Internet Recruitment of Asian American Breast Cancer Survivors

Recruitment and Retention Issues in a Technology-Based Intervention Among Korean American Midlife Women With Depressive Symptoms

The number of health technology-based intervention studies has grown significantly. However, issues in the recruitment and retention for such studies, especially of Asian Americans, have rarely been discussed. The purpose of this paper was to discuss issues in the recruitment and retention of a specific group of Asian Americans-Korean American midlife women with depressive symptoms-into a technology-based intervention study using computers and mobile devices with a measurement device and to provide directions for future participant recruitment and retention in technology-based intervention studies. The written memos of research team members and the written records of research team meetings were analyzed using a content analysis. The issues in the recruitment and retention process included (1) low recruitment and retention rates; (2) the perceived long intervention period; (3) strict inclusion/exclusion criteria; (4) concerns related to the use of a measurement device; and (5) the perceived adequacy of monetary incentives. Based on the issues identified in the study, several suggestions are made for future recruitment and retention of racial/ethnic minorities in technology-based intervention studies (eg, appropriate intervention period, innovative and creative motivation strategies, acceptable measurement scales and devices, and adequate monetary reimbursement).

Lessons from a Customer Discovery Study: a Technology-Based Cancer Support Program for Asian American Breast Cancer Survivors

PURPOSE

A culturally tailored technology-based cancer support program was recently developed and tested among Asian American breast cancer survivors. To explore future opportunities to sustain the program, the research team participated in the SPeeding Research-tested INTervention (SPRINT) program sponsored by the National Cancer Institute. The purpose of this discussion paper is to share the lessons that the research team gained from a customer discovery study through the SPRINT program.

METHODS

During the SPRINT program, a total of 73 stakeholders were recruited through a snowball sampling across the globe. Semi-structured interviews were conducted for customer discovery through WebEX, phone calls, and in-person visits (50 in-person interviews, 4 phone interviews, and 19 WebEx interviews). All the interviews were recorded using audio-taping or writing memos. Also, the research team wrote memos on the issues/concerns related to the project during the interview process. Then, the transcripts and memos were analyzed using a content analysis to provide evidence for the lessons.

RESULTS

The themes reflecting the lessons from the customer discovery study included (a) "who are the stakeholders"; (b) "depending on stakeholders"; (c) "what works or not"; (d) "personal versus family responsibilities"; and (e) "depending on countries' situations."

CONCLUSION

These lessons could provide directions for future development and implementation of technology-based cancer support programs for Asian American breast cancer survivors.

Achieving a Representative Sample of Asian Americans in Biomedical Research Through Community-Based Approaches: Comparing Demographic Data in the All of Us Research Program With the American Community Survey

BACKGROUND

Underrepresented persons are often not included in biomedical research. It is unknown if the general Asian American population is being represented in All of Us. The purpose of this study was to compare the Asian demographic data in the All of Us cohort with the Asian nationally representative data from the American Community Survey.

METHOD

Demographic characteristics and health literacy of Asians in All of Us were examined. Findings were qualitatively compared with the Asian data in the 2019 American Community Survey 1-year estimate.

RESULTS

Compared with the national composition of Asians, less All of Us participants were born outside the United States (64% vs 79%), were younger, and had higher levels of education (76% vs 52%). Over 60% of All of Us participants reported high levels of health literacy.

CONCLUSION

This study had implications for the development of strategies that ensure diverse populations are represented in biomedical research.

Applying the integrated marketing communication approach to recruit and retain African American women

Background: Researchers use multiple approaches to engage and maintain underrepresented populations in research. They often overlook integrated marketing communication (IMC), a useful approach for commercial marketing, for more established health promotion and social marketing techniques. There is limited information on the application of the IMC approach for recruiting and retaining African American study participants. This article explores the IMC approach used to recruit and retain volunteers for a community-based intervention.

Methods: This is a cross-sectional study relying on extracted data from the Multi-Theory Model (MTM) of Health Behavior Physical Activity intervention. A brief multiple-choice survey was administered to a sample of African American women (n=74) to assess the effectiveness of applying an IMC approach for recruiting and retaining volunteers for the multi-week program during January - June 2018. The measures were (1) source for study information, (2) preferred method of contact, (3) primary source for health information.

Results: Sixty-nine women listed their doctor as the primary source of health information and five women in the age group 18-34 identified social media (n=3) and websites (n=2). Age is significantly related to the preference of communication tools used to recruit and retain the African American participants. A statistical significance (P =0.025) suggests for women ages 51-69, a combination of radio, church, and word of mouth was more effective for recruitment. The older women preferred telephone calls compared to the women ages 18-50 who relied on texting.

Conclusion: IMC can synergize individual communication elements in a coordinated manner to address niche audiences and develop cost-effective health communications programs that can improve recruitment and retention efforts in minority populations.

Characteristics of Asian-American Breast Cancer Survivors Retained in a 3-Month Technology-Based Intervention

BACKGROUND

Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities.

OBJECTIVE

This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study.

METHODS

This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses.

RESULTS

The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers.

CONCLUSION

This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors.

IMPLICATIONS FOR PRACTICE

Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors.

Recruitment and Retention Strategies Among Racial and Ethnic Minorities in Web-Based Intervention Trials: Retrospective Qualitative Analysis

Background

Racial and ethnic minority groups are underrepresented in health research, contributing to persistent health disparities in the United States. Identifying effective recruitment and retention strategies among minority groups and their subpopulations is an important research agenda. Web-based intervention approaches are becoming increasingly popular with the ubiquitous use of the internet. However, it is not completely clear which recruitment and retention strategies have been successful in web-based intervention trials targeting racial and ethnic minorities.

Objective

This study aims to describe lessons learned in recruiting and retaining one of the understudied ethnic minority women—Korean Americans—enrolled in a web-based intervention trial and to compare our findings with the strategies reported in relevant published web-based intervention trials.

Methods

Multiple sources of data were used to address the objectives of this study, including the study team’s meeting minutes, participant tracking and contact logs, survey reports, and postintervention interviews. In addition, an electronic search involving 2 databases (PubMed and CINAHL) was performed to identify published studies using web-based interventions. Qualitative analysis was then performed to identify common themes addressing recruitment and retention strategies across the trials using web-based intervention modalities.

Results

A total of 9 categories of recruitment and retention strategies emerged: authentic care; accommodation of time, place, and transportation; financial incentives; diversity among the study team; multiple, yet standardized modes of communication; mobilizing existing community relationships with efforts to build trust; prioritizing features of web-based intervention; combined use of web-based and direct recruitment; and self-directed web-based intervention with human support. Although all the studies included in the analysis combined multiple strategies, prioritizing features of web-based intervention or use of human support were particularly relevant for promoting recruitment and retention of racial and ethnic minorities in web-based intervention trials.

Conclusions

The growing prevalence of internet use among racial and ethnic minority populations represents an excellent opportunity to design and deliver intervention programs via the internet. Future research should explore and compare successful recruitment and retention methods among race and ethnic groups for web-based interventions.

Trial Registration

ClinicalTrials.gov NCT03726619; https://clinicaltrials.gov/ct2/show/NCT03726619.

Recruitment of Asian Americans with Schizophrenia Spectrum Disorder for Research Participation: Barriers, Strategies, and Outcomes

Difficulty reaching Asian Americans with schizophrenia spectrum disorder has prompted mental health researchers to exclude this subpopulation from the sampling frame or enroll a comparatively smaller sample compared to other races and ethnicities with similar diagnoses. Understanding potential influences on research participation may facilitate efforts to increase the representation of this vulnerable yet underrepresented population in research. We detailed our experiences recruiting Asian Americans with schizophrenia spectrum disorder for participation in an observational study that evaluated their clinical outcomes. We applied the matching model of recruitment by identifying recruitment barriers encountered by or arising from the target group and researchers at the macro (community mental health center and academic institution), mediator (gatekeepers and research team), and micro (participant and interviewer) levels and then implementing a multilevel approach to overcoming identified obstacles. Our yearlong recruitment efforts yielded a diverse community sample (n = 75) recruited from six urban community mental health centers. Barriers to involving Asian Americans with schizophrenia spectrum disorder in research are complex and associated with being a member of a heterogeneous racial and ethnic minority group and having a serious psychiatric condition. Engaging Asian Americans with schizophrenia spectrum disorder in research is feasible if researchers devote time and resources to address barriers confronting the target group and challenges researchers encounter.

The Preliminary Efficacy of a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors

With few existing technology-based programs to support cancer pain management, the need for culturally tailored programs to support ethnic minority cancer survivors has been highlighted. The purpose of this study was to explore the preliminary efficacy of the technology-based CAncer Pain management support Program for Asian American survivors of breast cancer, a technology-based cancer pain management program, in improving the cancer pain experience of Asian American breast cancer survivors. This pilot study adopted a randomized repeated-measures pretest/posttest control group design with a sample of 94 Asian American breast cancer survivors. Study measures included the Brief Pain Inventory-Short Form, Support Care Needs Survey-34 Short Form, and Mishel Uncertainty in Illness Scale-Community. Data were analyzed using descriptive and inferential statistics including repeated-measures analysis of covariance. Although there were no significant differences in pain, there were significant changes in perceived isolation (F = 9.937, P < .01), personal resources (F = 6.612, P < .05), support care need (F = 8.299, P < .01), and degree of uncertainty (F = 8.722, P < .01) in the intervention group from pretest to posttest. These findings support the positive effects of CAncer Pain management support Program for Asian American survivors of breast cancer on the cancer pain experience of Asian American breast cancer survivors.

Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study

BACKGROUND

Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise.

OBJECTIVE

This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States.

METHODS

A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention).

RESULTS

From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up.

CONCLUSIONS

Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN12175285; http://www.isrctn.com/ISRCTN12175285.