Avoiding gender and minority barriers to NIH funding

The Mela Study: exploring barriers to diabetes research in black and minority ethnic groups

BACKGROUND

Black and minority ethnic (BME) groups are particularly susceptible to diabetes and its vascular complications in the United Kingdom and most western societies. To understand potential predisposition and tailor treatments accordingly, there is a real need to engage these groups in diabetes research. Despite this, BME participation in research studies continues to remain low in most countries and this may be a contributory factor to reduced health outcomes and poorer quality of life in these groups. This study explores the barriers BME groups may have towards participation in diabetes research in one area of East London, and includes local recommendations on how to improve this for the future.

METHODS

A questionnaire designed from previously reported exploratory work and piloted in several BME localities was distributed at the East London Bangladeshi Mela and similar cultural and religious events in London, UK. People were asked opportunistically to complete the survey themselves if they understood English, or discuss their responses with an advocate. The purpose of the questionnaire was to understand current local awareness with regards to diabetes, identify specific BME barriers and attitudes towards diabetes research by ethnicity, gender and age, and gain insight into how these barriers may be addressed.

RESULTS

Of 1682 people surveyed (16-90 years; median age 40 years), 36.4% were South Asian, 25.9% White, and 11.1% Black and other ethnicities; 26.6% withheld their ethnicity. Over half cited language problems generally (54%) and lack of research awareness (56%) as main barriers to engaging in research. South Asian groups were more likely to cite research as too time consuming (42%) whereas Black groups were more concerned with potential drug side effects in research (39%). Participants expressed a general mistrust of research, and the need for researchers to be honest in their approach. Recommendations for increased participation in South Asian groups centred round both helping the community (61%) and improving health (55%). With regards to gender influences, females (34.6%) were significantly more likely to fear drug side effects than males (23.8%), P<0.001. Females were also significantly more likely not to participate in research due to fear of experimentation (25.8%) compared with males (18.9%) P=<0.001.

CONCLUSION

Initial findings from the study demonstrate that in East London research barriers are focused on time, drug side effects, lack of awareness and language. There is a perception that research is time consuming even though the majority of those surveyed had not taken part in a research study. Further potential solutions from the survey have suggested that researchers also need to involve BME community leaders in their study strategy and indicate any individual health benefits to participation in research. Accessible studies with regards to time and advocacy provision need to be included in the design.

Effectiveness, efficiency, duration, and costs of recruiting for an African American women's lifestyle physical activity program

In a 48-week lifestyle physical activity controlled trial in African American women, we analyzed recruitment effectiveness, efficiency, duration, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01, and the mean cost was $74.57 per person. Results suggest that provision of health assessment screening by study staff as part of recruitment is effective for minimizing attrition and also might be cost-effective.

Is there still gender bias in nursing research? An update

Data from 300 studies published in four research journals in 2010-2011 were analyzed to assess whether nurse researchers continue to oversample females. One-third of the studies had samples that were 100% female and, on average, 74% of all study participants were female. As was found for studies published 5 years earlier, the bias against male participants was consistent across studies differing in methods, specialty areas, funding, and sample characteristics. Studies with male first authors, however, were significantly less likely to have biased samples. Authors of only 23.6% of studies with mixed-sex samples provided information about sex differences in outcomes. Because of gender bias, the evidence base for nursing practice may suffer from problems with generalizability.

Effective and cost-effective clinical trial recruitment strategies for postmenopausal women in a community-based, primary care setting

INTRODUCTION

Little evidence exists to guide investigators on the effectiveness and cost-effectiveness of various recruitment strategies in primary care research. The purpose of this study is to describe the effectiveness and cost-effectiveness of eight clinical trial recruitment methods for postmenopausal women in a community-based setting.

METHODS

A retrospective analysis of the yield and cost of eight different recruitment methods: 1) family physician (FP) recruiters, 2) FP referrals, 3) community presentations, 4) community events, 5) newsletters, 6) direct mailings, 7) posters, and 8) newspaper advertisements that were used to recruit postmenopausal women to a randomized clinical trial (RCT) evaluating the effectiveness of gabapentin in treating hot flashes.

RESULTS

We recruited 197 postmenopausal women from a total of 904 screened, with 291 of the remainder being ineligible and 416 declining to participate. Of the 904 women screened, 34 (3.8%) were from FP recruiters and 35 (3.9%) were from other FP referrals while 612 (67.7%) resulted from newspaper advertisements. Of the 197 women enrolled, 141 (72%) were from newspaper advertisements, with 26 (13%) following next from posters. Word of mouth was identified as an additional unanticipated study recruitment strategy. Metropolitan newspaper advertising at $112.73 (Canadian) per enrolled participant and posters at $119.98 were found to be cost-effective recruitment methods.

CONCLUSION

Newspaper advertisements were the most successful method to recruit postmenopausal women into a community-based, primary care RCT.

Understanding systems and rhythms for minority recruitment in intervention research

We describe one approach for recruitment and retention of minority individuals in intervention research using a systematic environmental perspective based on Bronfenbrenner's ecological systems (BES) model and the construct of temporality. An exemplar in a physical activity intervention study with low-income and primarily African American women is presented. The exemplar illustrates application of BES and temporality to enhance recruitment and retention in research focused on understanding and accommodating environmental influences. Using this theory based approach resulted in successful recruitment and a high level of participant retention.

The politics of conducting research on depression in a cross-cultural context

Successful community engagement is often a crucial component of effective qualitative research. In this article we reflect on our experience of engaging with ethnic minority communities in a qualitative study of help seeking for depression. Community engagement emerges as a complex process that provides important insights into the way mental illness is constructed in various cultural contexts and from diverse perspectives. Contested notions of ethnicity, culture, community, and depression were the domains in which personal and public politics were played out. We worked with bilingual research assistants who provided an entrée to the community. Despite this, disparate community subgroups and influential individuals vied for input into and control of the research agenda. We conclude that negotiating the politics of these processes requires great reflexivity and is itself a powerful seam of data, adding richness to findings about the experience of mental distress in a community seeking to locate itself within mainstream society.

Is there gender bias in nursing research?

Using data from a consecutive sample of 259 studies published in four leading nursing research journals in 2005-2006, we examined whether nurse researchers favor females as study participants. On average, 75.3% of study participants were female, and 38% of studies had all-female samples. The bias favoring female participants was statistically significant and persistent. The bias was observed regardless of funding source, methodological features, and other participant and researcher characteristics, with one exception: studies that had male investigators had more sex-balanced samples. When designing studies, nurse researchers need to pay close attention to who will benefit from their research and to whether they are leaving out a specific group about which there is a gap in knowledge.

American Academy of Nursing Expert Panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations

The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.

African Americans’ participation in clinical research: importance, barriers, and solutions

Ethical and scientifically sound research requires that any sample population represent the population as a whole. African-Americans suffer disproportionately from cancer, hypertension, and heart failure compared with whites, but they are commonly underrepresented in clinical trials of these diseases. Failure to include African-American subjects in clinical trials prevents generalizability of the results to this population. African-Americans are often underrepresented in clinical research for numerous historic, societal, educational, and economic reasons. Efforts to improve enrollment of African-American subjects requires recognition of the problem, planning, educational efforts, and investigator training. The incidence of heart disease and prostate cancer in African-Americans dictates that these patients be targeted for clinical trials of surgical research. The research team must appreciate the importance of community involvement and support in recruiting African-Americans participants. Additionally, the continued effort to recruit and train African-American investigators must be a priority.

Recruitment of African American Women to a Walking Program: Eligibility, Ineligibility, and Attrition During Screening

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

The National Research Service Award: strategies for developing a successful proposal

An important experience for doctoral students is developing and submitting an application for a National Research Service Award (NRSA) from the National Institutes of Health (NIH). This article provides an overview of the process of developing and submitting an NRSA proposal from the perspective of a sponsor of successful proposals as well as a member of the Scientific Review Section. Topics included are suggestions for writing and rewriting the proposal, developing a training plan specific to the proposal, selection of sponsors consultants and references, the review process, and revising and resubmitting a proposal. Tables give examples of (a) applicants identifying strengths and areas for growth, (b) activities to address areas for growth (c), and responses to a previous review. The intended audience is beginning doctoral students and novice sponsors.

Ethnic minority older adults participating in clinical research: developing trust

OBJECTIVE

African American, Latino, and American Indian older adults are underrepresented in clinical research studies. A significant barrier to participation in research is mistrust of the scientific community and institutions. The aims of this article are to discuss the lack of representation of ethnic minorities in clinical research.

METHODS

This article presents a review of the literature regarding medical research mistrust. Also described are the trust-building activities of the Resource Centers on Minority Aging Research (RCMAR), federally funded centers focused on research and aging in communities of color.

DISCUSSION

The RCMAR centers are building trust with the communities they serve, resulting in the recruitment and retention of ethnic minority older adults in clinical research studies and health promotion projects. Implications are discussed for other researchers toward building trust with ethnic minority elders to increase their participation in research.

Incorporating multiculturalism into oncology nursing research: the last decade

PURPOSE/OBJECTIVES

To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000.

DATA SOURCES

Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded.

DATA SYNTHESIS

Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education.

CONCLUSIONS

Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations.

IMPLICATIONS FOR NURSING

Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.

Adolescents' input on the development of an HIV risk reduction intervention

Adolescence is a developmental period often associated with sexual debut as well as risk taking. Given these considerations, HIV prevention interventions need to become an important component of adolescent health care. This article describes the use of formative research to guide intervention refinement. To refine an HIV risk reduction intervention that has been used successfully with adults, the authors conducted focus groups with 30 adolescent females. These participants identified misconceptions regarding HIV-related information and factors that influence motivation to participate in risky behaviors. They also suggested strategies for recruitment and retention in a longitudinal study. Formative research such as this can be used to develop interventions that are gender specific and developmentally and culturally appropriate for adolescents.

Qualitative research with diverse populations

OBJECTIVES

To describe the benefits of conducting qualitative research with members of diverse cultures.

DATA SOURCES

Research studies, articles and books on philosophy of science.

CONCLUSIONS

Qualitative research with diverse populations is useful when little research exists on a topic, when there are no reliable and valid instruments for the groups, and when the appropriate language to use or the appropriate concepts and questions to ask are unclear. Participating in research that includes discussing your experiences has also been found to be valuable to those participating.

IMPLICATIONS FOR NURSING PRACTICE

Qualitative studies with diverse groups are needed to understand the concepts that are important to members of these groups, and to guide us in asking the correct questions using correct language.

Recruitment and cardiovascular risk characteristics of African American and Caucasian midlife women

This article describes the use of multiple strategies to recruit women, particularly African American women, into a home-based, moderate-intensity walking intervention and compares African American to Caucasian midlife women on cardiovascular risk characteristics at entry into the program. One hundred seventy-three women aged 45 to 65 years were recruited using a variety of strategies. Baseline findings showed that, on average, the women in the program had modifiable cardiovascular risk factors with proportionately more African American women than Caucasian women having hypertension and low physical fitness. The findings also illustrate the importance of using multiple recruitment strategies to encourage midlife African American and Caucasian women to participate in intervention trials.