the context of YouTube. This study recruited participants in the United States who currently work out via a fitness YouTube channel through three waves of data collection during the COVID-19 era. The empirical results revealed that flow experience was significantly affected by information quality, visual content, and physical attractiveness. Also, YouTube channel satisfaction was significantly affected by social interaction, information quality, and visual content. Lastly, behavioral intention was significantly affected by flow experience and YouTube channel satisfaction. Based on the findings, this study proposes meaningful implications for the extant literature and social media industry during the COVID-19 pandemic.

Julien J, Huguet KL, Green L, Odedina FT, Kumar NB, Simmons VN, George TJ, Vadaparampil ST, Hodul PJ, Arnoletti JP, Awad ZT, Bose D, Jiang K, Centeno BA, Gwede CK, Malafa M, Judge SM, Judge AR, Jeong D, Bloomston M, Merchant NB, Fleming JB, Trevino JG. The Florida Pancreas Collaborative Next-Generation Biobank: Infrastructure to Reduce Disparities and Improve Survival for a Diverse Cohort of Patients with Pancreatic Cancer

Background: Well-annotated, high-quality biorepositories provide a valuable platform to support translational research. However, most biorepositories have poor representation of minority groups, limiting the ability to address health disparities. Methods: We describe the establishment of the Florida Pancreas Collaborative (FPC), the first state-wide prospective cohort study and biorepository designed to address the higher burden of pancreatic cancer (PaCa) in African Americans (AA) compared to Non-Hispanic Whites (NHW) and Hispanic/Latinx (H/L). We provide an overview of stakeholders; study eligibility and design; recruitment strategies; standard operating procedures to collect, process, store, and transfer biospecimens, medical images, and data; our cloud-based data management platform; and progress regarding recruitment and biobanking. Results: The FPC consists of multidisciplinary teams from fifteen Florida medical institutions. From March 2019 through August 2020, 350 patients were assessed for eligibility, 323 met inclusion/exclusion criteria, and 305 (94%) enrolled, including 228 NHW, 30 AA, and 47 H/L, with 94%, 100%, and 94% participation rates, respectively. A high percentage of participants have donated blood (87%), pancreatic tumor tissue (41%), computed tomography scans (76%), and questionnaires (62%). Conclusions: This biorepository addresses a critical gap in PaCa research and has potential to advance translational studies intended to minimize disparities and reduce PaCa-related morbidity and mortality.

Increased Awareness, Unchanged Behavior: Prediabetes Diagnosis in a Low-Income, Minority Population

Purpose

The purpose of the study was to explore preventive behaviors and attitudes among mostly low-income, young Hispanic women with and without prediabetes.

Methods

In 2017, a convenience sample of women without diabetes aged 18 to 49 years (n = 214, 77.8% Hispanic) was recruited from the waiting room of a community health center to complete a 77-item questionnaire. Attitudes, risk perception, and recent lifestyle change were measured using a validated instrument, the Risk Perceptions Survey: Developing Diabetes. Chi-squared tests and multivariable binary logistic regression were conducted to assess the relationship between prediabetes diagnosis and attitude or lifestyle variables.

Results

Women diagnosed with prediabetes were more likely to report worry about diabetes and to perceive themselves at higher risk for developing diabetes in the next 10 years than women without a prior prediabetes diagnosis. There was no significant association between prediabetes diagnosis and recent adoption of lifestyle changes compared with those without prediabetes. After controlling for demographic characteristics and risk factors for type 2 diabetes, prediabetes diagnosis was significantly associated with elevated risk perception for developing diabetes if no lifestyle change is made but not with worry or risk perception for developing diabetes generally.

Conclusions

Prediabetes diagnosis is associated with heightened perception of diabetes risk but not lifestyle change compared to women without prediabetes in this low-income, predominantly Hispanic population. Prediabetes counseling efforts must emphasize evidence-based approaches for motivating preventive behaviors.

A Feasibility Study of Muslim Cancer Survivors' Experience in the United States: Recruitment and Data Collection

BACKGROUND

Studies with U.S. Muslims have had difficulty recruiting participants.

METHOD

This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview.

RESULTS

Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews.

DISCUSSION

We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors.

Factors associated with participation and completion of a survey-based study

PURPOSE

The Healthy Work Place (HWP) study investigated methods to improve clinicians' dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice.

DESIGN/METHODOLOGY/APPROACH

In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed.

FINDINGS

In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418).

SOCIAL IMPLICATIONS

More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout.

ORIGINALITY/VALUE

There is limited research on clinicians' workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.

Lay Explanatory Models of Depression and Preferred Coping Strategies among Somali Refugees in Norway. A Mixed-Method Study

Objective: Refugees are at high risk of experiencing mental health problems due to trauma in their pasts and to acculturation stress as they settle in a new country. To develop efficient health services that meet the needs of refugees from different regions, an understanding is required of how they make sense of and prefer to cope with mental health problems. This study aims to investigate lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. Methods: The study used a mixed-method design with a vignette describing a moderately depressed person based on ICD-10 criteria. Firstly, a survey study was performed among Somali refugees (n = 101). Respondents were asked to give advice to the vignette character and complete the Cross-Cultural Depression Coping Inventory and the General Help-Seeking Questionnaire. Secondly, focus group interviews (n = 10) were conducted separately with males and females to examine the relationship between the explanatory models of depression and the preferred coping strategies. Results: The participants showed a strong preference for coping with depression by religious practices and reliance on family, friends, and their ethnic/religious community, rather than by seeking professional treatment from public health services (e.g., medical doctors, psychologists). Depressive symptoms were conceptualized as a problem related to cognition (thinking too much) and emotion (sadness), but not to biological mechanisms, and they were thought to result from spiritual possession, stress as a result of social isolation, and/or past trauma. Independently of time in exile, the participants showed a strong identification with their ethnic origin and associated values. Because participants emphasized the need to obey and follow the views of elders, fathers, and spiritual leaders, these authorities seemed to be "gatekeepers" for access to mental health services. Conclusion: The results highlight that mental health programs for Somali refugees should actively involve the ethnic community, including spiritual leaders, in order to reach patients in need and to foster treatment compliance.

Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands

Background

There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands.

Methods

We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis.

Results

The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies.

Conclusions

The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.

The salience of food labeling among low-income families with overweight children

OBJECTIVE

To explore the role of food labeling among low-income families with overweight children.

DESIGN

A longitudinal, qualitative study involving interviews, focus groups, and self-introspections.

SETTING

Perth, Western Australia.

PARTICIPANTS

Thirty-seven low-income parents (35 mothers, 2 fathers) of overweight children. Recruitment was performed by a social research company to access low-income parents residing across Perth.

PHENOMENON OF INTEREST

Extent to which disadvantaged parents of overweight children engage with nutrition labeling on food products.

ANALYSIS

Transcripts were imported into NVivo 9 for coding and analysis.

RESULTS

Nutrition labeling had low salience for most study participants when purchasing food for their overweight children. Few recognized that their children had a weight problem, and as such they experienced little motivation to access or use nutrition labeling when purchasing foods for their children. An exception was apparent among some parents who were particularly concerned about food additives and actively interrogated ingredients lists to facilitate avoiding products containing contraindicated additives.

CONCLUSIONS AND IMPLICATIONS

Policy makers seeking to address obesity through food labeling may need to address low levels of salience among disadvantaged families, who are more likely to suffer weight problems and are thus most in need of effective food labeling.