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Strahl A, Bücker L, Bechler U, Krüger L, Ries C, Hubert J, Beil FT, Rolvien T. Influence of health literacy on health-related quality of life after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1389-1400. [PMID: 37882818 PMCID: PMC10896873 DOI: 10.1007/s00402-023-05098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Personal knowledge about the own disease, a key component of health literacy (HL), may have a considerable impact on treatment outcomes. The purpose of this study was to investigate whether the patients' knowledge about the surgical procedure, risks, and aftercare, as well as the satisfaction with the preoperative level of information, has an influence on the health-related quality of life (HRQoL) after primary total hip arthroplasty (THA). MATERIALS AND METHODS A total of 176 patients (68.3 ± 10.3 years, 60.8% female) were evaluated. HRQoL was assessed prior to surgery as well as one and twelve months after THA using the 12-item Short Form Questionnaire. Following standardized surgical informed consent, HL was assessed preoperatively using a self-constructed quiz score, while information satisfaction was measured with a single-item rating scale. Sociodemographic and clinical characteristics, including pain (VAS), functionality (WOMAC), and psychological distress (PHQ-4), were also assessed at baseline. Multiple linear regression analyses were performed to examine whether HL, satisfaction with information, age, social class, WOMAC, VAS, and PHQ-4 predict HRQoL at one and twelve months post-surgery. RESULTS The average HL quiz score was 23 ± 5.1 out of a possible 33 points. Social class index significantly influenced HL (p < 0.001). A weak correlation between HL and age (r = 0.23, p = 0.01) and no correlation between HL and psychological distress (p = 0.868) were observed. One month after THA, physical HRQoL was significantly predicted by the WOMAC index (p = 0.031) and subjective satisfaction with information (p = 0.022), but not by HL. After twelve months, only the WOMAC was a significant predictor (p < 0.001) of physical HRQoL. CONCLUSION Although subjective satisfaction with the patient's preoperative level of information had a significant effect on the physical HRQoL at one month after THA, the influence of osteoarthritis severity outweighed this effect after twelve months. HL had no direct influence on HRQoL. These results suggest that patient satisfaction, rather than knowledge, predicts HRQoL.
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Affiliation(s)
- André Strahl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ulrich Bechler
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lara Krüger
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Ries
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Stuckenschneider T, Schmidt L, Speckmann EM, Koschate J, Zieschang T. Recruiting patients for falls prevention in the emergency department - worth the challenge. BMC Geriatr 2023; 23:880. [PMID: 38129767 PMCID: PMC10740331 DOI: 10.1186/s12877-023-04607-5] [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: 10/24/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited. OBJECTIVE Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study. METHODS The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics. RESULTS Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed. CONCLUSION ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory. TRIAL REGISTRATION DRKS00025949.
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Affiliation(s)
- Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany.
| | - Laura Schmidt
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Elisa-Marie Speckmann
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
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Akimoto K, Taparra K, Brown T, Patel MI. Diversity in Cancer Care: Current Challenges and Potential Solutions to Achieving Equity in Clinical Trial Participation. Cancer J 2023; 29:310-315. [PMID: 37963364 DOI: 10.1097/ppo.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Access to and participation in cancer clinical trials determine whether such data are applicable, feasible, and generalizable among populations. The lack of inclusion of low-income and marginalized populations limits generalizability of the critical data guiding novel therapeutics and interventions used globally. Such lack of cancer clinical trial equity is troubling, considering that the populations frequently excluded from these trials are those with disproportionately higher cancer morbidity and mortality rates. There is an urgency to increase representation of marginalized populations to ensure that effective treatments are developed and equitably applied. Efforts to ameliorate these clinical trial inclusion disparities are met with a slew of multifactorial and multilevel challenges. We aim to review these challenges at the patient, clinician, system, and policy levels. We also highlight and propose solutions to inform future efforts to achieve cancer health equity.
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Affiliation(s)
- Kai Akimoto
- From the Duluth Campus, University of Minnesota School of Medicine, Duluth, MN
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA
| | - Thelma Brown
- Division of Hematology and Oncology, The University of Alabama at Birmingham, AL
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Gamble E, Linehan C, Heavin C. Establishing Requirements for Technology to Support Clinical Trial Retention: Systematic Scoping Review and Analysis Using Self-determination Theory. J Med Internet Res 2023; 25:e38159. [PMID: 37052985 PMCID: PMC10141281 DOI: 10.2196/38159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Retaining participants in clinical trials is an established challenge. Currently, the industry is moving to a technology-mediated, decentralized model for running trials. The shift presents an opportunity for technology design to aid the participant experience and promote retention; however, there are many open questions regarding how this can be best supported. We advocate the adoption of a stronger theoretical position to improve the quality of design decisions for clinical trial technology to promote participant engagement. OBJECTIVE This study aimed to identify and analyze the types of retention strategies used in published clinical trials that successfully retain participants. METHODS A systematic scoping review was carried out on 6 electronic databases for articles published from 1990 to September 2020, namely CINAHL, The Cochrane Library, EBSCO, Embase, PsycINFO, and PubMed, using the concepts "retention," "strategy," "clinal trial," and "clinical research." This was followed by an analysis of the included articles through the lens of self-determination theory, an evidence-based theory of human motivation. RESULTS A total of 26 articles were included in this review. The motivational strategies identified in the clinical trials in our sample were categorized into 8 themes: autonomy; competence; relatedness; controlled motivation; branding, communication material, and marketing literature; contact, tracking, and scheduling methods and data collection; convenience to contribute to data collection; and organizational competence. The trials used a wide range of motivational strategies. Notably, the trials often relied on controlled motivation interventions and underused strategies to support intrinsic motivation. Moreover, traditional clinical trials relied heavily on human interaction and "relatedness" to support motivation and retention, which may cause problems in the move to technology-led decentralized trials. We found inconsistency in the data-reporting methods and that motivational theory-based approaches were not evident in strategy design. CONCLUSIONS This study offers direction and a framework to guide digital technology design decisions for future decentralized clinical trials to enhance participant retention during clinical trials. This research defines previous clinical trial retention strategies in terms of participant motivation, identifies motivational strategies, and offers a rationale for selecting strategies that will improve retention. It emphasizes the benefits of using theoretical frameworks to analyze strategic approaches and aid decision-making to improve the quality of technology design decisions.
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Affiliation(s)
- Eoin Gamble
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Conor Linehan
- School of Applied Psychology, University College Cork, Cork, Ireland
- Lero Research Centre, Cork, Ireland
| | - Ciara Heavin
- Department of Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
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Naik AG, Staab E, Li J, Siddiqui S, Wan W, Schaefer CT, Campbell A, Quinn M, Baig AA. Factors related to recruitment and retention of patients into diabetes group visits in Federally Qualified Health Centers. J Eval Clin Pract 2023; 29:146-157. [PMID: 35971210 PMCID: PMC10086856 DOI: 10.1111/jep.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023]
Abstract
UNLABELLED RATIONALE, AIMS AND OBJECTIVES: To examine factors related to recruitment of eligible patients and retention of enrolled patients in diabetes group visits (GVs). METHOD As part of a cluster randomized trial, 272 eligible patients were contacted and 75 patients were eventually enrolled in GVs at six community health centers (CHC). Fisher's exact tests and χ2 tests were used to compare enrolled and nonenrolled patients by patient recruitment method, gender and preferred language. Linear mixed models were used to evaluate characteristics associated with GV attendance such as diabetes self-empowerment and diabetes-associated distress. Content analysis was used to analyse patients' open-ended survey responses, and template analysis was used to analyse CHC staff interviews. RESULTS In terms of recruitment and enrollment analysis, patients who received in-person contact only and both phone and in-person contact comprised a greater fraction of the enrolled than unenrolled group, while those who received phone only and both phone and mail comprised a smaller fraction of the enrolled than unenrolled group (p = 0.004). In terms of retention analysis, 70 of the 75 enrolled patients attended at least one GV (93%). The average number of GVs was 3.2 out of 6 visits. Higher GV attendance was associated with lower baseline diabetes empowerment (p = 0.03). Patients' most common self-reported motivating factors to attend GVs were to learn more about diabetes, gain improved blood glucose control and find support from peers. CONCLUSION In-person recruitment for GVs at CHCs was more effective than recruitment by telephone/mail. Patients who felt less empowered to manage their diabetes were most motivated to attend GVs. These findings could help clinicians implement targeted recruitment of patient populations who are more likely to attend diabetes GVs and tailor self-management education interventions to their patient populations, particularly for underserved patients who face disparate clinical outcomes.
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Affiliation(s)
- Aaditi G Naik
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Erin Staab
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jefferine Li
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sara Siddiqui
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Wen Wan
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | | | | | - Michael Quinn
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Arshiya A Baig
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
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O'Donoghue J, Luther J, Hoque S, Mizrahi R, Spano M, Frisard C, Garg A, Crawford S, Byatt N, Lemon SC, Rosal M, Pbert L, Trivedi M. Strategies to improve the recruitment and retention of underserved children and families in clinical trials: A case example of a school-supervised asthma therapy pilot. Contemp Clin Trials 2022; 120:106884. [PMID: 35995130 PMCID: PMC9489677 DOI: 10.1016/j.cct.2022.106884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical trials. We examined this using a school-based asthma intervention, in preparation for a larger clinical trial in which our goal is to include an underserved study population. METHODS We recruited children with poorly controlled asthma in a two-site pilot cluster randomized controlled trial of school-supervised asthma therapy versus enhanced usual care (receipt of an educational asthma workbook). We sought a study population with a high percentage of children and families from racial/ethnic minority and low-income groups. The primary outcome of the pilot trial was recruitment/retention over 12 months. Strategies used to facilitate recruitment/retention of this study population included engaging pre-trial multi-level stakeholders, selecting trial sites with high percentages of underserved children and families, training diverse medical providers to recruit participants, conducting remote trial assessments, and providing multi-lingual study materials. RESULTS Twenty-six children [42.3% female, 11.5% Black, 30.8% Multiracial (Black & other), 76.9% Hispanic, and 92.3% with family income below $40,000] and their caregivers were enrolled in the study, which represents 55.3% of those initially referred by their provider, with 96.2%, 92.3%, and 96.2% retention at 3-, 6-, and 12-month follow-up, respectively. CONCLUSION Targeted strategies facilitated the inclusion of a medically underserved population of children and families in our pilot study, prior to expanding to a larger trial.
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Affiliation(s)
- Julia O'Donoghue
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America.
| | - Janki Luther
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Shushmita Hoque
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Raphael Mizrahi
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Michelle Spano
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Milagros Rosal
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Michelle Trivedi
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
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Henderson KH, Helmkamp LJ, Steiner JF, Havranek EP, Vupputuri SX, Hanratty R, Blair IV, Maertens JA, Dickinson M, Daugherty SL. Relationship Between Social Vulnerability Indicators and Trial Participant Attrition: Findings From the HYVALUE Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e007709. [PMID: 35418247 PMCID: PMC9117483 DOI: 10.1161/circoutcomes.120.007709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Social vulnerability indicators are associated with health care inequities and may similarly impede ongoing participation in research studies. We evaluated the association of social vulnerability indicators and research participant attrition in a trial focused on reducing health disparities. METHODS Self-identified White or Black adults enrolled in the HYVALUE trial (Hypertension and VALUEs), a randomized trial testing a values-affirmation intervention on medication adherence, from February 2017 to September 2019 were included. The self-reported measures of social vulnerability indicators included: (1) Black race; (2) female gender; (3) no health insurance; (4) unemployment; (5) a high school diploma or less; and (6) financial-resource strain. Full attrition was defined as not completing at least one 3- or 6-month follow-up study visit. Log-binomial regression models adjusted for age, gender, race, medical comorbidities, and the other social vulnerability indicators to estimate the relative risk of each social vulnerability indicator with study attrition. RESULTS Among 825 participants, the mean age was 63.3 years (±11.7 years), 60% were women, 54% were Black, and 97% reported at least one social vulnerability. Overall, 21% participants had full attrition after study enrollment. After adjustment for all other social vulnerabilities, only financial-resource strain remained consistently associated with full attrition (relative risk, 1.71 [95% CI, 1.28-2.29]). In a secondary analysis of partial attrition (completed only one follow-up visit), financial-resource strain (relative risk, 1.40 [95% CI, 1.09-1.81]) and being uninsured (relative risk, 1.54 [95% CI, 1.01-2.34]) were associated with partial attrition. CONCLUSIONS In a trial aimed at reducing disparities in medication adherence, participants who reported financial-resource strain had a higher risk of participant attrition independent of race or gender. Our findings suggest that efforts to retain diverse populations in clinical trials should extend beyond race and gender to consider other social vulnerability indicators. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03028597.
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Affiliation(s)
- Kamal H Henderson
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO (K.H.H.).,Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Laura J Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - John F Steiner
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO (J.F.S.)
| | - Edward P Havranek
- Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Denver Health and Hospital Authority, CO (E.P.H., R.H.)
| | - Suma X Vupputuri
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD (S.X.V.)
| | - Rebecca Hanratty
- Department of Medicine, Denver Health and Hospital Authority, CO (E.P.H., R.H.)
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder (I.V.B.)
| | - Julie A Maertens
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
| | - Stacie L Daugherty
- Division of Cardiology (K.H.H., E.P.H., S.L.D.), University of Colorado School of Medicine, Aurora, CO.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (L.J.H., E.P.H., J.A.M., M.D., S.L.D.), University of Colorado School of Medicine, Aurora, CO
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Crown A, Ramiah K, Siegel B, Joseph KA. The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11576-3. [PMID: 35357616 DOI: 10.1245/s10434-022-11576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 12/22/2022]
Abstract
Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142-150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.
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Affiliation(s)
- Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Bruce Siegel
- America's Essential Hospitals, Washington, DC, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University School of Medicine, NYC Health and Hospitals, Bellevue, New York, NY, USA.
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Terry N, Lipsky LM, Siega-Riz AM, Liu A, Nansel TR. The effect of remuneration schedule on data completion and retention in the pregnancy eating attributes study (PEAS). PLoS One 2021; 16:e0251533. [PMID: 33984020 PMCID: PMC8118263 DOI: 10.1371/journal.pone.0251533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6-month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self- reported assessments.
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Affiliation(s)
- Ndeah Terry
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Leah M. Lipsky
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Anna Maria Siega-Riz
- Department of Nutrition and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Aiyi Liu
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Tonja R. Nansel
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
- * E-mail:
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Nelson LA, Williamson SE, LeStourgeon LM, Mayberry LS. Retaining diverse adults with diabetes in a long-term trial: Strategies, successes, and lessons learned. Contemp Clin Trials 2021; 105:106388. [PMID: 33812991 DOI: 10.1016/j.cct.2021.106388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
Background Retention can be difficult in longitudinal trials, especially among minoritized groups and individuals with low socioeconomic status (SES) who may experience more barriers to research participation. Organized retention strategies may help; however, limited research has reported on this in detail. Methods We employed several strategies throughout a 15-month randomized controlled trial to encourage retention among a diverse sample of adults with type 2 diabetes. Participants were randomized to receive mobile health support for diabetes self-care for 12 months or an attention control. Participants completed assessments at 3, 6, 12, and 15 months post-baseline. We used three main categories of retention strategies: flexibility in participation (e.g., multiple methods for data collection), communication (e.g., tracking contacts), and community building (e.g., study branding, newsletters). We monitored participants' use of strategies and examined associations between participant characteristics and retention. Results Retention remained high (≥90%) at each follow-up assessment. Participants used various methods for survey completion: online (34%), in-person (31%), and mail (30%). Most (73%) used a mail-in A1c kit at least once. Multiple completion methods were important for retaining minoritized and lower SES participants who completed assessments in-person more frequently. Communication also facilitated retention; 39% of participants used a study Helpline and tracking systems helped maintain contact. Conclusions Retaining disadvantaged patients in clinical trials is necessary so findings generalize to and can benefit these populations. Retention strategies that reduce barriers to participation and engage participants and community partners can be successful. Future studies should assess the impact of retention strategies.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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11
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Hasan F, Widger K, Sung L, Wheaton L. End-of-Life Childhood Cancer Research: A Systematic Review. Pediatrics 2021; 147:peds.2020-003780. [PMID: 33597286 DOI: 10.1542/peds.2020-003780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children with incurable cancer may participate in research studies at the end of life (EOL). These studies create knowledge that can improve the care of future patients. OBJECTIVE To describe stakeholder perspectives regarding research studies involving children with cancer at the EOL by conduct of a systematic review. DATA SOURCES We used the following data sources: Ovid Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and ProQuest (inception until August 2020). STUDY SELECTION We selected 24 articles published in English that examined perceptions or experiences of research participation for children with cancer at the EOL from the perspectives of children, parents, and health professionals (HPs). DATA EXTRACTION Two authors independently extracted data, assessed study quality, and performed thematic analysis and synthesis. RESULTS Eight themes were identified: (1) seeking control; (2) faith, hope, and uncertainty; (3) being a good parent; (4) helping others; (5) barriers and facilitators; (6) information and understanding; (7) the role of HPs in consent and beyond; and (8) involvement of the child in decision-making. LIMITATIONS Study designs were heterogeneous. Only one study discussed palliative care research. CONCLUSIONS Some families participate in EOL research seeking to gain control and sustain hope, despite uncertainty. Other families choose against research, prioritizing quality of life. Parents may perceive research participation as the role of a "good parent" and hope to help others. HPs have positive views of EOL research but fear that parents lack understanding of the purpose of studies and the likelihood of benefit. We identified barriers to research participation and informed consent.
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Affiliation(s)
- Fyeza Hasan
- The Hospital for Sick Children, Toronto, Canada;
| | - Kimberley Widger
- The Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; and
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Successfully Recruiting Adults with a Low Socioeconomic Position into Community-Based Lifestyle Programs: A Qualitative Study on Expert Opinions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082764. [PMID: 32316344 PMCID: PMC7215437 DOI: 10.3390/ijerph17082764] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/24/2023]
Abstract
We explored experts’ perceived challenges and success factors in the recruitment of adults with a low socioeconomic position (SEP) for participation in community-based lifestyle modification programs. We conducted semi-structured interviews with 11 experienced project coordinators, based on a topic list that included experiences with recruitment, perceived barriers and success factors, and general views on recruitment strategies. Results revealed challenges related to the context of the program (e.g., limited program resources), psychosocial barriers of the participants (e.g., mistrust or skepticism), practical barriers (e.g., low literacy or having other priorities), and reasons to decline participation (e.g., lack of interest or motivation). Success factors were related to securing beneficial contextual and program-related factors (e.g., multi-layered recruitment strategy), establishing contact with the target group (e.g., via existing networks, community key-members), methods to increase engagement (e.g., personal approach and involvement of the target group in the program process) and making participation easier (e.g., providing transport), and providing various types of incentives. Concluding, the group of participants with low SEP covers a wide spectrum of individuals. Therefore, multiple recruitment strategies at multiple layers should be employed, and tailored. The lessons learned of those with hands-on experiences will help to enhance recruitment in future programs.
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Gelinas L, White SA, Bierer BE. Economic vulnerability and payment for research participation. Clin Trials 2020; 17:264-272. [DOI: 10.1177/1740774520905596] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been significant analysis of the ethical and regulatory issues involved with paying research participants, but less attention has been focused specifically on paying economically vulnerable individuals and the unique challenges it may present. This is important, as individuals of lower socio-economic standing are present in all disease groups and study populations. Moreover, clinical research is often conducted in economically under-developed locales, such as lower- or middle-income countries as well as impoverished locales of otherwise wealthy nations (such as, for example, rural Appalachia in the United States). Is it ethical to offer payment in such contexts? What are the ethical considerations relevant for determining payment rates and practices to individuals who are economically vulnerable? We offer an analysis of these issues, focusing on four unique areas of concern: (1) whether the risk of undue influence is greater for economically vulnerable individuals than for wealthier ones; (2) whether payment unacceptably raises the risk of ‘unjust influence’ or disproportionate representation of poor people in clinical research; (3) the positive reasons in favor of paying economically vulnerable people that stem from the ethical value of fairness; and (4) appropriate compensation rates for economically vulnerable populations. Our analysis supports the position that payment to economically vulnerable populations is ethically justified and indeed desirable when certain conditions are met.
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Affiliation(s)
- Luke Gelinas
- Advarra IRB, Columbia, MD, USA
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah A White
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Bierer
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Rioux C, Little TD. Missing data treatments in intervention studies: What was, what is, and what should be. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2019. [DOI: 10.1177/0165025419880609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Missing data are ubiquitous in studies examining preventive interventions. This missing data need to be handled appropriately for data analyses to yield unbiased results. After a brief discussion of missing data mechanisms, inappropriate missing data treatments and appropriate missing data treatments, we review the current state of missing data treatments in intervention studies as well as how they have evolved over the years. Although missing data treatments have improved over the years, antiquated missing data treatments associated with biased results are still prevalent. Furthermore, many studies do not appropriately report their rates of missing data and missing data treatments. Using appropriate missing data treatments is elemental to accurately identify effective preventive interventions and properly inform practice and policy.
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Affiliation(s)
| | - Todd D. Little
- Texas Tech University, USA
- North-West University, South Africa
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15
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Facilitators and Barriers to Participating in a Randomized Controlled Trial of a Psychological Therapy for Substance Use. J Nerv Ment Dis 2019; 207:487-496. [PMID: 31158110 DOI: 10.1097/nmd.0000000000001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research involving substance users with psychosis has high refusal and attrition rates. Understanding participants' experiences of research participation is therefore important. Twenty-two cannabis users with schizophrenia spectrum disorders were recruited. They were involved in a randomized controlled trial exploring the effectiveness of motivational interviewing plus cognitive behavioral therapy. Semistructured interviews were conducted, and their responses were analyzed using thematic analysis. Thematic analysis identified facilitators such as therapeutic benefit, knowledge about medical conditions, awareness of own drug habits, helping others, confidentiality, rapport with researchers, desiring social contact, and views of significant others. Barriers identified were cognitive challenge, amount of assessments, duration, and discussions about the past. Based on these insights, we recommend informing participants about clinical equipoise, confidentiality, and demands of the study; minimizing demands on participants; acknowledging participants' efforts; involving potential participants' significant others during recruitment; advertising research as an opportunity to help; and training researchers in building rapport.
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Im EO, Ji X, Kim S, Chee E, Bao T, Mao JJ, Chee W. Challenges in a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors. Comput Inform Nurs 2019; 37:243-249. [PMID: 31094913 PMCID: PMC6530489 DOI: 10.1097/cin.0000000000000503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper aims to discuss the challenges faced during a pilot study that tested a technology-based cancer pain management program among Asian American survivors of breast cancer and provide directions for future technology-based interventions for racial and ethnic minorities. Data consisting of research diaries and meeting minutes underwent content analysis to extract themes that reflected the challenges. The challenges included those related to (1) diversities within the population of Asian American survivors of breast cancer; (2) survivors' treatment and healing process; (3) Internet resources from the participants' countries of origin; (4) building trust between researchers and participants/gatekeepers; (5) fidelity of the intervention; and (6) cultural sensitivity. Future design and implementation of technology-based programs for racial and ethnic minorities must consider these challenges.
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Affiliation(s)
- Eun-Ok Im
- Author Affiliations: School of Nursing, Duke University (Drs Im, Kim, and W. Chee), Durham, NC; School of Nursing, University of Delaware (Dr Ji), Newark; School of Engineering, North Carolina State University (Ms E. Chee), Raleigh; and Integrative Breast Oncology (Dr Bao) and Integrative Medicine (Dr Mao), Memorial Sloan-Kettering Cancer Center, New York, NY
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17
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Metse AP, Hizam NAN, Wiggers J, Wye P, Bowman JA. Factors associated with retention in a smoking cessation trial for persons with a mental illness: a descriptive study. BMC Med Res Methodol 2018; 18:177. [PMID: 30587149 PMCID: PMC6307187 DOI: 10.1186/s12874-018-0640-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Exploring factors associated with retention in randomised trials provides insight into potential threats to internal and external study validity, and may inform the development of interventions to increase retention in future trials. Given a paucity of existing research in the field, a study was conducted to explore factors associated with retention in a smoking intervention trial involving persons with a mental illness, considering demographic and smoking characteristics, treatment condition and engagement in prior follow-up assessments. Method A descriptive study was undertaken using data derived from a RCT of a smoking cessation intervention initiated in four adult psychiatric inpatient units in New South Wales (NSW), Australia. Retention assessment was undertaken at 1, 6 and 12-months post-discharge. A Generalised Linear Mixed Model was adopted to explore associations between retention at any follow up time point and demographic and smoking characteristics. Chi square analyses explored the association between retention at all follow up time points and treatment condition, and binary logistic regression analyses assessed for relationships between retention at 12-month follow up and engagement in prior follow up assessments. Results Retention rates were 63, 56 and 60% at the 1, 6 and 12-month assessments, respectively. No association was found between retention at any follow-up time point and 13 of 15 demographic and smoking characteristics. Younger participants and those who identified to be Aboriginal and/or Torres Strait Islander were more likely to be retained (both ps > 0.05). Retention rates did not vary according to treatment condition at any follow-up time point. Participants who completed a prior assessment were more likely to complete the 12 month assessment (both prior assessments: OR 10.7, p < 0.001; 6 month assessment: OR 6.01, p < 0.001; and 1 month assessment: OR 1.8, p = 0.002). Conclusion The underrepresentation of younger participants and those identifying to be Aboriginal and/or Torres Strait Islander may limit the generalisability of findings. Findings suggest that inclusion of multiple contacts during a trial follow up period may increase retention at the final assessment. Interventions to improve retention, overall and for those sub-groups less likely to be retained, in smoking trials involving persons with a mental illness are needed. Further assessment of sample characteristics, and also trial design factors, associated with retention in this field is warranted.
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Affiliation(s)
- Alexandra P Metse
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Murdoch University, South Street, Murdoch, WA, 6150, Australia.
| | - Nur Ashikin Noor Hizam
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jenny A Bowman
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Kiwanuka N, Mpendo J, Asiimwe S, Ssempiira J, Nalutaaya A, Nambuusi B, Wambuzi M, Kabuubi B, Namuniina A, Oporia F, Nanvubya A, Ssetaala A. A randomized trial to assess retention rates using mobile phone reminders versus physical contact tracing in a potential HIV vaccine efficacy population of fishing communities around Lake Victoria, Uganda. BMC Infect Dis 2018; 18:591. [PMID: 30463524 PMCID: PMC6249980 DOI: 10.1186/s12879-018-3475-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background High retention (follow-up) rates improve the validity and statistical power of outcomes in longitudinal studies and the effectiveness of programs with prolonged administration of interventions. We assessed participant retention in a potential HIV vaccine trials population of fishing communities along Lake Victoria, Uganda. Methods In a community-based individual randomized trial, 662 participants aged 15–49 years were randomized to either mobile phone or physical contact tracing reminders and followed up at months 1, 2, 3, 6, 12 and 18 post-enrolment. The visit schedules aimed at mimicking a vaccine efficacy trial representing an early interval (months 1–6) where most vaccinations would be administered and a later period of post-vaccination follow-up. The primary outcome was retention measured as the proportion of post-baseline follow up visits completed by a participant. Retention was estimated in early and later follow-up intervals, and overall for all the six follow-up visits. Adjusted differences in retention between the study arms were determined by multivariable logistic regression using Stata® 14. One participant was later dropped from the analysis because of age ineligibility discovered after enrolment. Results Of the expected total follow up visits of 3966 among 661 participants, 84.1% (3334) were attained; 82.1% (1626/1980) in the phone arm and 86% (1708/1986) in the physical tracing arm (p = 0.001). No statistically significant differences in retention were observed between the study arms in the first 6 months but thereafter, retention was significantly higher for physical contact reminders than mobile phones; 91.5% versus 82.1% (p < 0.0001) at month 12 and 82.8% versus 75.4%, (p = 0.021) at month 18. Controlling for sex, age, education, occupation, community location, length of stay and marital status, the odds of good retention (completing 5 out of 6 follow-up visits) were 1.56 (95% CI;1.08–2.26, p = 0.018) for physical contact tracing compared to mobile phone tracing. Other statistically significant predictors of good retention were residing on islands and having stayed in the fishing communities for 5 or more years. Conclusions Among fishing communities of Lake Victoria, Uganda, 84% of follow-up visits can be attained and participant retention is higher using physical contact reminders than mobile phones. Trial registration number PACTR201311000696101 (http://www.pactr.org/). retrospectively registered on 05 November, 2013.
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Affiliation(s)
- Noah Kiwanuka
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda. .,Clinical Trials Unit, College of Health Sciences, Makerere University, Kampala, Uganda.
| | | | | | - Julius Ssempiira
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda
| | | | - Betty Nambuusi
- Clinical Trials Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Frederick Oporia
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda
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Lee RE, Reese-Smith JY, Mama SK, Medina AV, Wolfe KL, Estabrooks PA. Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis. Transl Behav Med 2017; 7:106-114. [PMID: 27256575 DOI: 10.1007/s13142-016-0385-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values < .05). This study showed moderate levels of reach but overrepresented higher educated, wealthier, and older women at the completion of the study. Representativeness can change over the course of the study and impact the practicality of translating research to practice.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA.
| | - Jacqueline Y Reese-Smith
- Department of Psychology, Jackson State University, 1400 J.R. Lynch Street, LIB Rm 232, Jackson, MS, 39217, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Ashley V Medina
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Kristin L Wolfe
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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21
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Berlin NL, Momoh AO, Qi J, Hamill JB, Kim HM, Pusic AL, Wilkins EG. Racial and ethnic variations in one-year clinical and patient-reported outcomes following breast reconstruction. Am J Surg 2017; 214:312-317. [PMID: 28215963 DOI: 10.1016/j.amjsurg.2017.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/05/2017] [Accepted: 02/05/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Existing studies evaluating racial and ethnic disparities focus on describing differences in procedure type and the proportion of women who undergo reconstruction following mastectomy. This study seeks to examine racial and ethnic variations in clinical and patient-reported outcomes (PROs) following breast reconstruction. METHODS The Mastectomy Reconstruction Outcomes Consortium is an 11 center, prospective cohort study collecting clinical and PROs following autologous and implant-based breast reconstruction. Mixed-effects regression models, weighted to adjust for non-response, were performed to evaluate outcomes at one-year postoperatively. RESULTS The cohort included 2703 women who underwent breast reconstruction. In multivariable models, Hispanic or Latina patients were less likely to experience any complications and major complications. Black or African-American women reported greater improvements in psychosocial and sexual well-being. CONCLUSIONS Despite differences in pertinent clinical and socioeconomic variables, racial and ethnic minorities experienced equivalent or better outcomes. These findings provide reassurance in the context of numerous racial and ethnic health disparities and build upon our understanding of the delivery of surgical care to women with or at risk for developing breast cancer.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Adeyiza O Momoh
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Ji Qi
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer B Hamill
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Edwin G Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
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Owen-Smith AA, Woodyatt C, Sineath RC, Hunkeler EM, Barnwell LT, Graham A, Stephenson R, Goodman M. Perceptions of Barriers to and Facilitators of Participation in Health Research Among Transgender People. Transgend Health 2016; 1:187-196. [PMID: 28861532 PMCID: PMC5549538 DOI: 10.1089/trgh.2016.0023] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Although transgender people may be at increased risk for a range of health problems, they have been the subject of relatively little health research. An important step toward expanding the evidence base is to understand and address the reasons for nonparticipation and dropout. The aim of this study was to explore the perceptions of barriers to and facilitators of participation in health research among a sample of transgender people in San Francisco, CA, and Atlanta, GA. Methods: Twelve in-person focus groups (FGs) were conducted; six (three with transwomen, three with transmen) were conducted in San Francisco and six FGs were conducted in Atlanta (three with transwomen and three with transmen). FGs were audiorecorded, transcribed, and uploaded to MaxQDA software for analysis. A codebook was used to code transcripts; new codes were added iteratively as they arose. All transcripts were coded by at least 2 of the 4 researchers and, after each transcript was coded, the researchers met to discuss any discrepancies, which were resolved by consensus. Results: Among 67 FG participants, 37 (55%) identified as transmen and 30 (45%) identified as transwomen. The average age of participants was ∼41 years (range 18-67) and the majority (61%) were non-Hispanic Whites. Several barriers that can hinder participation in health research were identified, including logistical concerns, issues related to mistrust, a lack of awareness about participation opportunities, and psychosocial/emotional concerns related to being "outed." A broad range of facilitators were also identified, including the opportunity to gain knowledge, access medical services, and contribute to the transgender community. Conclusion: These findings provide insights about the perceived barriers to and facilitators of research participation and offer some guidance for researchers in our ongoing effort to engage the transgender community in health research.
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Affiliation(s)
- Ashli A Owen-Smith
- Department of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Cory Woodyatt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - R Craig Sineath
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Enid M Hunkeler
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - La Tasha Barnwell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ashley Graham
- Department of Anthropology, University of Connecticut, Storrs, Connecticut
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Keller CS, Gonzales A, Fleuriet KJ. Retention of Minority Participants in Clinical Research Studies. West J Nurs Res 2016; 27:292-306. [PMID: 15781904 DOI: 10.1177/0193945904270301] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recruitment of minority participants for clinical research studies has been the topic of several analytical works. Yet retention of participants, most notably minority and underserved populations, is less reported and understood, even though these populations have elevated health risks. This article describes two related, intervention-based formative research projects in which researchers used treatment theory to address issues of recruitment and retention of minority women participants in an exercise program to reduce obesity. Treatment theory incorporates a model of health promotion that allows investigators to identify and control sources of extraneous variables. The authors’ research demonstrates that treatment theory can improve retention of minority women participants by considering critical inputs, mediating processes, and substantive participant characteristics in intervention design.
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Robinson L, Adair P, Coffey M, Harris R, Burnside G. Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children: a systematic review. Trials 2016; 17:294. [PMID: 27334018 PMCID: PMC4918126 DOI: 10.1186/s13063-016-1415-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/28/2016] [Indexed: 02/01/2023] Open
Abstract
Background Randomised controlled trials (RCTs) are recommended as the ‘gold standard’ in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children. Aim To identify predictors of recruitment and retention in RCTs involving children. Methods A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0–12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists. Results Twenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research. Conclusion Parent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1415-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Robinson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK. .,R&D Department, Salford Royal NHS Foundation Trust, Summerfield House, Stott Lane, Salford, M6 8HD, UK.
| | - Pauline Adair
- Health Psychology and Behavioural Medicine Research Group, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow, G1 1QE, UK
| | - Margaret Coffey
- School of Health Sciences, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Rebecca Harris
- Department of Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Waterhouse Building, Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Girvan Burnside
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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Somerson JS, Bartush KC, Shroff JB, Bhandari M, Zelle BA. Loss to follow-up in orthopaedic clinical trials: a systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 40:2213-2219. [PMID: 27142421 DOI: 10.1007/s00264-016-3212-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/19/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE The rate of patients lost to follow-up may contribute to bias in randomized controlled trials (RCTs). METHODS We systematically reviewed orthopaedic RCTs from 2008 to 2011, including 559 RCTs with 131,836 enrolled subjects. The loss to follow-up rates and minimum follow-up times were recorded for each trial. Orthopaedic subspecialty, country of origin, number of enrolled patients, patient age, follow-up strategy, and funding type were also recorded. RESULTS Loss to follow-up was not reported in 111 of these studies (20 %). Mean loss to follow-up was 10.4 %. No orthopaedic subspecialty demonstrated significantly different follow-up rates. Remote follow-up strategies did not reduce the loss to follow-up rate. Studies with a minimum follow-up length of three years showed significantly higher loss to follow-up rates compared with studies with shorter minimum follow-up time (14.8 % versus 9.8 %, p = 0.01). Studies performed in the United States had a significantly higher rate of loss to follow-up compared with non-United States studies (13.8 % versus 9.4 %; p = 0.01). CONCLUSIONS Loss to follow-up rates in published orthopaedic randomized controlled trials is overall relatively low. A substantial portion of publications does not adequately report follow-up data. Studies performed in the United States and studies with longer follow-up periods seem to be at higher risk for loss to follow-up.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Katherine C Bartush
- Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Jeffrey B Shroff
- Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | | | - Boris A Zelle
- Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
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Maximizing Patient Recruitment and Retention in a Secondary Stroke Prevention Clinical Trial: Lessons Learned from the STAND FIRM Study. J Stroke Cerebrovasc Dis 2016; 25:1371-80. [PMID: 27009610 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recruitment and retention of patients in a clinical trial is important for generalizability and robustness of findings. We aimed to investigate features of a study design that were associated with recruitment and retention in a Phase II and Phase III trial of a secondary prevention program for stroke. METHODS Following informed consent in hospital, Phase II participants were randomized to intervention or usual care. Baseline clinical assessments were conducted at home approximately 3 months after discharge. In Phase III study, informed consent was obtained at home. We compared the characteristics of participants recruited and retained to 12 months for both phases. Interviews with study nurses were undertaken in order to ascertain their opinions of features of study design. Triangulation was used to identify the features of study design that nurses thought had improved recruitment and retention. RESULTS All 24 eligible participants were recruited to the Phase II pilot study (100% recruitment), with 67% retention at 12 months. In Phase III study, 570 participants were recruited, and 93% of these participants had reached their 12-month assessment (n = 532) and were still participating. Consistent with the greater patient retention in Phase III study, nurses reported that patients' willingness to participate was greater when consent was obtained at home. CONCLUSION Following a change in the consent process from hospital to home, more participants continued participation to 12 months. Pilot studies can provide important data to improve study design and better understand potential barriers to recruitment and retention.
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Dussel V, Orellana L, Soto N, Chen K, Ullrich C, Kang TI, Geyer JR, Feudtner C, Wolfe J. Feasibility of Conducting a Palliative Care Randomized Controlled Trial in Children With Advanced Cancer: Assessment of the PediQUEST Study. J Pain Symptom Manage 2015; 49:1059-69. [PMID: 25640275 PMCID: PMC4530789 DOI: 10.1016/j.jpainsymman.2014.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon. OBJECTIVES To evaluate the feasibility of conducting a PPC-RCT in pediatric cancer patients. METHODS This was a cohort study embedded in the Pediatric Quality of Life and Evaluation of Symptoms Technology Study (NCT01838564). This multicenter PPC-RCT evaluated an electronic patient-reported outcomes system. Children aged two years and older, with advanced cancer, and potentially eligible for the study were included. Outcomes included: pre-inclusion attrition (patients not approached, refusals); post-inclusion attrition (drop-out, elimination, death, and intermittent attrition (IA; missing surveys) over nine months of follow-up); child/teenager self-report rates; and, reasons to enroll/participate. RESULTS Over five years, of the 339 identified patients, 231 were eligible (in 22, we could not verify eligibility); 84 eligible patients were not approached and 43 declined participation. Patients not approached were more likely to die or have brain tumors. We enrolled 104 patients. Average enrollment rate was one patient per site per month; shortening follow-up from nine to three months (with optional re-enrollment) increased recruitment by 20%. A total of 87 patients completed the study (24 died) and 17 dropped out. Median IA was 41% in the first 20 weeks of follow-up and more than 60% in the eight weeks preceding death. Child/teenager self-report was 94%. Helping others, low burden procedures, incentives, and staff attitude were frequent reasons to enroll/participate. CONCLUSION A PPC-RCT in children with advanced cancer was feasible, post-inclusion retention adequate; many families participated for altruistic reasons. Strategies that may further PPC-RCT feasibility include: increasing target population through large multicenter studies, approaching sicker patients, preventing exclusion of certain patient groups, and improving data collection at end of life.
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Affiliation(s)
- Veronica Dussel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit Faculty of Health, Deakin University, Victoria, Australia
| | - Natalie Soto
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Kun Chen
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christina Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tammy I Kang
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey R Geyer
- Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA; Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; University of Washington, Seattle, Washington, USA
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Ravenell J, Leighton-Herrmann E, Abel-Bey A, DeSorbo A, Teresi J, Valdez L, Gordillo M, Gerin W, Hecht M, Ramirez M, Noble J, Cohn E, Jean-Louis G, Spruill T, Waddy S, Ogedegbe G, Williams O. Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial. Trials 2015; 16:176. [PMID: 25927452 PMCID: PMC4417303 DOI: 10.1186/s13063-015-0703-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 − 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City. Design and Methods In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films – one in English and one in Spanish – on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up. Discussion This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one church in almost every neighborhood in the USA, churches have the ability and reach to play an important role in the dissemination and translation of stroke prevention programs in minority communities. Trial registration NCT01909271; July 22, 2013
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Affiliation(s)
- Joseph Ravenell
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Ellyn Leighton-Herrmann
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Amparo Abel-Bey
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Alexandra DeSorbo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Jeanne Teresi
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - Lenfis Valdez
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Madeleine Gordillo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - William Gerin
- The Pennsylvania State University, 208 Biobehavioral Health Building University Park, Pennsylvania, PA, 16802, USA.
| | - Michael Hecht
- The Pennsylvania State University, 501 Keller Building University Park, Pennsylvania, PA, 16802, USA.
| | - Mildred Ramirez
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - James Noble
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Elizabeth Cohn
- Center for Health Innovation, Adelphi University, P.O. Box 701, Garden City, NY, 11530, USA.
| | - Giardin Jean-Louis
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Tanya Spruill
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Salina Waddy
- National Institute of Neurological Disorders and Stroke at the National Institutes of Health, 6001 Executive Boulevard, North Bethesda, MD, 20852, USA.
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Olajide Williams
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
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Leak C, Goggins K, Schildcrout JS, Theobald C, Donato KM, Bell SP, Schnelle J, Kripalani S. Effect of Health Literacy on Research Follow-Up. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:83-91. [PMID: 26513035 PMCID: PMC4706551 DOI: 10.1080/10810730.2015.1058442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence, and health care system distrust. In a sample of 2,042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days, and 90 days after hospital discharge. In addition, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up.
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Affiliation(s)
- Cardella Leak
- Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center
- Department of Anesthesiology, Vanderbilt University Medical Center
| | - Cecelia Theobald
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | | | - Susan P. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | - John Schnelle
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
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Al Shammeri O, Stafford RS, Alzenaidi A, Al-Hutaly B, Abdulmonem A. Quality of medical management in coronary artery disease. Ann Saudi Med 2014; 34:488-93. [PMID: 25971821 PMCID: PMC6074575 DOI: 10.5144/0256-4947.2014.488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure < 140/90 mm Hg ( < 130/80 mm Hg in diabetics and renal disease patients), low-density lipoprotein (LDL) < 2 mmol/L, smoking cessation and aerobic physical activity, and hemoglobin (Hb) A1c < 7%. Unfortunately, preliminary data suggest a wide gap between recommended and actual practices. The study aims to estimate the rate of achieving of OMT in CAD patients in Qassim Province. DESIGN AND SETTINGS This observational study enrolled 207 consecutive CAD patients seen in cardiology clinic in Prince Sultan Cardiac Center in Qassim between January 2012 and May 2012. METHODS Eligible participants were over the age of 18, with CAD documented by either noninvasive testing or by coronary angiogram. We collected the demographic, medications, laboratory, and clinical data through in-person interviews, medical records, and an electronic patient database. RESULTS OMT was achieved in only 10.4% of CAD patients. The rate of achievement of target systolic blood pressure was 76.5%, target diastolic blood pressure 88%, target LDL 68%, adherence to medications 91%. Diabetes was common (64% of all patients), and only 24% of these patients achieved the target HbA1c. CONCLUSION The poor achievement of optimal medical therapy in CAD patients contributes to prevent.able mortality, morbidity, and health care costs. The observed shortcomings warrant investment in strategies to achieve OMT in these high-risk patients.
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Affiliation(s)
- Owayed Al Shammeri
- Owayed Al-Shammeri, MD, Department of Medicine, Qassim University,, PO Box 6655, Buraidah 51452, Saudi Arabia, T: +966 53 272 1010,, F: +966 11 490 4444,
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Idoko OT, Owolabi OA, Odutola AA, Ogundare O, Worwui A, Saidu Y, Smith-Sanneh A, Tunkara A, Sey G, Sanyang A, Mendy P, Ota MOC. Lessons in participant retention in the course of a randomized controlled clinical trial. BMC Res Notes 2014; 7:706. [PMID: 25298043 PMCID: PMC4200120 DOI: 10.1186/1756-0500-7-706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are increasingly being conducted as new products seek to enter the market. Deployment of such interventions is based on evidence obtained mainly from the gold standard of randomized controlled clinical trials (RCCT). A crucial factor in the ability of RCCTs to provide credible and generalisable data is sample size and retention of the required number of subjects at completion of the follow-up period. However, recruitment and retention in clinical trials are hindered by prevalent peculiar challenges in Africa that need to be circumvented. This article shares experiences from a phase II trial that recorded a high retention rate at 14 months follow-up at a new clinical trial site. METHODS Mothers bringing children less than two months of age to the health facility were given information and invited to have their child enrolled if the inclusion criteria were fulfilled. Participants were enrolled over 8 months. Trial procedures, duration and risks/benefits were painstakingly and sequentially explained to the communities, parents and relevant relatives before and during the trial period. The proportions of participants that completed or did not complete the trial were analyzed including the reasons for failure to complete all trial procedures. RESULTS 1044 individuals received information regarding the trial of which 371 returned for screening. 300 (81%) of them who fulfilled the inclusion criteria and did not meet any exclusion criteria were enrolled and 94% of these completed the trial. Consent withdrawal was the main reason for not completing the trial largely (75%) due to the father not being involved at the point of consenting or parents no longer being comfortable with blood sampling. CONCLUSIONS Participant retention in clinical trials remains a crucial factor in ensuring generalisability of trial data. Appropriate measures to enhance retention should include continuous community involvement in the process, adequate explanation of trial procedures and risks/benefits; and innovative tracing of participants adapted for the setting.
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Exploring the influence of demographic and medical characteristics of African-American and Latinas on enrollment in a behavioral intervention study for breast cancer survivors. Qual Life Res 2014; 24:445-54. [DOI: 10.1007/s11136-014-0758-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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Clark F, Pyatak EA, Carlson M, Blanche EI, Vigen C, Hay J, Mallinson T, Blanchard J, Unger JB, Garber SL, Diaz J, Florindez LI, Atkins M, Rubayi S, Azen SP. Implementing trials of complex interventions in community settings: the USC-Rancho Los Amigos pressure ulcer prevention study (PUPS). Clin Trials 2014; 11:218-29. [PMID: 24577972 PMCID: PMC3972348 DOI: 10.1177/1740774514521904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects. PURPOSE We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury. METHODS Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes. RESULTS PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination. LIMITATIONS We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings. CONCLUSIONS Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.
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Affiliation(s)
- Florence Clark
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A. Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Mike Carlson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Erna Imperatore Blanche
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Cheryl Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Joel Hay
- Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Trudy Mallinson
- School of Medicine and Health Sciences, The University of George Washington, Washington, DC, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Susan L. Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jesus Diaz
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lucia I. Florindez
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Michal Atkins
- Pressure Ulcer Management Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Salah Rubayi
- Pressure Ulcer Management Service, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Stanley Paul Azen
- Division of Biostatistics, University of Southern California, Los Angeles, CA, USA
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Carlson M, Jackson J, Mandel D, Blanchard J, Holguin J, Lai MY, Marterella A, Vigen C, Gleason S, Lam C, Azen S, Clark F. Predictors of retention among African American and Hispanic older adult research participants in the Well Elderly 2 randomized controlled trial. J Appl Gerontol 2014; 33:357-82. [PMID: 24652865 DOI: 10.1177/0733464812471444] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to document predictors of long-term retention among minority participants in the Well Elderly 2 Study, a randomized controlled trial of a lifestyle intervention for community-dwelling older adults. The primary sample included 149 African American and 92 Hispanic men and women aged 60 to 95 years, recruited at senior activity centers and senior residences. Chi-square and logistic regression procedures were undertaken to examine study-based, psychosocial and health-related predictors of retention at 18 months following study entry. For both African Americans and Hispanics, intervention adherence was the strongest predictor. Retention was also related to high active coping and average (vs. high or low) levels of activity participation among African Americans and high social network strength among Hispanics. The results suggest that improved knowledge of the predictors of retention among minority elders can spawn new retention strategies that can be applied at individual, subgroup, and sample-wide levels.
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Affiliation(s)
- Mike Carlson
- University of Southern California, Los Angeles, CA, USA
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Brueton VC, Stevenson F, Vale CL, Stenning SP, Tierney JF, Harding S, Nazareth I, Meredith S, Rait G. Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews. BMJ Open 2014; 4:e003835. [PMID: 24464427 PMCID: PMC3902408 DOI: 10.1136/bmjopen-2013-003835] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the strategies used to improve retention in primary care randomised trials. DESIGN Qualitative in-depth interviews and thematic analysis. PARTICIPANTS 29 UK primary care chief and principal investigators, trial managers and research nurses. METHODS In-depth face-to-face interviews. RESULTS Primary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers. CONCLUSIONS The findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.
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Meneses KM, Benz RL, Hassey LA, Yang ZQ, McNees MP. Strategies to retain rural breast cancer survivors in longitudinal research. Appl Nurs Res 2013; 26:257-62. [PMID: 24035222 PMCID: PMC3836865 DOI: 10.1016/j.apnr.2013.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
Abstract
AIMS To describe the retention of rural women in the Rural Breast Cancer Survivors (RBCS) Intervention. BACKGROUND Few studies describe strategies and procedures for retention of participants enrolled in cancer research. Fewer studies focus on underserved rural cancer survivors. METHODS A descriptive design was used. A conceptual model of retention based on three factors: researcher, participant, and context with primary, secondary, and tertiary strategies was used to unify the data. RESULTS 432 women enrolled in the RBCS study, of which 332 (77%) were retained and completed the 12 month study. Favorable retention strategies included: run-in period, persistent attempts to re-contact hard to reach, recruitment and enrollment tracking database, and a trusting and supportive relationship with the research nurse. CONCLUSION A conceptual model of retention with differential strategies can maintain participant retention in a longitudinal research study.
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Affiliation(s)
- Karen M Meneses
- School of Nursing, University of Alabama, Birmingham, AL 35294, USA.
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Butler J, Quinn SC, Fryer CS, Garza MA, Kim KH, Thomas SB. Characterizing researchers by strategies used for retaining minority participants: results of a national survey. Contemp Clin Trials 2013; 36:61-7. [PMID: 23764697 DOI: 10.1016/j.cct.2013.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/15/2022]
Abstract
Limited attention has been given to the optimal strategies for retaining racial and ethnic minorities within studies and during the follow-up period. High attrition limits the interpretation of results and reduces the ability to translate findings into successful interventions. This study examined the retention strategies used by researchers when retaining minorities in research studies. From May to August 2010, we conducted an online survey with researchers (principal investigators, research staff, and IRB members) and examined their use of seven commonly used retention strategies. The number and type of retention strategies used, how these strategies differ by researcher type, and other characteristics (e.g., funding) were explored. We identified three clusters of researchers: comprehensive retention strategy researchers - utilized the greatest number of retention strategies; moderate retention strategy researchers - utilized an average number of retention strategies; and limited retention strategy researchers - utilized the least number of retention strategies. The comprehensive and moderate retention strategy researchers were more likely than the limited retention strategy researchers to conduct health outcomes research, work with a community advisory board, hire minority staff, use steps at a higher rate to overcome retention barriers, develop new partnerships with the minority community, modify study materials for the minority population, and allow staff to work flexible schedules. This study is a novel effort to characterize researchers, without implying a value judgment, according to their use of specific retention strategies. It provides critical information for conducting future research to determine the effectiveness of using a combination of retention strategies.
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Affiliation(s)
- James Butler
- University of Maryland, School of Public Health, Maryland Center for Health Equity and Department of Behavioral and Community Health, College Park, MD 20742, USA.
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Coleman-Phox K, Laraia BA, Adler N, Vieten C, Thomas M, Epel E. Recruitment and retention of pregnant women for a behavioral intervention: lessons from the maternal adiposity, metabolism, and stress (MAMAS) study. Prev Chronic Dis 2013; 10. [PMID: 23469765 PMCID: PMC3592785 DOI: 10.5888/pcd10.120096] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Recruiting participants for research studies can be challenging. Many studies fall short of their target or must prolong recruitment to reach it. We examined recruitment and retention strategies and report lessons learned in a behavioral intervention developmental trial to encourage healthy pregnancy weight gain and stress reduction in low-income overweight pregnant women. Methods In the San Francisco Bay area from February 2010 through March 2011, we used direct and indirect strategies to recruit English-speaking overweight and obese pregnant women who were aged 18 to 45, were in the early stages of pregnancy, and who had an annual household income less than 500% of the federal poverty guidelines. Eligible women who consented participated in focus groups or an 8-week behavioral intervention. We identified successful recruiting strategies and sites and calculated the percentage of women who were enrolled and retained. Results Of 127 women screened for focus group participation, 69 were eligible and enrolled. A total of 57 women participated in 9 focus groups and 3 women completed individual interviews for a completion rate of 87%. During recruitment for the intervention, we made contact with 204 women; 135 were screened, 33% were eligible, and 69.1% of eligible women enrolled. At 1 month postpartum, 82.6% of eligible women completed an assessment. Recruiting at hospital-based prenatal clinics was the highest-yielding strategy. Conclusion The narrow window of eligibility for enrolling early stage pregnant women in a group intervention presents obstacles. In-person recruitment was the most successful strategy; establishing close relationships with providers, clinic staff, social service providers, and study participants was essential to successful recruitment and retention.
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Affiliation(s)
- Kimberly Coleman-Phox
- Center for Health and Community, University of California, 3333 California St, Ste 465, Box 0844, San Francisco, CA 94143-0844, USA.
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Hadidi N, Lindquist R, Treat-Jacobson D, Swanson P. Participant withdrawal: challenges and practical solutions for recruitment and retention in clinical trials. Creat Nurs 2013; 19:37-41. [PMID: 23600026 DOI: 10.1891/1078-4535.19.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A major challenge in the conduct of clinical trials is recruiting and retaining adequate numbers of study participants. Pressure for steady recruitment and retention is great. A wide range of strategies are used to retain participants; however, some approaches raise ethical questions. This article examines issues of participant retention, literature addressing the volunteer nature of informed consent, the moral distress surrounding participant withdrawal, and potential ethical implications. Strategies are proposed to resolve issues and reduce participant and investigator distress. Case studies of two patients with complex chronic illnesses illustrate practical solutions and lessons learned.
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Affiliation(s)
- Niloufar Hadidi
- University of Minnesota, School of Nursing, Minneapolis, Minnesota, USA.
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Ebenibo S, Edeoga C, Ammons A, Egbuonu N, Dagogo-Jack S. Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC): retention strategies. Diabetes Care 2013; 36:e50-1. [PMID: 23520377 PMCID: PMC3609494 DOI: 10.2337/dc12-1834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sotonte Ebenibo
- From the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Chimaroke Edeoga
- From the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ann Ammons
- From the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nonso Egbuonu
- From the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Samuel Dagogo-Jack
- From the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Chun N, Park M. The impact of health insurance mandates on drug innovation: evidence from the United States. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:323-344. [PMID: 22290504 DOI: 10.1007/s10198-012-0379-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/11/2012] [Indexed: 05/31/2023]
Abstract
An important health policy issue is the low rate of patient enrollment into clinical trials, which may slow down the process of clinical trials and discourage their supply, leading to delays in innovative life-saving drug treatments reaching the general population. In the US, patients' cost of participating in a clinical trial is considered to be a major barrier to patient enrollment. In order to reduce this barrier, some states in the US have implemented policies requiring health insurers to cover routine care costs for patients enrolled in clinical trials. This paper evaluates empirically how effective these policies were in increasing the supply of clinical trials and speeding up their completion, using data on cancer clinical trials initiated in the US between 2001 and 2007. Our analysis indicates that the policies did not lead to an increased supply in the number of clinical trials conducted in mandate states compared to non-mandate states. However, we find some evidence that once clinical trials are initiated, they are more likely to finish their patient recruitment in a timely manner in mandate states than in non-mandate states. As a result, the overall length to completion was significantly shorter in mandate states than in non-mandate states for cancer clinical trials in certain phases. The findings hint at the possibility that these policies might encourage drug innovation in the long run.
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Affiliation(s)
- Natalie Chun
- Asian Development Bank, Mandaluyong City 1550, Philippines.
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Gupta V, Chandra A, Yogi R, Sihota R, Singh D. Prevalence and Causes of Patient Dropout After Glaucoma Surgery. Ophthalmic Epidemiol 2013; 20:40-4. [DOI: 10.3109/09286586.2012.741278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A Randomized Trial Assessing the Effectiveness of Ezetimibe in South Asian Canadians with Coronary Artery Disease or Diabetes: The INFINITY Study. Adv Prev Med 2012; 2012:103728. [PMID: 23304534 PMCID: PMC3529456 DOI: 10.1155/2012/103728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/26/2012] [Accepted: 10/30/2012] [Indexed: 01/11/2023] Open
Abstract
Background. There is a paucity of data regarding the effectiveness and safety of lipid-lowering treatments among South-Asian patients.
Methods. Sixty-four South-Asian Canadians with coronary artery disease or diabetes and persistent hypercholesterolemia on statin therapy, were randomized to ezetimibe 10 mg/day co-administered with statin therapy (EZE + Statin) or doubling their current statin dose (STAT2). Primary outcome was the proportion of patients achieving target LDL-C (<2.0 mmol/L) after 6 weeks. Secondary outcomes included the change in lipid profile and the incidence of treatment-emergent adverse events through 12 weeks. Exploratory markers for vascular inflammation were assessed at baseline and 12 weeks. Results. At 6 weeks, the primary outcome was significantly higher among the EZE + Statin patients (68% versus 36%; P = 0.031) with an OR (95% CI) of 3.97 (1.19, 13.18) upon accounting for baseline LDL-C and adjusting for age. At 12 weeks, 76% of EZE + Statin patients achieved target LDL-C compared to 48% (P = 0.047) of the STAT2 patients (adjusted OR (95% CI) = 3.31 (1.01,10.89)). No significant between-group differences in exploratory markers were observed with the exception of CRP. Conclusions. Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 6 and 12 weeks compared to patients doubling their statin dose. Ezetimibe/statin combination therapy was well tolerated among this cohort of South-Asian Canadians, without safety concerns.
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Barnett J, Aguilar S, Brittner M, Bonuck K. Recruiting and retaining low-income, multi-ethnic women into randomized controlled trials: successful strategies and staffing. Contemp Clin Trials 2012; 33:925-32. [PMID: 22732312 DOI: 10.1016/j.cct.2012.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/16/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
Developing effective recruitment and retention strategies in populations with traditionally high attrition rates is critical to the success of Randomized Controlled Trials (RCTs). Data on successful participation of women from low-income, minority populations in RCTs of behavioral interventions are limited. This is problematic given the multiplicity of Healthy People 2020 goals that target health disparities in these populations. This paper reports successful recruitment and retention methods from two separately funded NIH clinical trials of primary care-based prenatal interventions to increase breastfeeding among ethnically diverse, low-income women in urban medical centers in the Bronx, NY. It also presents the required staff effort necessary to conduct such a successful RCT, in terms of full-time equivalents (FTEs). Results include timely recruitment of 941 participants over 29 months, with 98.1% completing >¯¯1 follow-up interview. A recruitment and retention plan that maximized study staff access and availability to the participant, as well as strong study staff rapport with participants, addressed previously reported barriers in this population, optimizing follow-up rates. A qualitative assessment of the participants' study experience suggesting that high retention was due to strong rapport with participants, short interviews requiring little time commitment, and participants' perception of the study as informative, provides further evidence of our approach's effectiveness. Logistical protocol procedures and staff management strategies relating to successful recruitment/retention are provided to propose a practical, cost-effective and translational recruitment-retention plan for other researchers to adopt.
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Affiliation(s)
- Josephine Barnett
- Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, USA.
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Recruitment of lactating women into a randomized dietary intervention: Successful strategies and factors promoting enrollment and retention. Contemp Clin Trials 2011; 32:505-11. [DOI: 10.1016/j.cct.2011.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 02/21/2011] [Accepted: 03/01/2011] [Indexed: 11/23/2022]
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Childs JD, Teyhen DS, Van Wyngaarden JJ, Dougherty BF, Ladislas BJ, Helton GL, Robinson ME, Wu SS, George SZ. Predictors of web-based follow-up response in the Prevention Of Low Back Pain In The Military Trial (POLM). BMC Musculoskelet Disord 2011; 12:132. [PMID: 21668961 PMCID: PMC3127808 DOI: 10.1186/1471-2474-12-132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 06/13/2011] [Indexed: 11/25/2022] Open
Abstract
Background Achieving adequate follow-up in clinical trials is essential to establish the validity of the findings. Achieving adequate response rates reduces bias and increases probability that the findings can be generalized to the population of interest. Therefore, the purpose of this study was to determine the influence of attention, demographic, psychological, and health status factors on web-based response rates in the ongoing Prevention of Low Back Pain in the Military (POLM) trial. Methods Twenty companies of Soldiers (n = 4,325) were cluster randomized to complete a traditional exercise program including sit-ups (TEP) with or without a psychosocial educational program (PSEP) or a core stabilization exercise program (CSEP) with or without PSEP. A subgroup of Soldiers (n = 371) was randomized to receive an additional physical and ultrasound imaging (USI) examination of key trunk musculature. As part of the surveillance program, all Soldiers were encouraged to complete monthly surveys via email during the first year. Descriptive statistics of the predictor variables were obtained and compared between responders and non-responders using two sample t-tests or chi-square test, as appropriate. Generalized linear mixed models were subsequently fitted for the dichotomous outcomes to estimate the effects of the predictor variables. The significance level was set at .05 a priori. Results The overall response rate was 18.9% (811 subjects) for the first year. Responders were more likely to be older, Caucasian, have higher levels of education and income, reservist military status, non smoker, lower BMI, and have received individualized attention via the physical/USI examination (p < .05). Age, race/ethnicity, education, military status, smoking history, BMI, and whether a Soldier received the physical/USI examination remained statistically significant (p < .05) when considered in a full multivariate model. Conclusion The overall web based response rate during the first year of the POLM trial was consistent with studies that used similar methodology, but lower when compared to rates expected for standard clinical trials. One year response rate was significantly associated with demographic characteristics, health status, and individualized attention via additional testing. These data may assist for planning of future trials that use web based response systems. Trial Registration This study has been registered at reports at http://clinicaltrials.gov (NCT00373009).
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physical Therapy (MCCS-HMT), Army Medical Department Center and School, Fort Sam Houston, TX 78234, USA.
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Hinnant JB, Elmore-Staton L, El-Sheikh M. Developmental trajectories of respiratory sinus arrhythmia and preejection period in middle childhood. Dev Psychobiol 2011; 53:59-68. [PMID: 20882584 DOI: 10.1002/dev.20487] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Autonomic nervous system (ANS) activity has been linked repeatedly to children's socioemotional and behavioral adaptive functioning and development, yet the literature on how various indexes of ANS activity develop in childhood is sparse. We utilized latent growth modeling to investigate the development of respiratory sinus arrhythmia (RSA), an established index of parasympathetic nervous system (PNS), and preejection period (PEP), a marker of sympathetic nervous system (SNS) influence on the heart, in children aged 8-10 years. At age 8, 251 children (128 girls, 123 boys; 162 European American, 89 African American) participated. Longitudinal data were collected during two additional waves when children were 9 and 10 years of age, with a 1-year lag between each wave. Children's RSA and PEP exhibited significant stability over time. Marginally significant variability was found among children in how RSA changed over time (slope), but there was no significant interindividual variability in PEP changes over development. A conditional growth curve model (i.e., one with predictor variables) showed that initial levels of RSA and PEP and the slope of RSA over time were predicted by several demographic factors including the child's sex and race; RSA of European American children showed significant increases over time while African American children had higher initial RSA but no significant change over time. Findings extend basic knowledge in developmental biopsychology and have implications for research focusing on ANS measures as important predictors, moderators, and mediators of childhood adaptation.
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Affiliation(s)
- J Benjamin Hinnant
- Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849, USA.
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Sahay S, Gupte N, Brahme RG, Nirmalkar A, Bembalkar S, Bollinger RC, Mehendale S. Predictors of retention among men attending STI clinics in HIV prevention programs and research: a case control study in Pune, India. PLoS One 2011; 6:e17448. [PMID: 21412414 PMCID: PMC3055872 DOI: 10.1371/journal.pone.0017448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 02/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background Retention is critical in HIV prevention programs and clinical research. We studied retention in the three modeled scenarios of primary prevention programs, cohort studies and clinical trials to identify predictors of retention. Methodology/Principal Findings Men attending Sexually Transmitted Infection (STI) clinics (n = 10, 801) were followed in a cohort study spanning over a ten year period (1993–2002) in Pune, India. Using pre-set definitions, cases with optimal retention in prevention program (n = 1286), cohort study (n = 940) and clinical trial (n = 896) were identified from this cohort. Equal number of controls matched for age and period of enrollment were selected. A case control analysis using conditional logistic regression was performed. Being employed was a predictor of lower retention in all the three modeled scenarios. Presence of genital ulcer disease (GUD), history of commercial sex work and living away from the family were predictors of lower retention in primary prevention, cohort study and clinical trial models respectively. Alcohol consumption predicted lower retention in cohort study and clinical trial models. Married monogamous men were less likely to be retained in the primary prevention and cohort study models. Conclusions/Significance Predicting potential drop-outs among the beneficiaries or research participants at entry point in the prevention programs and research respectively is possible. Suitable interventions might help in optimizing retention. Customized counseling to prepare the clients properly may help in their retention.
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Affiliation(s)
- Seema Sahay
- Division of Social and Behavioral Research, National AIDS Research Institute, Pune, India.
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Germino BB, Mishel MH, Alexander GR, Jenerette C, Blyler D, Baker C, Vines AI, Green M, Long DG. Engaging African American breast cancer survivors in an intervention trial: culture, responsiveness and community. J Cancer Surviv 2010; 5:82-91. [PMID: 20886374 DOI: 10.1007/s11764-010-0150-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 09/14/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Younger breast cancer survivors often lead extremely busy lives with multiple demands and responsibilities, making them difficult to recruit into clinical trials. African American women are even more difficult to recruit because of additional historical and cultural barriers. In a randomized clinical trial of an intervention, we successfully used culturally informed, population-specific recruitment and retention strategies to engage younger African-American breast cancer survivors. METHODS Caucasian and African American breast cancer survivors were recruited from multiple communities and sites. A variety of planned recruitment and retention strategies addressed cultural and population-specific barriers and were guided by three key principals: increasing familiarity with the study in the communities of interest; increasing the availability and accessibility of study information and study participation; and using cultural brokers. RESULTS Accrual of younger African-American breast cancer survivors increased by 373% in 11 months. The steepest rise in the numbers of African-American women recruited came when all strategies were in place and operating simultaneously. Retention rates were 87% for both Caucasian and African American women. DISCUSSSION/CONCLUSIONS: To successfully recruit busy, younger African American cancer survivors, it is important to use a multifaceted approach, addressing cultural and racial/ethnic barriers to research participation; bridging gaps across cultures and communities; including the role of faith and beliefs in considering research participation; recognizing the demands of different life stages and economic situations and the place of research in the larger picture of peoples' lives. Designs for recruitment and retention need to be broadly conceptualized and specifically applied. IMPLICATIONS FOR CANCER SURVIVORS For busy cancer survivors, willingness to participate in and complete research participation is enhanced by strategies that address barriers but also acknowledge the many demands on their time by making research familiar, available, accessible and credible.
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Affiliation(s)
- Barbara B Germino
- School of Nursing, University of North Carolina at Chapel Hill, CB# 7460, Chapel Hill, NC 27599, USA.
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Lee CS, Hayes RB, McQuaid EL, Borrelli B. Predictors of retention in smoking cessation treatment among Latino smokers in the Northeast United States. HEALTH EDUCATION RESEARCH 2010; 25:687-697. [PMID: 20237106 DOI: 10.1093/her/cyq010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Only one previous study on minority retention in smoking cessation treatment has been conducted (Nevid JS, Javier RA, Moulton JL III. Factors predicting participant attrition in a community-based, culturally specific smoking cessation program for Hispanic smokers. Health Psychol 1996; 15: 226-29). We investigated predictors of intervention completion and assessment completion among Latino smokers (n = 131) with asthmatic children participating in a home-based asthma education study that included smoking cessation counseling. METHODS We examined a variety of pretreatment demographic and psychosocial predictors of intervention completion (completing all three home visits versus <3), assessment completion (attendance/not) and total study participation (completing all six contacts versus <6). RESULTS Lower levels of depressed mood (OR = 0.912, 95% CI: 0.857-0.971, P < 0.01) and fewer 'pros' of smoking (OR = 0.882, 95% CI: 0.809-0.961, P < 0.01) predicted intervention completion. Predictors of assessment completion included having more friends who smoke (OR = 2.09, 95% CI: 1.23-3.56, P < 0.01), fewer pros of smoking (OR = 0.87, 95% CI: 0.81-0.95, P < 0.01) and a strong belief that quitting smoking would benefit the child's asthma (OR = 1.69, 95% CI: 1.04-2.74, P < 0.05). Unemployed participants were more likely to complete all six study contacts than those who were working (OR = 0.37, 95% CI: 0.14-0.99, P < 0.05). DISCUSSION Findings suggest the need to tailor retention strategies during active treatment and follow-up assessments to target those who at risk of dropping out.
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Affiliation(s)
- Christina S Lee
- Center for Alcohol.ddiction Studies, Brown Medical School, 121 South Main Street, Providence, RI 02912, USA.
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