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Esiaka D, Yarborough CC, Fausto BA, Gluck MA. A Mini-Review of Strategies for Recruiting Older African Americans to Alzheimer's Disease Research. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:419-428. [PMID: 36120808 PMCID: PMC11025449 DOI: 10.1177/0272684x221118493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
African Americans experience higher incidence and prevalence of Alzheimer's disease (AD). Yet, they continue to be underrepresented in AD research, limiting the ability to generalize findings to the increasingly diverse US population. To reduce AD disparities, targeted efforts are needed to increase the representation of African Americans in AD research. This mini review identified evidence-based strategies that increased research participation among older African Americans. Four recruitment strategies emerged from eight published peer-reviewed studies that directly evaluated the effectiveness of strategies aimed at increasing the number of African American participants in Alzheimer's research. The strategies include community outreach and education, face-to-face discussions, remote access, and referral and partnership with local organizations. Across different locations, these strategies increased the number of African Americans enrolled into AD research, the number of people that signed up to donate their brains for AD research upon death, and the knowledge and perception of AD in the communities. Targeted efforts are effective in increasing AD research participation among older African Americans, especially when combined with approaches that emphasize transparency and mutual trust and involve the community as stakeholders in the research process.
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Affiliation(s)
- Darlingtina Esiaka
- Aging and Brain Health Alliance, Center for Molecular and Behavioral Neuroscience, Rutgers University–Newark, Newark, NJ, USA
| | - Christina C. Yarborough
- Aging and Brain Health Alliance, Center for Molecular and Behavioral Neuroscience, Rutgers University–Newark, Newark, NJ, USA
| | - Bernadette A. Fausto
- Aging and Brain Health Alliance, Center for Molecular and Behavioral Neuroscience, Rutgers University–Newark, Newark, NJ, USA
| | - Mark A. Gluck
- Aging and Brain Health Alliance, Center for Molecular and Behavioral Neuroscience, Rutgers University–Newark, Newark, NJ, USA
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Walker AIB, Trani J, Banks CF, Murphy SA, Zha W, Williams MM, Day GS, Zhu Y, Ances BM, Hill CV, Hudson DL, Babulal GM. Recruiting a prospective community cohort to study Alzheimer's disease and structural and social determinants of health among adults racialized as Black: The ARCHES cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12473. [PMID: 38756718 PMCID: PMC11097001 DOI: 10.1002/trc2.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION This ongoing, prospective study examines the effectiveness of methods used to successfully recruit and retain 238 Black older adults in a longitudinal, observational Alzheimer's disease (AD) study. METHODS Recruitment strategies included traditional media, established research registries, speaking engagements, community events, and snowball sampling. Participants were asked to complete an annual office testing session, blood-based biomarker collection, optional one-time magnetic resonance imaging (MRI) scan, and community workshop. RESULTS Within the first 22 months of active recruitment, 629 individuals expressed interest in participating, and 238 enrolled in the ongoing study. Of the recruitment methods used, snowball sampling, community events, and speaking engagements were the most effective. DISCUSSION The systemic underrepresentation of Black participants in AD research impacts the ability to generalize research findings and determine the effectiveness and safety of disease-modifying treatments. Research to slow, stop, or prevent AD remains a top priority but requires diversity in sample representation. Highlights Provide flexible appointments in the evening or weekends, offering transportation assistance, and allowing participants to complete study visits at alternative locations, such as senior centers or community centers.Continuously monitor and analyze recruitment data to identify trends, challenges, and opportunities for improvement.Implement targeted strategies to recruit participants who are underrepresented based on sex, gender, or education to increase representation.Diversify the research team to include members who reflect the racial and cultural backgrounds of the target population, to enhance trust and rapport with prospective participants.
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Affiliation(s)
- Alexis I. B. Walker
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgAuckland ParkJohannesburgSouth Africa
| | - Christian F. Banks
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Samantha A. Murphy
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Gregory S. Day
- Department of NeurologyMayo Clinic in FloridaJacksonvilleFloridaUSA
| | - Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Beau M. Ances
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Darrell L. Hudson
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgAuckland ParkJohannesburgSouth Africa
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Jacobsen E, Lucas H, Moran C, Dixon RG, Ganguli M. Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project. Alzheimer Dis Assoc Disord 2024; 38:160-167. [PMID: 38748658 PMCID: PMC11178142 DOI: 10.1097/wad.0000000000000618] [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: 11/17/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge. METHODS We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies. RESULTS Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups. CONCLUSIONS We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
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Affiliation(s)
- Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Heather Lucas
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Catherine Moran
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | | | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry
- University of Pittsburgh, School of Medicine, Department of Neurology
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology
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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore‐Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez‐Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 PMCID: PMC11032522 DOI: 10.1002/alz.13752] [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: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of MedicineAlzheimer's Disease Resource Center for Minority Aging ResearchUniversity of Texas Rio Grande ValleyBrownsvilleTexasUSA
| | - Carl Hill
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Percy Griffin
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Stephen Hall
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for HealthHealth Care Policy, and Aging ResearchNew BrunswickNew JerseyUSA
| | - Jason Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ganesh Babulal
- Department of NeurologySchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Roland Thorpe
- Center on AgingCenter on Health Disparities SolutionsHopkins Population CenterAlzheimer's Disease Resource Center for Minority Aging ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State UniversitySeattleWashingtonUSA
| | - Spero Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Andrea Gilmore‐Bykovskyi
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alyssa Gamaldo
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | | | - Lisa Barnes
- Rush University Medical CenterChicagoIllinoisUSA
| | - Amy Kind
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Bryan James
- Rush University Medical CenterChicagoIllinoisUSA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public HealthDepartment of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Sarah Szanton
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Rachel Whitmer
- Department of Public Health SciencesDepartment of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | | | - Kacie Deters
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rina Das
- National Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | | | - Maria Carrillo
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Ferra F, Drewelow E, Klein O, Daum M, Walde P, Gerullis K, Kilimann I, Tomlin J, Teipel S, Völlm B. Implementation and evaluation of participatory advisory boards in mental health research: a research protocol of the 'PART-Beirat' project. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:112. [PMID: 38057888 DOI: 10.1186/s40900-023-00522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The use of participatory research approaches in the field of dementia and forensic mental health research has been on the rise. Advisory board structures, involving people with lived experience (PWLE), have frequently been used for guiding and leading research. Yet, there has been limited guidance on the establishment, retention and use of advisory boards in the field of dementia and forensic mental health research. OBJECTIVE This project outlined in this research protocol will investigate the benefits and challenges of establishing three patient advisory boards, involving PWLE, practitioners and researchers with the purpose to guide research. Data will be used to develop guidelines for best practice in involving PWLE in dementia and forensic mental health research through advisory boards. METHODS The research project will be divided into three phases: Phase I will involve two topic-specific systematic reviews on the use of participatory research with PWLE, followed by an initial study exploring PWLE's, practitioners' and researchers' expectations on research involvement. Phase II will consist of the establishment of three advisory boards, one focusing on dementia, one on forensic mental health and one overarching coordinating advisory board, which will involve PWLE from both fields. Phase III, will consist of interviews and focus groups with advisory board members, exploring any challenges and benefits of involving PWLE and practitioners in advisory boards for guiding research. To capture the impact of involving PWLE in different research phases and tasks, interviews and focus groups will be conducted at four different points of time (0, 6, 12, 18 months). Reflexive thematic analysis will be used for the analysis of data. DISCUSSION The project aims to explore the involvement of PWLE and practitioners in guiding research and aims to develop guidelines for best practice in establishing and using patient advisory boards in dementia and forensic mental health research and involving PWLE and practitioners in research.
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Affiliation(s)
- Fenia Ferra
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany.
| | - Eva Drewelow
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany
| | - Olga Klein
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Marcel Daum
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Peggy Walde
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany
| | - Kai Gerullis
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany
| | - Ingo Kilimann
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, UK
| | - Stefan Teipel
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Birgit Völlm
- Clinic of Forensic Psychiatry, Rostock University Medical Centre, Rostock, Germany
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Franzen S, Nuytemans K, Bourdage R, Caramelli P, Ellajosyula R, Finger E, Illán-Gala I, Loi SM, Morhardt D, Pijnenburg Y, Rascovsky K, Williams MM, Yokoyama J, Alladi S, Broce I, Castro-Suarez S, Coleman K, de Souza LC, Dacks PA, de Boer SCM, de Leon J, Dodge S, Grasso S, Gupta V, Gupta V, Ghoshal N, Kamath V, Kumfor F, Matias-Guiu JA, Narme P, Nielsen TR, Okhuevbie D, Piña-Escudero SD, Garcia RR, Scarioni M, Slachevsky A, Suarez-Gonzalez A, Tee BL, Tsoy E, Ulugut H, Babulal GM, Onyike CU. Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities-focused research. Alzheimers Dement 2023; 19:5817-5836. [PMID: 37270665 PMCID: PMC10693651 DOI: 10.1002/alz.13129] [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: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 06/05/2023]
Abstract
Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Karen Nuytemans
- John P. Hussman Institute for Human Genomics and Dr. John T. Macdonald Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, FL
| | - Renelle Bourdage
- Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Boulogne-Billancourt, France
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Ratnavalli Ellajosyula
- Manipal Hospitals, Bangalore and Annasawmy Mudaliar Hospital, Bangalore, India
- Manipal Academy of Higher Education (MAHE), India
| | - Elizabeth Finger
- Parkwood Institute Research, London, Ontario, Canada
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Samantha M. Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville VIC Australia 3050
- Department of Psychiatry, University of Melbourne, Parkville VIC Australia 3052
| | - Darby Morhardt
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Katya Rascovsky
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania Perelman School of Medicine
| | | | - Jennifer Yokoyama
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Iris Broce
- Department of Neurosciences, UC San Diego
- Department of Neurology, UC San Francisco
| | - Sheila Castro-Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Atlantic Senior Fellow for Equity in Brain Health at the University of California San Francisco, San Francisco, CA, 94115, USA
| | | | - Leonardo Cruz de Souza
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Sterre C. M. de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Jessica de Leon
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Shana Dodge
- The Association for Frontotemporal Degeneration
| | - Stephanie Grasso
- Speech, Language and Hearing Sciences, The University of Texas at Austin
| | - Veer Gupta
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3216, Australia
| | - Vivek Gupta
- Macquarie Medical school, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Nupur Ghoshal
- Depts. of Neurology and Psychiatry, Knight Alzheimer Disease Research Center, Washington University School of Medicine
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fiona Kumfor
- The University of Sydney, Brain & Mind Centre and the School of Psychology, Sydney, Australia
| | - Jordi A. Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Pauline Narme
- Laboratoire Mémoire Cerveau et Cognition (UR 7536), Institut de Psychologie, Université Paris Cité, Boulogne-Billancourt, France
| | - T. Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Okhuevbie
- Department of Cell Biology and Genetics, University of Lagos, Nigeria
- Department of Comparative Biosciences, University of Wisconsin-Madison, USA
| | - Stefanie D. Piña-Escudero
- Global Brain Health Institute at the Memory and Aging Center. University of California, San Francisco, USA
| | - Ramiro Ruiz Garcia
- Instituto Nacional de Neurología y Neurocirurgía Manuel Velasco Suárez, Mexico DF, Mexico
| | - Marta Scarioni
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Intitute of Biomedical Sciences (ICBM), Neurocience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit, Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Boon Lead Tee
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, United States
| | - Elena Tsoy
- Speech, Language and Hearing Sciences, The University of Texas at Austin
- Global Brain Health Institute, University of California San Francisco and Trinity College Dublin
| | - Hülya Ulugut
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Ganesh M. Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chiadi U. Onyike
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Szabo‐Reed AN, Hall T, Vidoni ED, Van Sciver A, Sewell M, Burns JM, Cullum CM, Gahan WP, Hynan LS, Kerwin DR, Rossetti H, Stowe AM, Vongpatanasin W, Zhu DC, Zhang R, Keller JN, Binder EF. Recruitment methods and yield rates for a multisite clinical trial exploring risk reduction for Alzheimer's disease (rrAD). ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12422. [PMID: 37841653 PMCID: PMC10576444 DOI: 10.1002/trc2.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The risk reduction for Alzheimer's disease (rrAD) trial was a multisite clinical trial to assess exercise and intensive vascular pharmacological treatment on cognitive function in community-dwelling older adults at increased risk for Alzheimer's disease. METHODS Eligibility, consent, and randomization rates across different referral sources were compared. Informal interviews conducted with each site's project team were conducted upon study completion. RESULTS Initially, 3290 individuals were screened, of whom 28% were eligible to consent, 805 consented to participate (87.2% of those eligible), and 513 (36.3% of those consented) were randomized. Emails sent from study site listservs/databases yielded the highest amount (20.9%) of screened individuals. Professional referrals from physicians yielded the greatest percentage of consented individuals (57.1%). Referrals from non-professional contacts (ie, friends, family; 75%) and mail/phone contact from a site (73.8%) had the highest yield of randomization. DISCUSSION Professional referrals or email from listservs/registries were most effective for enrolling participants. The greatest yield of eligible/randomized participants came from non-professional and mail/phone contacts. Future trials should consider special efforts targeting these recruitment approaches. Highlights Clinical trial recruitment is commonly cited as a significant barrier to advancing our understanding of cognitive health interventions.The most cited referral source was email, followed by interviews/editorials on the radio, television, local newspapers, newsletters, or magazine articles.The referral method that brought in the largest number of contacts was email but did not result in the greatest yield of consents or eligible participants.The sources that yielded the greatest likelihood of consent were professional referrals (ie, physician), social media, and mail/phone contact from study site.The greatest yield of eligible/randomized participants came from non-professional contacts and mail/phone contact from a site.Findings suggest that sites may need to focus on more selective referral sources, such as using contact mailing and phone lists, rather than more widely viewed recruitment sources, such as social media or TV/radio advertisements.
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Affiliation(s)
- Amanda N. Szabo‐Reed
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Tristyn Hall
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasUSA
| | - Eric D. Vidoni
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Angela Van Sciver
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
| | - Monica Sewell
- Department of Internal MedicineDivision of Geriatrics & Nutritional ScienceWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Jeffrey M. Burns
- KU Alzheimer's Disease Research Center, University of Kansas Medical CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - C. Munro Cullum
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
- Department of NeurologyUT Southwestern Medical CenterDallasTexasUSA
| | - William P. Gahan
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Linda S. Hynan
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Diana R. Kerwin
- Kerwin Research Center and Memory CareDallasTexasUSA
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Heidi Rossetti
- Department of PsychiatryUT Southwestern Medical CenterDallasTexasUSA
| | - Ann M. Stowe
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Wanpen Vongpatanasin
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - David C. Zhu
- Department for RadiologyMichigan State UniversityEast LansingMichiganUSA
| | - Rong Zhang
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasUSA
- Department of NeurologyUT Southwestern Medical CenterDallasTexasUSA
| | - Jeffrey N. Keller
- Institute for Dementia Research and PreventionPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Ellen F. Binder
- Department of Internal MedicineDivision of Geriatrics & Nutritional ScienceWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
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8
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Lim AC, Barnes LL, Weissberger GH, Lamar M, Nguyen AL, Fenton L, Herrera J, Han SD. Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:101. [PMID: 37491471 PMCID: PMC10368705 DOI: 10.1038/s43856-023-00333-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Racial and ethnic minoritized groups are disproportionately at risk for Alzheimer's Disease (AD), but are not sufficiently recruited in AD neuroimaging research in the United States. This is important as sample composition impacts generalizability of findings, biomarker cutoffs, and treatment effects. No studies have quantified the breadth of race/ethnicity representation in the AD literature. METHODS This review identified median race/ethnicity composition of AD neuroimaging US-based research samples available as free full-text articles on PubMed. Two types of published studies were analyzed: studies that directly report race/ethnicity data (i.e., direct studies), and studies that do not report race/ethnicity but used data from a cohort study/database that does report this information (i.e., indirect studies). RESULTS Direct studies (n = 719) have median representation of 88.9% white or 87.4% Non-Hispanic white, 7.3% Black/African American, and 3.4% Hispanic/Latino ethnicity, with 0% Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, Multiracial, and Other Race participants. Cohort studies/databases (n = 44) from which indirect studies (n = 1745) derived are more diverse, with median representation of 84.2% white, 83.7% Non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. Notably, 94% of indirect studies derive from just 10 cohort studies/databases. Comparisons of two time periods using a median split for publication year, 1994-2017 and 2018-2022, indicate that sample diversity has improved recently, particularly for Black/African American participants (3.39% from 1994-2017 and 8.29% from 2018-2022). CONCLUSIONS There is still underrepresentation of all minoritized groups relative to Census data, especially for Hispanic/Latino and Asian American individuals. The AD neuroimaging literature will benefit from increased representative recruitment of ethnic/racial minorities. More transparent reporting of race/ethnicity data is needed.
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Affiliation(s)
- Aaron C Lim
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gali H Weissberger
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Raman Gat, Israel
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Jennifer Herrera
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA.
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA.
- USC School of Gerontology, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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9
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Arce Rentería M, Mobley TM, Evangelista ND, Medina LD, Deters KD, Fox‐Fuller JT, Minto LR, Avila‐Rieger J, Bettcher BM. Representativeness of samples enrolled in Alzheimer's disease research centers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12450. [PMID: 37287650 PMCID: PMC10242202 DOI: 10.1002/dad2.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/16/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023]
Abstract
To generalize findings on the mechanisms and prognosis in Alzheimer's disease and related dementias (ADRD), it is critical for ADRD research to be representative of the population. Sociodemographic and health characteristics across ethnoracial groups included in the National Alzheimer's Coordinating Center sample (NACC) were compared to the nationally representative Health and Retirement Study (HRS). Baseline NACC data (n = 36,639) and the weighted 2010 HRS wave (N = 52,071,840) were included. We assessed covariate balance by calculating standardized mean differences across harmonized covariates (i.e., sociodemographic, health). NACC participants were older, more educated, with worse subjective memory and hearing, but endorsed fewer depressive symptoms compared to HRS participants. While all racial and ethnic groups in NACC differed from HRS participants in the same way overall, these differences were further amplified between racial and ethnic groups. NACC participants do not represent the U.S. population in key demographic and health factors, which differed by race and ethnicity. HIGHLIGHTS We examined selection factors included in NACC studies compared to a nationally representative sample.Selection factors included demographic and health factors and self-reported memory concerns.Results suggest that NACC participants are not representative of the U.S. population.Importantly, selection factors differed across racial and ethnic groups.Findings are suggestive of selection bias within NACC studies.
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Affiliation(s)
- Miguel Arce Rentería
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsColumbia University Medical CenterNew York CityNew YorkUSA
| | - Taylor M. Mobley
- Department of EpidemiologyUniversity of CaliforniaLos Angeles Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Nicole D. Evangelista
- Department of Clinical and Health Psychology, Center for Cognitive Aging and MemoryCollege of Public Health and Health Professions, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Luis D. Medina
- Department of PsychologyUniversity of HoustonHoustonTexasUSA
| | - Kacie D. Deters
- Department of Integrative Biology & PhysiologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Joshua T. Fox‐Fuller
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Lex R. Minto
- Department of PsychologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Justina Avila‐Rieger
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsColumbia University Medical CenterNew York CityNew YorkUSA
| | - Brianne M. Bettcher
- Behavioral Neurology SectionDepartment of NeurologyUniversity of Colorado Alzheimer's and Cognition CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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10
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Abstract
Recruitment of persons with dementia into research studies is essential to provide evidence for effective care and treatment. However, recruitment is known to be difficult for this population. The current integrative review was undertaken to synthesize evidence surrounding best practices for recruiting older adults with dementia into research. Fourteen studies were identified that examined recruitment strategies for persons with cognitive impairment over a 10-year time period. Most studies were retrospective and descriptive. Studies revealed three facilitators and three barriers for recruitment. Facilitators included community partnerships and trust, incentives, and use of multiple recruitment methods. Barriers included non-targeted recruitment methods, gatekeepers, and mistrust. Further studies, including randomized controlled trials, are needed to determine specific strategies that yield effective recruitment. Theoretically based recruitment strategies need to be defined and tested and the measures of recruitment efforts standardized to compare effectiveness and build a science of recruitment. [Research in Gerontological Nursing, 15(5), 255-264.].
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11
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Ejem D, Atkins GC, Perkins M, Morhardt DJ, Williams IC, Cothran FA, Epps F, Scott C, Mittelman M, Clay OJ. Stressors and Acceptability of Services Among Black Caregivers of Persons With Memory Problems. J Gerontol Nurs 2022; 48:13-18. [PMID: 35648582 DOI: 10.3928/00989134-20220505-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to identify stressors of Black family caregivers (FCGs) of persons with memory problems (PWMPs), services of interest, and barriers to use of these services. Black FCGs were recruited from the Alzheimer's family program at the University of Alabama at Birmingham and affiliated geriatric clinics, media sources, and word-of-mouth referrals. Of 38 Black FCGs interviewed, 26 (68%) were female, 18 (47%) were employed, and 21 (55%) were adult children. Average age of FCGs was 52.11 years. Mean scores for the AD8 Dementia Screening Scale (mean = 13.95, SD = 2.17) and Clinical Dementia Scale Sum of Boxes (mean = 7.29, SD = 0.87) were higher than clinical cutoffs. The most common stressors for Black FCGs were PWMPs' inability to remember who they were, managing care recipients' financial affairs, and managing PWMPs' comorbid conditions. FCGs were most interested in educational material regarding treatment and diagnosis (55.3%), caring for people with dementia (52.6%), understanding dementia (52.6%), and financial/legal services (52.6%). FCGs stated that transportation difficulties and the need for a relief person were barriers to use of services. Results suggest that Black FCGs may be more likely to participate in interventions that include virtual conferencing modalities. [Journal of Gerontological Nursing, 48(6), 13-18.].
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12
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Desaire H, Stepler KE, Robinson RAS. Exposing the Brain Proteomic Signatures of Alzheimer's Disease in Diverse Racial Groups: Leveraging Multiple Data Sets and Machine Learning. J Proteome Res 2022; 21:1095-1104. [PMID: 35276041 PMCID: PMC9097891 DOI: 10.1021/acs.jproteome.1c00966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Recent studies have highlighted that the proteome can be used to identify potential biomarker candidates for Alzheimer's disease (AD) in diverse cohorts. Furthermore, the racial and ethnic background of participants is an important factor to consider to ensure the effectiveness of potential biomarkers for representative populations. A promising approach to survey potential biomarker candidates for diagnosing AD in diverse cohorts is the application of machine learning to proteomics data sets. Herein, we leveraged six existing bottom-up proteomics data sets, which included non-Hispanic White, African American/Black, and Hispanic participants, to study protein changes in AD and cognitively unimpaired participants. Machine learning models were applied to these data sets and resulted in the identification of amyloid-β precursor protein (APP) and heat shock protein β-1 (HSPB1) as two proteins that have high ability to distinguish AD; however, each protein's performance varied based upon the racial and ethnic background of the participants. HSPB1 particularly was helpful for generating high areas under the curve (AUCs) for African American/Black participants. Overall, HSPB1 improved the performance of the machine learning models when combined with APP and/or participant age and is a potential candidate that should be further explored in AD biomarker discovery efforts.
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Affiliation(s)
- Heather Desaire
- Department of Chemistry, University of Kansas, Lawrence, Kansas 66045, United States
| | - Kaitlyn E. Stepler
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, United States
| | - Renã A. S. Robinson
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, United States
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN 37212, United States
- Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN 37232, United States
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN 37232, United States
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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13
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Li M, Kim H, Sereika SM, Nissley TJ, Lingler JH. Willingness to Participate in Clinical Research Among Individuals With Cognitive Impairment. Res Gerontol Nurs 2022; 15:76-84. [PMID: 35148207 PMCID: PMC9341492 DOI: 10.3928/19404921-20220131-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This secondary analysis examined (1) factors associated with willingness to participate in clinical research for cognitive health among individuals with cognitive impairment and their care partners, and (2) concordance regarding such willingness between individuals with cognitive impairment and their care partners (dyads). Neuropsychological factors and willingness to participate in clinical research were collected using self-reported questionnaires. Participants' sociodemographic and clinical information was extracted from the University of Pittsburgh Alzheimer's Disease Research Center record. Binary logistic regression and Cohen's kappa coefficient analyses were performed. Greater trust in medical researchers (p = 0.031, B = 0.127) and more severe cognitive impairment (p = 0.009, B = -0.289) were associated with willingness to participate in clinical research among individuals with cognitive impairment. Dyadic agreement on willingness to have the individual with cognitive impairment enroll in clinical research was poor to fair (κ = 0.380). Findings suggest that individuals with cognitive impairment with greater trust in health professionals are more likely to agree to clinical research participation. Nurses and other health care providers who counsel individuals with cognitive impairment and their care partners should work to build trusting relationships with participants and be mindful of how increased trust can alter power dynamics between participants and health care professionals. [Research in Gerontological Nursing, 15(2), 76-84.].
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Affiliation(s)
- Mengchi Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Hyejin Kim
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Susan M. Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Sewell MC, Neugroschl J, Umpierre M, Chin S, Zhu CW, Velasco N, Gonzalez S, Acabá-Berrocal A, Bianchetti L, Silva G, Collazo A, Sano M. Research Attitudes and Interest Among Elderly Latinxs: The Impact of a Collaborative Video and Community Peers. J Alzheimers Dis 2021; 82:771-779. [PMID: 34092634 DOI: 10.3233/jad-210027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research. OBJECTIVE To assess the impact of a composite intervention on attitudes toward research and research participation among elderly Latinx. The intervention was a collaboratively produced research participation video shown during presentations with our elderly community advisory board (CAB) as co-presenters. METHODS The video was created by the ADRC and CAB. All senior center attendees were eligible to participate. Afterwards, the Research Attitudes Questionnaire (RAQ) and a brief questionnaire on the impact of the video were administered. Using Wilcoxon Rank Sum Tests, Chi Square, and OLS regressions, RAQ responses were compared to those from a historical cohort from similar centers. RESULTS 74 in the "Historical Cohort 1" and 104 in "Intervention Cohort 2" were included. RAQ total score was higher in Cohort 2 than Cohort 1 (28.5 versus 26.1, p < 0.05) after controlling for age, education, and country of origin. In response to the question "Has the video influenced your willingness and interest to participate in research", 88.7%of the participants in Cohort 2 reported being "more" or "much more" interested in research. CONCLUSION Tailoring community research recruitment programs to include relatable peers using novel recruitment techniques may have positive implications for improving enrollment of diverse elderly individuals in research.
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Affiliation(s)
- Margaret C Sewell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Neugroschl
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mari Umpierre
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shehan Chin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn W Zhu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, James J. Peters VAMC, Bronx, NY, USA
| | - Nelly Velasco
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sabrina Gonzalez
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Gabriela Silva
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alma Collazo
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, James J. Peters VAMC, Bronx, NY, USA
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15
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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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16
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Julbe-Delgado D, O'Brien JL, Abdulkarim R, Hudak EM, Maeda H, Edwards JD. Quantifying Recruitment Source and Participant Communication Preferences for Alzheimer's Disease Prevention Research. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2021; 8:299-305. [PMID: 34101787 DOI: 10.14283/jpad.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence on effective engagement of diverse participants in AD prevention research is lacking. OBJECTIVES To quantify recruitment source in relation to race, ethnicity, and retention. DESIGN Prospective cohort study. SETTING University lab. PARTICIPANTS Participants included older adults (N=1170) who identified as White (86%), Black (8%), and Hispanic/Latino ethnicity (6%). MEASUREMENTS The Cognitive Aging Lab Marketing Questionnaire assessed recruitment source, social media use, and research opportunity communication preferences. RESULTS Effective recruitment methods and communication preferences vary by race and ethnicity. The most common referral sources were postcards for racial minorities, friend/family referrals for Hispanic/Latinos, and the newspaper for Whites. Whereas Whites preferred email communications, Hispanic/Latinos preferred texts. CONCLUSIONS Recruiting diverse samples in AD prevention research is clinically relevant given high AD-risk of minorities and that health disparities are propagated by their under-representation in research. Our questionnaire and these results may be applied to facilitate effective research engagement.
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Affiliation(s)
- D Julbe-Delgado
- Jerri D. Edwards, University of South Florida, 3515 E. Fletcher Ave, MDT 200, Tampa, FL 33613, USA, Telephone: (813) 974-6703; Fax (813) 974-2882,
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17
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Comparing fluid biomarkers of Alzheimer's disease between African American or Black African and white groups: A systematic review and meta-analysis. J Neurol Sci 2020; 421:117270. [PMID: 33349466 DOI: 10.1016/j.jns.2020.117270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE Biomarker research for Alzheimer's disease (AD) has grown rapidly in recent years, ensuing the integration of the AD fluid biomarker profile: Aβ1-42, t-tau, and p-tau181, into clinical and research criteria. However, current insights of AD arise almost exclusively from studies on white individuals. Some studies have revealed that epidemiology, clinical features, and genetics of AD show variations between individuals from black and white backgrounds, conveying the importance of ethnoracial differences, and the possibility of such differences also influencing AD biomarker levels. This systematic review explored whether AD fluid biomarker levels differ between African American (AA) or Black African and white groups. AIM To compare AD fluid biomarkers (Aβ1-42, p-tau181, and t-tau) levels between AA or Black Africans and white individuals. METHOD PubMed, Scopus, and other sources were explored for studies that quantified AD biomarkers in biological fluid from whites and AA or Black African groups. Meta-analyses were performed to find the standardized mean difference for biomarkers that were quantified in ≥3 studies. RESULTS Five studies were included; studies on Black Africans were not found. The meta-analyses found CSF t-tau and p-tau181 were consistently lower in AA than white individuals, in samples with normal cognition or with mild cognitive impairment/dementia. CONCLUSIONS The meta-analyses found significant differences for CSF tau between AA and white individuals with normal cognition and within the dementia spectrum, expressing the importance of taking into account ethnoracial factors when interpreting CSF AD biomarkers levels. However, the generalisability of these differences is restricted by small samples' size, lack of unified methodologies and recruitment's biases within studies; further large multicentre studies with harmonized protocols and sufficient power are imperative to investigate the extent of ethnoracial differences across the spectrum of cognitive decline, with vaster efforts necessary to diversify recruitment.
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18
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Denny A, Streitz M, Stock K, Balls-Berry JE, Barnes LL, Byrd GS, Croff R, Gao S, Glover CM, Hendrie HC, Hu WT, Manly JJ, Moulder KL, Stark S, Thomas SB, Whitmer R, Wong R, Morris JC, Lingler JH. Perspective on the "African American participation in Alzheimer disease research: Effective strategies" workshop, 2018. Alzheimers Dement 2020; 16:1734-1744. [PMID: 33034414 PMCID: PMC7887120 DOI: 10.1002/alz.12160] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022]
Abstract
The Washington University School of Medicine Knight Alzheimer Disease Research Center's "African American Participation in Alzheimer Disease Research: Effective Strategies" Workshop convened to address a major limitation of the ongoing scientific progress regarding Alzheimer's disease and related dementias (ADRD): participants in most ADRD research programs overwhelmingly have been limited to non-Hispanic white persons, thus precluding knowledge as to how ADRD may be represented in non-white individuals. Factors that may contribute to successful recruitment and retention of African Americans into ADRD research were discussed and organized into actionable next steps as described within this report.
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Affiliation(s)
- Andrea Denny
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Marissa Streitz
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kristin Stock
- Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Joyce E Balls-Berry
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Raina Croff
- Layton Aging & Alzheimer's Disease Center, Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Hugh C Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jennifer J Manly
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Krista L Moulder
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Susan Stark
- Department of Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Stephen B Thomas
- Maryland Center for Health Equity, University of Maryland College Park, College Park, Maryland, USA
| | - Rachel Whitmer
- Alzheimer's Disease Research Center, UC Davis School of Medicine, Sacramento, California, USA
| | - Roger Wong
- Public Health Sciences Brown School, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center, Harvey A & Dorismae Hacker Friedman Distinguished Professor of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jennifer H Lingler
- School of Nursing and Alzheimer's Disease Research Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Stepler KE, Mahoney ER, Kofler J, Hohman TJ, Lopez OL, Robinson RAS. Inclusion of African American/Black adults in a pilot brain proteomics study of Alzheimer's disease. Neurobiol Dis 2020; 146:105129. [PMID: 33049317 PMCID: PMC7990397 DOI: 10.1016/j.nbd.2020.105129] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease (AD) disproportionately affects certain racial and ethnic subgroups, such as African American/Black and Hispanic adults. Genetic, comorbid, and socioeconomic risk factors contribute to this disparity; however, the molecular contributions have been largely unexplored. Herein, we conducted a pilot proteomics study of postmortem brains from African American/Black and non-Hispanic White adults neuropathologically diagnosed with AD compared to closely-matched cognitively normal individuals. Examination of hippocampus, inferior parietal lobule, and globus pallidus regions using quantitative proteomics resulted in 568 differentially-expressed proteins in AD. These proteins were consistent with the literature and included glial fibrillary acidic protein, peroxiredoxin-1, and annexin A5. In addition, 351 novel proteins in AD were identified, which could partially be due to cohort diversity. From linear regression analyses, we identified 185 proteins with significant race x diagnosis interactions across various brain regions. These differences generally were reflective of differential expression of proteins in AD that occurred in only a single racial/ethnic group. Overall, this pilot study suggests that disease understanding can be furthered by including diversity in racial/ethnic groups; however, this must be done on a larger scale.
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Affiliation(s)
- Kaitlyn E Stepler
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, United States of America
| | - Emily R Mahoney
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN 37212, United States of America; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - Julia Kofler
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States of America
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN 37212, United States of America; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America; Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, United States of America; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, United States of America
| | - Renã A S Robinson
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, United States of America; Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN 37212, United States of America; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America; Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America; Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN 37232, United States of America.
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20
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Brewster GS, Bonds K, McLennon S, Moss KO, Epps F, Lopez RP. Missing the Mark: The Complexity of African American Dementia Family Caregiving. JOURNAL OF FAMILY NURSING 2020; 26:294-301. [PMID: 32757815 PMCID: PMC7721986 DOI: 10.1177/1074840720945329] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Alzheimer's disease and related dementias (ADRDs) have a significant impact on families. Family nurses are in an ideal position to address the needs of families affected by ADRD. However, to be most effective, family nurses and researchers need culturally appropriate theories to guide practice and research. On November 17, 2018, five nurse researchers presented findings of their research with African American families at the Gerontological Society of America's annual meeting. The results reported and the lively discussion that ensued suggested that the current paradigms framing research and practice with African American families affected by ADRD may not be adequate. There is a need to consider culturally congruent, family-centered theories to guide research and practice with this population of families.
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Affiliation(s)
| | - Kalisha Bonds
- Emory University, Atlanta, GA, USA
- Oregon Health & Science University, Portland, USA
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21
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Bardach SH, Barber JM, Schmitt FA, Van Eldik LJ, Boggess MB, Yarbrough M, Jones KC, Jicha GA. The Effectiveness of Community-based Outreach Events for the Promotion of African American Research Participation. Alzheimer Dis Assoc Disord 2020; 34:344-349. [PMID: 32809985 PMCID: PMC7677178 DOI: 10.1097/wad.0000000000000404] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION African Americans (AA) are disproportionately affected by Alzheimer's disease and related dementias yet are under-represented in clinical research. Outreach events for AA are offered to encourage research participation; however, this approach's effectiveness remains largely unexplored. METHODS To explore the effectiveness of AA-focused versus general audience events, the authors examined attendance data over 5 years, encompassing 10 general audience events and 4 events focused on AA. For each individual, the authors searched center records for recruitment contacts and research enrollment. Summary scores for attendance at AA-focused events, general audience events, and total events were compared between those with and without research involvement. RESULTS Out of 773 unique AA that attended ≥1 event, 88 became or were involved in research (11.4% engagement). AA-focused events achieved greater AA attendance than general audience events. Although research-engaged individuals were more likely to have ever attended an AA-focused event than a general audience event, attendance at AA-focused events did not statistically relate to research engagement. In contrast, attendance at events focused on the general public was related to an increased likelihood of research participation. DISCUSSION These findings have important implications for designing and implementing community events to encourage AA research participation.
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Affiliation(s)
- Shoshana H Bardach
- Sanders-Brown Center on Aging
- Graduate Center for Gerontology, College of Public Health
| | | | | | - Linda J Van Eldik
- Sanders-Brown Center on Aging
- Neuroscience, College of Medicine, University of Kentucky, Lexington, KY
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22
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Stout SH, Babulal GM, Johnson AM, Williams MM, Roe CM. Recruitment of African American and Non-Hispanic White Older Adults for Alzheimer Disease Research Via Traditional and Social Media: a Case Study. J Cross Cult Gerontol 2020; 35:329-339. [PMID: 32712751 PMCID: PMC7418860 DOI: 10.1007/s10823-020-09405-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The increasing prevalence of Alzheimer disease (AD), higher risk among certain ethnoracial groups, and lack of effective therapies highlights the need to recruit and enroll diverse populations in prospective, observational studies and clinical trials. However, there is little known about the effectiveness of traditional media vs. social media outreach on recruitment in aging study studies. This study retrospectively examined the effectiveness and differences in using both traditional and social media materials for the recruitment of African American (AA) versus non-Hispanic white (NHW) participants for a prospective, longitudinal study examining preclinical AD and driving outcomes. Participants needed to be at least 65 years old, drive at least an average of once weekly, own a vehicle that was manufactured in 1996 or later, and agree to cognitive testing, psychometric testing, brain magnetic resonance imaging (MRI), brain amyloid positron emission tomography (PET), and cerebrospinal fluid collection via lumbar puncture. A total of 546 individuals contacted the study coordinator by phone or email. Of those individuals, 97 enrolled and 192 were not contacted secondary to filling enrollment capacity. Sixteen participants (16.5%) were AA and the remainder were NHW. Of the 354 individuals whom the coordinator contacted back, approximately 73% declined or did not return calls. Social media was more effective with recruiting NHW participants, while traditional advertisement (newspaper) was more successful in recruiting AA participants in this urban setting. Prospective studies should balance participant burden and enrollment with a targeted, multi-tiered recruitment plan and sufficient budget to reach the population of interest.
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Affiliation(s)
- Sarah H Stout
- Knight Alzheimer's Disease Research Center, 4488 Forest Park Blvd, Saint Louis, MO, 63108, USA.
- Department of Neurology, Saint Louis, MO, USA.
| | - Ganesh M Babulal
- Knight Alzheimer's Disease Research Center, 4488 Forest Park Blvd, Saint Louis, MO, 63108, USA
- Department of Neurology, Saint Louis, MO, USA
| | - Ann M Johnson
- Center for Clinical Studies, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Catherine M Roe
- Knight Alzheimer's Disease Research Center, 4488 Forest Park Blvd, Saint Louis, MO, 63108, USA
- Department of Neurology, Saint Louis, MO, USA
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23
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Olson NL, Albensi BC. Race- and Sex-Based Disparities in Alzheimer's Disease Clinical Trial Enrollment in the United States and Canada: An Indigenous Perspective. J Alzheimers Dis Rep 2020; 4:325-344. [PMID: 33024940 PMCID: PMC7504979 DOI: 10.3233/adr-200214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Randomized clinical trials (RCT) involve labor-intensive, highly regulated, and controlled processes intended to transform scientific concepts into clinical outcomes. To be effective and targeted, it is imperative they include those populations who would most benefit from those outcomes. Alzheimer's disease (AD) is most detrimental to the aging population, and its clinical manifestation is influenced by socio-economic factors such as poverty, poor education, stress, and chronic co-morbidities. Indigenous populations in the United States and Canada are among the minority populations most influenced by poor socio-economic conditions and are prone to the ravages of AD, with Indigenous women carrying the added burden of exposure to violence, caregiving stresses, and increased risk by virtue of their sex. Race- and sex-based disparities in RCT enrollment has occurred for decades, with Indigenous men and women very poorly represented. In this review, we examined literature from the last twenty years that reinforce these disparities and provide some concrete suggestions and guidelines to increase the enrollment numbers in AD RCT among this vulnerable and poorly represented population.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
- Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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24
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Powell WR, Buckingham WR, Larson JL, Vilen L, Yu M, Salamat MS, Bendlin BB, Rissman RA, Kind AJH. Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology. JAMA Netw Open 2020; 3:e207559. [PMID: 32525547 PMCID: PMC7290421 DOI: 10.1001/jamanetworkopen.2020.7559] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022] Open
Abstract
Importance Social determinants of health, such as income, education, housing quality, and employment, are associated with disparities in Alzheimer disease and health generally, yet these determinants are rarely incorporated within neuropathology research. Objective To establish the feasibility of linking neuropathology data to social determinants of health exposures using neighborhood disadvantage metrics (the validated Area Deprivation Index) and to evaluate the association between neighborhood disadvantage and Alzheimer disease-related neuropathology. Design, Setting, and Participants This cross-sectional study consisted of decedents with a known home address who donated their brains to 1 of 2 Alzheimer disease research center brain banks in California and Wisconsin between January 1, 1990, and December 31, 2016. Neither site had preexisting social metrics available for their decedents. Neuropathologic features were obtained from each site for data collected using the standardized Neuropathology Data Set form and from autopsy reports. Data were analyzed from June 7 to October 10, 2019. Exposures Geocoded decedent addresses linked to neighborhood disadvantage as measured by the Area Deprivation Index calculated for the year of death. Main Outcomes and Measures Presence of Alzheimer disease neuropathology. The association between neighborhood disadvantage and Alzheimer disease neuropathology was evaluated via logistic regression, adjusting for age, sex, and year of death. Results The sample consisted of 447 decedents (249 men [56%]; mean [SD] age, 80.3 [9.5] years; median year of death, 2011) spanning 24 years of donation. Fewer decedents (n = 24 [5.4%]) originated from the top 20% most disadvantaged neighborhood contexts. Increasing neighborhood disadvantage was associated with an 8.1% increase in the odds of Alzheimer disease neuropathology for every decile change on the Area Deprivation Index (adjusted odds ratio, 1.08; 95% CI, 1.07-1.09). As such, living in the most disadvantaged neighborhood decile was associated with a 2.18 increased odds of Alzheimer disease neuropathology (adjusted odds ratio, 2.18; 95% CI, 1.99-2.39). Conclusions and Relevance The findings of this cross-sectional study suggest that social determinants of health data can be linked to preexisting autopsy samples as a means to study sociobiological mechanisms involved in neuropathology. This novel technique has the potential to be applied to any brain bank within the United States. To our knowledge, this is the first time Alzheimer disease neuropathology has been associated with neighborhood disadvantage.
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Affiliation(s)
- W. Ryan Powell
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - William R. Buckingham
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jamie L. Larson
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Leigha Vilen
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Menggang Yu
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison
| | - M. Shahriar Salamat
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara B. Bendlin
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison
| | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego
- Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla
| | - Amy J. H. Kind
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin
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25
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Bardach SH, Parsons K, Gibson A, Jicha GA. "From Victimhood to Warriors": Super-researchers' Insights Into Alzheimer's Disease Clinical Trial Participation Motivations. THE GERONTOLOGIST 2020; 60:693-703. [PMID: 31322657 DOI: 10.1093/geront/gnz096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recruitment and retention of research participant serve as a significant challenge in the search for ways to slow or prevent Alzheimer's disease. While barriers to participation are well documented, less is known about motivations for Alzheimer's disease clinical research participation. The purpose of this study was to explore what motivates individuals-who ultimately develop an ongoing connection to research and frequently participate-to engage and stay involved in Alzheimer's disease research. RESEARCH DESIGN AND METHODS Individuals who had participated in multiple Alzheimer's disease-related clinical trials, or their study partners, were interviewed about their decisions to engage and remain in research. FINDINGS Interviews were completed with 33 individuals, 28 research participants, and 5 study partners. All interviews were audio-recorded and transcribed verbatim for analysis. Respondents indicated learning about research opportunities through the media, community events, doctors, and other research participants. While many were initially motivated by a family history or knowing someone with Alzheimer's disease, others had no personal exposure. Individuals in prevention studies were generally proactive and viewed research as a constructive way to address memory concerns. While several individuals acknowledged personal benefits of research participation, most indicated an understanding of the importance of research and being motivated to help others in the future, frequently referencing a sense of social responsibility or moral obligation to help. Positive relationships with personnel at the site encouraged continued involvement. DISCUSSION AND IMPLICATIONS These findings suggest that efforts to identify research participants should highlight the value of research and help illuminate how participation may contribute to well-being of future generations.
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Affiliation(s)
- Shoshana H Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,College of Public Health, University of Kentucky, Lexington
| | - Kelly Parsons
- Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Allison Gibson
- College of Social Work, University of Kentucky, Lexington
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington.,College of Medicine, University of Kentucky, Lexington
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26
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Salazar CR, Hoang D, Gillen DL, Grill JD. Racial and ethnic differences in older adults' willingness to be contacted about Alzheimer's disease research participation. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12023. [PMID: 32399482 PMCID: PMC7207155 DOI: 10.1002/trc2.12023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We sought to examine the association of race/ethnicity with willingness to engage in studies that involve procedures typical of Alzheimer's disease (AD) clinical trials and determine whether any observed differences could be explained by research attitudes. METHODS We studied 2749 adults aged ≥50 years who enrolled in a community-based recruitment registry. RESULTS Compared to non-Hispanic (NH) whites (n = 2393, 87%), Hispanics (n = 191, 7%), NH Asians (n = 129, 5%) and NH blacks (n = 36, 1%) were 44%, 46%, and 64% less willing, respectively, to be contacted for studies that have requirements typical of AD prevention trials, namely: cognitive testing, brain imaging, blood draws, and investigational medications. Mediation by research attitudes was explored, but did not explain the observed differences. DISCUSSION Our findings suggest that ethnoracial minorities are less willing to engage in studies that are typical of AD prevention trials. Future work should focus on understanding the factors that drive these differences.
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Affiliation(s)
- Christian R. Salazar
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
| | - Dan Hoang
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
| | - Daniel L. Gillen
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Joshua D. Grill
- UC Irvine 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
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27
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Kikut A, Vaughn M, Salowe R, Sanyal M, Merriam S, Lee R, Becker E, Lomax-Reese S, Lewis M, Ryan R, Ross A, Cui QN, Addis V, Sankar PS, Miller-Ellis E, Cannuscio C, O'Brien J. Evaluation of a multimedia marketing campaign to engage African American patients in glaucoma screening. Prev Med Rep 2020; 17:101057. [PMID: 32025476 PMCID: PMC6997297 DOI: 10.1016/j.pmedr.2020.101057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/23/2019] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
Our objective was to determine which messaging approaches from a marketing campaign were most effective in recruiting African American individuals to a glaucoma screening and research study. We conducted a multimedia marketing campaign in Philadelphia from 01/31/2018 to 06/30/2018. Messaging approaches included radio advertisements and interviews (conducted in partnership with a local radio station with a large African American listener base), print materials, event tables, and online postings. Participants received free glaucoma screenings and the opportunity to enroll in our glaucoma genetics study. These screenings allowed individuals with glaucoma to receive a full examination and treatment plan with a glaucoma specialist, as well as to contribute to future efforts to identify genetic variants underlying this disease. We compared inquiry, enrollment, and cost yield for each messaging approach. Our campaign resulted in 154 unique inquiries, with 98 patients receiving glaucoma screenings (64%) and 60 patients enrolling in our study (39%). Commercials on WURD radio yielded the highest number of inquiries (62%) and enrollments (62%), but at relatively high cost ($814/enrolled patient). The most inexpensive approach that yielded more than five enrollments was postcards ($429/enrolled patient). Our campaign suggests that high-frequency commercials and postcards distributed at targeted healthcare locations are particularly effective and affordable options for connecting with the African American community. Our findings can help to inform recruitment efforts for other understudied diseases in minority populations.
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Affiliation(s)
- Ava Kikut
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Marquis Vaughn
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohima Sanyal
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayaka Merriam
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Becker
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Ahmara Ross
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N. Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi S. Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carolyn Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
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28
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Gilmore-Bykovskyi AL, Jin Y, Gleason C, Flowers-Benton S, Block LM, Dilworth-Anderson P, Barnes LL, Shah MN, Zuelsdorff M. Recruitment and retention of underrepresented populations in Alzheimer's disease research: A systematic review. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:751-770. [PMID: 31921966 PMCID: PMC6944728 DOI: 10.1016/j.trci.2019.09.018] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Alzheimer's disease and related dementias (ADRD) disproportionately impact racial and ethnic minority and socioeconomically disadvantaged adults. Yet, these populations are significantly underrepresented in research. METHODS We systematically reviewed the literature for published reports describing recruitment and retention of individuals from underrepresented backgrounds in ADRD research or underrepresented participants' perspectives regarding ADRD research participation. Relevant evidence was synthesized and evaluated for quality. RESULTS We identified 22 eligible studies. Seven studies focused on recruitment/retention approaches, all of which included multifaceted efforts and at least one community outreach component. There was considerable heterogeneity in approaches used, specific activities and strategies, outcome measurement, and conclusions regarding effectiveness. Despite limited use of prospective evaluation strategies, most authors reported improvements in diverse representation in ADRD cohorts. Studies evaluating participant views focused largely on predetermined explanations of participation including attitudes, barriers/facilitators, education, trust, and religiosity. Across all studies, the strength of evidence was low. DISCUSSION Overall, the quantity and quality of available evidence to inform best practices in recruitment, retention, and inclusion of underrepresented populations in ADRD research are low. Further efforts to systematically evaluate the success of existing and emergent approaches will require improved methodological standards and uniform measures for evaluating recruitment, participation, and inclusivity.
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Affiliation(s)
- Andrea L. Gilmore-Bykovskyi
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Yuanyuan Jin
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Carey Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Flowers-Benton
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Laura M. Block
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Peggye Dilworth-Anderson
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Manish N. Shah
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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29
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Cronin RM, Jerome RN, Mapes B, Andrade R, Johnston R, Ayala J, Schlundt D, Bonnet K, Kripalani S, Goggins K, Wallston KA, Couper MP, Ellitt MR, Harris P, Begale M, Munoz F, Lopez-Class M, Cella D, Condon D, AuYoung M, Mazor KM, Mikita S, Manganiello M, Borselli N, Fowler S, Rutter JL, Denny JC, Karlson EW, Ahmedani BK, O’Donnell C. Development of the Initial Surveys for the All of Us Research Program. Epidemiology 2019; 30:597-608. [PMID: 31045611 PMCID: PMC6548672 DOI: 10.1097/ede.0000000000001028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these information sources. We report the process used to develop and refine the initial three surveys for this program. METHODS The All of Us survey development process included: (1) prioritization of domains for scientific needs, (2) examination of existing validated instruments, (3) content creation, (4) evaluation and refinement via cognitive interviews and online testing, (5) content review by key stakeholders, and (6) launch in the All of Us electronic participant portal. All content was translated into Spanish. RESULTS We conducted cognitive interviews in English and Spanish with 169 participants, and 573 individuals completed online testing. Feedback led to over 40 item content changes. Lessons learned included: (1) validated survey instruments performed well in diverse populations reflective of All of Us; (2) parallel evaluation of multiple languages can ensure optimal survey deployment; (3) recruitment challenges in diverse populations required multiple strategies; and (4) key stakeholders improved integration of surveys into larger Program context. CONCLUSIONS This efficient, iterative process led to successful testing, refinement, and launch of three All of Us surveys. Reuse of All of Us surveys, available at http://researchallofus.org, may facilitate large consortia targeting diverse populations in English and Spanish to capture participant-provided information to supplement other data, such as genetic, physical measurements, or data from electronic health records.
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Affiliation(s)
- Robert M. Cronin
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca N. Jerome
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandy Mapes
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Regina Andrade
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Johnston
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Ayala
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth A. Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mick P. Couper
- Survey Research Center, University of Michigan. Ann Arbor, MI, USA
- Joint Program in Survey Methodology, University of Maryland, College Park, MD, USA
| | - Michael R. Ellitt
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Paul Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fatima Munoz
- Department of Research and Health Promotion, San Ysidro Health, San Diego, California, USA
| | - Maria Lopez-Class
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Condon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California, United States
| | | | - Steve Mikita
- Spinal Muscular Atrophy Foundation, New York, New York, United States of America
| | | | | | - Stephanie Fowler
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joni L. Rutter
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joshua C. Denny
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth W. Karlson
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Section of Clinical Sciences, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Chris O’Donnell
- Cardiology Section, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wong R, Amano T, Lin SY, Zhou Y, Morrow-Howell N. Strategies for the Recruitment and Retention of Racial/Ethnic Minorities in Alzheimer Disease and Dementia Clinical Research. Curr Alzheimer Res 2019; 16:458-471. [DOI: 10.2174/1567205016666190321161901] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 02/07/2023]
Abstract
Background:Racial/ethnic minorities have among the highest risks for Alzheimer disease and dementia, but remain underrepresented in clinical research studies.Objective:To synthesize the current evidence on strategies to recruit and retain racial/ethnic minorities in Alzheimer disease and dementia clinical research.Methods:We conducted a systematic review by searching CINAHL, EMBASE, MEDLINE, PsycINFO, and Scopus. We included studies that met four criteria: (1) included a racial/ethnic minority group (African American, Latino, Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander); (2) implemented a recruitment or retention strategy for Alzheimer disease or dementia clinical research; (3) conducted within the U.S.; and (4) published in a peer-reviewed journal.Results:Of the 19 included studies, 14 (73.7%) implemented recruitment strategies and 5 (26.3%) implemented both recruitment and retention strategies. Fifteen studies (78.9%) focused on African Americans, two (10.6%) on both African Americans and Latinos, and two (10.5%) on Asians. All the articles were rated weak in the study quality. Four major themes were identified for the recruitment strategies: community outreach (94.7%), advertisement (57.9%), collaboration with health care providers (42.1%), and referral (21.1%). Three major themes were identified for the retention strategies: follow-up communication (15.8%), maintain community relationship (15.8%), and convenience (10.5%).Conclusion:Our findings highlight several promising recruitment and retention strategies that investigators should prioritize when allocating limited resources, however, additional well-designed studies are needed. By recruiting and retaining more racial/ethnic minorities in Alzheimer disease and dementia research, investigators may better understand the heterogeneity of disease progression among marginalized groups. PROSPERO registration #CRD42018081979.
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Affiliation(s)
- Roger Wong
- Brown School, Washington University in St. Louis, Saint Louis, MO, United States
| | - Takashi Amano
- Brown School, Washington University in St. Louis, Saint Louis, MO, United States
| | - Shih-Yin Lin
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yuanjin Zhou
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Nancy Morrow-Howell
- Brown School, Washington University in St. Louis, Saint Louis, MO, United States
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Askari N, Bilbrey AC, Garcia Ruiz I, Humber MB, Gallagher-Thompson D. Dementia Awareness Campaign in the Latino Community: A Novel Community Engagement Pilot Training Program with Promotoras. Clin Gerontol 2018; 41:200-208. [PMID: 29240536 PMCID: PMC5935246 DOI: 10.1080/07317115.2017.1398799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To create a curriculum about Alzheimer's disease and dementia, and to train Promotoras affiliated with a local community education and health advocacy organization, in order to raise awareness and knowledge of what dementia is, and how it can be recognized, in persons of Hispanic/Latino descent. METHODS Community based participatory research (CPBR) model was used to create materials, implement training, and engage/empower Promotoras to educate the local community. RESULTS Pre-post findings indicated a positive learning experience for the Promotoras and willingness to share new dementia information with their community. One year post-evaluative survey with a subset showed outreach to an average of 15-25 community members, indicating positive reception of this new information. CONCLUSIONS CPBR model is a successful education and outreach tool with Latino communities. Our Dementia Awareness Campaign was a success with the first 20 Promotoras trained; at present we plan to train additional groups in nearby communities with significant Hispanic/Latino populations. CLINICAL IMPLICATIONS In order to get Latinos to seek early detection, we need to first educate them about dementia, win trust, and encourage treatment-seeking. Early intervention, diagnosis, and prevention will benefit from educational campaigns using the CBPR model.
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Affiliation(s)
- Nusha Askari
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA.,b Department of Neurology , Stanford University , Palo Alto , California , USA
| | - Ann Choryan Bilbrey
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University , Palo Alto , California , USA
| | - Iliana Garcia Ruiz
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University , Palo Alto , California , USA.,d Nuestra Casa , Palo Alto , California , USA
| | - Marika Blair Humber
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA.,e Palo Alto University , Palo Alto , CA , USA
| | - Dolores Gallagher-Thompson
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University , Palo Alto , California , USA
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Babulal GM, Williams MM, Stout SH, Roe CM. Driving Outcomes among Older Adults: A Systematic Review on Racial and Ethnic Differences over 20 Years. Geriatrics (Basel) 2018; 3. [PMID: 29657944 PMCID: PMC5896559 DOI: 10.3390/geriatrics3010012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The population of older adults (aged 65 years and older) in the United States will become more racially and ethnically diverse in the next three decades. Additionally, the growth of the aging population will come with an expansion in the number of older drivers and an increased prevalence of chronic neurological conditions. A major gap in the aging literature is an almost exclusive focus on homogenous, non-Hispanic white samples of older adults. It is unclear if this extends to the driving literature. A systematic review of SCOPUS, PubMed, CINAHL Plus, and Web of Science examined articles on driving and racial/ethnic differences among older adults. Eighteen studies met inclusion criteria and their results indicate that racial and ethnic minorities face a greater risk for driving reduction, mobility restriction, and driving cessation. The majority of studies compared African Americans to non-Hispanic whites but only examined race as a covariate. Only four studies explicitly examined racial/ethnic differences. Future research in aging and driving research needs to be more inclusive and actively involve different racial/ethnic groups in study design and analysis.
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Affiliation(s)
- Ganesh M. Babulal
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.H.S.); (C.M.R.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Correspondence: ; Tel.: +1-(952)-334-8536
| | | | - Sarah H. Stout
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.H.S.); (C.M.R.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Catherine M. Roe
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.H.S.); (C.M.R.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Boada M, Santos-Santos MA, Rodríguez-Gómez O, Alegret M, Cañabate P, Lafuente A, Abdelnour C, Buendía M, de Dios MJ, Morera A, Sanabria Á, Campo L, Ruiz A, Tárraga L. Patient Engagement: The Fundació ACE Framework for Improving Recruitment and Retention in Alzheimer's Disease Research. J Alzheimers Dis 2018; 62:1079-1090. [PMID: 29562541 PMCID: PMC5870013 DOI: 10.3233/jad-170866] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 01/06/2023]
Abstract
Alzheimer's disease (AD) research is at a critical time. The global society is increasingly aware of the frightening rate of growth of the human and financial burden caused by this condition and of the urgent need to halt its progression. Consequently, the scientific community holds great responsibility to quickly put in place and optimize the machinery necessary for testing new treatments or interventions. In this context demand for participants for AD research is at an all-time high. In this review, we will focus on a methodological factor that is increasingly recognized as a key factor that shapes trial populations and affects validity of results in clinical trials: patient engagement, recruitment, and retention. We outline specific problems relevant to patient engagement in AD including recruiting enough participants, difficulties in participant retention, ensuring the recruited sample is representative of the general AD population, the burden of screening failures, and new challenges related to recruiting in preclinical disease. To address the urgent need for more research studying the applicability and cost-effectiveness of different recruitment strategies across different settings and nationalities, we describe the Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project, a public-private partnership promoted by the Innovative Medicine Initiative (IMI), which will provide a large multinational quantitative analysis comparing different innovative recruitment models. We also discuss strategies that address each problem and draw on the experience of Fundació ACE to argue that focusing resources on comprehensive AD centers that offer coordinated clinical and social care and participate in basic and clinical research, is an effective and efficient way of implementing many of the discussed strategies.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miguel A. Santos-Santos
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, IDIBELL, Spain
| | - Octavio Rodríguez-Gómez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Cañabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Asunción Lafuente
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mar Buendía
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria José de Dios
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - América Morera
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ángela Sanabria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Laura Campo
- International Corporate Affairs, Alzheimer’s Disease, Eli Lilly and Co
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
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Northridge ME, Shedlin M, Schrimshaw EW, Estrada I, De La Cruz L, Peralta R, Birdsall S, Metcalf SS, Chakraborty B, Kunzel C. Recruitment of racial/ethnic minority older adults through community sites for focus group discussions. BMC Public Health 2017; 17:563. [PMID: 28599637 PMCID: PMC5466755 DOI: 10.1186/s12889-017-4482-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Despite a body of evidence on racial/ethnic minority enrollment and retention in research, literature specifically focused on recruiting racially/ethnically diverse older adults for social science studies is limited. There is a need for more rigorous research on methodological issues and the efficacy of recruitment methods. Cultural obstacles to recruitment of racial/ethnic minority older adults include language barriers, lack of cultural sensitivity of target communities on the part of researchers, and culturally inappropriate assessment tools. Methods Guided by the Consolidated Framework for Implementation Research (CFIR), this study critically appraised the recruitment of racial/ethnic minority older adults for focus groups. The initial approach involved using the physical and social infrastructure of the ElderSmile network, a community-based initiative to promote oral and general health and conduct health screenings in places where older adults gather, to recruit racial/ethnic minority adults for a social science component of an interdisciplinary initiative. The process involved planning a recruitment strategy, engaging the individuals involved in its implementation (opinion leaders in senior centers, program staff as implementation leaders, senior community-based colleagues as champions, and motivated center directors as change agents), executing the recruitment plan, and reflecting on the process of implementation. Results While the recruitment phase of the study was delayed by 6 months to allow for ongoing recruitment and filling of focus group slots, the flexibility of the recruitment plan, the expertise of the research team members, the perseverance of the recruitment staff, and the cultivation of change agents ultimately resulted in meeting the study targets for enrollment in terms of both numbers of focus group discussions (n = 24) and numbers of participants (n = 194). Conclusions This study adds to the literature in two important ways. First, we leveraged the social and physical infrastructure of an existing program to recruit participants through community sites where older adults gather. Second, we used the CFIR to guide the appraisal of the recruitment process, which underscored important considerations for both reaching and engaging this underserved population. This was especially true in terms of understanding the disparate roles of the individuals involved in implementing and facilitating the recruitment plan.
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Affiliation(s)
- Mary E Northridge
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 433 First Avenue, 7th Floor, Room 726, New York, NY, 10010, USA. .,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. .,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA. .,Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Michele Shedlin
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Eric W Schrimshaw
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ivette Estrada
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Leydis De La Cruz
- Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Rogelina Peralta
- Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Stacia Birdsall
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Sara S Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Bibhas Chakraborty
- Duke-National University of Singapore (Duke-NUS) Medical School, Centre for Quantitative Medicine, Singapore, Singapore
| | - Carol Kunzel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
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Stark S, Somerville E, Keglovits M, Conte J, Li M, Hu YL, Yan Y. Protocol for the home hazards removal program (HARP) study: a pragmatic, randomized clinical trial and implementation study. BMC Geriatr 2017; 17:90. [PMID: 28427336 PMCID: PMC5397804 DOI: 10.1186/s12877-017-0478-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network. METHODS We will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study. DISCUSSION This intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02392013 . Retrospectively registered on March 5, 2015.
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Affiliation(s)
- Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Jane Conte
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Melody Li
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Yi-Ling Hu
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108 USA
| | - Yan Yan
- Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8067, St. Louis, MO 63110 USA
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N'Songo A, Carrasquillo MM, Wang X, Burgess JD, Nguyen T, Asmann YW, Serie DJ, Younkin SG, Allen M, Pedraza O, Duara R, Greig Custo MT, Graff-Radford NR, Ertekin-Taner N. African American exome sequencing identifies potential risk variants at Alzheimer disease loci. NEUROLOGY-GENETICS 2017; 3:e141. [PMID: 28480329 PMCID: PMC5406839 DOI: 10.1212/nxg.0000000000000141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/10/2017] [Indexed: 01/14/2023]
Abstract
Objective: In African Americans, we sought to systematically identify coding Alzheimer disease (AD) risk variants at the previously reported AD genome-wide association study (GWAS) loci genes. Methods: We identified coding variants within genes at the 20 published AD GWAS loci by whole-exome sequencing of 238 African American participants, validated these in 300 additional participants, and tested their association with AD risk in the combined cohort of 538 and with memory endophenotypes in 319 participants. Results: Two ABCA7 missense variants (rs3764647 and rs3752239) demonstrated significant association with AD risk. Variants in MS4A6A, PTK2B, and ZCWPW1 showed significant gene-based association. In addition, coding variants in ZCWPW1 (rs6465770) and NME8 (rs10250905 and rs62001869) showed association with memory endophenotypes. Conclusions: Our findings support a role for ABCA7 missense variants in conferring AD risk in African Americans, highlight allelic heterogeneity at this locus, suggest the presence of AD-risk variants in MS4A6A, PTK2B, and ZCWPW1, nominate additional variants that may modulate cognition, and importantly provide a thorough screen of coding variants at AD GWAS loci that can guide future studies in this population.
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Affiliation(s)
- Aurelie N'Songo
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Minerva M Carrasquillo
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Xue Wang
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Jeremy D Burgess
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Thuy Nguyen
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Yan W Asmann
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Daniel J Serie
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Steven G Younkin
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Mariet Allen
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Otto Pedraza
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Ranjan Duara
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Maria T Greig Custo
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Neill R Graff-Radford
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience (A.N., M.M.C., J.D.B., T.N., S.G.Y., M.A., N.E.-T.), Department of Health Science Research (X.W., Y.W.A., D.J.S.), Department of Psychiatry and Psychology (O.P.), and Department of Neurology (N.R.G.-R., N.E.-T.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D., M.T.G.C.), Mount Sinai Medical Center, Miami Beach, FL
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Chang TE, Brill CD, Traeger L, Bedoya CA, Inamori A, Hagan PN, Flaherty K, Hails K, Yeung A, Trinh NH. Association of Race, Ethnicity and Language with Participation in Mental Health Research Among Adult Patients in Primary Care. J Immigr Minor Health 2017; 17:1660-9. [PMID: 25398517 DOI: 10.1007/s10903-014-0130-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Racial and ethnic minorities remain underrepresented in clinical psychiatric research, but the reasons are not fully understood and may vary widely between minority groups. We used the Z-test of independent proportions and binary logistic regression to examine the relationship between race, ethnicity or primary language and participation in screening as well as interest in further research participation among primary care patients being screened for a depression study. Minorities were less likely than non-Hispanic Whites to complete the initial screening survey. Latinos and Blacks were more likely to agree to be contacted for research than non-Hispanic Whites. Among Latinos, primary language was associated with willingness to be contacted for research. Associations between research participation and race, ethnicity and language are complex and vary across different enrollment steps. Future research should consider stages of the research enrollment process separately to better understand barriers and identify targets for intervention.
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Affiliation(s)
- Trina E Chang
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA.
| | - Charlotte D Brill
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Lara Traeger
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
| | - C Andres Bedoya
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
| | - Aya Inamori
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Patrick N Hagan
- Center for Community Health Improvement, Massachusetts General Hospital, Boston, MA, USA
| | | | - Katherine Hails
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Albert Yeung
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Nhi-Ha Trinh
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
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Abstract
Alzheimer disease (AD) research faces challenges to successful enrollment, especially to clinical trials and biomarker studies. Failure to recruit the planned number of participants in a timely manner threatens the internal validity and success of clinical research, raising concerns about external validity and generalizability of results, and possibly leading to disparities in disease treatment. Methods to improve recruitment exist, but require varying levels of staff effort and financial resources, and evidence of effectiveness is often lacking or inconsistent. In this review, we summarize some of the available methods to improve AD research recruitment, the available literature to support or refute these strategies, and some of the experiences at the authors' AD Research Centers. We discuss the use of community-based participatory research principles and participant registries as a means to enhance research enrollment and increase diversity of research samples.
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Steinman L, Hammerback K, Snowden M. It Could Be a Pearl to You: Exploring Recruitment and Retention of the Program to Encourage Active, Rewarding Lives (PEARLS) With Hard-to-Reach Populations. THE GERONTOLOGIST 2013; 55:667-76. [PMID: 24270214 DOI: 10.1093/geront/gnt137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/09/2013] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY We partnered with 3 social service organizations to identify hard-to-reach populations, barriers to reach, and strategies for improving recruitment and retention for Program to Encourage Active, Rewarding Lives (PEARLS), a home-based depression-care management program for elders. DESIGN AND METHODS We conducted semistructured interviews with staff and former PEARLS participants. All interviews were transcribed verbatim and thematically analyzed. RESULTS Veterans, African Americans, Filipino men, other immigrants and English-language learners, old-older adults, rural communities, and people with limited education were identified as hard to reach. The themes of trust, cultural appropriateness, meet them where they are, and framing and reframing, cut across barriers to participation in PEARLS and approaches for overcoming these barriers. IMPLICATIONS Research findings will be used to inform technical assistance activities with PEARLS providers, changes to PEARLS program and training materials, and future PEARLS research activities.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, University of Washington School of Public Health, Seattle.
| | - Kristen Hammerback
- Health Promotion Research Center, University of Washington School of Public Health, Seattle
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Harborview Medical Center, University of Washington Medical Center, Seattle
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Etkin CD, Farran CJ, Barnes LL, Shah RC. Recruitment and enrollment of caregivers for a lifestyle physical activity clinical trial. Res Nurs Health 2012; 35:70-81. [PMID: 22083931 PMCID: PMC3729020 DOI: 10.1002/nur.20466] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2011] [Indexed: 11/09/2022]
Abstract
This article presents the efficacy of the recruitment framework used for a clinical trial with sedentary family caregivers of persons with Alzheimer's disease. An integrated social marketing approach with principles of community-based participatory research provided the theoretical framework for organizing recruitment activities. This multi-pronged approach meant that caregivers were identified from a range of geographic locations and numerous sources including a federally funded Alzheimer's disease center, health care providers, community based and senior organizations, and broad-based media. Study enrollment projections were exceeded by 11% and resulted in enrolling n = 211 caregivers into this clinical trial. We conclude that social marketing and community-based approaches provide a solid foundation for organizing recruitment activities for clinical trials with older adults.
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Affiliation(s)
- Caryn D Etkin
- College of Nursing, Rush University Medical Center, 600 S. Paulina St., 1080 AAC, Chicago, IL 60612, USA
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41
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Nápoles AM, Chadiha LA. Advancing the science of recruitment and retention of ethnically diverse populations. THE GERONTOLOGIST 2011; 51 Suppl 1:S142-6. [PMID: 21565815 DOI: 10.1093/geront/gnr019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We highlight several critical challenges that must be addressed to accelerate the advancement of the science on recruitment and retention of ethnically diverse older adults into health research. These include the relative lack of attention by researchers to methodological issues related to recruitment and retention of ethnically diverse populations and the inadequacy of funding to advance systematically this field. We describe strategies used by the Resource Centers on Minority Aging Research and other National Institute of Aging-funded programs to advance the science of recruitment of ethnically diverse older adults. Finally, we propose a set of broad recommendations designed to generate a body of evidence on successful methods of recruitment and retention of ethnically diverse populations in health research. To eliminate health disparities and better understand aging processes in ethnically diverse populations, much more research is needed on effective strategies for increasing minority enrollment in health research. Comparative effectiveness research on more intensive recruitment and retention methods, which are often needed for including diverse populations, will require dedicated funding and concerted efforts by investigators.
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Affiliation(s)
- Anna M Nápoles
- Division of General Internal Medicine, University of California San Francisco 94118-1944, USA.
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Joseph CLM, Saltzgaber J, Havstad SL, Johnson CC, Johnson D, Peterson EL, Alexander G, Couper MP, Ownby DR. Comparison of early-, late-, and non-participants in a school-based asthma management program for urban high school students. Trials 2011; 12:141. [PMID: 21645394 PMCID: PMC3126736 DOI: 10.1186/1745-6215-12-141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 06/06/2011] [Indexed: 11/10/2022] Open
Abstract
Background To assess bias and generalizability of results in randomized controlled trials (RCT), investigators compare participants to non-participants or early- to late-participants. Comparisons can also inform the recruitment approach, especially when working with challenging populations, such as urban adolescents. In this paper, we describe characteristics by participant status of urban teens eligible to participate in a RCT of a school-based, web-based asthma management program. Methods The denominator for this analysis was all students found to be eligible to participate in the RCT. Data were analyzed for participants and non-participants of the RCT, as well as for students that enrolled during the initially scheduled recruitment period (early-participants) and persons that delayed enrollment until the following fall when recruitment was re-opened to increase sample size (late-participants). Full Time Equivalents (FTEs) of staff associated with recruitment were estimated. Results Of 1668 teens eligible for the RCT, 386 enrolled early, and 36 enrolled late, leaving 1246 non-participants. Participants were younger (p < 0.01), more likely to be diagnosed, use asthma medication, and have moderate-to-severe disease than non-participants, odds ratios (95% Confidence Intervals) = 2.1(1.7-2.8), 1.7(1.3-2.1), 1.4(1.0-1.8), respectively. ORs were elevated for the association of late-participation with Medicaid enrollment, 1.9(0.7-5.1) and extrinsic motivation to enroll, 1.7(0.6-5.0). Late-participation was inversely related to study compliance for teens and caregivers, ORs ranging from 0.1 to 0.3 (all p-values < 0.01). Early- and late-participants required 0.45 FTEs/100 and 3.3 FTEs/100, respectively. Conclusions Recruitment messages attracted youth with moderate-to-severe asthma, but extending enrollment was costly, resulting in potentially less motivated, and certainly less compliant, participants. Investigators must balance internal versus external validity in the decision to extend recruitment. Gains in sample size and external validity may be offset by the cost of additional staff time and the threat to internal validity caused by lower participant follow-up. Trial Registration ClinicalTrials.gov: NCT00201058
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Affiliation(s)
- Christine L M Joseph
- Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI, USA.
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Dilworth-Anderson P. Introduction to the science of recruitment and retention among ethnically diverse populations. THE GERONTOLOGIST 2011; 51 Suppl 1:S1-4. [PMID: 21565811 PMCID: PMC3106368 DOI: 10.1093/geront/gnr043] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recruitment and retention of research participants is evolving with the changing demographics of the American population, in particular its growing diversity. The cultural-historical background and sociopolitical conditions of each diverse group poses unique challenges in developing successful recruitment and retention methods and strategies. This critical collection of articles demonstrates important theoretical and conceptual frameworks that seek to address the shortcomings of previous models of recruiting diverse populations. Understanding the key components of cultural distinctions, such as values and beliefs, community cohesion, and collective history, has proven to be instrumental in reaching out to these diverse groups. This important strategy has allowed researchers to overcome the barriers that have been fostered in the past and has built the trust necessary to move forward into an inclusive approach to aging research. Not to be overlooked, an important factor to achieving success in recruitment and retention of diverse populations is having access to resources that allow for ongoing connection with research participants.
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Affiliation(s)
- Peggye Dilworth-Anderson
- Department of Health Policy and Management, Gillings School of Global Public Health 1102 D McGavran Greenberg Hall, CB 7411, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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