Factors influencing post-menopausal African-American women's participation in a clinical trial

Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review

Background

Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment.

Objectives

To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation.

Material and methods

Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework.

Results

Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders.

Conclusion

The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.

Factors affecting patient participation in orthopaedic trials comparing surgery to non-surgical interventions

Background

Randomized controlled trials (RCTs) are considered the most robust research design to determine the effectiveness of interventions. RCTs comparing surgery to non-surgical alternatives are particularly difficult to perform, partly due to difficulties with recruitment. Low recruitment rates can limit the internal and external validity of a trial thus understanding their causes may be important for avoiding protracted recruitment periods. This study aimed to report patient factors that influenced participation in a trial comparing surgery to a non-surgical treatment approach.

Methods

This study was a cross-sectional study nested within CROSSBAT (Combined Randomized and Observational Study of Surgery For Type B Ankle Fracture Treatment). Eligible participants willing to be randomized were randomized while those who declined randomization were offered participation in an observational cohort. Participants from both groups (randomized and observational) were asked to indicate their level of agreement on a 100 mm line with statements concerning reasons for acceptance or rejection of randomization. A subset were asked to state the primary reason for agreeing to participate or not in the trial.

Results

The nested study included 312 participants; 113 who accepted and 199 who declined randomization. Participants unwilling to be randomized (those in the observational arm of the study) predominantly received a non-surgical intervention. They were significantly more worried about receiving treatment by chance (55 mm vs. 33 mm; p < 0.0001) and had a significantly higher preference for one particular treatment (less equipoise) (82 mm vs 43 mm; p < 0.0001) compared to participants willing to be randomized. Influence from clinicians and risk avoidance were primary influences of participation. Participants’ responses regarding protocol burden, study follow-up requirements and altruism did not significantly differ between groups.

Conclusion

Patient non-participation in an RCT comparing surgery to no surgery is related to concern about receiving a treatment through chance and the presence of a strong preference for a particular treatment, particularly a non-surgical one. To avoid protracted recruitment periods, investigators can increase the number of study sites and ensure personnel involved have equipoise and are trained to provide a balanced view of both treatment arms.

Factors influencing women's decision to participate or not in a surgical randomised controlled trial for surgical treatment of female stress urinary incontinence

The study aims to explore the potentially influential factors affecting women's decision to accept/decline participation in surgical randomised trial using a novel acceptance/refusal questionnaire (ARQ). All women who were eligible to participate in SIMS-RCT were asked to complete the relevant section (acceptance/refusal) of the ARQ. Women reported its degree of relevance for their decision on a six-point Likert scale (0 = highly irrelevant, 5 = highly relevant). 135 (98%) and 31 (70%) women completed the acceptance and refusal sections of the ARQ, respectively. The most influencing factor in women's acceptance was the anticipation of “potential personal benefit”; percentage of relevance (POR) was 91.9%, followed by interest in helping others by “supporting innovative medical research”; POR was 87.7%. Most influencing factor in refusal for participation was “do not have time for follow-up”; POR was 56.8%, followed by “do not like the concept of randomisation”; POR was 54.4%. In conclusion, this study identifies the most influential factors relevant to women decision-making whether or not to participate in RCTs assessing surgical interventions for female stress urinary incontinence (SUI). A number of factors leading to refusal of participation are potentially correctable leading to better recruitment rates in future RCTs.

Variability in frontotemporal brain structure: the importance of recruitment of African Americans in neuroscience research

Background

Variation in brain structure is both genetically and environmentally influenced. The question about potential differences in brain anatomy across populations of differing race and ethnicity remains a controversial issue. There are few studies specifically examining racial or ethnic differences and also few studies that test for race-related differences in context of other neuropsychiatric research, possibly due to the underrepresentation of ethnic minorities in clinical research. It is within this context that we conducted a secondary data analysis examining volumetric MRI data from healthy participants and compared the volumes of the amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebral volume between Caucasian and African-American participants. We discuss the importance of this finding in context of neuroimaging methodology, but also the need for improved recruitment of African Americans in clinical research and its broader implications for a better understanding of the neural basis of neuropsychiatric disorders.

Methodology/Principal Findings

This was a case control study in the setting of an academic medical center outpatient service. Participants consisted of 44 Caucasians and 33 ethnic minorities. The following volumetric data were obtained: amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebrum. Each participant completed a 1.5 T magnetic resonance imaging (MRI). Our primary finding in analyses of brain subregions was that when compared to Caucasians, African Americans exhibited larger left OFC volumes (F _1,68 = 7.50, p = 0.008).

Conclusions

The biological implications of our findings are unclear as we do not know what factors may be contributing to these observed differences. However, this study raises several questions that have important implications for the future of neuropsychiatric research.

Clinical trials: the challenge of recruitment and retention of participants

AIMS AND OBJECTIVES

This article, based on the available literature, attempts to discuss the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers.

BACKGROUND

The inability to recruit and retain the required participants in a research project poses serious threats to both the internal and the external validity of a research study. Despite serious implications, the issues of recruitment and retention do not receive due attention in research and publications. Literature suggests a lack of coordinated efforts to collect information on the outcomes of recruitment experiences in clinical trials and population studies. Studies often mention the number of participants who refuse to participate; however, the majority of the studies often fail to mention the specific reasons insufficient recruitment or retention of the participants.

DESIGN

A methodological paper.

METHOD

Various participant-, context-, environment- and research-related factors are examined that affect the phenomenon of recruitment and retention of the participants in a study.

RESULTS

Delayed or inefficient recruitment also has financial and ethical implications. Although there are many pieces of information scattered throughout academic journals on recruitment and retention of participants in research, few authors have dealt with the issue holistically. It is imperative for researchers to understand the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers.

CONCLUSION

Appropriate recording and reporting of the problems faced while recruiting and retaining the participants in research studies can help not only in understating the challenge, but will also help in devising the strategies to overcome this problem. This article was an attempt to synthesise and review the available literature on recruitment and retention issues, which demand extensive theoretical and conceptual thinking as part of the research design.

RELEVANCE TO PRACTICE

An understanding of the challenges and issues related to recruitment and retention can help researchers to think ahead about the strategies to overcome these issues and consequently save the time and energy of the participants, researchers and funding agencies.

Engaging black older adults and caregivers in urban communities in health research

The under-representation of the Black population in research may lead to poor health outcomes for them and a decreased capacity to generalize results to Black populations. This article describes ways in which sensitivity to cultural distinctions of Black older adults and their current or future caregivers can enhance their recruitment and retention in research. Cultural mores play an important role in the shaping of one's perceptions, definitions, responses to disease, and participation in health regimens. Similarly, one's cultural orientation plays a role in how a person is effectively recruited and retained in resear Wenger's translation process model uses cultural meaning to inform research decisions. This model was used in a recent study of Black older adults and their caregivers and will be described in this article. Effectively engaging Black individuals in health research is essential for improving their health.

Recruitment and retention of community-dwelling, aging women in nursing studies

BACKGROUND

Despite recent attention to women's lack of participation in health research, little nursing literature documents or describes recruitment and retention issues related to an increasingly large segment of the population, aging women who dwell in the community.

OBJECTIVES

An analysis of a subset of published nursing research was conducted to identify: (a) demographics of samples that included community-dwelling, aging women; (b) recruitment and retention issues; and (c) the frequency and completeness with which each of these areas is reported.

METHOD

An electronic database search was conducted for reports of funded nursing research that included women aged 65 and older that were published in a subset of English-language nursing journals between 1994 and June 1999. Research reports in which community-dwelling women were recruited for participation were selected for analysis (N = 50).

RESULTS

Racial composition of the sample was included in 66% of reports; educational and employment status in 68% and 48%, respectively; and marital status in 64%. The majority of participants was White and married. It was impossible to determine the racial and marital status of the remainder of participants because of incomplete or ambiguous reporting. Recruitment and retention issues were addressed in only 23% of relevant reports, but specific recommendations can be derived from these reports to help other researchers.

CONCLUSION

It is imperative for nurse researchers to include more information in research reports about their samples of community-dwelling, aging women and their successes and failures with recruitment and retention. This will help future researchers to study the population and will link nursing research to the larger social context of women's lives.

Using direct mail to recruit Hispanic adults into a dietary intervention: an experimental study

Identifying strategies for successful recruitment of ethnic minorities into scientific studies is critical. Without effective methods, investigators may fail to recruit the desired sample size, take longer to recruit than planned, and delay progress for research in minority health. Direct mail is an appealing recruitment method because of the potential for reaching large target populations and producing a high volume of inquiries about a study with relatively little staff effort. To determine which of three direct mail strategies yielded higher recruitment, 561 Hispanic employees were randomly assigned to receive either: (a) a flyer about a worksite dietary intervention; (b) the same flyer plus a personalized hand-signed letter containing heart disease risk statistics for the general American population; or (c) the flyer plus a personalized hand-signed letter containing statistics for Hispanics. Two orthogonal chi-square comparisons were examined. The personalized letters plus flyer yielded a significantly higher response rate (7.8%) than the flyer alone (2.1%), X2(1, N = 561) = 7.5, p = .006. However, the personalized letter with Hispanic heart disease risk statistics did not yield a statistically significant higher response rate (9.1%) than the letter with the general population risk statistics (6.5%), X2(1, N = 370) = 0.9, p > .34. These findings suggest that personalized approaches can increase the effectiveness of direct mail efforts for recruiting ethnic minorities into interventions and may be particularly helpful for large-scale interventions.

Barriers to participation in randomised controlled trials: a systematic review

METHOD

A systematic review of three bibliographic databases from 1986 to 1996 identified 78 papers reporting barriers to recruitment of clinicians and patients to randomised controlled trials.

RESULTS

Clinician barriers included: time constraints, lack of staff and training, worry about the impact on the doctor-patient relationship, concern for patients, loss of professional autonomy, difficulty with the consent procedure, lack of rewards and recognition, and an insufficiently interesting question. Patient barriers included: additional demands of the trial, patient preferences, worry caused by uncertainty, and concerns about information and consent.

CONCLUSIONS

To overcome barriers to clinician recruitment, the trial should address an important research question and the protocol and data collection should be as straightforward as possible. The demands on clinicians and patients should be kept to a minimum. Dedicated research staff may be required to support clinical staff and patients. The recruitment aspects of a randomised controlled trial should be carefully planned and piloted. Further work is needed to quantify the extent of problems associated with clinician and patient participation, and proper evaluation is required of strategies to overcome barriers.

TB or not TB? Increasing door-to-door response to screening

Tuberculosis (TB) has made a disconcerting come-back in the United States in recent years. In 1994, Texas ranked third nationally in total number of TB cases and fifth in annual TB case rates. This is of great concern to the Texas Department of Health (TDH) and has led to the development of TB Innovative Demonstration Projects under the Tuberculosis Elimination Division of the TDH. One such project involves identifying high-risk communities by utilizing a computer-based geographic information system and then sending field-workers door-to-door offering free skin testing. Because this project was so successful in identifying positive skin test reactors, numerous requests have been made to duplicate its methods. One area of improvement is to increase individual and family participation. The purpose of this article is to present a survey of the literature on nonresponse in door-to-door soliciting, analyze the project's methods of soliciting and nonresponse, and propose ways nonresponse can be decreased in future projects of this nature.