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Redvers N, Larson S, Rajpathy O, Olson D. American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review. PLoS One 2024; 19:e0302562. [PMID: 38687762 PMCID: PMC11060564 DOI: 10.1371/journal.pone.0302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. METHODS A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. RESULTS Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. CONCLUSION Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Sarah Larson
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Olivia Rajpathy
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Devon Olson
- Library Resources, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
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Rothschild HT, Lianoglou BR, Sahin Hodoglugil NN, Tick K, Brown JEH, Sparks TN. Trust in prenatal exome sequencing for expectant families facing unexplained fetal anomalies. Prenat Diagn 2024; 44:263-269. [PMID: 38158591 PMCID: PMC10947859 DOI: 10.1002/pd.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Despite exome sequencing (ES) becoming increasingly incorporated into the prenatal setting, few studies have elucidated motivations for and trust in ES and genomic research among a diverse cohort of patients and their partners. METHODS This is a qualitative study that involved semi-structured interviews with pregnant or recently pregnant individuals and their partners, interviewed separately, in the setting of ES performed through research for a fetal structural anomaly. All interview transcripts were coded thematically and developed by a multidisciplinary team. RESULTS Thirty-five individuals participated, the majority of whom (66%) self-identified as a racial or ethnic group underrepresented in genomic research. Many patients and their partners expressed trust in the healthcare system and research process and appreciated the extensive testing for information and closure. There were nonetheless concerns about data privacy and protection for individuals, including those underrepresented, who participated in genomic testing and studies. CONCLUSION Our findings illustrate important elements of motivation, trust and concern related to prenatal ES performed in the research setting, taking into account the perspectives not only of diverse and underrepresented study participants but also partners of pregnant individuals.
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Affiliation(s)
- Harriet T Rothschild
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Billie R Lianoglou
- Center for Maternal Fetal Precision Medicine, UCSF, San Francisco, California, USA
- Department of Surgery, UCSF, San Francisco, California, USA
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, UCSF, San Francisco, California, USA
| | | | - Katie Tick
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Julia E H Brown
- Program in Bioethics, UCSF, San Francisco, California, USA
- Institute for Health & Aging, School of Nursing, UCSF, San Francisco, California, USA
| | - Teresa N Sparks
- Center for Maternal Fetal Precision Medicine, UCSF, San Francisco, California, USA
- Institute for Human Genetics, UCSF, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco, California, USA
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Cadieux JH, Davidson LS, Mazul A, Ortmann A. The Association of Race With Decreased Access to Pediatric Hearing Healthcare in the United States. Ear Hear 2024; 45:269-275. [PMID: 37990353 DOI: 10.1097/aud.0000000000001445] [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: 11/23/2023]
Abstract
Successful intervention to support a child with congenital hearing loss requires early identification and consistent access to frequent professional services. In the early 2000s, the United States implemented an initiative, Early Hearing Detection and Intervention (EHDI), to provide timely identification and treatment of congenital hearing loss. This national program aims to screen hearing by 1 month of age, diagnose hearing loss by 3 months of age, and provide intervention to infants with hearing loss by 6 months of age. To date, the United States is successfully implementing hearing screening by 1 month of age but continually struggling to diagnose and treat congenital hearing loss promptly for many infants. This article begins by exploring the current state of American children and families, focusing on social determinants of health, specifically race and poverty. The objective is to understand how race affects social determinants of health, and ultimately hearing healthcare access for children. A narrative literature review spanning public health, sociology, and hearing research was completed to inform this work. The current body of literature supports the conclusion that race and racism, separate from poverty, lead to decreased access to pediatric hearing healthcare. Interventions targeting these issues are necessary to improve timely access to hearing loss diagnosis and treatment for American children.
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Affiliation(s)
- Jamie H Cadieux
- Department of Otolaryngology, Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Therapy and Audiology Services, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Lisa S Davidson
- Department of Otolaryngology, Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otolaryngology, Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela Mazul
- Department of Otolaryngology, Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amanda Ortmann
- Department of Otolaryngology, Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otolaryngology, Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Conniff KR, Grill JD, Gillen DL. Retention of American Indian and Alaska Native participants in the National Alzheimer's Coordinating Center Uniform Data Set. Alzheimers Dement 2024; 20:1601-1613. [PMID: 38053483 PMCID: PMC10984415 DOI: 10.1002/alz.13573] [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: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION The number of American Indian and Alaska Native (AI/AN) elders is expected to double by 2060. Thus it is imperative to retain AI/AN participants in longitudinal research studies to identify novel risk factors and potential targets for intervention for Alzheimer's disease and related dementias in these communities. METHODS The National Alzheimer's Coordinating Center houses uniformly collected longitudinal data from the network of National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADRCs). We used logistic regression to quantify participant retention at 43 ADRCs, comparing self-identified AI/AN participants to non-Hispanic White (NHW) participants, adjusting for potential confounding factors including baseline diagnosis, age, sex, education, and smoking. RESULTS The odds of AI/AN participant retention at the first follow-up visit were significantly lower than those for NHW participants (adjusted odds ratio [aOR]: 0.599; 95%: 0.46-0.78; p < 0.001). DISCUSSION These results suggest the need for improved strategies to retain AI/AN participants, perhaps including improved researcher-community relationships and community engagement and education. HIGHLIGHTS American Indian and Alaska Native (AI/AN) research participants were retained to the first follow-up appointment at lower rates than non-Hispanic White (NHW) participants. AI/AN participants are retained at lower rates than NHW participants for long-term follow-up. The majority of AI/AN participants were not retained to the second follow-up visit.
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Affiliation(s)
- Kyle R. Conniff
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Daniel L. Gillen
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
- Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
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White EJ. Racial Discrimination, School Racial Composition, and Anxiety Symptoms in American Indian Adolescents. J Adolesc Health 2024; 74:1-2. [PMID: 38103917 DOI: 10.1016/j.jadohealth.2023.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, Oklahoma; University of Tulsa, Oxley College of Health & Natural Sciences, Tulsa, Oklahoma
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Hardcastle F, Lyle K, Horton R, Samuel G, Weller S, Ballard L, Thompson R, De Paula Trindade LV, Gómez Urrego JD, Kochin D, Johnson T, Tatz-Wieder N, Redrup Hill E, Robinson Adams F, Eskandar Y, Harriss E, Tsosie KS, Dixon P, Mackintosh M, Nightingale L, Lucassen A. The ethical challenges of diversifying genomic data: A qualitative evidence synthesis. CAMBRIDGE PRISMS. PRECISION MEDICINE 2023; 2:e1. [PMID: 38549845 PMCID: PMC10953735 DOI: 10.1017/pcm.2023.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2024]
Abstract
This article aims to explore the ethical issues arising from attempts to diversify genomic data and include individuals from underserved groups in studies exploring the relationship between genomics and health. We employed a qualitative synthesis design, combining data from three sources: 1) a rapid review of empirical articles published between 2000 and 2022 with a primary or secondary focus on diversifying genomic data, or the inclusion of underserved groups and ethical issues arising from this, 2) an expert workshop and 3) a narrative review. Using these three sources we found that ethical issues are interconnected across structural factors and research practices. Structural issues include failing to engage with the politics of knowledge production, existing inequities, and their effects on how harms and benefits of genomics are distributed. Issues related to research practices include a lack of reflexivity, exploitative dynamics and the failure to prioritise meaningful co-production. Ethical issues arise from both the structure and the practice of research, which can inhibit researcher and participant opportunities to diversify data in an ethical way. Diverse data are not ethical in and of themselves, and without being attentive to the social, historical and political contexts that shape the lives of potential participants, endeavours to diversify genomic data run the risk of worsening existing inequities. Efforts to construct more representative genomic datasets need to develop ethical approaches that are situated within wider attempts to make the enterprise of genomics more equitable.
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Affiliation(s)
- Faranak Hardcastle
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Kate Lyle
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Rachel Horton
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Gabrielle Samuel
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- King’s College London, London, UK
| | - Susie Weller
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Lisa Ballard
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Rachel Thompson
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Luiz Valerio De Paula Trindade
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - José David Gómez Urrego
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Daniel Kochin
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tess Johnson
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | | | - Florence Robinson Adams
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Centre for Science and Policy, University of Cambridge, Cambridge, UK
| | - Yoseph Eskandar
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | | | - Padraig Dixon
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Anneke Lucassen
- Clinical Ethics, Law and Society group (CELS), and Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), The NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
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Crooks N, Singer RB, Smith A, Ott E, Donenberg G, Matthews AK, Patil CL, Haider S, Johnson AK. Barriers to PrEP uptake among Black female adolescents and emerging adults. Prev Med Rep 2023; 31:102062. [PMID: 36467542 PMCID: PMC9712981 DOI: 10.1016/j.pmedr.2022.102062] [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: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
HIV/AIDS disproportionately impacts Black cisgender female adolescents and emerging adults. Pre-Exposure Prophylaxis (PrEP) reduces the risk of HIV infection; however, structural barriers may exacerbate resistance to PrEP in this population. The purpose of this paper is to understand the characteristics of age, race, gender, history, and medical mistrust as barriers to PrEP uptake among Black female adolescents and emerging adults (N = 100 respondents) between the ages of 13-24 years in Chicago. Between January and June of 2019, participants completed the survey. We used directed content analysis to examine reported barriers to PrEP uptake. The most commonly identified barriers to PrEP uptake were side effects (N = 39), financial concerns (N = 15), and medical mistrust (N = 12). Less frequently reported barriers included lack of PrEP knowledge and misconceptions (N = 9), stigma (N = 2), privacy concerns (N = 4). We describe innovative multi-level strategies to provide culturally safe care to improve PrEP acceptability among Black female adolescents and emerging adults in Chicago. These recommendations may help mitigate the effect of medical mistrust, stigma, and misconceptions of PrEP within Black communities.
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Affiliation(s)
- Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Randi B. Singer
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Ariel Smith
- Department of Population Health Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Emily Ott
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, USA
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL, USA
| | | | - Crystal L. Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL, USA
| | - Amy K. Johnson
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University
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Ricard JA, Parker TC, Dhamala E, Kwasa J, Allsop A, Holmes AJ. Confronting racially exclusionary practices in the acquisition and analyses of neuroimaging data. Nat Neurosci 2023; 26:4-11. [PMID: 36564545 DOI: 10.1038/s41593-022-01218-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
Across the brain sciences, institutions and individuals have begun to actively acknowledge and address the presence of racism, bias, and associated barriers to inclusivity within our community. However, even with these recent calls to action, limited attention has been directed to inequities in the research methods and analytic approaches we use. The very process of science, including how we recruit, the methodologies we utilize and the analyses we conduct, can have marked downstream effects on the equity and generalizability of scientific discoveries across the global population. Despite our best intentions, the use of field-standard approaches can inadvertently exclude participants from engaging in research and yield biased brain-behavior relationships. To address these pressing issues, we discuss actionable ways and important questions to move the fields of neuroscience and psychology forward in designing better studies to address the history of exclusionary practices in human brain mapping.
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Affiliation(s)
- J A Ricard
- Department of Psychology, Yale University, New Haven, CT, USA.
| | - T C Parker
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA.
| | - E Dhamala
- Department of Psychology, Yale University, New Haven, CT, USA
| | - J Kwasa
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - A Allsop
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - A J Holmes
- Department of Psychology, Yale University, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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White EJ, Demuth MJ, Wiglesworth A, Coser AD, Garrett BA, Kominsky TK, Jernigan V, Thompson WK, Paulus M, Aupperle R. Five recommendations for using large-scale publicly available data to advance health among American Indian peoples: the Adolescent Brain and Cognitive Development (ABCD) Study SM as an illustrative case. Neuropsychopharmacology 2023; 48:263-269. [PMID: 36385331 PMCID: PMC9751109 DOI: 10.1038/s41386-022-01498-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
American Indian and Alaska Native (AIAN) populations have suffered a history of exploitation and abuse within the context of mental health research and related fields. This history is rooted in assimilation policies, historical trauma, and cultural loss, and is promulgated through discrimination and disregard for traditional culture and community knowledge. In recognition of this history, it is imperative for researchers to utilize culturally sensitive approaches that consider the context of tribal communities to better address mental health issues for AIAN individuals. The public availability of data from large-scale studies creates both opportunities and challenges when studying mental health within AIAN populations. This manuscript has two goals; first, showcase an example of problematic use of Adolescent Brain Cognitive Development (ABCD) StudySM data to promulgate stereotypes about AIAN individuals and, second, in partnership with collaborators from Cherokee Nation, we provide five recommendations for utilizing data from publicly available datasets to advance health research in AIAN populations. Specifically, we argue for the consideration of (1) the heterogeneity of the communities represented, (2) the importance of focusing on AIAN health and well-being, (3) engagement of relevant communities and AIAN community leaders, (4) consideration of historical and ongoing injustices, and (5) engagement with AIAN regulatory agencies or review boards. These recommendations are founded on principles from broader indigenous research efforts emphasizing community-engaged research and principles of Indigenous Data Sovereignty and Governance.
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA.
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK, USA.
| | - Mara J Demuth
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | | | | | | | - Valarie Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State Universit y Center for Health Sciences, Tulsa, OK, USA
| | | | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Robin Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley School of Community Medicine, University of Tulsa, Tulsa, OK, USA
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Gunn AJ, Hardesty M, Overstreet N, Wallace S. "Every time I tell my story I learn something new": Voice and inclusion in research with Black women with histories of substance use and incarceration. CRIMINOLOGY & CRIMINAL JUSTICE : THE INTERNATIONAL JOURNAL OF POLICY AND PRACTICE 2022; 22:505-524. [PMID: 38362478 PMCID: PMC10868846 DOI: 10.1177/17488958211005820] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
While current ethical procedures aim to minimize risks to imprisoned individuals, there is heightened awareness of the need to protect those who participate in research post-incarceration while under community-based supervision. Formerly incarcerated women, in particular, face myriad challenges to community reintegration which also make them vulnerable participants in research. As such, this study explores how 28 formerly incarcerated Black women experience the qualitative research process. Findings revealed that women engaged in research because these contexts were viewed as therapeutic spaces for raising awareness that can help others. Moreover, the interview process allowed women to share their pasts in ways that promote their recovery from addiction. Participants also reported risks of emotional distress and fears regarding researcher stigma. The implications for trauma-informed interviewing practices underscore the need for greater considerations of the role of the researcher, research environment, and how they contribute to one's personal recovery.
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Ivani S, Dutilh Novaes C. Public engagement and argumentation in science. EUROPEAN JOURNAL FOR PHILOSOPHY OF SCIENCE 2022; 12:54. [PMID: 35958803 PMCID: PMC9361237 DOI: 10.1007/s13194-022-00480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Public engagement is one of the fundamental pillars of the European programme for research and innovation Horizon 2020. The programme encourages engagement that not only fosters science education and dissemination, but also promotes two-way dialogues between scientists and the public at various stages of research. Establishing such dialogues between different groups of societal actors is seen as crucial in order to attain epistemic as well as social desiderata at the intersection between science and society. However, whether these dialogues can actually help attaining these desiderata is far from obvious. This paper discusses some of the costs, risks, and benefits of dialogical public engagement practices, and proposes a strategy to analyse these argumentative practices based on a three-tiered model of epistemic exchange. As a case study, we discuss the phenomenon of vaccine hesitancy, arguably a result of suboptimal public engagement, and show how the proposed model can shed new light on the problem.
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Affiliation(s)
| | - Catarina Dutilh Novaes
- VU Amsterdam, Amsterdam, Netherlands
- Arché, University of St. Andrews, St. Andrews, Scotland, UK
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Tone-Pah-Hote T, Redvers N. The commercialization of biospecimens from Indigenous Peoples: A scoping review of benefit-sharing. Front Med (Lausanne) 2022; 9:978826. [PMID: 35991662 PMCID: PMC9386140 DOI: 10.3389/fmed.2022.978826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background There is ongoing and increasing interest in the commercialization of biospecimen-derived products from Indigenous Peoples. Discourse on benefit-sharing specifically in the context of the commercialization of Indigenous Peoples biospecimens are currently lacking. A better understanding of the potential ethical imperatives is in need of exploration on this emerging topic. This review sought to elucidate through categorization the current discourse in the peer-reviewed literature on the commercialization of Indigenous Peoples' biospecimens from a benefit-sharing perspective. Methods A scoping review methodology was utilized to perform a search of PubMed, CINAHL, Embase and Google Scholar. A two-stage screening process was used to assess the relevance of any included articles with subsequent manual open coding of articles. Content analysis was applied to identify the main categories and sub-categories within the article data. Results Thirty-three articles met the inclusion criteria for analysis. Four overarching categories from the included articles were identified regarding the most common discourse on the commercialization of Indigenous Peoples' biospecimens from a benefit-sharing perspective, including: exploitation through biocolonialism, sovereignty and Indigenous rights, ethical considerations for benefit-sharing, and guidelines and standards concerns. Conclusion This scoping review highlighted the crucial need to keep Indigenous communities at the center of research projects, ensuring any benefits, advancement, and potential commercial profits are returned to communities through clear and ethical agreements. We encourage all research institutions and institutional ethical review bodies to better clarify the collective needs and interests of Indigenous communities while centering their sovereignty and rights within the research process as it pertains to potential biospecimen product commercialization.
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Affiliation(s)
- Tarlynn Tone-Pah-Hote
- Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
| | - Nicole Redvers
- Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
- Department of Indigenous Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
- *Correspondence: Nicole Redvers
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Diller E, Kouame G, Young DM, Johnson JA. Gathering Health Perspectives of the Justice Involved: A Multisite Needs Assessment Survey. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:243-251. [PMID: 35649191 PMCID: PMC9529364 DOI: 10.1089/jchc.20.09.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The well-being of justice-involved individuals must be of high priority to achieve health equity, reduce health disparities, and improve community health. To better understand the health interests and needs of justice-involved individuals, a survey was administered inquiring about health information-seeking behavior and health topics of interest. The survey was administered using secure tablet computers and completed by 1,888 incarcerated participants in 35 jails in 17 states. Salient themes that emerged from this research include the relatively equal use of the internet and health care providers as resources for health information; the extensive interest in learning about multiple health care topics; and demographic variations in health information-seeking behaviors and health topics of interest. Tailoring correctional health education programs to coincide with the interests and needs of the justice-involved population may attract more participants and thus result in better self-care management skills and health outcomes upon reentering communities.
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Affiliation(s)
- Elena Diller
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Gail Kouame
- Robert B. Greenblatt, MD Library, Augusta University, Augusta, Georgia, USA
| | - David M Young
- College of Nursing & Extension Service, Montana State University, Bozeman, Montana, USA.,Gallatin County Detention Center, Bozeman, Montana, USA
| | - J Aaron Johnson
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA.,Department of Psychological Sciences, Augusta University, Augusta, Georgia, USA
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14
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Thomas K. Early relational health - A promising approach for equitable systems change in pediatrics: A commentary. Infant Ment Health J 2022; 43:507-514. [PMID: 35579363 DOI: 10.1002/imhj.21984] [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: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/11/2022]
Abstract
Pediatric primary care plays a critical role in supporting the healthy development of young children. Wisdom and research suggest that every developmental domain is shaped by the quality of close relationships, particularly the caregiver-child relationship. Therefore, pediatric primary care has a unique opportunity to support and nurture early relationships using the Early Relational Health (ERH) framework and its applications Early Relational Health Screen, and Early Relational Health Conversations. ERH and its applications recognize years of innovation focused on the promotion of the wellbeing of caregiver-child relationships, and children's long-term development. Central to enhancing and elevating pediatric practice is intentional effort in using diversity-informed, anti-racist, equitable systems of care frameworks. This Commentary offers a call to action for pediatric primary care to create more equitable and inclusive practice via ERH. The call to action includes deepening self and institutional awareness; allocating resources for systems change, including infusing greater equity into departmental structures; and, building authentic relationships with patients, families, and communities. This will result in intentional systems change centered on equitable practice.
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
Introduction There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). Methods We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. Results Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. Conclusions Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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16
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Hull SC, Nez Diné FL, Blome JM. Solidarity as an Aspirational Basis for Partnership with Tribal Communities. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:14-17. [PMID: 34554069 DOI: 10.1080/15265161.2021.1965258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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17
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Saunkeah B, Beans JA, Peercy MT, Hiratsuka VY, Spicer P. Extending Research Protections to Tribal Communities. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:5-12. [PMID: 33449863 PMCID: PMC8280236 DOI: 10.1080/15265161.2020.1865477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The history of research in American Indian/Alaska Native (AI/AN) communities has been marked by unethical practices, resulting in mistrust and reluctance to participate in research. Harms are not limited to individual persons-tribal communities experience harmful misrepresentation and generalizations disrespectful of AI/AN groups' heritage, cultures, and beliefs. The Belmont Report's research ethics principles are applied primarily to protect individual research participants. The principles of sovereignty and solidarity are argued to be important concepts in extending Belmont's research protections to tribal communities. Sovereignty, an expression of respect for autonomy at a group level, is the basis for tribal self-determination. The principle of solidarity provides an ethical underpinning for tribes' obligations to protect community interests and culture. Extension of Belmont through these principles should serve to minimize harms to AI/AN groups in research.
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Dancis J, Coleman BR. Transformative dissonant encounters: Opportunities for cultivating antiracism in White nursing students. Nurs Inq 2021; 29:e12447. [PMID: 34350660 DOI: 10.1111/nin.12447] [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: 12/24/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/27/2022]
Abstract
Sharply in focus in the United States right now is the disproportionate COVID-19 infection, hospitalization, and mortality rates of Black, Indigenous, Hispanic, and Pacific Islanders living in the United States in contrast to White people. These COVID-19 disparities are but one example of how systemic racism filters into health outcomes for many Black, Indigenous, and other People of Color (BIPOC). With these issues front and center, more attention is being given to the ways that White medical professionals contribute to these disparities, including their socialization to ignore or deny inequities. As such, the present study sought to understand how educating White health-care pre-professionals about systemic racism might influence their understanding of and responsibility for disrupting White supremacy. Data were drawn from 49 White-identified nursing students who participated in a mapping project that uncovered instantiations of systemic racism in the United States. Participant written reflections were analyzed using thematic analysis. Findings revealed that mapping projects can develop White people's knowledge and understanding of systemic racism. We introduce the construct, transformative dissonant encounters, to describe how this project precipitated shifts in world view necessary for White people to confront systemic racism. Implications for nursing educators, psychological researchers, and antiracist activists are discussed.
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Affiliation(s)
- Julia Dancis
- Applied Psychology, Portland State University, Portland, Oregon, USA
| | - Brett Russell Coleman
- Health and Community Studies, Western Washington University, Bellingham, Washington, USA
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19
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Abstract
The collection and use of human genetic data raise important ethical questions about how to balance individual autonomy and privacy with the potential for public good. The proliferation of local, national, and international efforts to collect genetic data and create linkages to support large-scale initiatives in precision medicine and the learning health system creates new demands for broad data sharing that involve managing competing interests and careful consideration of what constitutes appropriate ethical trade-offs. This review describes these emerging ethical issues with a focus on approaches to consent and issues related to justice in the shifting genomic research ecosystem.
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Affiliation(s)
- Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY 10032, USA;
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20
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Blacksher E, Hiratsuka VY, Blanchard JW, Lund JR, Reedy J, Beans JA, Saunkeah B, Peercy M, Byars C, Yracheta J, Tsosie KS, O’Leary M, Ducheneaux G, Spicer PG. Deliberations with American Indian and Alaska Native People about the Ethics of Genomics: An Adapted Model of Deliberation Used with Three Tribal Communities in the United States. AJOB Empir Bioeth 2021; 12:164-178. [PMID: 34125006 PMCID: PMC8274345 DOI: 10.1080/23294515.2021.1925775] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received. METHODS We adapted democratic deliberation, an approach to stakeholder engagement, for use with three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation. RESULTS A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement. CONCLUSION The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described.
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Affiliation(s)
- Erika Blacksher
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | | | - Jessica W. Blanchard
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma, USA
| | - Justin R. Lund
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
| | - Justin Reedy
- Department of Communication, University of Oklahoma, Norman, Oklahoma, USA
| | - Julie A. Beans
- South Central Foundation Research Department, Anchorage, Alaska, USA
| | - Bobby Saunkeah
- Chickasaw Nation Department of Health, Division of Research and Public Health, Ada, Oklahoma, USA
| | - Micheal Peercy
- Chickasaw Nation Department of Health, Division of Research and Public Health, Ada, Oklahoma, USA
| | - Christie Byars
- Chickasaw Nation Department of Health, Division of Research and Public Health, Ada, Oklahoma, USA
| | - Joseph Yracheta
- Missouri Breaks Industries, Inc, Research Department, Eagle Butte, South Dakota, USA
| | - Krystal S. Tsosie
- Missouri Breaks Industries, Inc, Research Department, Eagle Butte, South Dakota, USA
| | - Marcia O’Leary
- Missouri Breaks Industries, Inc, Research Department, Eagle Butte, South Dakota, USA
| | - Guthrie Ducheneaux
- Missouri Breaks Industries, Inc, Research Department, Eagle Butte, South Dakota, USA
| | - Paul G. Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
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21
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Milani SA, Swain M, Otufowora A, Cottler LB, Striley CW. Willingness to Participate in Health Research Among Community-Dwelling Middle-Aged and Older Adults: Does Race/Ethnicity Matter? J Racial Ethn Health Disparities 2021; 8:773-782. [PMID: 32808194 PMCID: PMC7431111 DOI: 10.1007/s40615-020-00839-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Older adults, including racial and ethnic minorities, are underrepresented in research. As the US population ages, the number of older racial and ethnic minority individuals will increase. Including these individuals in research is an important step towards reducing health disparities. METHODS We used data from HealthStreet, a University of Florida community engagement program which uses community health workers to assess the health of the community, to assess willingness to participate in different types of health research by race/ethnicity. Descriptive statistics and logistic regression models were used to assess willingness to participate among adults aged 50 and older, by race/ethnicity (n = 4694). RESULTS Our sample was 42.0% non-Hispanic White, 52.8% non-Hispanic Black, and 5.2% Hispanic. Non-Hispanic White participants reported more past research participation than non-Hispanic Black and Hispanic participants (28.7% vs. 19.0% and 19.2%, respectively). Compared with non-Hispanic White participants, non-Hispanic Black participants were less willing to participate in most types of studies, while Hispanic participants were less willing to participate in studies that might be seen as invasive (required blood sample, genetic sample, or participants to take medicine, or use of medical equipment). CONCLUSIONS Our study provides investigators with a general profile of research preferences by race/ethnicity; compared with non-Hispanic White individuals, non-Hispanic Black individuals are less willing to participate in most studies, while Hispanic individuals are less willing to participate in studies that may be seen as invasive or demanding. It is imperative to include diverse older adults in health research. By tailoring research based on preferences we can improve recruitment in underrepresented populations.
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Affiliation(s)
- Sadaf Arefi Milani
- Sealy Center on Aging, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA.
| | - Michael Swain
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ayodeji Otufowora
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
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22
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Vigil D, Sinaii N, Karp B. American Indian and Alaska Native Enrollment in Clinical Studies in the National Institutes of Health's Intramural Research Program. Ethics Hum Res 2021; 43:2-9. [PMID: 34019337 DOI: 10.1002/eahr.500090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical studies conducted by the National Institutes of Health's Intramural Research Program (NIH-IRP) provide eligible individuals with access to innovative research treatments that may not otherwise be available. The NIH-IRP's mission is to include all Americans, including American Indians and Alaska Natives, in its clinical research. This study is the first to provide data about inclusion of American Indians/Alaska Natives in NIH-IRP clinical studies. We analyzed data from the more than 1,800 NIH-IRP protocols active in 2014 and 2017. We found that the absolute number of American Indian/Alaska Native enrollees increased between 2014 and 2017 but remained at 1% of all participants, a disproportionately low level. The number of clinical studies that enrolled American Indian/Alaska Native individuals similarly did not change. NIH efforts to expand participation of American Indians/Alaska Natives in clinical studies has often focused on research within their communities or on health needs specific to these groups. Those efforts should expand to include processes and protections for the proportionate and ethical inclusion of American Indians and Alaska Natives who individually enroll in studies that are not specific to American Indians, Alaska Natives, or their tribal nations.
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Affiliation(s)
- Deionna Vigil
- Postbaccalaureate Intramural Research Training Award Fellow at the National Institute of Neurological Disorders and Stroke at the time of this study and is now a research program coordinator with the Johns Hopkins Center for American Indian Health
| | - Ninet Sinaii
- Epidemiologist statistician at the National Institutes of Health Clinical Center
| | - Barbara Karp
- Neurologist at the National Institute of Neurological Disorders and Stroke (NINDS)
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23
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A Step in the Right Direction: Measuring Indicators of Responsible Community Engagement in Samburu, Kenya. JOURNAL OF ACADEMIC ETHICS 2021. [DOI: 10.1007/s10805-021-09408-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Perceptions of 'Precision' and 'Personalised' Medicine in Singapore and Associated Ethical Issues. Asian Bioeth Rev 2021; 13:179-194. [PMID: 33959200 PMCID: PMC8079483 DOI: 10.1007/s41649-021-00165-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Governments are investing in precision medicine (PM) with the aim of improving healthcare through the use of genomic analyses and data analytics to develop tailored treatment approaches for individual patients. The success of PM is contingent upon clear public communications that engender trust and secure the social licence to collect and share large population-wide data sets because specific consent for each data re-use is impractical. Variation in the terminology used by different programmes used to describe PM may hinder clear communication and threaten trust. Language is used to create common understanding and expectations regarding precision medicine between researchers, clinicians and the volunteers. There is a need to better understand public interpretations of PM-related terminology. This paper reports on a qualitative study involving 24 focus group participants in the multi-lingual context of Singapore. The study explored how Singaporeans interpret and understand the terms ‘precision medicine’ and ‘personalised medicine’, and which term they felt more aptly communicates the concept and goals of PM. Results suggest that participants were unable to readily link the terms with this area of medicine and initially displayed preferences for the more familiar term of ‘personalised’. The use of visual aids to convey key concepts resonated with participants, some of whom then indicated preferences for the term ‘precision’ as being a more accurate description of PM research. These aids helped to facilitate dialogue around the ethical and social value, as well as the risks, of PM. Implications for programme developers and policy makers are discussed.
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25
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Freeman AA, Arbuckle J, Petty EM. Preparing genetic counselors to serve Native American communities. J Genet Couns 2021; 30:1388-1398. [PMID: 33734526 DOI: 10.1002/jgc4.1405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/09/2022]
Abstract
As a medical specialty, genetic counseling (GC) espouses cultural sensitivity, a patient-centered approach, and an eye for the individual, familial, and community-wide implications of genetics and genomics in medicine. Within the past decades, the field of GC has recognized and attempted to address a need for the greater diversity of providers and practice settings that will help to address health inequities across underrepresented communities (Channaoui et al., 2020). Accreditation for GC training programs mandates equipping students with multicultural sensitivity and knowledge on health disparities. Currently however, there are limited published data about how GC programs are accomplishing these aims for Native American individuals and communities. Furthermore, there are limited published data on the unique needs and perspectives of Native Americans who may seek GC services. This disconnect may pose barriers for genetic counselors who aim to provide respectful and relevant care to Native American patients. Education of GC students is one important way to set the tone for a lifetime of practice and to inspire awareness and action toward alleviating disparities. Thus, we surveyed GC training programs in North America to investigate how they are working to (a) address disparities in Native American professional representation and student enrollment, (b) deliver culturally relevant curricula and clinical opportunities that serve the needs of Native Americans, and (c) positively engage Native American communities in North America. We found that reported recruitment efforts, curricula content, clinical opportunities, and community engagement efforts to address the needs of Native American are limited across GC training programs surveyed. By bringing awareness to current methods, success factors, and barriers in this space, we hope to open the door for meaningful partnerships between leaders of Native American communities and GC training programs in the pursuit of greater equity.
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Affiliation(s)
- Abigail A Freeman
- Master of Genetic Counseling Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.,Genetic Counseling Services, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Jacquelynn Arbuckle
- Native American Center for Health Professions, University of Wisconsin, Madison, WI, USA
| | - Elizabeth M Petty
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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26
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Giordano AL, Schmit MK, Schmit EL. Best Practice Guidelines for Publishing Rigorous Research in Counseling. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda L. Giordano
- Department of Counseling and Human Development Services University of Georgia
| | - Michael K. Schmit
- Department of Counseling Texas A&M University–Commerce
- Now at Hazelden Betty Ford Graduate School of Addiction Studies
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Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature. Mayo Clin Proc 2021; 96:733-743. [PMID: 33004216 DOI: 10.1016/j.mayocp.2020.03.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/14/2023]
Abstract
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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Dickerson DL, Parker J, Johnson CL, Brown RA, D'Amico EJ. Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned. Clin Trials 2021; 18:83-91. [PMID: 33231130 PMCID: PMC7878293 DOI: 10.1177/1740774520971774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population. METHODS We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017. RESULTS We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals. CONCLUSION Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), University of California Los Angeles, Los Angeles, CA, USA
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29
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Heck JL, Jones EJ, Bohn D, McCage S, Parker JG, Parker M, Pierce SL, Campbell J. Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review. J Womens Health (Larchmt) 2021; 30:220-229. [PMID: 33211616 DOI: 10.1089/jwh.2020.8890] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.
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Affiliation(s)
- Jennifer L Heck
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Diane Bohn
- Cass Lake Indian Health Service, Cass Lake, Minnesota, USA
| | - Shondra McCage
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Mahate Parker
- OB Hospitalist Group, Greenville, South Carolina, USA
| | - Stephanie L Pierce
- Department of Maternal-Fetal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Blanchard J, Hiratsuka V, Beans JA, Lund J, Saunkeah B, Yracheta J, Woodbury RB, Blacksher E, Peercy M, Ketchum S, Byars C, Spicer P. Power Sharing, Capacity Building, and Evolving Roles in ELSI: The Center for the Ethics of Indigenous Genomic Research. COLLABORATIONS (CORAL GABLES, FLA.) 2020; 3:18. [PMID: 34708212 PMCID: PMC8547310 DOI: 10.33596/coll.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Persistent, unresolved issues stemming from a legacy of scientific exploitation and bio-colonialism have kept many tribal nations from participating in genomic research. The Center for the Ethics of Indigenous Genomic Research (CEIGR) aims to model meaningful community engagement that moves toward more inclusive and equitable research practices related to genomics. This article reflects on key successes and challenges behind CEIGR's efforts to shape Ethical, Legal and Social Implications (ELSI) research in ways that are informed by Indigenous perspectives, to locate community partnerships at the center of genomics research, and to conduct normative and empirical research with Indigenous communities that is grounded in the concepts of reciprocity, transparency and cultural competency. The structure of CEIGR represents an important shift away from a traditional model centered on a university-based principal investigators toward a partner-centered research approach that emphasizes equity and community control by distributing power and decision-making across all CEIGR partner sites. We discuss three features of CEIGR that have contributed to this shift towards an equitable, community-driven partnership: 1) balancing local priorities with collective goals; 2) distributing power in ways that promote equitable partnerships; and 3) capacity building and co-learning across partner sites. The discussion of these three areas in this article speaks to a particular strength of our Center: the interdependence among partners and collective willingness to maintain a plasticity of leadership that creates space for all of our partners to lead, support, exchange and strengthen ELSI research.
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Hubbard AR, Monnig LA. Using Anthropological Principles to Transform the Teaching of Human "Difference" and Genetic Variation in College Classrooms. SCIENCE & EDUCATION 2020; 29:1541-1565. [PMID: 33078044 PMCID: PMC7557306 DOI: 10.1007/s11191-020-00164-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
Exposure to information about genetics is at an all-time high, while a full understanding of the biocultural complexity of human difference is low. This paper demonstrates the value of an "anthropological approach" to enhance genetics education in biology, anthropology, and other related disciplines, when teaching about human differences such as race/ethnicity, sex/gender, and disability. As part of this approach, we challenge educators across social and natural sciences to critically examine and dismantle the tacit cultural assumptions that shape our understanding of genetics and inform the way we perceive (and teach about) human differences. It calls on educators from both social and natural science disciplines to "de-silo" their classrooms and uses examples from our biological anthropology and sociocultural anthropology classrooms, to demonstrate how educators can better contextualize the "genetics" of human difference in their own teaching. Numerous opportunities to transform our teaching exist, and we are doing a disservice to our students by not taking these critical steps.
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Affiliation(s)
- Amelia R. Hubbard
- Department of Sociology and Anthropology, Wright State University, 270 Millett Hall, 3640 Col. Glenn Hwy, Dayton, OH 45435 USA
| | - Laurel A. Monnig
- Department of Sociology and Anthropology, Wright State University, 270 Millett Hall, 3640 Col. Glenn Hwy, Dayton, OH 45435 USA
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Beans JA, Woodbury RB, Wark KA, Hiratsuka VY, Spicer P. Perspectives on Precision Medicine in a Tribally Managed Primary Care Setting. AJOB Empir Bioeth 2020; 11:246-256. [PMID: 32940567 PMCID: PMC7606746 DOI: 10.1080/23294515.2020.1817172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Precision medicine (PM) research and clinical application is moving forward at a rapid pace. To ensure ethical inclusion of all populations in PM, in-depth understanding of diverse communities' views of PM research and PM implementation is necessary. METHODS Semi-structured interviews were conducted to explore perspectives on PM in a tribally managed healthcare organization. Thematic analysis was used to analyze data from 46 interviews. RESULTS Participants described gains in diagnostic efficiency, risk identification for preventable disease, and the advancement of population-specific biomedical research as key benefits of PM. Concerns expressed related to privacy risks associated with data-sharing, overpromising on PM, and managing patient expectations related to PM. Stakeholders encouraged PM implementation to be preceded by health education activities that leverage a range of communication strategies. CONCLUSION Perspectives described in this study may aid in and should be considered prior to implementation of PM in this and other healthcare systems, especially those serving diverse populations.
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Affiliation(s)
| | | | | | | | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
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Survey Development: Community Involvement in the Design and Implementation Process. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years:S77-S83. [PMID: 31348193 DOI: 10.1097/phh.0000000000001016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Documenting Tribal health priorities is needed to inform research agendas, policy efforts, advocacy, and funding. However, published literature rarely documents the methods used to develop surveys in Indigenous communities. This methods paper includes two objectives: (1) increase knowledge and understanding about the importance of community involvement in public health activities; and (2) provide an example of how the Rocky Mountain Tribal Leaders Council Epidemiology Center (RMTEC) worked with one Tribal community to develop a health priorities survey. This paper describes how the RMTEC worked with a Tribal community and Tribal College students to develop, pilot, and revise a health priorities survey. Recommendations focus on the need for more culturally-responsive survey methods, the importance of building Tribal capacity for health research, and the value of piloting surveys in communities prior to implementation.
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Abstract
This article demonstrates how researchers from both the sciences and the humanities can learn from Charles Darwin’s mixed methodology. We identify two basic challenges that face emotion research in the sciences, namely a mismatch between experiment design and the complexity of life that we aim to explain, and problematic efforts to bridge the gap, including invalid inferences from constrained study designs, and equivocal use of terms like “sympathy” and “empathy” that poorly reflect such methodological constraints. We argue that Darwin’s mixed methodology is a model for addressing these challenges even in laboratory work on emotion, because it shows how close observation of emotional phenomena makes sense only within broader historical contexts. The article concludes with 5 practical research recommendations.
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Walls M, Dertinger M, Unzen M, Forsberg A, Aronson B, Wille S, al’Absi M. Assessment of feasibility and outcomes of a salivary cortisol collection protocol in five American Indian communities. Stress 2020; 23:265-274. [PMID: 31578895 PMCID: PMC7174135 DOI: 10.1080/10253890.2019.1675628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We evaluated the feasibility and outcomes of administering a naturalistic saliva collection procedure and assessment in American Indian (Indigenous) communities. We focus on Indigenous adults living with type 2 diabetes given the "epidemic" of the disease disproportionately impacting many tribal groups. Data are from community-based participatory research (CBPR) involving 5 tribal communities. Participants were randomly selected from tribal clinic records. The sample includes 188 adults living with type 2 diabetes (56% female; age range = 18-77 years; M age = 46.3 years). Participants provided a total of 748 saliva samples, representing 4 samples/participant on a single day with instructions for collection at 4 time points: upon waking, 1 h after waking, 2 h after waking, and at 8 PM. Saliva sample times were recorded by participants on paper and electronically via placement in a Medication Event Monitoring System (MEMS®) bottle. Overall, 67% of samples were completed within 10 min of protocol instructions and 91% of participants provided at least one useable sample (79% provided four useable samples). Noncompliance, behavioral and environmental factors were not robustly associated with deviations in observed cortisol indices. Results suggest that home-based, community interviewer-involved protocols yields valid data with high compliance. The success of this study was facilitated by exemplary efforts of tribal community-based interviewers and our overall CBPR approach.Lay summaryAuthentic efforts for tribal community partnerships in research are critical to successfully implementing biological assessments with American Indians given legacies of research misconduct and mistrustOur Community-Based Participatory Research with 5 tribes yielded high participant compliance to a home-based salivary cortisol collection protocolLack of compliance to salivary cortisol protocol and medication usage were not consistently associated with observed cortisol indices.
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Affiliation(s)
- Melissa Walls
- Johns Hopkins University, Bloomberg School of Public Health, Center for American Indian Health
- 1915 South Street, Duluth, MN 55812,
| | - Melinda Dertinger
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus
| | - Michael Unzen
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus
| | - Angie Forsberg
- Johns Hopkins University, Bloomberg School of Public Health, Center for American Indian Health
| | - Benjamin Aronson
- Department of Social and Administrative Pharmacy, Ohio Northern University
| | - Stephanie Wille
- Johns Hopkins University, Bloomberg School of Public Health, Center for American Indian Health
| | - Mustafa al’Absi
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus
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Larimer ME, Parker M, Lostutter T, Rhew I, Eakins D, Lynch A, Walter T, Egashira L, Kipp BJ, Duran B. Perceived descriptive norms for alcohol use among tribal college students: Relation to self-reported alcohol use, consequences, and risk for alcohol use disorder. Addict Behav 2020; 102:106158. [PMID: 31830672 DOI: 10.1016/j.addbeh.2019.106158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 01/31/2023]
Abstract
This research addressed gaps in the literature by testing relationships between perceived descriptive alcohol use norms and individual's own alcohol use and consequences among tribal college and university (TCU) students. Survey data were collected from 3239 tribal college students in 22 TCUs across the United States in 2015 and 2016, of whom 3174 provided usable data on the variables of interest for the current manuscript. Results indicated students misperceived the descriptive norms for alcohol use at their TCU, on average estimating students at their college drank more frequently, more per occasion, and more total drinks per week relative to the observed averages on these outcomes. Participants' own drinking was significantly related to their perceived norms, with higher perceived norms related to more drinking. In addition, higher perceived norms were associated with greater alcohol-related negative consequences and lower likelihood of being a non-drinker. These findings extend research with students at majority-serving colleges and universities, indicating normative misperceptions exist and have similar relationships to alcohol use and consequences among TCU students nationwide. These findings support adaptation of normative feedback interventions for use with TCU students to emphasize healthy alcohol norms and correct misperceptions that support the stereotype that all students drink to excess.
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Affiliation(s)
- Mary E Larimer
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States.
| | - Myra Parker
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Ty Lostutter
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Isaac Rhew
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Danielle Eakins
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Alex Lynch
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Theresa Walter
- Center for the Study of Health & Risk Behaviors, Department of Psychiatry & Behavioral Sciences, University of Washington, United States
| | - Leo Egashira
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, United States
| | | | - Bonnie Duran
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, United States
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Parker M, Pearson C, Donald C, Fisher CB. Beyond the Belmont Principles: A Community-Based Approach to Developing an Indigenous Ethics Model and Curriculum for Training Health Researchers Working with American Indian and Alaska Native Communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:9-20. [PMID: 31355974 PMCID: PMC6750973 DOI: 10.1002/ajcp.12360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Individuals responsible for carrying out research within their diverse communities experience a critical need for research ethics training materials that align with community values. To improve the capacity to meet local human subject protections, we created the research Ethics Training for Health in Indigenous Communities (rETHICS), a training curriculum aligned within American Indian and Alaska Native (AI/AN) context, culture, and community-level ethical values and principles. Beginning with the Belmont Report and the Common Rule that defines research with human subjects (46 CFR 45), the authors convened three different expert panels (N = 37) to identify Indigenous research values and principles common across tribal communities. The resulting culturally grounded curriculum was then tested with 48 AI/AN individuals, 39 who also had recorded debriefing interviews. Using a thematic analysis, we coded the qualitative feedback from the expert panel discussions and the participant debriefings to assess content validity. Participants identified five foundational constructs needed to ensure cultural-grounding of the AI/AN-specific research training curriculum. These included ensuring that the module was: (a) framed within an AI/AN historical context; (b) reflected Indigenous moral values; (c) specifically linked AI/AN cultural considerations to ethical procedures; (d) contributed to a growing Indigenous ethics; and (e) provided Indigenous-based ethics tools for decision making. Using community-based consultation and feedback from participants led to a culturally grounded training curriculum that teaches research ethical principles and procedures for conducting research with AI/ANs. The curriculum is available for free and the community-based process used can be adapted for other cultural groups.
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Affiliation(s)
- Myra Parker
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behavior, School of Medicine, University of Washington, Seattle, WA, USA
| | - Cynthia Pearson
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Caitlin Donald
- Prevention Research Center, Oregon Health Sciences University, Portland, OR, USA
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Correction: Beans, J.A.; et al. Community Protections in American Indian and Alaska Native Participatory Research–A Scoping Review. Soc. Sci. 2019, 8(4), 127. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8090247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The authors wish to make the following change to their paper (Beans et al [...]
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Abstract
In 2014, the Centers for Disease Control and Prevention (CDC) commissioned the Urban Indian Health Institute (UIHI) to coordinate a multifaceted national evaluation plan for Good Health and Wellness in Indian Country (GHWIC), CDC's largest investment in chronic disease prevention for American Indians and Alaska Natives (AI/ANs). GHWIC is a collaborative agreement among UIHI, CDC, tribal organizations, and individual tribes. In collaboration, UIHI and CDC drew upon an indigenous framework, prioritizing strength-based approaches for documenting program activities, to develop a 3-tiered evaluation model. The model incorporated locally tailored metrics, adherence to tribal protocols, and cultural priorities. Ultimately, federal requirements and data collection processes were aligned with tribal strengths and bidirectional learning was promoted. We describe how UIHI worked with tribal recipients, tribal health organizations, Tribal Epidemiology Centers, and CDC to develop and implement the model on the basis of an indigenous framework of mutual trust and respect.
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Affiliation(s)
- Thomas J Lawrence
- Seattle Indian Health Board, Urban Indian Health Institute, 611 12th Ave S, Seattle, WA 98144.
| | - Rosalina D James
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
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Harris KJ, Brown B, Shankle L, Tryon M, Pedersen M, Panarella SK, Swaney G. Community Readiness Model for Prevention Planning: Addressing Childhood Obesity in American Indian Reservation Communities. J Racial Ethn Health Disparities 2019; 6:1144-1156. [PMID: 31332689 DOI: 10.1007/s40615-019-00616-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The community readiness model (CRM) is a stage-matched assessment protocol to assess community readiness to address a public health issue. To identify appropriate, culturally sensitive, and community-specific intervention strategies for preventing obesity in children, researchers, and community members formed a partnership to address childhood obesity within one American Indian Reservation. METHODS The CRM guided 30 interviews in five communities to direct the team's efforts in addressing obesity among children residing on the reservation. Interviews were scored across six dimensions on an anchored scale of one through nine; scores were then averaged to determine an overall readiness score for each community. A thematic analysis of interview responses aided in interpretation of the readiness scores and identified areas for prevention planning and intervention development. RESULTS The overall community readiness score for the communities was 2.9 (SD = 0.5), which falls between 2 (denial/resistance) and 3 (vague awareness) on the anchored rating scale. The thematic analysis resulted in a hierarchal classification scheme with six broad themes that corresponded to the CRM dimensions and 13 sub-themes. DISCUSSION The low readiness scores directed the team to implement corresponding strategies to increase awareness, while the thematic analysis suggested that action-based approaches might also be appropriate. The narrow range of scores suggest that community-wide assessments may be sufficient unless specific information is needed for each region of the community. The CRM may be an effective way to assess community readiness to address childhood obesity on an American Indian Reservation.
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Affiliation(s)
- Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Blakely Brown
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Lindsey Shankle
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code L222, Portland, OR, 97239, USA
| | - Michael Tryon
- Summit Medical Fitness Center, 205 Sunnyview Lane, Kalispell, MT, 59901, USA
| | - Maja Pedersen
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | | | - Gyda Swaney
- Department of Psychology, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
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Chadwick JQ, Copeland KC, Branam DE, Erb-Alvarez JA, Khan SI, Peercy MT, Rogers ME, Saunkeah BR, Tryggestad JB, Wharton DF. Genomic Research and American Indian Tribal Communities in Oklahoma: Learning From Past Research Misconduct and Building Future Trusting Partnerships. Am J Epidemiol 2019; 188:1206-1212. [PMID: 31081852 PMCID: PMC6601530 DOI: 10.1093/aje/kwz062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/14/2022] Open
Abstract
Research misconduct and consequential harms have been inflicted upon American Indian/Alaska Native communities for decades. To protect their people and culture and to retain oversight over research, many Native communities have established tribal health research and institutional review boards. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study showcases a successful, trusting research collaboration with tribal nations and academic investigators in Oklahoma. In 2006, the TODAY Study investigators proposed a modification of the study protocol to collect biological specimens from participants for genomic analyses and indefinite storage. Partnering American Indian tribal nations elected not to participate in the genomics collection and repository proposal. Reasons included 1) protection of cultural values, 2) concerns regarding community anonymity, 3) a potential threat to tribal services eligibility, 4) broad informed consent language, and 5) vague definitions of data access and usage. The nations believed the proposed genomics analyses presented a risk of harm to their people and nations without clear benefit. Since the 2006 proposal and the advancement of genomics research, many tribal communities in Oklahoma, appreciating the potential benefits of genomic research, are developing policies regarding oversight of/access to data and biological specimens to mitigate risks and provide members and communities with opportunities to participate in safe and meaningful genomic research.
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Affiliation(s)
- Jennifer Q Chadwick
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kenneth C Copeland
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Sohail I Khan
- Department of Health Research, Cherokee Nation, Tahlequah, Oklahoma
| | - Michael T Peercy
- Department of Health, Division of Research and Public Health, The Chickasaw Nation, Ada, Oklahoma
| | - Mark E Rogers
- Tribal Health System, Absentee Shawnee Tribe, Shawnee, Oklahoma
| | - Bobby R Saunkeah
- Department of Health, Division of Research and Public Health, The Chickasaw Nation, Ada, Oklahoma
| | - Jeanie B Tryggestad
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David F Wharton
- Heath Services Authority, Choctaw Nation of Oklahoma, Durant, Oklahoma
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Abstract
Experiences with unethical research practices have caused some American
Indian and Alaska Native (AIAN) individuals, organizations, and tribes to
mistrust health research. To build trust and repair relationships, current
research with AIAN peoples often involves participatory research (PR)
approaches. This article assesses community-level protections described in the
scientific literature on PR involving AIAN communities. A scoping review search
in PubMed and PsychInfo for articles published between January 2000 and June
2017 yielded an AIAN PR article dataset. Of 178 articles, a subset of 23
articles that described aspects of community protections were analyzed for
descriptions of community-level protection practices. We identified the presence
or absence of a description of four community protection measures in each
article: a tribal research department, the development of community-level
mechanisms for research regulation if not present, community collaboration
throughout the research process, and project employment of a community member.
The development of community-level mechanisms for research regulation was
described in 39% of the articles. Ninety-one percent of these articles described
community collaboration during the research process. Seventeen percent included
descriptions of all four community-level protection measures. The extent and
consistency to which community-level protections are described is variable; the
current literature lacks reporting on community-level protection practices
specific to tribal communities.
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Symbiotic Allegory as Innovative Indigenous Research Methodology. ANS Adv Nurs Sci 2019; 43:E25-E35. [PMID: 30839331 DOI: 10.1097/ans.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article introduces symbiotic allegory, an innovative research method designed by the researcher, an American Indian Chippewa. Symbiotic allegory incorporates traditional methods (storytelling, the Dream Catcher-Medicine Wheel, traditional grounding ceremonies) with Western interview methodology to evoke trust and candor among Plains Indians who had never voiced the traumatic stories of their childhood boarding school experiences. Implications reflect the importance of creating methodologies that incorporate the ways of knowing of the group being studied, which is best accomplished by a researcher who comes from within the ranks of the population being studied.
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Burns J, Persaud-Sharma D, Green D. Beyond JNC 8: implications for evaluation and management of hypertension in underserved populations. Acta Cardiol 2019; 74:1-8. [PMID: 29504458 DOI: 10.1080/00015385.2018.1435987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In the United States, hypertension is a significant medical problem that affects nearly 1 in 3 adults, causes thousands of deaths annually, and costs the nation billions of dollars annually for medical management in terms of hospitalisations, lost wages, and pharmacotherapy. The management guidelines of hypertension have greatly varied between different healthcare organisations including the American College of Cardiology (ACC), the European Society of Cardiology (ESC) and the Joint National Committee (JNC-7, 8). One of the points of contention is the generalisability of the guidelines to all individuals despite empirical evidence suggesting racial sensitivities to pharmacotherapy and high clinical adversities with elevations in blood pressure (BP). This manuscript will aim to review a brief history of the guidelines, the adjustment of the BP goals with pharmacotherapy for the management of hypertension, and discuss several socioeconomic factors attributing to higher clinical risks for certain minority racial groups susceptible to the new BPs goals for management under the JNC-8.
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Affiliation(s)
- Joseph Burns
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Dharam Persaud-Sharma
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Dollie Green
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Humanities Health and Society, Herbert Wertheim College of Medicine, Miami, FL, USA
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Braithwaite J. Colonized Silence: Confronting the Colonial Link in Rural Alaska Native Survivors' Non-Disclosure of Child Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2018; 27:589-611. [PMID: 30004819 DOI: 10.1080/10538712.2018.1491914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Though there is evidence linking the history of colonialism and oppression of Indigenous people to the high rates of rape and child sexual abuse experienced by this population today, it is less understood how colonial processes, past and present, condition the decision to disclose or report victimization. Drawing on a survivorship storytelling study of rural Alaska Native survivors of child sexual abuse, this paper underscores the importance of centering colonialism in understanding the culture of silence surrounding sexual victimization among Indigenous people. Results show that reasons for non-disclosure are quite embedded within larger social, historical and political themes of colonialism, oppression, and marginalization. Implications for policy and praxes are discussed, as well as a broader mandate of social change to remove barriers to disclosure.
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Kilburn MR, Lyon K, Anderson C, Gutman P, Whitesell NR. METHODOLOGICAL CONSIDERATIONS FOR HOME-VISITING RESEARCH IN TRIBAL COMMUNITIES. Infant Ment Health J 2018; 39:303-311. [PMID: 29767412 DOI: 10.1002/imhj.21709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Drawing on previous studies and the collective experience of conducting rigorous evaluations as part of the Tribal Maternal, Infant, and Early Childhood Home Visiting grants, we outline methodological considerations that will inform future research in tribal communities, particularly in the area of home visiting. The methodological issues we discuss are study design choices, measurement and data collection, and including community members in all aspects of the research.
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Pearson CR, Parker M, Zhou C, Donald C, Fisher CB. A culturally tailored research ethics training curriculum for American Indian and Alaska Native communities: a randomized comparison trial. CRITICAL PUBLIC HEALTH 2018; 29:27-39. [PMID: 30613127 PMCID: PMC6320230 DOI: 10.1080/09581596.2018.1434482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/23/2017] [Indexed: 11/20/2022]
Abstract
The primary aim of this study was to develop an American Indian and Alaska Native (AIAN) tailored research with human subjects curriculum that would increase the participation of AIAN members in research affecting their communities. We used a community-engaged research approach to co-design and evaluate a culturally tailored online human subjects curriculum among a national sample of AIAN community members (n = 244) with a standard nationally used online curriculum (n = 246). We evaluated pre-and post-test measures to assess group differences in ethics knowledge, perceived self-efficacy to apply such knowledge to protocol review, and trust in research. Analysis of regional tribal differences assessed curriculum generalizability. Using an 80% correct item cut-off at first attempt as passing criterion, the tailored curriculum achieved a 59.3% passing rate versus 28.1% in the standard curriculum (p < .001). For both arms, participants reported a significant increase in trust in research and in research review efficacy. Participants took less time to complete the training and reported significantly higher acceptability, satisfaction, and understandability of the curriculum for the tailored curriculum. This culturally tailored research ethics curriculum has the potential to increase participation in AIAN communities in research affecting tribal members. The AIAN curriculum achieved significantly higher levels of participants' research ethics knowledge, self-efficacy in reviewing research protocols, trust in research, and completion of the training requirements. Culturally grounded training curricula may help remedy the impact of historical research ethics abuses involving AIAN communities that have contributed to mistrust of research and lack of community engagement in research.
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Affiliation(s)
- C. R. Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - M. Parker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - C. Zhou
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - C. Donald
- Center for Healthy Communities, Oregon Health & Science University, Portland, OR, USA
| | - C. B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, USA
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Dave G, Frerichs L, Jones J, Kim M, Schaal J, Vassar S, Varma D, Striley C, Ruktanonchai C, Black A, Hankins J, Lovelady N, Cene C, Green M, Young T, Tiwari S, Cheney A, Cottler L, Sullivan G, Brown A, Burke J, Corbie-Smith G. Conceptualizing trust in community-academic research partnerships using concept mapping approach: A multi-CTSA study. EVALUATION AND PROGRAM PLANNING 2018; 66:70-78. [PMID: 29053983 PMCID: PMC5705432 DOI: 10.1016/j.evalprogplan.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Collaborations between communities, healthcare practices and academic institutions are a strategy to address health disparities. Trust is critical in the development and maintaining of effective collaborations. The aim of this pilot study was to engage stakeholders in defining determinants of trust in community academic research partnerships and to develop a framework for measuring trust. METHODS The study was conducted by five collaborating National Institute of Health' Clinical and Translational Sciences Awardees. We used concept mapping to engage three stakeholders: community members, healthcare providers and academicians. We conducted hierarchical cluster analysis to assess the determinants of trust in community-academic research partnerships. RESULTS A total of 186 participants provided input generating 2,172 items that were consolidated into 125 unique items. A five cluster solution was defined: authentic, effective and transparent communication; mutually respectful and reciprocal relationships; sustainability; committed partnerships; and, communication, credibility and methodology to anticipate and resolve problems. CONCLUSION Results from this study contribute to an increasing empirical body of work to better understand and improve the underlying factors that contribute to building and sustaining trust in community academic research partnerships.
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Affiliation(s)
- Gaurav Dave
- University of North Carolina-Chapel Hill, United States.
| | - Leah Frerichs
- University of North Carolina-Chapel Hill, United States
| | | | | | | | | | | | | | | | - Adina Black
- University of North Carolina-Chapel Hill, United States
| | | | | | - Crystal Cene
- University of North Carolina-Chapel Hill, United States
| | - Melissa Green
- University of North Carolina-Chapel Hill, United States
| | - Tiffany Young
- University of North Carolina-Chapel Hill, United States
| | | | - Ann Cheney
- University of California-Riverside, United States
| | | | | | - Arleen Brown
- University of California-Los Angeles, United States
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Muñoz del Carpio Toia A, Dueñas Ancco A, Sánchez Rodríguez K, Begazo ML. Adecuación cultural y capacitación acerca del proceso de consentimiento informado en proyecto sobre nutrición escolar en un pueblo indígena aymara de Perú. PERSONA Y BIOÉTICA 2017. [DOI: 10.5294/pebi.2017.21.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Antecedentes: es importante que las investigaciones respeten normas éticas y la toma del consentimiento informado (CI) con la debida adecuación cultural y verificando su comprensión en comunidades indígenas de las regiones Andina y Amazónica, incluidas hoy en investigaciones sociales y médicas. Objetivo: determinar el grado de comprensión del CI en una comunidad aymara del Perú con un proyecto de nutrición escolar. Metodología: se realizó un estudio de campo cuasi experimental, prospectivo, de intervención educativa en Puno, en 2015. Se explicó a los líderes aymaras los objetivos y procedimientos del estudio de nutrición escolar y CI. Se confeccionó un cuestionario de conocimientos y prácticas de loncheras saludables para niños aymaras; un programa educativo de nutrición escolar y dos formatos de CI (simple y con adecuación cultural). La documentación fue evaluada por un comité de ética de la investigación. Resultados: 70 pobladores aymaras participaron del proyecto de investigación. El grado de comprensión del CI se modificó con significancia estadística luego de la intervención educativa y la adecuación cultural.
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Gampa V, Smith C, Muskett O, King C, Sehn H, Malone J, Curley C, Brown C, Begay MG, Shin S, Nelson AK. Cultural elements underlying the community health representative - client relationship on Navajo Nation. BMC Health Serv Res 2017; 17:19. [PMID: 28069014 PMCID: PMC5223387 DOI: 10.1186/s12913-016-1956-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs’ interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction. Methods In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques. Results The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client’s family, and the community. Conclusion Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1956-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vikas Gampa
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Casey Smith
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Olivia Muskett
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Hannah Sehn
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Partners in Health, Boston, MA, USA
| | - Jamy Malone
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Partners in Health, Boston, MA, USA
| | - Cameron Curley
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Brown
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya Shin
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Partners in Health, Boston, MA, USA.
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