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Cohen A, Rasheduzzaman M, O'Connell B, Brown T, Taniuchi M, Krometis LA, Hubbard A, Scheuerman P, Edwards M, Darling A, Pennala B, Price S, Lytton B, Wettstone E, Pholwat S, Ward H, Hallinger DR, Simmons SO, Griffin SM, Kobylanski J, Egorov AI, Wade TJ. Drinking water sources, quality, and associated health outcomes in Appalachian Virginia: A risk characterization study in two counties. Int J Hyg Environ Health 2024; 260:114390. [PMID: 38772087 DOI: 10.1016/j.ijheh.2024.114390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES In the US, violations of drinking water regulations are highest in lower-income rural areas overall, and particularly in Central Appalachia. However, data on drinking water use, quality, and associated health outcomes in rural Appalachia are limited. We sought to assess public and private drinking water sources and associated risk factors for waterborne pathogen exposures for individuals living in rural regions of Appalachian Virginia. METHODS We administered surveys and collected tap water, bottled water, and saliva samples in lower-income households in two adjacent rural counties in southwest Virginia (bordering Kentucky and Tennessee). Water samples were tested for pH, temperature, conductivity, total coliforms, E. coli, free chlorine, nitrate, fluoride, heavy metals, and specific pathogen targets. Saliva samples were analyzed for antibody responses to potentially waterborne infections. We also shared water analysis results with households. RESULTS We enrolled 33 households (83 individuals), 82% (n = 27) with utility-supplied water and 18% with private wells (n = 3) or springs (n = 3). 58% (n = 19) reported household incomes of <$20,000/year. Total coliforms were detected in water samples from 33% (n = 11) of homes, E. coli in 12%, all with wells or springs (n = 4), and Aeromonas, Campylobacter, and Enterobacter in 9%, all spring water (n = 3). Diarrhea was reported for 10% of individuals (n = 8), but was not associated with E. coli detection. 34% (n = 15) of saliva samples had detectable antibody responses for Cryptosporidium spp., C. jejuni, and Hepatitis E. After controlling for covariates and clustering, individuals in households with septic systems and straight pipes had significantly higher likelihoods of antibody detection (risk ratios = 3.28, 95%CI = 1.01-10.65). CONCLUSIONS To our knowledge, this is the first study to collect and analyze drinking water samples, saliva samples, and reported health outcome data from low-income households in Central Appalachia. Our findings indicate that utility-supplied water in this region was generally safe, and individuals in low-income households without utility-supplied water or sewerage have higher exposures to waterborne pathogens.
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Affiliation(s)
- Alasdair Cohen
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA; Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA.
| | - Md Rasheduzzaman
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Bethesda O'Connell
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Teresa Brown
- Department of Natural Sciences, University of Virginia's College at Wise, Wise, VA, USA
| | - Mami Taniuchi
- Department of Civil and Environmental Engineering, University of Virginia, Charlottesville, VA, USA; Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Leigh-Anne Krometis
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alan Hubbard
- Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Phillip Scheuerman
- Department of Environmental and Occupational Health and Safety Sciences, East Tennessee State University, Johnson City, TN, USA
| | - Marc Edwards
- Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Amanda Darling
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA; Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Blaine Pennala
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Sarah Price
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Breanna Lytton
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Erin Wettstone
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Suporn Pholwat
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Daniel R Hallinger
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Steven O Simmons
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Shannon M Griffin
- Office of Research and Development, US Environmental Protection Agency, Cincinnati, OH, USA
| | - Jason Kobylanski
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Andrey I Egorov
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Timothy J Wade
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
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Mahmud FH, Clarke ABM, Elia Y, Curtis J, Benitez-Aguirre P, Cameron FJ, Chiesa ST, Clarson C, Couper JJ, Craig ME, Dalton RN, Daneman D, Davis EA, Deanfield JE, Donaghue KC, Jones TW, Marshall SM, Neil A, Marcovecchio ML. Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data. BMC Med 2023; 21:506. [PMID: 38124088 PMCID: PMC10734126 DOI: 10.1186/s12916-023-03222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations. METHODS Retrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort's distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial's intervention was targeted (national). RESULTS Recruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001). CONCLUSIONS Significant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials. TRIAL REGISTRATION NCT01581476. Registered on 20 April 2012.
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Affiliation(s)
- Farid H Mahmud
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada.
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Yesmino Elia
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Jacqueline Curtis
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Fergus J Cameron
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Scott T Chiesa
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Jennifer J Couper
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - R Neil Dalton
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Denis Daneman
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Elizabeth A Davis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - John E Deanfield
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sally M Marshall
- Faculty of Clinical Medical Sciences, Diabetes Research Group, Translational and Clinical Research Institute, Newcastle University, 4Th Floor William Leech Building, Framlington Place, Newcastle Upon Tyne, UK
| | - Andrew Neil
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
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Feasibility of using Facebook for HIV prevention: Implications for translational research among justice-involved women who use drugs in rural Appalachia. J Clin Transl Sci 2023; 6:e127. [PMID: 36590363 PMCID: PMC9794968 DOI: 10.1017/cts.2022.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Justice-involved women from rural Appalachia face significant barriers to the utilization of evidence-based HIV prevention interventions in spite of high rates of injection drug use and risky sexual practices. Adapting evidence-based practices to incorporate the cultural uniqueness of the target population is needed in order to advance translational and clinical science in this area. This study provides a descriptive overview of indicators of feasibility and acceptability of an adapted version of the National Institute on Drug Abuse Standard HIV prevention intervention for delivery using Facebook through a small randomized controlled pilot study with rural Appalachian women. Method Study methods include the random selection of rural Appalachian women from two local jails, screening for study eligibility, baseline data collection, random assignment to study interventions, and follow-up in the community three months post-release. Results Results indicate that the feasibility of the approach was supported through study enrollment of the target population who reported regular Facebook use and HIV risk behaviors including drug use and sex. Acceptability of the intervention was demonstrated through enrollment in the study intervention, engagement in the intervention through Facebook, and indicators of HIV/HCV knowledge. Conclusions Study findings contribute to the critical and unmet need to advance translational science on the delivery of evidence-based prevention interventions in real-world rural Appalachian settings to understudied, vulnerable individuals who are often overlooked in targeted prevention efforts.
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Smith JS, Vaz OM, Gaber CE, Des Marais AC, Chirumamilla B, Hendrickson L, Barclay L, Richman AR, Brooks X, Pfaff A, Brewer NT. Recruitment strategies and HPV self-collection return rates for under-screened women for cervical cancer prevention. PLoS One 2023; 18:e0280638. [PMID: 36952486 PMCID: PMC10035812 DOI: 10.1371/journal.pone.0280638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/04/2023] [Indexed: 03/25/2023] Open
Abstract
In the United States, medically underserved women carry a heavier burden of cancer incidence and mortality, yet are largely underrepresented in cancer prevention studies. My Body, My Test is a n observational cohort, multi-phase cervical cancer prevention study in North Carolina that recruited low-income women, aged 30-65 years and who had not undergone Pap testing in ≥ 4 years. Participants were offered home-based self-collection of cervico-vaginal samples for primary HPV testing. Here, we aimed to describe the recruitment strategies utilized by study staff, and the resulting recruitment and self-collection kit return rates for each specific recruitment strategy. Participants were recruited through different approaches: either direct (active, staff-effort intensive) or indirect (passive on the part of study staff). Of a total of 1,475 individuals screened for eligibility, 695 were eligible (47.1%) and 487 (70% of eligible) participants returned their self-collection kit. Small media recruitment resulted in the highest number of individuals found to be study eligible, with a relatively high self-collection kit return of 70%. In-clinic in-reach resulted in a lower number of study-eligible women, yet had the highest kit return rate (90%) among those sent kits. In contrast, 211 recruitment which resulted in the lowest kit return of 54%. Small media, word of mouth, and face-to-face outreach resulted in self-collection kit return rates ranging from 72 to 79%. The recruitment strategies undertaken by study staff support the continued study of reaching under-screened populations into cervical cancer prevention studies.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Olivia M Vaz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Charley E Gaber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Bhavika Chirumamilla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Lori Hendrickson
- Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, NC, United States of America
| | - Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States of America
| | - Xian Brooks
- School of Nursing, University of Louisville, Louisville, KY, United States of America
| | - Anna Pfaff
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
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Bottled and Well Water Quality in a Small Central Appalachian Community: Household-Level Analysis of Enteric Pathogens, Inorganic Chemicals, and Health Outcomes in Rural Southwest Virginia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148610. [PMID: 35886462 PMCID: PMC9319903 DOI: 10.3390/ijerph19148610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023]
Abstract
Consumption of unsafe drinking water is associated with a substantial burden of disease globally. In the US, ~1.8 million people in rural areas lack reliable access to safe drinking water. Our objective was to characterize and assess household-level water sources, water quality, and associated health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and bottled water) from consenting households in a small rural community without utility-supplied water in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms, E. coli, nitrate, sulfate, metals (e.g., arsenic, cadmium, lead), and 30+ enteric pathogens. Among the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used bottled water as their primary drinking water source. Total coliforms were detected in water samples from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter, Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or specific pathogens (risk ratio = 1.25, cluster-robust standard error = 1.64, p = 0.865). Although our sample size was small, our findings suggest that a considerable number of lower-income residents without utility-supplied water in rural areas of southwest Virginia may be exposed to microbiological and/or chemical contaminants in their water, and many, if not most, rely on bottled water as their primary source of drinking water.
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Federico R, Pérez E, Geneviève M, O'Loughlin J, Mylene R, Marie-Pierre S, Potvin L. Engaging with community organizations to recruit and retain vulnerable adults: The Pathways Study. SSM Popul Health 2022; 18:101088. [PMID: 35464615 PMCID: PMC9019387 DOI: 10.1016/j.ssmph.2022.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 10/29/2022] Open
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Alvord TW, Marriott LK, Nguyen PT, Shafer A, Brown K, Stoller W, Volpi JL, Vandehey-Guerrero J, Ferrara LK, Blakesley S, Solomon E, Kuehl H, Palma AJ, Farris PE, Hamman KJ, Cotter M, Shannon J. Public perception of predictive cancer genetic testing and research in Oregon. J Genet Couns 2020; 29:259-281. [PMID: 32220044 DOI: 10.1002/jgc4.1262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/24/2022]
Abstract
The potential for using widespread genetic testing to inform health care has become a viable option, particularly for heritable cancers. Yet, little is known about how to effectively communicate the benefits and risks of both personal genetic testing and participation in biorepositories that aid scientific advancements. Nationwide efforts are engaging communities in large genetic studies to better estimate the population-wide prevalence of heritable cancers but have been met with hesitance or declination to participate in some communities. To successfully engage an Oregon population in longitudinal research that includes predictive genetic testing for pathogenic or likely pathogenic variants associated with an increased risk for cancer, researchers conducted 35 focus groups (two of which were held in Spanish) in 24 of Oregon's 36 counties to better understand knowledge and attitudes related to genetic testing and willingness to participate in longitudinal genetic research. A total of 203 adults (mean = 45.6 years; range 18-88), representing a range of education levels and prior knowledge of genetic research, participated in the focus groups. The majority (85%) of participants reported personal or family diagnoses of cancer (e.g., self, family, friends). A majority (87%) also reported a strong interest in cancer genetic testing and receiving genetic information about themselves. Nearly all focus groups (94%, 33 of 35 sites) included participant discussion citing their families (e.g., children, close relatives, and extended family members) as key motivators for participation in genetic research. For example, participants reported interest in increasing personal knowledge about their own and their families' cancer risks in order to respond proactively, if a pathogenic variant was found. While most focus groups (94%, 33 of 35 sites) included participant discussion describing barriers to predictive genetic, testing such as concerns about outcomes, the desire to learn about health risks in oneself mitigated or outweighed those fears for many participants. Other commonly reported concerns were related to potential mistrust of insurance companies, researchers, or institutions, or lack of knowledge about genetics, genetic testing, or genetic research. Participants, particularly in rural areas, highlighted critical factors for research recruitment, such as trust, personal interaction, public education about genetic research, and clear communication about study goals and processes. Our statewide findings reflect that public interest in predictive cancer genetic testing and cancer genetic research can surpass lack of knowledge of the complex topics, particularly when benefits for self and family are emphasized and when study considerations are well articulated.
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Affiliation(s)
- Teala W Alvord
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.,BUILD EXITO Trainee, Portland State University, Portland, OR, USA
| | - Lisa K Marriott
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Phuc T Nguyen
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.,BUILD EXITO Trainee, Portland State University, Portland, OR, USA
| | - Autumn Shafer
- School of Journalism and Communication, University of Oregon, Eugene, OR, USA
| | - Kim Brown
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Wesley Stoller
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer L Volpi
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jill Vandehey-Guerrero
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Laura K Ferrara
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Steven Blakesley
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Erin Solomon
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Hannah Kuehl
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Amy J Palma
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Paige E Farris
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Kelly J Hamman
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Madisen Cotter
- BUILD EXITO Trainee, Portland State University, Portland, OR, USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Fête M, Aho J, Benoit M, Cloos P, Ridde V. Barriers and recruitment strategies for precarious status migrants in Montreal, Canada. BMC Med Res Methodol 2019; 19:41. [PMID: 30808301 PMCID: PMC6390306 DOI: 10.1186/s12874-019-0683-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Precarious status migrants are a group of persons who are vulnerable, heterogeneous, and often suspicious of research teams. They are underrepresented in population-based research projects, and strategies to recruit them are described exclusively in terms of a single cultural group. We analyzed the recruitment strategies implemented during a research project aimed at understanding precarious status migrants' health status and healthcare access in Montreal, Canada. The research sample consisted of 854 persons recruited from a variety of ethnocultural communities between June 2016 and September 2017. This article analyzes the strategies implemented by the research team to respond to the challenges of that recruitment, and assess the effectiveness of those strategies. Based on the results, we share the lessons learned with a view to increasing precarious status migrants' representation in research. METHOD A mixed sequential design was used to combine qualitative data gathered from members of the research team at a reflexive workshop (n = 16) and in individual interviews (n = 15) with qualitative and quantitative data collected using the conceptual mapping method (n = 10). RESULTS The research team encountered challenges in implementing the strategies, related to the identification of the target population, the establishment of community partnerships, and suspicion on the part of the individuals approached. The combination of a venue-based sampling method, a communications strategy, and the snowball sampling method was key to the recruitment. Linking people with resources that could help them was useful in obtaining their effective and non-instrumental participation in the study. Creating a diverse and multicultural team helped build trust with participants. However, the strategy of matching the ethnocultural identity of the interviewer with that of the respondent was not systematically effective. CONCLUSION The interviewers' experience and their understanding of the issue are important factors to take into consideration in future research. More over, the development of a community resource guide tailored to the needs of participants should be major components of any research project targeting migrants. Finally, strategies should be implemented as the result of a continuous reflexive process among all members of the research team.
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Affiliation(s)
- Margaux Fête
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Josephine Aho
- School of Public Health, University of Montreal, Montreal, Canada
| | - Magalie Benoit
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Patrick Cloos
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- School of Social Work, Faculty of Arts and Sciences, University of Montreal, Montreal, Canada
| | - Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- French Institute for Research on Sustainable Development (IRD), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
- Fellow de l’Institut Français des Migrations, Paris, France
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Carpenter R, Theeke LA. Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence. Int J Nurs Sci 2018; 5:230-237. [PMID: 31406830 PMCID: PMC6626207 DOI: 10.1016/j.ijnss.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. OBJECTIVES The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. DESIGN The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. PROCEDURES The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. RESULTS Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. CONCLUSIONS These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
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Thomson TL, Nemeth JM, Peng J, Lu B, Ferketich AK, Paskett ED, Wewers ME. Address-Based Sampling for Recruiting Rural Subpopulations: A 2-Phase, Multimode Approach. J Rural Health 2017; 34:193-201. [PMID: 28685888 DOI: 10.1111/jrh.12249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This article describes recruitment of a subpopulation of women in a rural area, extending an existing method of a 2-phase address-based sampling protocol to include a mixed-mode approach. METHODS Phase 1 included a household enumeration questionnaire mailed to randomly selected households (n = 1,950) in 3 Ohio Appalachian counties to identify members of the eligible subgroup. The second phase of recruitment involved contacting 1 randomly selected eligible woman enumerated by each household, based on return of the questionnaire. These women (n = 599) were invited by field interviewers to participate in a one-time in-person health survey. FINDINGS Of the women invited to participate, a total of 408 completed the interview. Based on American Association for Public Opinion Research Response Rate 1 calculations, the response rates were 44.4% and 70.3% for phases 1 and 2, respectively. Response rates in this study were encouraging, especially for the second phase in-person interview. CONCLUSION We discuss implications for future research using a mixed-mode approach in this subpopulation.
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Affiliation(s)
- Tiffany L Thomson
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
| | - Julianna M Nemeth
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
| | - Juan Peng
- Center for Biostatistics, Ohio State University College of Medicine, Columbus, Ohio
| | - Bo Lu
- Division of Biostatistics, Ohio State University College of Public Health, Columbus, Ohio
| | - Amy K Ferketich
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
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Estabrooks P, You W, Hedrick V, Reinholt M, Dohm E, Zoellner J. A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: The Talking Health Trial. Int J Behav Nutr Phys Act 2017; 14:7. [PMID: 28103935 PMCID: PMC5248490 DOI: 10.1186/s12966-017-0462-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/05/2017] [Indexed: 01/30/2023] Open
Abstract
Background A primary challenge for behavior change strategies is ensuring that interventions can be effective while also attracting a broad and representative sample of the target population. The purpose of this case-study was to report on (1) the reach of a randomized controlled trial targeting reduced sugary beverages, (2) potential participant characteristic differences based on active versus passive recruitment strategies, and (3) recruitment strategy cost. Methods Demographic and recruitment information was obtained for 8 counties and for individuals screened for participation. Personnel activities and time were tracked. Costs were calculated and compared by active versus passive recruitment. Results Six-hundred and twenty, of 1,056 screened, individuals were eligible and 301enrolled (77% women; 90% white; mean income $21,981 ± 16,443). Eighty-two and 44% of those responding to passive and active methods, respectively, enrolled in the trial. However, active recruitment strategies yielded considerably more enrolled (active = 199; passive = 102) individuals. Passive recruitment strategies yielded a less representative sample in terms of gender (more women), education (higher), and income (higher; p’s <0.05). The average cost of an actively recruited and enrolled participant was $278 compared to $117 for a passively recruited and enrolled participant. Conclusions Though passive recruitment is more cost efficient it may reduce the reach of sugary drink reduction strategies in lower educated and economic residents in rural communities. Trial registration Clinicaltrials.gov; ID: NCT02193009, July 2014, retrospectively registered.
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Affiliation(s)
- Paul Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
| | - Wen You
- Department of Applied and Agricultural Economics, Virginia Tech, 304 Hutcheson Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 335A Wallace Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Margaret Reinholt
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Erin Dohm
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Jamie Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
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Jones DL, Starcher RW, Eicher JL, Wilcox S. Adoption of a Tai Chi Intervention, Tai Ji Quan: Moving for Better Balance, for Fall Prevention by Rural Faith-Based Organizations, 2013-2014. Prev Chronic Dis 2016; 13:E92. [PMID: 27418214 PMCID: PMC4951076 DOI: 10.5888/pcd13.160083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Translating evidence-based, community-delivered, fall-prevention exercise programs into new settings is a public health priority. COMMUNITY CONTEXT Older adults (aged ≥65 y) are at high risk for falls. We conducted a community engagement project in West Virginia to evaluate the adoption of a tai chi exercise program, Tai Ji Quan: Moving for Better Balance, by rural faith-based organizations (FBOs) and exercise instructors by recruiting 20 FBOs and 20 or more exercise instructors and by obtaining input from key stakeholders (representatives of FBOs, community representatives, exercise instructors) regarding potential barriers and facilitators to program adoption. METHODS We used both multistage, purposeful random sampling and snowball sampling to recruit FBOs and exercise instructors in 7 West Virginia counties. Two forums were held with stakeholders to identify barriers and facilitators to program adoption. We calculated separate adoption rates for organizations and exercise instructors. OUTCOME It took up to 3 months to recruit each FBO with an adoption rate of 94%. We made 289 telephone calls, sent 193 emails and 215 letters, distributed brochures and flyers to 69 FBOs, held 118 meetings, and made 20 trips over a period of 31 days (8,933 miles traveled). Nineteen of 22 trained exercise instructors started classes, an instructor adoption rate of 86%. Key issues regarding adoption were the age requirement for participants, trust, education, and competing priorities. INTERPRETATION Although we had recruitment challenges, our adoption rates were similar to or higher than those reported in other studies, and the objectives of the community engagement project were met. Clustering the FBOs and having them located closer geographically to our location may have reduced our resource use, and using a recruitment coordinator from the local community may have enabled us to gain the trust of congregants and clergy support.
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Affiliation(s)
- Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy and WVU Injury Control Research Center, West Virginia University, 1 Medical Center Dr, PO Box 9196, Morgantown, WV 26506.
| | | | | | - Sara Wilcox
- Sara Wilcox, University of South Carolina, Columbia, South Carolina
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Bodewes AJ, Kunst AE. Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands. BMC Res Notes 2016; 9:319. [PMID: 27328767 PMCID: PMC4915185 DOI: 10.1186/s13104-016-2124-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands. Methods We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis. Results The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies. Conclusions The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.
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Affiliation(s)
- Adee J Bodewes
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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15
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Spears CR, Sandberg JC, O'Neill JL, Grzywacz JG, Howard TD, Feldman SR, Arcury TA. Recruiting underserved mothers to medical research: findings from North Carolina. J Health Care Poor Underserved 2014; 24:1801-15. [PMID: 24185171 DOI: 10.1353/hpu.2013.0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies.
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Arcas MM, Buron A, Ramis O, Esturi M, Hernández C, Macià F. [Can a mobile phone short message increase participation in breast cancer screening programmes?]. ACTA ACUST UNITED AC 2014; 29:188-96. [PMID: 25002239 DOI: 10.1016/j.cali.2014.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/27/2014] [Accepted: 02/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of a mobile phone short message on women's uptake in a breast cancer screening programme. METHODS A total of 703 women from a Basic Health Area of Barcelona, and with a mobile phone number registered, were invited to participate in a breast cancer screening programme between 25 January 2011 and 22 March 2011. The control group (n=470) followed the usual appointment track, and the intervention group (n=233) received, after the first letter of invitation, a mobile phone short message reminder. The differences between the two groups were analysed, comparing the uptake rates according to age, educational level, and participation in previous round, as well as the number of re-invitation calls to non-attenders according to uptake, age and level of education;and the percentages of exclusions of both groups. RESULTS The intervention group had a greater uptake than the control group (78.1% vs. 72.3%), with a significant trend observed in the 55-59 years age group (P=.036) and the low secondary educational level (P=.014).The intervention group mean of re-invitation calls of non-attenders lower than the control group (.41 vs. .65, P<.05), a pattern observed in all the categories of the independent variables, and among younger age groups, lower and middle educational levels, and previously participating women (.09 vs. .19, P=.012). CONCLUSIONS The inclusion of a mobile phone short message in a breast cancer screening programme may increase uptake rates and lead to a management improvement.
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Affiliation(s)
- M M Arcas
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Unidad Docente de Medicina Preventiva y Salud Pública PSMAR-UPF-ASPB, Barcelona, España
| | - A Buron
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Red de investigación en servicios sanitarios en enfermedades crónicas (REDISSEC), España.
| | - O Ramis
- Alhorasolutions S.L., Barcelona, España
| | - M Esturi
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - C Hernández
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - F Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Red de investigación en servicios sanitarios en enfermedades crónicas (REDISSEC), España
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Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 2014; 14:42. [PMID: 24669751 PMCID: PMC3974746 DOI: 10.1186/1471-2288-14-42] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. Methods A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. Results In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. Conclusions To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.
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Affiliation(s)
- Billie Bonevski
- School of Medicine & Public Health, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia.
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Mills LA, Head KJ, Vanderpool RC. HPV vaccination among young adult women: a perspective from Appalachian Kentucky. Prev Chronic Dis 2013; 10:E17. [PMID: 23391293 PMCID: PMC3567923 DOI: 10.5888/pcd10.120183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Few studies have assessed barriers to human papillomavirus (HPV) vaccination uptake and adherence, particularly among women of Appalachian Kentucky, a population with higher rates of cervical cancer, lower rates of HPV vaccination, and lower socioeconomic status compared with the rest of the nation. The objective of this study was to address women's reasons for declining the HPV vaccine and, among women who initiated the vaccine series, barriers to completion of the 3-dose regimen. METHODS We recruited 17 women aged 18 to 26 from a Federally Qualified Health Center who participated in in-depth, semistructured telephone interviews. All interviews were audio-recorded and transcribed verbatim; analysis of the interview transcripts was an iterative process conducted by all 3 authors. RESULTS We identified 3 primary barriers: 1) a knowledge gap wherein women are both uninformed and misinformed about cervical cancer, HPV, and the HPV vaccine, all of which affect vaccination behaviors; 2) environmental and tangible barriers (transportation and prioritizing health over other responsibilities such as child care, work, and school); and 3) ambiguous information sources, which contribute to misinformation and subsequently affect vaccination decisions. CONCLUSION Health professionals should use clear and purposeful communication about how cervical cancer develops, the purpose and safety of the HPV vaccine, and the necessity of completing the 3-dose series. Health promotion campaigns and services tailored for young women in Appalachian Kentucky that focus on increasing knowledge and eliminating barriers are needed.
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Affiliation(s)
- Laurel A Mills
- Eastern Kentucky University, Department of Health Promotion and Administration, Richmond, KY 40475, USA.
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Miyamoto S, Henderson S, Young H, Ward D, Santillan V. Recruiting rural participants for a telehealth intervention on diabetes self-management. J Rural Health 2012; 29:69-77. [PMID: 23289657 DOI: 10.1111/j.1748-0361.2012.00443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recruiting rural and underserved participants in behavioral health interventions is challenging. Community-based recruitment approaches are effective, but they are not always feasible in multisite, diverse community interventions. This study evaluates the feasibility of a rapid, multisite approach that uses rural clinic site coordinators to recruit study participants. The approach allows for rural recruitment in areas where researchers may not have developed long-term collaborative relationships. METHODS Adults with diabetes were recruited from rural Federally Qualified Health Center (FQHC) clinics. Recruitment feasibility was assessed by analyzing field notes by the project manager and health coaches, and 8 in-depth, semistructured interviews with clinic site coordinators and champions, followed by thematic analysis of field notes and interviews. FINDINGS Forty-seven rural sites were contacted to obtain the 6 sites that participated in the study. On average, sites took 14 days to commit to study participation. One hundred and twenty-one participants were acquired from letters mailed to eligible participants and, in some sites, by follow-up phone calls from site coordinators. Facilitators and deterrents affecting study recruitment fell into 4 broad categories--study design, site, site coordinator, and participant factors. CONCLUSION The rapid multisite approach led to quick and efficient recruitment of clinic sites and participants. Recruitment success was achieved in some, but not all, rural sites. The study highlights the opportunities and challenges of recruiting rural clinics and rural, underserved participants in multisite research. Suggestions are provided for improving recruitment for future interventions.
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Affiliation(s)
- Sheridan Miyamoto
- Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA.
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Head KJ, Cohen EL. Young women's perspectives on cervical cancer prevention in Appalachian Kentucky. QUALITATIVE HEALTH RESEARCH 2012; 22:476-87. [PMID: 22068039 DOI: 10.1177/1049732311425053] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Human papillomavirus (HPV) vaccination coupled with routine Papanicolaou (Pap) tests can prevent pervasive HPV infections causing cervical cancer. However, both HPV vaccination rates and Pap testing rates in Appalachian Kentucky are lower among all age groups than the rest of the United States. We recruited 19 young women residing in Appalachian Kentucky from university-based and rural clinical settings for group and individual interviews. After considering an integrated behavioral framework, we illustrate these women's perspectives by detailing five themes, including (a) experiential beliefs pose barriers to performing behaviors, (b) three vaccine doses complicate vaccination intention, (c) women have misunderstandings about HPV and the HPV vaccination function, (d) normative influences cue action (and inaction), and (e) specific environmental and contextual barriers exist to performing cervical cancer prevention behaviors in Appalachian Kentucky. These findings related to cervical cancer prevention in Appalachian Kentucky have implications for health-message design and clinical practice.
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Paskett ED, Fisher JL, Lengerich EJ, Schoenberg NE, Kennedy SK, Conn ME, Roberto KA, Dwyer SK, Fickle D, Dignan M. Disparities in underserved white populations: the case of cancer-related disparities in Appalachia. Oncologist 2012; 16:1072-81. [PMID: 21873582 DOI: 10.1634/theoncologist.2011-0145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations.
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Affiliation(s)
- Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio, USA
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Ory MG, Smith ML, Bolin JN. Forward: Contextualizing rurality for family and community health research. FAMILY & COMMUNITY HEALTH 2011; 34:90-92. [PMID: 21378504 DOI: 10.1097/01.fch.0000395568.99810.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Marcia G Ory
- School of Rural Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843, USA
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