1
|
Henderson C, Scott T, Schinder B, Hager E, Friedman FS, Miller E, Ragavan MI. Shifting the Paradigm From Participant Mistrust to Researcher & Institutional Trustworthiness: A Qualitative Study of Researchers' Perspectives on Building Trustworthiness With Black Communities. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:127-136. [PMID: 36125424 DOI: 10.1177/0272684x221117710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Black communities are deeply underrepresented in research, due, in large part, to research mistrust. It is critical to shift the burden of trust building from communities to researchers and research institutions, which have perpetrated harm against Black communities for centuries. In this study, we examine researchers' perspectives on how to become trustworthy to Black-identifying participants and communities. METHODS We conducted semi-structured interviews with researchers affiliated with our institution's Clinical and Translational Science Institute. Participants were recruited through email and responded to the study team if they wished to participate. Interviews occurred through Zoom, took 60 minutes, and were audio recorded. We used an inductive thematic data analysis approach. RESULTS Sixteen researchers, who were affiliated with medicine, public health, psychology, education, and nursing, participated in this study. Participants agreed that researchers bear the responsibility for building trust and noted how critical it is to address the underrepresentation of Black participants in research through equitable recruitment and that researchers must be transparent and engage in reciprocal research practices. Community-partnered research was highlighted as a way to develop trustworthiness. Finally, participants noted that trustworthiness must also be built at the institutional level, rather than just by individual researchers. DISCUSSION To our knowledge, this is one of the first studies to examine researchers' perspectives on how to build their own trustworthiness, with a specific focus on trust-building with Black communities. Explicit training and resources are needed to build trustworthiness into academic centers.
Collapse
Affiliation(s)
| | | | | | - Erricka Hager
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
2
|
Kirkpatrick CE, Hu S, Lee N, Hong Y, Lee S, Hinnant A. Overcoming Black Americans' Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars. HEALTH COMMUNICATION 2023; 38:2663-2675. [PMID: 35924326 PMCID: PMC10809270 DOI: 10.1080/10410236.2022.2105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.
Collapse
Affiliation(s)
- Ciera E. Kirkpatrick
- Advertising & Public Relations, College of Journalism & Mass Communications, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Sisi Hu
- Advertising, School of Journalism and Strategic Media, University of Arkansas, Fayetteville, Arkansas, USA
| | - Namyeon Lee
- Department of Mass Communication, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - Yoorim Hong
- Strategic Communication, School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Sungkyoung Lee
- Strategic Communication, School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Amanda Hinnant
- Journalism Studies, School of Journalism, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
3
|
Using a multicultural and multilingual awareness-raising strategy to enhance enrollment of racially underrepresented minoritized communities - the PassITON trial. J Clin Transl Sci 2023; 7:e9. [PMID: 36755543 PMCID: PMC9879880 DOI: 10.1017/cts.2022.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Racially and ethnically minoritized populations have been historically excluded and underrepresented in research. This paper will describe best practices in multicultural and multilingual awareness-raising strategies used by the Recruitment Innovation Center to increase minoritized enrollment into clinical trials. The Passive Immunity Trial for Our Nation will be used as a primary example to highlight real-world application of these methods to raise awareness, engage community partners, and recruit diverse study participants.
Collapse
|
4
|
Narayanasamy S, Mourad A, Turner NA, Le T, Rolfe RJ, Okeke NL, O’Brien SM, Baker AW, Wrenn R, Rosa R, Rockhold FW, Naggie S, Stout JE. COVID-19 Trials: Who Participates and Who Benefits? South Med J 2022; 115:256-261. [PMID: 35365841 PMCID: PMC8945389 DOI: 10.14423/smj.0000000000001374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has disproportionately afflicted vulnerable populations. Older adults, particularly residents of nursing facilities, represent a small percentage of the population but account for 40% of mortality from COVID-19 in the United States. Racial and ethnic minority individuals, particularly Black, Hispanic, and Indigenous Americans have experienced higher rates of infection and death than the White population. Although there has been an unprecedented explosion of clinical trials to examine potential therapies, participation by members of these vulnerable communities is crucial to obtaining data generalizable to those communities. METHODS We undertook an open-label, factorial randomized clinical trial examining hydroxychloroquine and/or azithromycin for hospitalized patients. RESULTS Of 53 screened patients, 11 (21%) were enrolled. Ten percent (3/31) of Black patients were enrolled, 33% (7/21) of White patients, and 50% (6/12) of Hispanic patients. Forty-seven percent (25/53) of patients declined participation despite eligibility; 58%(18/31) of Black patients declined participation. Forty percent (21/53) of screened patients were from a nursing facility and 10% (2/21) were enrolled. Enrolled patients had fewer comorbidities than nonenrolled patients: median modified Charlson comorbidity score 2.0 (interquartile range 0-2.5), versus 4.0 (interquartile range 2-6) for nonenrolled patients (P = 0.006). The limitations of the study were the low participation rate and the multiple treatment trials concurrently recruiting at our institution. CONCLUSIONS The high rate of nonparticipation in our trial of nursing facility residents and Black people emphasizes the concern that clinical trials for therapeutics may not target key populations with high mortality rates.
Collapse
Affiliation(s)
- Shanti Narayanasamy
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Ahmad Mourad
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Nicholas A. Turner
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Thuy Le
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Robert J. Rolfe
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Nwora Lance Okeke
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Sean M. O’Brien
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Arthur W. Baker
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Rebekah Wrenn
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Rossana Rosa
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Frank W. Rockhold
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Susanna Naggie
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| | - Jason E. Stout
- From the Division of Infectious Diseases and Departments of Biostatistics and Bioinformatics and Medicine, Duke University School of Medicine, Durham, North Carolina, and UnityPoint Health, Des Moines, Iowa
| |
Collapse
|
5
|
Van Scoy LJ, Witt PD, Bramble C, Richardson C, Putzig I, Currin L, Wasserman E, Tucci A, Levi BH, Green MJ. Success of a Community-Based Delivery at Recruiting Individuals from Underserved Communities for an Observational Cohort Study of an Advance Care Planning Intervention. J Pain Symptom Manage 2022; 63:e149-e154. [PMID: 34662724 DOI: 10.1016/j.jpainsymman.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Underserved and minority populations are often reluctant to engage in advance care planning and/or research often due to distrust in healthcare and/or research institutions. AIM To determine if use of a community-based delivery model can facilitate recruitment of individuals from underserved communities in research about advance care planning. DESIGN Recruitment data are presented from a prospective, mixed methods observational cohort study that examined the feasibility and preliminary efficacy of a community-based delivery model involving an end-of-life conversation game to motivate participants to complete advance care planning behaviors. Event attendance and research participation data are reported. SETTING/PARTICIPANTS Game events were held in community venues in 27 states across the US in 2018-2019. The model involved leveraging existing social networks to recruit attendees and research participants to community game day events. Attendees were eligible for research if they were adults who read/spoke English. RESULTS A total of 1,122 individuals attended events at 53 sites. Participants generally reported low income (48% reported $30,000 annual income). At sites with research assistants, there was a 90% consent rate (92% were Black). At community outreach sites, 45% agreed to a follow-up research phone call (49% were Black). CONCLUSIONS Use of the community-based delivery model successfully engaged undeserved communities in a research-based advance care planning related community outreach event. This model may be useful for overcoming underserved and minority populations' skepticism and distrust of healthcare and research that is a common barrier to progress in health agendas, especially advance care planning.
Collapse
Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Public Health Sciences (L.J.V.S., E.W.), Penn State College of Medicine, Hershey, Pennsylvania, USA.
| | - Pamela D Witt
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy Bramble
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | | | - Irene Putzig
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Lindsey Currin
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Emily Wasserman
- Department of Public Health Sciences (L.J.V.S., E.W.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amy Tucci
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Benjamin H Levi
- Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Pediatrics, Penn State College of Medicine (B.H.L.), Hershey, Pennsylvania, USA
| | - Michael J Green
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
6
|
Ramos SR, Lardier DT, Bond KT, Boyd DT, O’Hare OM, Nelson LE, Guthrie BJ, Kershaw T. Participatory Design of a Web-Based HIV Oral Self-Testing Infographic Experiment (HOTIE) for Emerging Adult Sexual Minority Men of Color: A Mixed Methods Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11881. [PMID: 34831644 PMCID: PMC8618392 DOI: 10.3390/ijerph182211881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/31/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Abstract
Health communication is a key health promotion approach for translating research findings into actionable information. The purpose of this study was to use participatory design to create and then test the usability and comprehension of an HIV self-testing infographic in a sample of 322 emerging adult, sexual minority men of color. Our study objectives addressed three challenges to HIV self-testing: (1) correct usage of the test stick, (2) understanding the number of minutes to wait before reading the result, and (3) how to correctly interpret a negative or a positive HIV result. This study was a two-phase, sequential, mixed methods, pilot, online, randomized controlled trial. Results suggested a significant mean difference between the control and intervention groups on HIV self-testing knowledge, with the control group outperforming the intervention group. However, two-thirds or better of the participants in the intervention group were able to comprehend the three critical steps to HIV self-testing. This was a promising finding that has resulted in the authors' development of additional recommendations for using participatory design for visual aid development in HIV prevention research. Participatory design of an HIV self-testing infographic is a rigorous approach, as a health communication strategy, to address public health priorities.
Collapse
Affiliation(s)
| | - David T. Lardier
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Keosha T. Bond
- School of Medicine, The City University of New York, New York, NY 10031, USA;
| | - Donte T. Boyd
- College of Social Work, The Ohio State University, Columbus, OH 43210, USA;
| | - Olivia M. O’Hare
- College of Nursing, New York University, New York, NY 10010, USA;
| | - LaRon E. Nelson
- School of Nursing, Yale University, Orange, CT 06477, USA;
- School of Public Health, Yale University, New Haven, CT 06520, USA;
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06520, USA
| | - Barbara J. Guthrie
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA;
| | - Trace Kershaw
- School of Public Health, Yale University, New Haven, CT 06520, USA;
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06520, USA
| |
Collapse
|
7
|
Lewis KL, Turbitt E, Chan PA, Epps S, Biesecker BB, Erby LAH, Fasaye GA, Biesecker LG. Engagement and return of results preferences among a primarily African American genomic sequencing research cohort. Am J Hum Genet 2021; 108:894-902. [PMID: 33887195 PMCID: PMC8206196 DOI: 10.1016/j.ajhg.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
Genomics researchers are increasingly interested in what constitutes effective engagement of individuals from underrepresented groups. This is critical for longitudinal projects needed to inform the implementation of precision medicine. Return of results is one opportunity for engagement. The aims of this study were to determine participant perspectives on optimal engagement strategies and priorities for return of results and the extent to which focus groups were an effective modality for gathering input on these topics. We conducted six professionally moderated focus groups with 49 participants in a genomics research study. Transcripts from audio-recorded sessions were coded by two researchers and themes were discussed with the wider research team. All groups raised the issue of mistrust. Individuals participated nonetheless to contribute their perspectives and benefit their community. Many group members preferred engagement modalities that are offered to all participants and allow them to share the nuances of their perspectives over the use of participant representatives and surveys. All groups created a consensus ranking for result return priorities. Results for life-threatening conditions were the highest priority to return, followed by those related to treatable conditions that affect physical or mental health. We advocate for engagement strategies that reach as many participants as possible and allow them to share their perspectives in detail. Such strategies are valued by participants, can be effective for developing return of results policies, and may help institutions become more trustworthy.
Collapse
Affiliation(s)
- Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA.
| | - Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Priscilla A Chan
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Sandra Epps
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | | | - Lori A H Erby
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Grace-Ann Fasaye
- Genetics Branch, National Cancer Institute, Bethesda, MD 20892, USA
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Black patients with heart failure in the United States are underrepresented in clinical trials relative to their overrepresentation in the heart failure population and in adverse heart failure outcomes. We aim to evaluate historical trends in this space and highlight recent developments. RECENT FINDINGS Multiple landmark heart failure trials published since 2019 have underrepresented Black patients, though several discussed this lack of representation as limitations. A review of large heart failure clinical trials from 2001 to 2016 found persistent underrepresentation of Black patients without significant change over time. Trials enrolling from North America exclusively had more proportional representation, enrolling an average of 31.6% Black participants. SUMMARY There is a shrinking proportion of Black patients in pivotal heart failure trials despite a higher prevalence of disease and associated adverse outcomes. There is increasing awareness of these disparities within the heart failure community, potentially leading to improved representation in future studies.
Collapse
Affiliation(s)
- Tariq U Azam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
9
|
Affiliation(s)
- David H Strauss
- Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard University, Cambridge, MA, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sarah A White
- Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard University, Cambridge, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Barbara E Bierer
- Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard University, Cambridge, MA, USA. .,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Warren RC, Forrow L, Hodge DA, Truog RD. Trustworthiness before Trust - Covid-19 Vaccine Trials and the Black Community. N Engl J Med 2020; 383:e121. [PMID: 33064382 DOI: 10.1056/nejmp2030033] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rueben C Warren
- From the National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL (R.C.W., D.A.H.); and the Center for Bioethics, Harvard Medical School, Boston (L.F., R.D.T.)
| | - Lachlan Forrow
- From the National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL (R.C.W., D.A.H.); and the Center for Bioethics, Harvard Medical School, Boston (L.F., R.D.T.)
| | - David Augustin Hodge
- From the National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL (R.C.W., D.A.H.); and the Center for Bioethics, Harvard Medical School, Boston (L.F., R.D.T.)
| | - Robert D Truog
- From the National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL (R.C.W., D.A.H.); and the Center for Bioethics, Harvard Medical School, Boston (L.F., R.D.T.)
| |
Collapse
|