Participant recruitment from minority religious groups: the case of the Islamic population in South Australia

Cardiovascular Health and Disease in the Pakistani American Population

PURPOSE OF REVIEW

This narrative review seeks to elucidate clinical and social factors influencing cardiovascular health, explore the challenges and potential solutions for enhancing cardiovascular health, and identify areas where further research is needed to better understand cardiovascular issues in native and American Pakistani populations.

RECENT FINDINGS

The prevalence of cardiometabolic disease is high not only in Pakistan but also among its global diaspora. This situation is further complicated by the inadequacy of current cardiovascular risk assessment tools, which often fall short of accurately gauging the risk among Pakistani individuals, underscoring the urgent need for more tailored and effective assessment methodologies. Moreover, social determinants play a crucial role in shaping cardiovascular health. The burden of cardiovascular disease and upstream risk factors is high among American Pakistani individuals. Future research is needed to better understand the heightened risk of cardiovascular disease among Pakistani individuals.

Cultural threat perceptions predict violent extremism via need for cognitive closure

Understanding the psychological processes that drive violent extremism is a pressing global issue. Across six studies, we demonstrate that perceived cultural threats lead to violent extremism because they increase people's need for cognitive closure (NFC). In general population samples (from Denmark, Afghanistan, Pakistan, France, and an international sample) and a sample of former Mujahideen in Afghanistan, single-level and multilevel mediation analyses revealed that NFC mediated the association between perceived cultural threats and violent extremist outcomes. Further, in comparisons between the sample of former Afghan Mujahideen and the general population sample from Afghanistan following the known-group paradigm, the former Mujahideen scored significantly higher on cultural threat, NFC, and violent extremist outcomes. Moreover, the proposed model successfully differentiated former Afghan Mujahideen participants from the general Afghan participants. Next, two preregistered experiments provided causal support for the model. Experimentally manipulating the predictor (cultural threat) in Pakistan led to higher scores on the mediator (NFC) and dependent variables (violent extremist outcomes). Finally, an experiment conducted in France demonstrated the causal effect of the mediator (NFC) on violent extremist outcomes. Two internal meta-analyses using state-of-the-art methods (i.e., meta-analytic structural equation modeling and pooled indirect effects analyses) further demonstrated the robustness of our results across the different extremist outcomes, designs, populations, and settings. Cultural threat perceptions seem to drive violent extremism by eliciting a need for cognitive closure.

Body image among Muslim women in Israel: exploring religion and sociocultural pressures

The study aimed to investigate the association of the Muslim religion, as a multidimensional factor, with social pressures related to body image concerns, among Muslim women in Israel. Four hundred and Seventy-five Israeli Muslim women ages between 18 and 30 years completed questionnaire measures of strength of religious faith, wearing a traditional head cover (the Hijab), positive and negative body image, media exposure, societal pressures to conform to Western body ideals and its internalization, from 2016 to 2018. Strength of religious faith and wearing the Hijab were positively associated with positive aspects of body image, while only strength of religious faith negatively correlated with body dissatisfaction. Further, mediation analyses revealed that the relationship between the strength of religious faith and both positive body image and body dissatisfaction was mediated by media pressures. Notably, reduced peer pressures had more influence on positive body image, while reduced family pressures were more influential for negative body image. These results are discussed with regard to promoting a more intricate and multicultural understanding of body image concepts.

'Can you please hold my hand too, not only my breast?' The experiences of Muslim women from Turkish and Moroccan descent giving birth in maternity wards in Belgium

Objectives

To reach nuanced understanding of the perinatal experiences of ethnic minority women from Turkish and Moroccan descent giving birth in maternity wards in Belgium thereby gaining insight into the underlying challenges of providing intercultural care for ethnic minority persons in a hospital setting.

Methods

A qualitative study design was used by conducting In-depth interviews with 24 women from Turkish and Moroccan descent who gave birth during the past three years in maternity wards in Flanders, Belgium. The interviews were analysed using a Grounded Theory Approach.

Results

This study shows that the women’s care experiences were shaped by the care interactions with their caregivers, more specifically on the attention that was given by the caregivers towards two essential dimensions of the care relationship, viz. Ereignis (attention to what happens) and Erlebnis (attention to how it happens). These two dimensions were interrelated in four different ways, which defined the women’s care experiences as being either ‘uncaring’, ‘protocolized’, ‘embraced’ or ‘ambiguous’. Moreover, these experiences were fundamentally embedded within the women’s cultural context, which has to be understood as a relational process in which an emotional and moral meaning was given to the women’s care expectations, interactions and interpretations of care.

Conclusions

The findings reveal that the quality of intercultural care depends on the nature and quality of care interactions between ethnic minority patients and caregivers much more than on the way in which cultural questions and tensions are being handled or dealt with in a practical way. As such, the importance of establishing a meaningful care relationship should be the priority when providing intercultural care. In this, a shift in perspective on ‘culture’ from being an ‘individual culture-in-isolation’ towards an understanding of culture as being inter-relational and emerging from within these care relationships is necessary.

Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study

BACKGROUND

Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants' health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany.

OBJECTIVE

One of IMIRA's objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys.

METHODS

The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants' motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code).

RESULTS

We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a "feeling of connectedness" to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because "if you are standing at the front door, you will be let in for sure."

CONCLUSIONS

The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

Cross-cultural integration affects attitudes towards people with HIV/AIDS in Australia

BACKGROUND

The stigma associated with HIV/AIDS represents a significant issue. It can hinder help-seeking behaviours, fracture relationships, conceal prevalence rates and curtail public health initiatives to reduce HIV/AIDS. Culture is known to shape this stigma - it influences how individuals and the communities they represent understand the causes of HIV/AIDS, how it can and should be treated, and how people living with HIV/AIDS (PLWHA) should be regarded. Following recent increases in both HIV/AIDS and cross-cultural migration, this study determines the effect of cross-cultural integration on the tendency to stigmatise PLWHA.

METHODS

This was achieved by surveying adults who are at the nexus of two dissimilar cultures - adults from the Australian-Iranian community (n=236). While the Iranian culture is largely collectivistic, the Australian culture is largely individualistic.

RESULTS

Survey results indicated the respondents represented a collectivistic (44.1%), transitional (33.5%) or an individualistic (22.4%) culture. Those within the collectivistic culture held the most stigmatising views about PLWHA, supporting coercive policies and reporting they would avoid PLWHA. Those within the individualistic culture held the most positive attitudes. Furthermore, regression analysis indicated that movement from a collectivistic to an individualistic culture significantly reduced stigmatising attitudes towards PLWHA.

CONCLUSIONS

This study is the first to demonstrate the benefits afforded by an individualist culture, particularly for PLWHA. The article concludes with a discussion on the implications associated with these findings, particularly for researchers and practitioners within the health promotion field.

Perceptions, Practices, and Mother’s Willingness to Provide Meconium for Use in the Assessment of Environmental Exposures among Children in Mukono and Pallisa Districts, Uganda

Presence of biomarkers or metabolites is assessed in various human biospecimens including meconium in the investigation of exposures to environmental contaminants. This study gathered data on the perceptions and practices of mothers in two rural districts of Uganda concerning meconium and their willingness to provide meconium from their babies for research purposes. The study reveals a wide range of perceptions and beliefs around meconium as well as a number of associated taboos and practices. Many participants noted that meconium could be used to detect ailments among newborns based on its appearance. Practices and beliefs included using it to prevent stomach discomfort and other ailments of newborns, as a means to confirm paternity and initiate the child into the clan as well as facilitating father-child bonding that included ingestion of meconium by the fathers. Most mothers indicated scepticism in accepting to provide meconium for research purposes and had fears of unscrupulous people disguising as researchers and using meconium to harm their children. However, some were willing to provide meconium, if it helped to detect ailments among their children. These perceptions and practices may negatively influence mothers’ willingness to participate in meconium study. However, through provision of educational and behaviour change interventions, mothers’ willingness to participate in a meconium study can be improved.

Barriers and facilitators to recruitment of South Asians to health research: a scoping review

OBJECTIVES

People of South Asian ethnicity are under-represented in health research studies. The objectives of this scoping review were to examine the barriers and facilitators to recruitment of South Asians to health research studies and to describe strategies for improving recruitment.

DESIGN

Scoping review METHODS: Using the Arksey and O'Malley framework for scoping reviews, we comprehensively searched electronic databases (MEDLINE via PubMed, Cochrane Library, CINAHL and PsycINFO). Studies that identified barriers and facilitators to recruitment, or recruitment strategies for South Asian populations were included. Recruitment barriers, facilitators and strategies were grouped thematically and summarised narratively.

SYNTHESIS

Of 1846 potentially relevant articles, 15 met the inclusion criteria and were included in the thematic synthesis. Multiple facilitators and barriers to enrolment of South Asians in health research studies were identified; these most commonly related to logistical challenges, language and cultural barriers, concerns about adverse consequences of participating and mistrust of research. Several actionable strategies were discussed, the most common being engagement of South Asian communities, demonstration of cultural competency, provision of incentives and benefits, language sensitivity through the use of translators and translated materials and the development of trust and personal relationships.

CONCLUSION

There is a growing awareness of the barriers and facilitators to recruitment of South Asian participants to health research studies. Knowledge of effective recruitment strategies and implementation during the grant funding stages may reduce the risk of poor recruitment and representation of South Asians.

Human biomonitoring from an environmental justice perspective: supporting study participation of women of Turkish and Moroccan descent

BACKGROUND

Environmental justice research shows how socially disadvantaged groups are more exposed and more vulnerable to environmental pollution. At the same time, these groups are less represented and, thus, less visible in biomedical studies. This socioeconomic participation bias is a form of environmental injustice within research practice itself.

METHODS

We designed, implemented and evaluated a targeted recruitment strategy to enhance the participation of socially disadvantaged pregnant women in a human biomonitoring study in Belgium. We focused on women of Turkish and Moroccan descent and developed a setup using personal buddies that enabled information transfer about study conditions in the pre-parturition period as well as support and follow-up with questionnaires in the post-parturition period.

RESULTS

We identified four barriers to the participation of women with a vulnerable social and ethnic background which were related to psychosocial and situational factors. Lack of trust in researchers and no perceived study benefits were important personal barriers; the complex study design and difficult self-administered questionnaires were equally significant barriers.

CONCLUSION

By investing in direct, person-to-person contact with trusted buddies and supported by practical advice about cultural and linguistic sensitivity, it was possible to increase study participation of socially disadvantaged people. Above all, this required openness and flexibility in the mind-set of researchers so that study design and procedures could be better grounded in the experiences and circumstances of underprivileged groups.

A Bicultural Researcher's Reflections on Ethical Research Practices With Muslim Immigrant Women: Merging Boundaries and Challenging Binaries

Bicultural researchers are well positioned to identify tensions, disrupt binaries of positions, and reconcile differences across cultural contexts to ensure ethical research practices. This article focuses on a bicultural researcher's experiences of ethically important moments in research activities with Muslim immigrant women. Three ethical principles of respect, justice, and concern for welfare are highlighted, revealing the implications of binary constructions of identity, the value of situated knowledge in creating ethical research practices, and the need to recognize agency as a counterforce to oppressive narratives about Muslim women.

Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands

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.

Impact of participant incentives and direct and snowball sampling on survey response rate in an ethnically diverse community: results from a pilot study of physical activity and the built environment

Community-wide efforts to encourage healthy behaviours must respond to the needs of existing neighbourhoods, especially those where low physical activity (PA) is associated with social, economic, and cultural challenges. This study reports on the effect of direct and snowball sampling strategies and financial incentive levels on the response rates of a built environment and PA survey in a predominately urban, low-SES new-immigrant community. Women residing in the Jane-Finch neighbourhood of Toronto, Ontario were selected to participate by quasi-random sampling, yielding a response rate of 41.5%. The survey completion rate per contact attempt increased 2-fold when incentives were increased from $10 to $20 and a further threefold following the increase from $20 to $30. Snowball sampled respondents were older, less likely to have full-time employment, and had lower educational attainment than directly sampled participants. With appropriate incentives, face-to-face contact, and snowball sampling, survey-based research is feasible within a low-SES, high minority population.

Factors that promote and prohibit access to participants in the clinical setting: a review of response rates from a health communication intervention study

OBJECTIVE

This report examines the factors that influence researchers' abilities to recruit participants into health communication studies conducted within the clinical setting.

METHOD

Review of response rates over a 15 month data collection period for an intervention study on patient-physician communication, low health literacy, and diabetes management.

RESULTS

Most patients were willing to participate (73%). The challenge was not fostering interest in the study, but rather being able to approach potential participants. Over the course of the study, patients with diabetes visited the clinic 1263 times yet interviewers were only able to approach patients 196 times for potential inclusion in the study. Confounding factors that affected recruiting participants included the interviewers' availability and clinic schedule, as well as patient chief complaint and no show or rescheduling rates.

CONCLUSION

Researchers must engage in collaborative efforts with clinic staff during the research design phase, maximize their availability to approach potential patients, and capitalize on the insights of clinic staff to approach those patients who fit the study criteria and would be most willing to participate in the research project.

PRACTICE IMPLICATIONS

Researchers must learn about the clinic, reduce research burden, and be flexible to work within the constraints of the clinic setting.