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Cakici JA, Dimmock D, Caylor S, Gaughran M, Clarke C, Triplett C, Clark MM, Kingsmore SF, Bloss CS. Assessing Diversity in Newborn Genomic Sequencing Research Recruitment: Race/Ethnicity and Primary Spoken Language Variation in Eligibility, Enrollment, and Reasons for Declining. Clin Ther 2023; 45:736-744. [PMID: 37429778 DOI: 10.1016/j.clinthera.2023.06.014] [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] [Received: 01/26/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Diagnostic genomic research has the potential to directly benefit participants. This study sought to identify barriers to equitable enrollment of acutely ill newborns into a diagnostic genomic sequencing research study. METHODS We reviewed the 16-month recruitment process of a diagnostic genomic research study enrolling newborns admitted to the neonatal intensive care unit at a regional pediatric hospital that primarily serves English- and Spanish-speaking families. Differences in eligibility, enrollment, and reasons for not enrolling were examined as functions of race/ethnicity and primary spoken language. FINDINGS Of the 1248 newborns admitted to the neonatal intensive care unit, 46% (n = 580) were eligible, and 17% (n = 213) were enrolled. Of the 16 languages represented among the newborns' families, 4 (25%) had translated consent documents. Speaking a language other than English or Spanish increased a newborn's likelihood of being ineligible by 5.9 times (P < 0.001) after controlling for race/ethnicity. The main reason for ineligibility was documented as the clinical team declined having their patient recruited (41% [51 of 125]). This reason significantly affected families who spoke languages other than English or Spanish and was able to be remediated with training of the research staff. Stress (20% [18 of 90]) and the study intervention(s) (20% [18 of 90]) were the main reasons given for not enrolling. IMPLICATIONS This analysis of eligibility, enrollment, and reasons for not enrolling in a diagnostic genomic research study found that recruitment generally did not differ as a function of a newborn's race/ethnicity. However, differences were observed depending on the parent's primary spoken language. Regular monitoring and training can improve equitable enrollment into diagnostic genomic research. There are also opportunities at the federal level to improve access to those with limited English proficiency and thus decrease disparities in representation in research participation.
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Affiliation(s)
- Julie A Cakici
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA; School of Public Health, San Diego State University, San Diego, California, USA
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Sara Caylor
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Mary Gaughran
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Christina Clarke
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | | | - Michelle M Clark
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Stephen F Kingsmore
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Cinnamon S Bloss
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, USA.
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Gonzales XF, Heeringa SG, Briceño EM, Mehdipanah R, Levine DA, Langa KM, Garcia N, Longoria R, Morgenstern LB. Mexican Americans Participate in Research More than Expected while non-Hispanic Whites Participate Less than Expected. J Health Care Poor Underserved 2022; 33:590-596. [PMID: 35574862 PMCID: PMC9132253 DOI: 10.1353/hpu.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify Hispanic/Latinx and non Hispanic White participation rates in a community-based project using door-to-door recruitment. METHODS We conducted a two-stage area probability sample of housing units in Nueces County, Texas, using Census data including Mexican Americans (MAs) and non-Hispanic Whites (NHWs). From May 2018-February 2020, residents over 64 were asked to take a cognitive screen. We compared expected and observed ethnic-specific participation. RESULTS Nearly a thousand (996) participants enrolled. Accounting for sampling error, the observed count of MAs (n=609) significantly exceeded expectations ([inline-graphic 01], [95% CI: 521,542]). The observed count of NHWs (n=387) was less than expected ([inline-graphic 02], [95% CI: 455, 473]. The sub-group with the largest difference in observed vs. expected participants was MA women, n=376 observed, 306 (95% CI: 300, 312) expected. CONCLUSIONS Mexican Americans were significantly more likely to participate than expected, challenging the notion that ethnic minority populations are less likely to agree to research.
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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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Srinivasan T, Sutton EJ, Beck AT, Cuellar I, Hernandez V, Pacyna JE, Shaibi GQ, Kullo IJ, Lindor NM, Singh D, Sharp RR. Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center. J Prim Care Community Health 2021; 12:21501327211000242. [PMID: 33729042 PMCID: PMC7975483 DOI: 10.1177/21501327211000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Minority communities have had limited access to advances in genomic medicine.
Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health
Center in Phoenix, Arizona, partnered to assess the feasibility of offering
genomic screening to Latino patients receiving care at a community-based
health center. We examined primary care provider (PCP) experiences reporting
genomic screening results and integrating those results into patient
care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other
members of the health care team charged with supporting patients who
received positive genomic screening results. Interviews were recorded,
transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results
indicating a genetic variant that warranted clinical management. PCPs felt
genomic screening was valuable to patients and their families, and that
genomic research should strive to include underrepresented minorities.
Providers identified multiple challenges integrating genomic sequencing into
patient care, including difficulties maintaining patient contact over time;
arranging follow-up medical care; and managing results in an environment
with limited genetics expertise. Providers also reflected on the ethics of
offering genomic sequencing to patients who may not be able to pursue
diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing
advances in precision medicine to community-based health centers serving
under-resourced populations. By proactively considering patient support
needs, and identifying financial assistance programs and patient-referral
mechanisms to support patients who may need specialized medical care, PCPs
and other health care providers can help to ensure that precision medicine
lives up to its full potential as a tool for improving patient care.
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Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021; 6:5. [PMID: 38645686 PMCID: PMC11026954 DOI: 10.12688/wellcomeopenres.16558.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 04/23/2024] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the Rpackage for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies-including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards-have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people's values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as 'co-production', 'engagement of knowledges', 'rules of engagement' and 'stewardship' emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India.
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Affiliation(s)
- Prasanna Warrier
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Calvin Wai-Loon Ho
- Faculty of Law and Centre for Medical Ethics and Law, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Susan Bull
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, OX3 7LF, UK
| | - Mario Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Manjulika Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
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Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16558.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the R package for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies—including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards—have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people’s values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as ‘co-production’, ‘engagement of knowledges’, ‘rules of engagement’ and ‘stewardship’ emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India
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