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Roucoux G, Thonon F, Zucman D, Rey D, Abgrall S, Eriksson LE, Préau M, Michels D, Chéret A, Duracinsky M. Questioning the "Ease" in disease: Was living with HIV a burden or boost during the first wave of Covid-19 in France? A qualitative study (COVIDHIV). PLoS One 2024; 19:e0295223. [PMID: 38452028 PMCID: PMC10919596 DOI: 10.1371/journal.pone.0295223] [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: 07/20/2022] [Accepted: 11/18/2023] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Clinical research has focused on risk factors and treatment for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), particularly in people with a comorbidity including the human immunodeficiency virus (HIV), but little attention has been paid to the care pathway. This article aims to show how living with HIV may have been a biopsychosocial burden or boost in care pathways for Covid-19. METHOD People living with HIV (PLHIV) from 9 clinical centers were invited to participate in this qualitative study. The sampling was purposive with a maximum variation in their sociodemographic profiles. Semi-structured interviews were conducted until data saturation, then coded for thematic analysis, using an inductive general approach. RESULTS We interviewed 34 PLHIV of which 20 had SARS-COV-2 once. They were 24 males, 26 born in France; median age: 55. Twenty had a CD4 number above 500, and all were on antiretroviral therapy (ART). HIV appeared as a burden when Covid-19 symptoms reminded HIV seroconversion, fear of contamination, and triggered questions about ART effectiveness. HIV was not considered relevant when diagnosing Covid-19, caused fear of disclosure when participants sought SARS-COV-2 testing, and its care in hospitals was disrupted by the pandemic. ART-pill fatigue caused avoidance for Covid-19 treatment. As a boost, living with HIV led participants to observe symptoms, to get advice from healthcare professionals, and screening access through them. Some participants could accept the result of screening or a clinical diagnosis out of resilience. Some could consider ART or another drug prescribed by their HIV specialist help them to recover from Covid-19. CONCLUSION Living with HIV could function as a burden and/or a boost in the care pathways for Covid-19, according to patients' relationship to their HIV history, comorbidities and representation of ART. Covid-19 in PLHIV needs further qualitative study to gain a more comprehensive assessment of the pandemic's consequences on their lives and coping strategies.
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Affiliation(s)
- Guillaume Roucoux
- ECEVE, UMR-S 1123, Inserm, Université Paris Cité, Paris, France
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Frédérique Thonon
- ECEVE, UMR-S 1123, Inserm, Université Paris Cité, Paris, France
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | | | - David Rey
- Trait d’Union–Strasbourg University Hospitals, Strasbourg, France
| | - Sophie Abgrall
- Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France
- UVSQ, INSERM U1018, CESP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Marie Préau
- Inserm Unit 1296 « Radiations: Defense, Health, Environment », Lyon, France
- Lyon 2 Lumière University, Lyon, France
| | - David Michels
- AIDES (French HIV/AIds and Viral Hepatites Organization), Pantin, France
- Laboratoire de Recherche Communautaire, Coalition PLUS, Pantin, France
| | - Antoine Chéret
- Outpatient Medicine Service, University Hospital, Pointe-à-Pitre, Guadeloupe, France
- Internal Medicine Unit, Cochin Hospital, Paris, France
| | - Martin Duracinsky
- ECEVE, UMR-S 1123, Inserm, Université Paris Cité, Paris, France
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Internal Medicine Unit, Le Kremlin Bicêtre Hospital, Bicêtre, France
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Morrow RL, Mintzes B, Gray G, Law MR, Garrison S, Dormuth CR. Public reporting of clinical trial findings as an ethical responsibility to participants: a qualitative study. BMJ Open 2023; 13:e068221. [PMID: 36944466 PMCID: PMC10032397 DOI: 10.1136/bmjopen-2022-068221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To understand how the experiences and views of trial participants, trial investigators and others connected to clinical trial research relate to whether researchers have a duty to participants to publicly report research findings. DESIGN Qualitative interview study. SETTING Semistructured interviews held in person or by telephone between March 2019 and April 2021 with participants in the Canadian provinces of Alberta, British Columbia and Ontario. PARTICIPANTS 34 participants, including 10 clinical trial participants, 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators and 3 research ethics board members. ANALYSIS We conducted a thematic analysis, including qualitative coding of interview transcripts and identification of key themes. MAIN OUTCOME MEASURES Key themes identified through qualitative coding of interview data. RESULTS Most clinical trial participants felt that reporting clinical trial results is important. Accounts of trial participants suggest their contributions are part of a reciprocal relationship involving the expectation that research will advance medical knowledge. Similarly, comments from trial investigators suggest that reporting trial results is part of reciprocity with trial participants and is a necessary part of honouring informed consent. Accounts of trial investigators suggest that when drug trials are not reported, this may undermine informed consent in subsequent trials by withholding information on harms or efficacy relevant to informed decisions on whether to conduct or enroll in future trials of similar drugs. CONCLUSION The views of trial participants, trial investigators and others connected to clinical trial research in Canada suggest that researchers have an obligation to participants to publicly report clinical trial results and that reporting results is necessary for honouring informed consent.
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Affiliation(s)
- Richard L Morrow
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | - Garry Gray
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Garrison
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin R Dormuth
- Anaesthesiology, Pharmacology, and Therapeutics, Therapeutics Initiative, The University of British Columbia, Vancouver, British Columbia, Canada
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Mukherjee S, Reji D. Lay, professional, and artificial intelligence perspectives on risky medical decisions and COVID-19: How does the number of lives matter in clinical trials framed as gains versus losses? Q J Exp Psychol (Hove) 2021; 75:784-795. [PMID: 34609226 DOI: 10.1177/17470218211052037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcomes of clinical trials need to be communicated effectively to make decisions that save lives. We investigated whether framing can bias these decisions and if risk preferences shift depending on the number of patients. Hypothetical information about two medicines used in clinical trials having a sure or a risky outcome was presented in either a gain frame (people would be saved) or a loss frame (people would die). The number of patients who signed up for the clinical trials was manipulated in both frames in all the experiments. Using an unnamed disease, lay participants (experiment 1) and would-be medical professionals (experiment 2) were asked to choose which medicine they would have administered. For COVID-19, lay participants were asked which medicine should medical professionals (experiment 3), artificially intelligent software (experiment 4), and they themselves (experiment 5) favour to be administered. Broadly consistent with prospect theory, people were more risk-seeking in the loss frames than the gain frames. However, risk-aversion in gain frames was sensitive to the number of lives with risk-neutrality at low magnitudes and risk-aversion at high magnitudes. In the loss frame, participants were mostly risk-seeking. This pattern was consistent across laypersons and medical professionals, further extended to preferences for choices that medical professionals and artificial intelligence programmes should make in the context of COVID-19. These results underscore how medical decisions can be impacted by the number of lives at stake while revealing inconsistent risk preferences for clinical trials during a real pandemic.
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Affiliation(s)
- Sumitava Mukherjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Divya Reji
- Centre for Cognitive and Brain Sciences, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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Rodríguez-Torres E, González-Pérez MM, Díaz-Pérez C. Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemp Clin Trials Commun 2021; 23:100829. [PMID: 34401599 PMCID: PMC8358641 DOI: 10.1016/j.conctc.2021.100829] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.
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Affiliation(s)
| | | | - Clemente Díaz-Pérez
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, USA
- The Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, USA
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Dubé K, Perry KE, Mathur K, Lo M, Javadi SS, Patel H, Concha-Garcia S, Taylor J, Kaytes A, Dee L, Campbell D, Kanazawa J, Smith D, Gianella S, Auerbach JD, Saberi P, Sauceda JA. Altruism: Scoping review of the literature and future directions for HIV cure-related research. J Virus Erad 2020; 6:100008. [PMID: 33294210 PMCID: PMC7695811 DOI: 10.1016/j.jve.2020.100008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The question of what motivates people to participate in research is particularly salient in the HIV field. While participation in HIV research was driven by survival in the 1980's and early 1990's, access to novel therapies became the primary motivator with the advent of combination antiretroviral therapy (cART) in the late 1990s. In the HIV cure-related research context, the concept of altruism has remained insufficiently studied. METHODS We conducted a scoping review to better contextualize and understand how altruism is or could be operationalized in HIV cure-related research. We drew from the fields of altruism in general, clinical research, cancer, and HIV clinical research-including the HIV prevention, treatment, and cure-related research fields. DISCUSSION Altruism as a key motivating factor for participation in clinical research has often been intertwined with the desire for personal benefit. The cancer field informs us that reasons for participation usually are multi-faceted and complex. The HIV prevention field offers ways to organize altruism-either by the types of benefits achieved (e.g., societal versus personal), or the origin of the values that motivate research participation. The HIV treatment literature reveals the critical role of clinical interactions in fostering altruism. There remains a dearth of in-depth knowledge regarding reasons surrounding research participation and the types of altruism displayed in HIV cure-related clinical research. CONCLUSION Lessons learned from various research fields can guide questions which will inform the assessment of altruism in future HIV cure-related research.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kushagra Mathur
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Megan Lo
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Sogol S. Javadi
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- HIV Neurobehavioral Research Program, UCSD, San Diego, CA, USA
| | - Jeff Taylor
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP – PS), Palm Springs, CA, USA
| | - Andy Kaytes
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- AIDS Action Baltimore, Baltimore, MD, CA, USA
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David Smith
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Sara Gianella
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Judith D. Auerbach
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
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Dubé K, Eskaf S, Evans D, Sauceda J, Saberi P, Brown B, Averitt D, Martel K, Meija M, Campbell D, Barr L, Kanazawa J, Perry K, Patel H, Luter S, Poteat T, Auerbach JD, Wohl DA. The Dose Response: Perceptions of People Living with HIV in the United States on Alternatives to Oral Daily Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:324-348. [PMID: 31608651 DOI: 10.1089/aid.2019.0175] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There are two concurrent and novel major research pathways toward strategies for HIV control: (1) long-acting antiretroviral therapy (ART) formulations and (2) research aimed at conferring sustained ART-free HIV remission, considered a step toward an HIV cure. The importance of perspectives from people living with HIV on the development of new modalities is high, but data are lacking. We administered an online survey in which respondents selected their likelihood of participation or nonparticipation in HIV cure/remission research based on potential risks and perceived benefits of these new modalities. We also tested the correlation between perceptions of potential risks and benefits with preferences of virologic control strategies and/or responses to scenario choices, while controlling for respondent characteristics. Of the 282 eligible respondents, 42% would be willing to switch from oral daily ART to long-acting ART injectables or implantables taken at 6-month intervals, and 24% to a hypothetical ART-free remission strategy. We found statistically significant gender differences in perceptions of risk and preferences of HIV control strategies, and possible psychosocial factors that could mediate willingness to switch to novel HIV treatment or remission options. Our study yielded data on possible desirable product characteristics for future HIV treatment and remission options. Findings also revealed differences in motivations and preferences across gender and other sociodemographic characteristics that may be actionable as part of research recruitment efforts. The diversity of participant perspectives reveals the need to provide a variety of therapeutic options to people living with HIV and to acknowledge their diverse experiential expertise when developing novel HIV therapies.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
| | - Shadi Eskaf
- Environmental Finance Center, UNC School of Government, Chapel Hill, North Carolina
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Dawn Averitt
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Krista Martel
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Maria Meija
- The Well Project Community Advisory Board, Tamarac, Florida
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee Representative, Baltimore, Maryland
| | - John Kanazawa
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kelly Perry
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Hursch Patel
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Stuart Luter
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Tonia Poteat
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- UNC Department of Social Medicine, School of Medicine, Chapel Hill, North Carolina
| | - Judith D. Auerbach
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina, Chapel Hill, North Carolina
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Burkhalter JE, Aboulafia DM, Botello-Harbaum M, Lee JY. Participant characteristics and clinical trial decision-making factors in AIDS malignancy consortium treatment trials for HIV-infected persons with cancer (AMC #S006). HIV CLINICAL TRIALS 2019; 19:235-241. [PMID: 30890062 DOI: 10.1080/15284336.2018.1537349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Overall, people living with HIV/AIDS (PLWHA) are living longer, but compared with the general population, they are at elevated risk for numerous AIDS-defining and non-AIDS-defining cancers. The AIDS Malignancy Consortium (AMC) is dedicated to conducting clinical trials aimed at prevention and treatment of cancers among PLWHA. OBJECTIVE To examine patient-level characteristics and perceptions that influence decision-making regarding AMC treatment trial participation. METHODS PLWHA diagnosed with cancer or anal high-grade intraepithelial neoplasia who were ≥18 years old and offered participation on a therapeutic AMC clinical trial were eligible. Participants completed a 17-item survey assessing sociodemographic and other factors potentially influencing decision-making regarding trial participation. RESULTS The sample of 67 participants was mainly male (n = 62, 92.5%), non-Hispanic (89.5%) and white (67.2%), with a mean age of 48.3 years. About half of participants were screened for lymphoma studies. Nearly all (98.5%) of the participants learned about AMC clinical trials from a medical provider, most (73.1%) knew little about clinical trials in general, and half decided on trial participation on their own. Altruism was the most frequently cited reason for trial participation. Participant recommendations for improving AMC trial accrual included systems changes to speed access to clinical trials and reduce participant burden. CONCLUSIONS This formative study highlights the perceived benefits to others, i.e. altruism, as an important factor in trial decision-making, little knowledge about clinical trials in general, and the role of physicians in informing participants about clinical trials. Future research should address knowledge barriers and explore systems- and provider-level factors affecting accrual to AMC trials.
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Affiliation(s)
- Jack E Burkhalter
- a Department of Psychiatry & Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY, USA
| | - David M Aboulafia
- b Department of Hematology/Oncology , Virginia Mason Medical Center , Seattle , WA, USA (Retired)
| | | | - Jeannette Y Lee
- d AIDS Malignancy Center Statistical Center , University of Arkansas for Medical Sciences , Little Rock , AR, USA
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Thurman WA, Harrison TC. Reaching the "Hard-to-Reach": Recruitment of Rural-Dwelling Adults With Disabilities. J Transcult Nurs 2019; 31:171-177. [PMID: 31204586 DOI: 10.1177/1043659619856667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: There are 46 million individuals living in rural America that require unique consideration for rural health research. Recruitment of research participants from disparity groups can be difficult as these groups can be hard-to-reach. In particular, strategies for reaching rural-dwelling Americans with disabilities are not well-documented. Furthermore, researchers sometimes underestimate the time and effort needed to recruit participants from hard-to-reach populations. The purpose of this article is to report the methods used to recruit 12 rural-dwelling adults with disabilities into a qualitative study. Method: The recruitment strategies discussed in this article were used in a grounded theory study. Results: Fifty percent of the sample in this study was recruited via a community gatekeeper, 33% responded to a classified advertisement, and 17% were recruited via the researchers' professional networks. Discussion: Lessons learned yield insights as to effective recruitment methods for rural dwellers as well as other hard-to-reach populations.
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Andrighetti HJ, Semaka A, Austin JC. Women's experiences of participating in a prospective, longitudinal postpartum depression study: insights for perinatal mental health researchers. Arch Womens Ment Health 2017; 20:547-559. [PMID: 28600644 PMCID: PMC5511519 DOI: 10.1007/s00737-017-0744-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
Barriers to recruitment for research on mental illness include participant distrust of researchers and social stigma. Though these issues may be acutely important in perinatal mental health research, they remain unexplored in this context. In order to inform strategies to more fully engage women in perinatal mental health research, we explored the motivations and experiences of women with a history of major depressive disorder who participated in a prospective longitudinal research study on postpartum depression (PPD). Sixteen women with a history of depression who had either completed or recently made a decision about participation in a longitudinal research study about PPD were interviewed by telephone. Qualitative, semi-structured interviews explored participants' decision-making about, and experiences of, participation. Interviews were audio-recorded, transcribed, and qualitatively analyzed using elements of grounded theory methodology. Follow-up interviews were conducted with four participants to refine and clarify preliminary results. Foundational elements necessary for women to consider participating in PPD research included personal acceptance of illness and trust in the research team/institution. Other main motivators included perceived personal relevance, anticipated benefits (including access to support/resources, learning opportunities, and improved self-worth), altruism, and accessible study procedures. Our data suggest that participating in perinatal mental health research may help women make meaning of their mental illness experience and is perceived as providing support. The findings-particularly around the importance of participant-researcher rapport and accessibility of study design-may inform strategies that improve participation rates, decrease attrition, and maximize participant benefits in perinatal mental health research.
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Affiliation(s)
- Heather J Andrighetti
- Department of Psychiatry, University of British Columbia, Rm A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Medical Genetics Program, London Health Sciences Centre, London, ON, Canada
| | - Alicia Semaka
- Department of Psychiatry, University of British Columbia, Rm A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Jehannine C Austin
- Department of Psychiatry, University of British Columbia, Rm A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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van der Biessen DA, van der Helm PG, Klein D, van der Burg S, Mathijssen RH, Lolkema MP, de Jonge MJ. Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation. Psychooncology 2017; 27:163-170. [PMID: 28665008 DOI: 10.1002/pon.4487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/31/2017] [Accepted: 06/22/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well-being as measured by the quality of life (QoL). METHODS An exploratory cross-sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data. RESULTS Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi-square (8) = 9.30, P = .32. CONCLUSIONS Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients' social context and values before proposing a phase I trial.
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Affiliation(s)
| | | | - Dennis Klein
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Simone van der Burg
- Scientific Institute for Quality of Healthcare, Radboud UMC, Nijmegen, the Netherlands
| | - Ron H Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maja J de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Dubé K, Evans D, Sylla L, Taylor J, Weiner BJ, Skinner A, Thirumurthy H, Tucker JD, Rennie S, Greene SB. Willingness to participate and take risks in HIV cure research: survey results from 400 people living with HIV in the US. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30295-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Krebber AMH, van Uden-Kraan CF, Melissant HC, Cuijpers P, van Straten A, Becker-Commissaris A, Leemans CR, Verdonck-de Leeuw IM. A guided self-help intervention targeting psychological distress among head and neck cancer and lung cancer patients: motivation to start, experiences and perceived outcomes. Support Care Cancer 2016; 25:127-135. [PMID: 27585808 PMCID: PMC5127860 DOI: 10.1007/s00520-016-3393-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
Background Recent results of a randomized clinical trial showed that a guided self-help intervention (based on problem-solving therapy) targeting psychological distress among head and neck cancer and lung cancer patients is effective. This study qualitatively explored motivation to start, experiences with and perceived outcomes of this intervention. Methods Data were collected from semi-structured interviews of 16 patients. All interviews were audio-recorded and transcribed verbatim. Data were analyzed individually by two coders and coded into key issues and themes. Results Patients participated in the intervention for intrinsic (e.g. to help oneself) and for extrinsic reasons (e.g. being asked by a care professional or to help improve health care). Participants indicated positive and negative experiences with the intervention. Several participants appreciated participating as being a pleasant way to work on oneself, while others described participating as too confrontational. Some expressed their disappointment as they felt the intervention had brought them nothing or indicated that they felt worse temporarily, but most participants perceived positive outcomes of the intervention (e.g. feeling less distressed and having learned what matters in life). Conclusions Cancer patients have various reasons to start a guided self-help intervention. Participants appreciated the guided self-help as intervention to address psychological distress, but there were also concerns. Most participants reported the intervention to be beneficial. The results suggest the need to identify patients who might benefit most from guided self-help targeting psychological distress and that interventions should be further tailored to individual cancer patients’ requirements.
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Affiliation(s)
- Anne-Marie H Krebber
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Cornelia F van Uden-Kraan
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Heleen C Melissant
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Pim Cuijpers
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemieke van Straten
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,VUmc Cancer Center, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, the Netherlands.
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Barnett W, Brittain K, Sorsdahl K, Zar HJ, Stein DJ. Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants. Philos Ethics Humanit Med 2016; 11:3. [PMID: 27435596 PMCID: PMC4952056 DOI: 10.1186/s13010-016-0036-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/23/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. METHODS Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. RESULTS Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child's health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. CONCLUSIONS Satisfaction scores were high and associated with increased visit attendance. Participants' perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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Affiliation(s)
- Whitney Barnett
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- />Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- />Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- />Medical Research Council Unit on Anxiety & Stress Disorders, Cape Town, South Africa
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Sokol R, Fisher E, Hill J. Identifying Those Whom Health Promotion Hardly Reaches: A Systematic Review. Eval Health Prof 2015; 38:518-37. [PMID: 26405265 DOI: 10.1177/0163278715605883] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To understand what circumstances lend groups to be recognized as hardly reached by health services and research, we systematically reviewed studies that identified their priority populations as hard to reach. We classified attributes of hardly reached groups into cultural/environmental, individual, and demographic domains. Of the 334 identified studies, 78.74% used attributes that were classified into the cultural/environmental, 74.85% the individual, and 50% the demographic domain to identify those hardly reached. Of all possible combinations of domains, the most common was the use of all three domains (28.74%). Overall, papers were more likely to use attributes to identify their hardly reached population that fell into more than one domain (74.85%) compared to only one domain (25.15%; χ(2), p < .0001). Through this review, we identified the attributes of those who have been identified as hardly reached in published research. No single attribute is used to identify those who are hardly reached. This reflects a socioecological perspective, emphasizing that both intrapersonal and external elements may cause interventions to fail to reach those intended. Moreover, the focus not on populations hardly reached but on the attributes of those hardly reached suggests objectives for interventions to reach them better.
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Affiliation(s)
- Rebeccah Sokol
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edwin Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Hill
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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