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Barry D, Steinberg JR, Towner M, Barber EL, Simon M, Roque DR. Enrollment of Racial and Ethnic Minoritized Groups in Gynecologic Oncology Clinical Trials: A Review of the Scope of the Problem, Contributing Factors, and Strategies to Improve Inclusion. Clin Obstet Gynecol 2023; 66:22-35. [PMID: 36657045 PMCID: PMC9869456 DOI: 10.1097/grf.0000000000000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Racial inequities are well-documented across the gynecologic oncology care continuum, including the representation of racial and ethnic minoritized groups (REMGs) in gynecologic oncology clinical trials. We specifically reviewed the scope of REMG disparities, contributing factors, and strategies to improve inclusion. We found systematic and progressively worsening under-enrollment of REMGs, particularly of Black and Latinx populations. In addition, race/ethnicity data reporting is poor, yet a prerequisite for accountability to recruitment goals. Trial participation barriers are multifactorial, and successful remediation likely requires multi-level strategies. More rigorous, transparent data on trial participants and effectiveness studies on REMG recruitment strategies are needed to improve enrollment.
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Affiliation(s)
- Danika Barry
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jecca R Steinberg
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Towner
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emma L Barber
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Melissa Simon
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Dario R Roque
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Smith JS, Vaz OM, Gaber CE, Des Marais AC, Chirumamilla B, Hendrickson L, Barclay L, Richman AR, Brooks X, Pfaff A, Brewer NT. Recruitment strategies and HPV self-collection return rates for under-screened women for cervical cancer prevention. PLoS One 2023; 18:e0280638. [PMID: 36952486 PMCID: PMC10035812 DOI: 10.1371/journal.pone.0280638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/04/2023] [Indexed: 03/25/2023] Open
Abstract
In the United States, medically underserved women carry a heavier burden of cancer incidence and mortality, yet are largely underrepresented in cancer prevention studies. My Body, My Test is a n observational cohort, multi-phase cervical cancer prevention study in North Carolina that recruited low-income women, aged 30-65 years and who had not undergone Pap testing in ≥ 4 years. Participants were offered home-based self-collection of cervico-vaginal samples for primary HPV testing. Here, we aimed to describe the recruitment strategies utilized by study staff, and the resulting recruitment and self-collection kit return rates for each specific recruitment strategy. Participants were recruited through different approaches: either direct (active, staff-effort intensive) or indirect (passive on the part of study staff). Of a total of 1,475 individuals screened for eligibility, 695 were eligible (47.1%) and 487 (70% of eligible) participants returned their self-collection kit. Small media recruitment resulted in the highest number of individuals found to be study eligible, with a relatively high self-collection kit return of 70%. In-clinic in-reach resulted in a lower number of study-eligible women, yet had the highest kit return rate (90%) among those sent kits. In contrast, 211 recruitment which resulted in the lowest kit return of 54%. Small media, word of mouth, and face-to-face outreach resulted in self-collection kit return rates ranging from 72 to 79%. The recruitment strategies undertaken by study staff support the continued study of reaching under-screened populations into cervical cancer prevention studies.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Olivia M Vaz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Charley E Gaber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Bhavika Chirumamilla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Lori Hendrickson
- Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, NC, United States of America
| | - Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States of America
| | - Xian Brooks
- School of Nursing, University of Louisville, Louisville, KY, United States of America
| | - Anna Pfaff
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
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Arana-Chicas E, Cartujano-Barrera F, Rieth KK, Richter KK, Ellerbeck EF, Cox LS, Graves KD, Diaz FJ, Catley D, Cupertino AP. Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of an mHealth Smoking Cessation Randomized Clinical Trial (Preprint). J Med Internet Res 2021; 24:e34863. [PMID: 35759320 PMCID: PMC9274407 DOI: 10.2196/34863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. Objective The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. Methods Latino smokers were enrolled into Decídetexto from 4 states—New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. Results Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). Conclusions Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services—groups who might benefit a great deal from the intervention. Trial Registration ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596 International Registered Report Identifier (IRRID) RR2-DOI: 10.1016/j.cct.2020.106188
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Affiliation(s)
- Evelyn Arana-Chicas
- Department of Surgery, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Francisco Cartujano-Barrera
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Katherine K Rieth
- Department of Otolaryngology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Kimber K Richter
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Edward F Ellerbeck
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Lisa Sanderson Cox
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington DC, DC, United States
| | - Francisco J Diaz
- Department of Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Delwyn Catley
- Center for Children's Healthy Lifestyle and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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Arana-Chicas E, Cartujano-Barrera F, Ogedegbe C, Ellerbeck EF, Cox LS, Graves KD, Diaz FJ, Catley D, Cupertino AP. Feasibility and Effectiveness of Recruiting Latinos in Decídetexto-A Smoking Cessation Clinical Trial from an Emergency Department Patient Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10859. [PMID: 34682601 PMCID: PMC8535914 DOI: 10.3390/ijerph182010859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022]
Abstract
There is an underrepresentation of Latinos in smoking cessation clinical trials. This study describes the feasibility and effectiveness of recruiting Latino smokers in the U.S. from an emergency department (ED) patient registry into a randomized smoking cessation clinical trial. Recruitment occurred from the Hackensack University Medical Center ED. Potential participants were contacted from a patient registry. The primary outcome was whether the participant responded to a call or text. Secondary outcomes included the best day of the week, week of the month, and time of day to obtain a response. Of the 1680 potential participants, 1132 were called (67.5%), while 548 (32.5%) were texted. For calls, response rate was higher compared to text (26.4% vs 6.4%; p < 0.001). More participants were interested in the study when contacted by calls compared to text (11.4% vs. 1.8%) and more participants were enrolled in the study when contacted by calls compared to text (1.1% vs. 0.2%). Regression models showed that ethnicity, age, time of day, and week of the month were not significantly associated with response rates. Recruitment of Latinos from an ED patient registry into a smoking cessation clinical trial is feasible using call and text, although enrollment may be low.
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Affiliation(s)
- Evelyn Arana-Chicas
- Department of Surgery and Public Health Sciences, School of Medicine, University of Rochester, Rochester, NY 14642, USA
| | - Francisco Cartujano-Barrera
- Department of Public Health Sciences, School of Medicine, University of Rochester, Rochester, NY 14642, USA; (F.C.-B.); (A.P.C.)
| | - Chinwe Ogedegbe
- Emergency Trauma Department, Hackensack University Medical Center, Hackensack, NJ 07601, USA;
| | - Edward F. Ellerbeck
- Department of Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA; (E.F.E.); (L.S.C.)
| | - Lisa Sanderson Cox
- Department of Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA; (E.F.E.); (L.S.C.)
| | - Kristi D. Graves
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC 20007, USA;
| | - Francisco J. Diaz
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Delwyn Catley
- Department of Pediatrics, Children’s Mercy Hospital, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA;
| | - Ana Paula Cupertino
- Department of Public Health Sciences, School of Medicine, University of Rochester, Rochester, NY 14642, USA; (F.C.-B.); (A.P.C.)
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Langer SL, Castro FG, Chen ACC, Davis KC, Joseph RP, Kim WS, Larkey L, Lee RE, Petrov ME, Reifsnider E, Youngstedt SD, Shaibi GQ. Recruitment and retention of underrepresented and vulnerable populations to research. Public Health Nurs 2021; 38:1102-1115. [PMID: 34240459 DOI: 10.1111/phn.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Felipe González Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Angela Chia-Chen Chen
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kelly Cue Davis
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Wonsun Sunny Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan E Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Shawn D Youngstedt
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature. Mayo Clin Proc 2021; 96:733-743. [PMID: 33004216 DOI: 10.1016/j.mayocp.2020.03.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/14/2023]
Abstract
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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Nickell A, Stewart SL, Burke NJ, Guerra C, Cohen E, Lawlor C, Colen S, Cheng J, Joseph G. Engaging limited English proficient and ethnically diverse low-income women in health research: A randomized trial of a patient navigator intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:1313-1323. [PMID: 30772115 PMCID: PMC8846431 DOI: 10.1016/j.pec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Evaluate a community-based navigator intervention to increase breast cancer patients' and survivors' access to information about health research participation opportunities. METHODS In the context of a Community Based Participatory Research collaboration, we conducted a prospective randomized controlled trial of the Health Research Engagement Intervention with pre- and post-intervention surveys (n = 133). The primary outcome was health research information-seeking behavior. Secondary outcomes were health research knowledge, willingness to participate in health research, and health empowerment. Qualitative interviews (n = 11) elucidated participant perspectives on the intervention. RESULTS There was no statistically significant difference between intervention and control groups' information-seeking behavior. Knowledge that not all health research studies are about drugs or treatments increased significantly from pre- to post-test among intervention group participants (32% to 48%, p = 0.012), but not in the control group (43% to 30%, p = 0.059); the difference between arms was statistically significant (p = 0.0012). Although survey responses indicated willingness to participate, qualitative interviews identified competing priorities that limited participants' motivation to seek enrollment information. CONCLUSIONS AND PRACTICE IMPLICATIONS Community-based navigators are a trusted, and therefore promising link between health research and low-income underserved communities. However, systemic barriers in health research infrastructures need to be addressed to include low income, LEP and immigrant populations.
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Affiliation(s)
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, USA
| | - Nancy J Burke
- Public Health University of California, Merced, USA; Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Claudia Guerra
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Elly Cohen
- BreastCancerTrials.org, San Francisco, USA
| | | | | | - Janice Cheng
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA.
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Hui SKA, Miller SM, Hazuda L, Engelman K, Ellerbeck EF. Novel Method for Recruiting Representative At-Risk Individuals into Cancer Prevention Trials: Online Health Risk Assessment in Employee Wellness Programs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:421-9. [PMID: 26507744 PMCID: PMC4848180 DOI: 10.1007/s13187-015-0927-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Participation in cancer prevention trials (CPT) is lower than 3 % among high-risk healthy individuals, and racial/ethnic minorities are the most under-represented. Novel recruitment strategies are therefore needed. Online health risk assessment (HRA) serves as a gateway component of nearly all employee wellness programs (EWPs) and may be a missed opportunity. This study aimed to explore employees' interest, willingness, motivators, and barriers of releasing their HRA responses to an external secure research database for recruitment purpose. We used qualitative research methods (focus group and individual interviews) to examine employees' interest and willingness in releasing their online HRA responses to an external, secure database to register as potential CPT participants. Fifteen structured interviews (40 % of study participants were of racial/ethnic minority) were conducted, and responses reached saturation after four interviews. All employees showed interest and willingness to release their online HRA responses to register as a potential CPT participant. Content analyses revealed that 91 % of participants were motivated to do so, and the major motivators were to (1) obtain help in finding personally relevant prevention trials, (2) help people they know who are affected by cancer, and/or (3) increase knowledge about CPT. A subset of participants (45 %) expressed barriers of releasing their HRA responses due to concerns about credibility and security of the external database. Online HRA may be a feasible but underutilized recruitment method for cancer prevention trials. EWP-sponsored HRA shows promise for the development of a large, centralized registry of racially/ethnically representative CPT potential participants.
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Affiliation(s)
- Siu-Kuen Azor Hui
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Leah Hazuda
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
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Tenorio SL, O'Donnell CI, Hernandez J, Rozjabek HM, Lynch D, Marcus PM. Culturally sensitive approaches to recruitment and retention of Hispanics in the national lung screening trial. J Immigr Minor Health 2016; 16:761-4. [PMID: 23780349 DOI: 10.1007/s10903-013-9862-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hispanics are underrepresented in medical research. At the National Lung Screening Trial's University of Colorado Denver screening center, traditional recruitment methods resulted in enrollment of few Hispanics. In response, the center adopted culturally sensitive recruitment techniques, including use of carefully-crafted bilingual materials. Bilingual interviewers were hired, and persons familiar with culture and language of groups of different Hispanic origin were consulted. Representation of Hispanics among participants enrolled at the Colorado center increased nearly threefold, from 3.3 to 9.4 %, after adoption of these methods. In this manuscript, we report on the specialized recruitment methods that were developed and how they were used to address known barriers to Hispanic recruitment.
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Affiliation(s)
- Sally L Tenorio
- Swedish Medical Center, Health One, Englewood, CO, 80113, USA
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10
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London L, Hurtado-de-Mendoza A, Song M, Nagirimadugu A, Luta G, Sheppard VB. Motivators and barriers to Latinas' participation in clinical trials: the role of contextual factors. Contemp Clin Trials 2015; 40:74-80. [PMID: 25433203 PMCID: PMC4357359 DOI: 10.1016/j.cct.2014.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Latinas are underrepresented in clinical trials despite the rise in Hispanic population. This study examines the factors associated with Latinas' willingness to participate in preventive breast cancer randomized clinical trials (RCTs). METHODS Women self-identifying as Latina, over age 40, with no prior history of breast cancer were eligible. Using the Behavior Model for Vulnerable Populations, we administered a survey (n=168) to assess predisposing (e.g., knowledge), enabling (e.g., trust) and need factors (e.g., risk perception). Intention to participate was defined using a lenient (maybe, probably or definitely) and a stringent criterion (probably and definitely). Chi-square tests and logistic regression models examined the associations of predisposing, enabling, and need factors with women's intentions to participate in RCTs. RESULTS Most participants (74.9%) were monolingual Spanish-speaking immigrants. Most (83.9%) reported willing to participate in clinical trials using the lenient definition (vs. 43.1% under the stringent definition). Using the lenient definition, the odds of willing to participate in RCTs were significantly lower for unmarried women (OR=.25, 95% CI=.08-.79) and those with lower cancer risk perceptions (OR=.20, 95% CI=.06-.63), while being significantly higher for women with lower language acculturation (OR=6.2, 95% CI=1.8-20.9). Using the stringent definition, women who did not endorse a motivation to enroll to help family members (if they had cancer) had significantly lower odds to report intent (OR=.33, 95% CI=.13-.86). CONCLUSION Many RCTs may have limited generalizability due to the low representation of minorities. Culturally targeted interventions that address the importance of family for Latinos may ultimately increase their participation in RCTs.
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Affiliation(s)
- Laricca London
- Department of Microbiology, Howard University College of Medicine, Washington, DC, USA
| | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA
| | - Minna Song
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA
| | - Ankita Nagirimadugu
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA
| | - Gheorghe Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA.
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Nickell A, Burke NJ, Cohen E, Caprio M, Joseph G. Educating low-SES and LEP survivors about breast cancer research: pilot test of the Health Research Engagement Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:746-52. [PMID: 24744119 PMCID: PMC4428555 DOI: 10.1007/s13187-014-0650-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Health Research Engagement Intervention (HREI) aims to reduce information and access disparities for breast cancer research opportunities among low-socioeconomic status (SES) and limited English proficient (LEP) breast cancer survivors by providing neutral, non-trial-specific information about health research via a trusted patient navigator. Qualitative methods in the context of a community-based participatory research design were used to iteratively design the HREI in collaboration with community-based care navigators from a trusted community organization, Shanti Project, and to locate appropriate research studies in collaboration with a web-based trial-matching service, BreastCancerTrials.org (BCT). Navigators were first trained in clinical trials and health research and then to deliver the HREI, providing feedback that was incorporated into both the HREI design and BCT's interface. Our intervention pilot with low SES and LEP survivors (n = 12) demonstrated interest in learning about "health research." All 12 participants opted to obtain more information when offered the opportunity. Post-intervention questionnaires showed that three of 11 (27 %) participants independently pursued additional information about research opportunities either online or by phone in the week following the intervention. Post-intervention navigator questionnaires indicated that navigators could confidently and efficiently deliver the intervention. LEP patients who pursued information independently faced language barriers. The HREI is a promising and potentially scalable intervention to increase access to neutral information about breast cancer research opportunities for low-SES and LEP individuals. However, in order for it to be effective, systems barriers to participation such as language accessibility at sources of health research information must be addressed.
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Affiliation(s)
- Alyssa Nickell
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Nancy J. Burke
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
| | - Elly Cohen
- BreastCancerTrials.org., San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, USA
| | - Maria Caprio
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
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Ceballos R, Knerr S, Scott MA, Hohl S, Malen R, Vilchis H, Thompson B. Latino beliefs about biomedical research participation: a qualitative study on the U.S.-Mexico border. J Empir Res Hum Res Ethics 2014; 9:10-21. [PMID: 25747293 PMCID: PMC4474137 DOI: 10.1177/1556264614544454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Latinos are under-represented in biomedical research conducted in the United States, impeding disease prevention and treatment efforts for this growing demographic group. We gathered perceptions of biomedical research and gauged willingness to participate through elicitation interviews and focus groups with Latinos living on the U.S.-Mexico border. Themes that emerged included a strong willingness to participate in biomedical studies and suggested that Latinos may be under-represented due to limited formal education and access to health information, not distrust. The conflation of research and clinical care was common and motivated participation. Outreach efforts and educational interventions to inform Latinos of participation opportunities and clarify harms and benefits associated with biomedical research participation will be essential to maintain trust within Latino communities.
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Affiliation(s)
- Rachel Ceballos
- Fred Hutchinson Cancer Research Center
- Department of Health Services, University of Washington
| | - Sarah Knerr
- Department of Health Services, University of Washington
| | - Mary Alice Scott
- Department of Anthropology, New Mexico State University
- Department of Public Health Sciences, New Mexico State University
| | | | | | - Hugo Vilchis
- Border Epidemiology & Environmental Health Center, New Mexico State University
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center
- Department of Health Services, University of Washington
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Hohl SD, Gonzalez C, Carosso E, Ibarra G, Thompson B. "I did it for us and I would do it again": perspectives of rural latinos on providing biospecimens for research. Am J Public Health 2014; 104:911-6. [PMID: 24625153 DOI: 10.2105/ajph.2013.301726] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We elicited perspectives of rural Latino farmworkers and non-farmworkers about their participation in a community-based participatory pesticides exposure study in which they provided multiple biospecimens. METHODS Between March and April 2012, we conducted semistructured, one-on-one interviews with 39 rural Latino farmworkers and non-farmworkers in Washington State (n = 39). Nineteen open-ended interview questions aimed to elicit participants' attitudes toward, expectations and experiences of biospecimen collection for research, and willingness to participate in future biomedical research studies. We reviewed and coded transcriptions using qualitative principles of grounded theory in which concepts were identified and themes derived from interview data. RESULTS We grouped themes into 3 major categories: (1) motivation to participate, (2) challenges of participation, and (3) perceived rewards of participation. Many participants were motivated by the perceived importance of the study topic and a desire to acquire and contribute to new knowledge. Respondents said that the benefits of participation outweighed the challenges, and many expressed satisfaction to be able to contribute to research that would benefit future generations. CONCLUSIONS Our findings supported the use of community-based participatory research to engage minorities as participants and invested parties in such studies.
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Affiliation(s)
- Sarah D Hohl
- Sarah D. Hohl, Claire Gonzalez, Elizabeth Carosso, Genoveva Ibarra, and Beti Thompson are with the Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA. Claire Gonzalez is also with the Molecular and Cellular Biology Program, University of Washington, Seattle
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Abstract
Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29% of respondents had never been screened for CRC. In the adjusted model, 36.6% of US adults age 50-59 years and 29.1% of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2%) reported never being screened than members of other racial and ethnic groups. Nearly 37% of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29% reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.
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Ulrich A, Thompson B, Livaudais JC, Espinoza N, Cordova A, Coronado GD. Issues in biomedical research: what do Hispanics think? Am J Health Behav 2013; 37:80-5. [PMID: 22943104 DOI: 10.5993/ajhb.37.1.9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine barriers and facilitators of biomedical research participation among Hispanics in a rural community in Washington State. METHODS Questionnaires addressed socio-demographics, health care access, and barriers and facilitators of participation in biomedical studies. This is a descriptive analysis of the findings. RESULTS Barriers include the need to care for family members (82%), fear of having to pay for research treatments (74%), cultural beliefs (65%), lack of time (75%) and trust (71%), and the degree of hassle (73%). Facilitators include having a friend/relative with the disease being researched (80%) and monetary compensation (73%). CONCLUSION Researchers should be mindful of these facilitators and barriers when recruiting for biomedical research studies.
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Affiliation(s)
- Angela Ulrich
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Wallington SF, Luta G, Noone AM, Caicedo L, Lopez-Class M, Sheppard V, Spencer C, Mandelblatt J. Assessing the awareness of and willingness to participate in cancer clinical trials among immigrant Latinos. J Community Health 2012; 37:335-43. [PMID: 21805372 DOI: 10.1007/s10900-011-9450-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinical trials are considered the gold standard of evidence about the efficacy of cancer prevention, early detection, and treatment interventions. A paucity of data exists on determinants of clinical trial participation in the growing US Latino population despite poor cancer outcomes in this group. This study seeks to describe correlates of awareness of and willingness to participate in clinical trials among largely Central, North, and South American Latinos using safety-net clinics. Between June 2007 and November 2008, we conducted an interviewer-administered, Spanish-language cross-sectional survey (n = 944). Logistic regression was used to assess effects of health information sources and psychosocial variables on awareness of and intention to participate in clinical trials. Analyses were completed in spring 2010. While only 48% knew what a clinical trial was, when explained, 65% indicated a willingness to participate. Providers were the most common source of health information. Use of Internet for health information, trust in health information, and higher education each independently increased the odds of clinical trial awareness, but obtaining information from providers did not. Contacting the Cancer Information Service and psychosocial factors were each independently associated with intent to join a clinical trial, while demographic factors were not. Information channels such as the Internet may be effective in conveying clinical trial information to Latinos. Providers being cited as the most common source of health information but not being associated with knowledge about or intent to participate in trials suggests a missed opportunity for communication to this population.
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Affiliation(s)
- Sherrie Flynt Wallington
- Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Research Building, W326A, 3970 Reservoir Rd, NW, Washington, DC 20057, USA.
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Graham AL, Lopez-Class M, Mueller NT, Mota G, Mandelblatt J. Efficiency and cost-effectiveness of recruitment methods for male Latino smokers. HEALTH EDUCATION & BEHAVIOR 2011; 38:293-300. [PMID: 21460176 DOI: 10.1177/1090198110372879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about the most effective strategies to recruit male Latino smokers to cessation research studies. The purpose of this study was to identify efficient and cost-effective research recruitment strategies for this priority population.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA.
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Gren L, Broski K, Childs J, Cordes J, Engelhard D, Gahagan B, Gamito E, Gardner V, Geisser M, Higgins D, Jenkins V, Lamerato L, Lappe K, Lowery H, McGuire C, Miedzinski M, Ogden S, Tenorio S, Watt G, Wohlers B, Marcus P. Recruitment methods employed in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Clin Trials 2009; 6:52-9. [PMID: 19254935 PMCID: PMC4651181 DOI: 10.1177/1740774508100974] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001. PURPOSE Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail. METHODS Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success. RESULTS In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was $9.64-35.38 for direct mail, excluding personnel costs. LIMITATIONS Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers. CONCLUSIONS Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations.
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Paskett ED, Reeves KW, McLaughlin JM, Katz ML, McAlearney AS, Ruffin MT, Halbert CH, Merete C, Davis F, Gehlert S. Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience. Contemp Clin Trials 2008; 29:847-61. [PMID: 18721901 PMCID: PMC2642621 DOI: 10.1016/j.cct.2008.07.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 07/22/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The recruitment of minority and underserved individuals to research studies is often problematic. The purpose of this study was to describe the recruitment experiences of projects that actively recruited minority and underserved populations as part of The Centers for Population Health and Health Disparities (CPHHD) initiative. METHODS Principal investigators and research staff from 17 research projects at eight institutions across the United States were surveyed about their recruitment experiences. Investigators reported the study purpose and design, recruitment methods employed, recruitment progress, problems or challenges to recruitment, strategies used to address these problems, and difficulties resulting from Institutional Review Board (IRB) or Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Additionally, information was collected about participant burden and compensation. Burden was classified on a three-level scale. Recruitment results were reported as of March 31, 2007. RESULTS Recruitment attainment ranged from 52% to 184% of the participant recruitment goals. Commonly reported recruitment problems included administrative issues, and difficulties with establishing community partnerships and contacting potential participants. Long study questionnaires, extended follow-up, and narrow eligibility criteria were also problematic. The majority of projects reported difficulties with IRB approvals, though few reported issues related to HIPAA requirements. Attempted solutions to recruitment problems varied across Centers and included using multiple recruitment sites and sources and culturally appropriate invitations to participate. Participant burden and compensation varied widely across the projects, however, accrual appeared to be inversely associated with the amount of participant burden for each project. CONCLUSION Recruitment of minority and underserved populations to clinical trials is necessary to increase study generalizbility and reduce health disparities. Our results demonstrate the importance of flexible study designs which allow adaptation to recruitment challenges. These experiences also highlight the importance of involving community members and reducing participant burden to achieve success in recruiting individuals from minority and underserved populations.
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Affiliation(s)
- Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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20
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Larkey LK, Gonzalez JA, Mar LE, Glantz N. Latina recruitment for cancer prevention education via Community Based Participatory Research strategies. Contemp Clin Trials 2008; 30:47-54. [PMID: 18775798 DOI: 10.1016/j.cct.2008.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 08/12/2008] [Accepted: 08/16/2008] [Indexed: 11/15/2022]
Abstract
Increasing minority participation in cancer research is an ethical and statistical necessity for gaining population-specific knowledge of cancer prevention, screening, and treatment. Locating and recruiting eligible and willing minority participants presents unique structural and cultural/linguistic challenges. Community Based Participatory Research provides a viable set of principles for facilitating recruitment in hard-to-recruit communities. We focus on the specific challenge of recruiting and engaging low-income and underinsured Latina women in cancer prevention education research, and present community-based strategies used to recruit women into a recently completed study in Arizona, Juntos en la Salud (Together in Health). Community representatives and promotoras' (Latino community health educators) involvement in site identification, individual recruitment, and development of strategies and materials for the interventions built engagement and trust. These strategies resulted in enrollment of an especially low-income, underinsured population. To emphasize the degree to which a particularly underserved population was recruited, we present data comparing demographic and screening profiles of enrollees to the general population of Latinos in Arizona.
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Affiliation(s)
- Linda K Larkey
- University of Arizona, College of Medicine, Arizona Cancer Center, Scottsdale, Arizona 85258, United States.
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