Recruitment and retention of African American and Hispanic girls and women in research

Establishing and Affirming Social Connections: Recruiting Non-Hispanic Black Adults with Type 2 Diabetes

The underrepresentation of non-Hispanic Black adults in clinical research impacts the generalizability and usefulness of research findings. The purpose of this article is to discuss recruitment strategies used in a research study examining the self-care of diabetes and diabetes distress in non-Hispanic Black adults with type 2 diabetes. In this cross-sectional correlation study, the participants were non-Hispanic Black adults with type 2 diabetes living in North Carolina. A questionnaire collected sociodemographic and clinical characteristics. This study was analyzed using descriptive statistics. In total, 512 individuals accessed the online survey. After data screening, 275 participants were used for data analysis. Sixteen recruitment sites provided letters of support, and 13 were active in the recruitment process. Most participants learned about the research study via social media. Social connections resulting in recruitment partners and using social media supported the successful recruitment. The recruitment strategies implemented can inform researchers of effective evidence-based recruitment strategies to increase the participation of non-Hispanic Black adults in clinical research.

Participant Satisfaction in a Cardiovascular Disease Prevention Intervention for Midlife Black Women

BACKGROUND

Midlife Black women suffer disproportionately from cardiovascular disease and are 65% more likely to die following a cardiac event compared with White women. Recruitment and retention of midlife Black women in clinical trials has been historically low. The culturally tailored Midlife Black Women's Stress Reduction and Wellness (B-SWELL) intervention was codeveloped with the community and designed to lower cardiovascular disease risk in midlife Black women.

OBJECTIVES

We sought to assess participant satisfaction in the randomized feasibility trial of the B-SWELL intervention.

METHODS

A feasibility trial comparing the B-SWELL to a wellness intervention was conducted in the winter and spring of 2021 in compliance with pandemic research protocols. An adapted survey tool was used to rate satisfaction with the intervention and its technology using a Likert-type scale (1 [strongly disagree] to 5 [strongly agree]). Survey subscales assessed usefulness, ease, and acceptability of the intervention(s).

RESULTS

Randomization yielded no statistical demographic differences (N = 48). Satisfaction for the interventions was high in both the B-SWELL and Wellness intervention groups with mean scores of 4.57 and 4.56, respectively. Mean scores for technology were 4.49 for the B-SWELL and 4.47 for the Wellness group. Subscales were also rated highly. Narrative responses were positively aligned with satisfaction scores.

CONCLUSIONS

Results support use of cultural adaptation and community participatory methods to develop and deliver interventions targeted to at-risk populations. Culturally adapted interventions designed in collaboration with the community have greater authenticity, increasing the potential for higher recruitment, retention, and participant satisfaction of underrepresented populations. The trial is registered in ClinicalTrials.gov (NCT04404478).

"Our Community Comes First": Investigating Recruitment Ads That Represent and Appeal to Black Women for Online, HIV-Related Research Studies

BACKGROUND

Black women are underrepresented in health-related research. Consulting Black women in the creation of recruitment materials may help increase their representation in research studies, but few of these recruitment materials have been evaluated. This manuscript reports on the impact of two ads (one featuring older women and one featuring younger women) created through multiple focus group sessions with Black women. The purpose of the ads were to recruit Black women to participate in an online research study about HIV prevention and pre-exposure prophylaxis, PrEP.

MATERIALS AND METHODS

Questions about the ads were embedded in the eligibility screener for inclusion in the online parent research study. Respondents were asked which ad they saw, what they liked about it, and what about the ad piqued their interest in the study.

RESULTS

In total, 301 Black women completed the eligibility screener for the online study and answered questions pertaining to the two ads. Most participants reported seeing the ad with younger women (260/301, 86.4%). Representation of Black women (n = 70), ad design (n = 64), relevance to Black women and the Black community (n = 60), and comprehensiveness of ad content (n = 38) were the top 4 ad features respondents liked. Relevance to Black women and the Black community (n = 104) as well as ad content (n = 54) (i.e., study purpose, location, duration, images, incentive) were the top two reasons provided about ads that piqued respondent's interest in the online study.

CONCLUSION

Findings showcase how recruitment ads informed by Black women could help increase their interest and participation in research.

Materials and Methods for Recruiting Systematically Marginalized Youth and Families for Weight-Management Intervention Trials: Community Stakeholders' Perspectives

Rates of overweight and obesity are problematic among systematically marginalized youth; however, these youth and their families are a hard-to-reach research population. The purpose of our study was to identify facilitators and barriers for recruiting systematically marginalized families in youth weight-management intervention research. This study built upon existing evidence through involvement of youth, parents, community agency workers, and school nurses, and an exploration of both recruitment materials and processes. Seven focus groups were conducted with 48 participants from 4 stakeholder groups (youth, parents, school nurses, and community agency workers). A codebook approach to thematic analysis was used to identify key facilitator and barrier themes related to recruitment materials and processes across the stakeholder groups. Ecological systems theory was applied to contextualize the facilitators and barriers identified. Participants reported the need to actively recruit youth in the study through engaging, fun recruitment materials and processes. Participants reported greater interest in recruitment at community-based events, as compared to recruitment through health care providers, underscoring the depth of distrust that this sample group has for the health care system. Recommendations for recruitment materials and processes for weight-management intervention research with systematically marginalized families are proposed.

Understanding Openness to Involvement in Sexual Health Care Research: Narratives from a Sample of Black College Women in the United States

Little is known about Black college women's openness to participating in sexual health care research. Guided by literature on Black feminism, the current study involved qualitative interviews with 39 Black Women (aged 19-25, mean age 20.7) from one historically Black university and one predominantly white university who answered questions about participating in research on the sexual health of Black women. Results from our thematic analysis found that participants were willing to participate in research when they were recruited by trusted community members, particularly Black female researchers. The women were willing to participate because they saw the value in having Black women's perspectives on sexual health research and improving Black women's lives. We found that participants believed that non-Black women researchers should receive training to increase understanding of the issues facing Black women and create safe and judgment-free spaces to engage Black Women in sexual health research. Participants wanted non-Black female and all male researchers to demonstrate a genuine interest in their lives as Black women. The findings highlight the importance of listening to the perspectives of participants and their experiences with sexual health care providers.

A perspective on enhancing representative samples in developmental human neuroscience: Connecting science to society

Marginalized groups are often underrepresented in human developmental neuroscientific studies. This is problematic for the generalizability of findings about brain-behavior mechanisms, as well as for the validity, reliability, and reproducibility of results. In the present paper we discuss selection bias in cohort studies, which is known to contribute to the underrepresentation of marginalized groups. First, we address the issue of exclusion bias, as marginalized groups are sometimes excluded from studies because they do not fit the inclusion criteria. Second, we highlight examples of sampling bias. Recruitment strategies are not always designed to reach and attract a diverse group of youth. Third, we explain how diversity can be lost due to attrition of marginalized groups in longitudinal cohort studies. We provide experience- and evidence-based recommendations to stimulate neuroscientists to enhance study population representativeness via science communication and citizen science with youth. By connecting science to society, researchers have the opportunity to establish sustainable and equal researcher-community relationships, which can positively contribute to tackling selection biases.

Strategies to improve the recruitment and retention of underserved children and families in clinical trials: A case example of a school-supervised asthma therapy pilot

BACKGROUND

Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical trials. We examined this using a school-based asthma intervention, in preparation for a larger clinical trial in which our goal is to include an underserved study population.

METHODS

We recruited children with poorly controlled asthma in a two-site pilot cluster randomized controlled trial of school-supervised asthma therapy versus enhanced usual care (receipt of an educational asthma workbook). We sought a study population with a high percentage of children and families from racial/ethnic minority and low-income groups. The primary outcome of the pilot trial was recruitment/retention over 12 months. Strategies used to facilitate recruitment/retention of this study population included engaging pre-trial multi-level stakeholders, selecting trial sites with high percentages of underserved children and families, training diverse medical providers to recruit participants, conducting remote trial assessments, and providing multi-lingual study materials.

RESULTS

Twenty-six children [42.3% female, 11.5% Black, 30.8% Multiracial (Black & other), 76.9% Hispanic, and 92.3% with family income below $40,000] and their caregivers were enrolled in the study, which represents 55.3% of those initially referred by their provider, with 96.2%, 92.3%, and 96.2% retention at 3-, 6-, and 12-month follow-up, respectively.

CONCLUSION

Targeted strategies facilitated the inclusion of a medically underserved population of children and families in our pilot study, prior to expanding to a larger trial.

An Overview of Cancer in the First 315,000 All of Us Participants

INTRODUCTION

The NIH All of Us Research Program will have the scale and scope to enable research for a wide range of diseases, including cancer. The program's focus on diversity and inclusion promises a better understanding of the unequal burden of cancer. Preliminary cancer ascertainment in the All of Us cohort from two data sources (self-reported versus electronic health records (EHR)) is considered.

MATERIALS AND METHODS

This work was performed on data collected from the All of Us Research Program's 315,297 enrolled participants to date using the Researcher Workbench, where approved researchers can access and analyze All of Us data on cancer and other diseases. Cancer case ascertainment was performed using data from EHR and self-reported surveys across key factors. Distribution of cancer types and concordance of data sources by cancer site and demographics is analyzed.

RESULTS AND DISCUSSION

Data collected from 315,297 participants resulted in 13,298 cancer cases detected in the survey (in 89,261 participants), 23,520 cancer cases detected in the EHR (in 203,813 participants), and 7,123 cancer cases detected across both sources (in 62,497 participants). Key differences in survey completion by race/ethnicity impacted the makeup of cohorts when compared to cancer in the EHR and national NCI SEER data.

CONCLUSIONS

This study provides key insight into cancer detection in the All of Us Research Program and points to the existing strengths and limitations of All of Us as a platform for cancer research now and in the future.

Strategies to Engage Systematically Marginalized Youth and Their Families in Research Using High-Tech Methods

The purpose of this study was to identify facilitators and barriers for engaging youth and families from a historically and systematically marginalized community in high-tech research. Adapting community-based participatory research principles, 4 focus groups were conducted with 13 youth and 12 parents. Using codebook thematic analysis, 5 facilitator themes (develop skills, ensure health, build understanding, promote safety, and help others, youth-initiated interest) and 4 barrier themes (anxiety and fear, skepticism, confusion, and unfamiliar/unknown experience) were identified. Youth and parent responses informed proposed guidelines for recruiting and engaging families in research using high-tech methods, particularly those from historically and systematically marginalized communities.

Feasibility study of a health coaching intervention to improve contraceptive continuation in adolescent and young adult women in Philadelphia, Pennsylvania

INTRODUCTION

Few interventions to improve contraceptive continuation are tailored to meet the developmental needs of young women under age 25 years. The Health Coaching for Contraceptive Continuation (HC3) intervention was designed to address this gap. In this special report, we describe the rationale for using health coaching, conceptual framework, intervention processes, and findings from a single-arm feasibility study of the intervention protocol.

METHODOLOGY

Health coaching is a person-centered behavioral change approach organized around five main strategies: providing education relevant to health goals, building health self-management skills, offering patient-centered counseling, identifying barriers to adherence, and fostering personal accountability for achieving health goals. We used these strategies to affect theory-driven mediators delineated in the Integrative Model of Behavioral Prediction (intentions, knowledge, attitudes, perceived social norms, and self-efficacy) and clinical mediators posited to change through program participation (shared contraceptive decision-making, method satisfaction, quality of life, distress tolerance, experiential avoidance, patient-coach alliance, and expectations of treatment effect). Experienced sexual health educators completed a manualized, 4-week health training program adapted from the National Society of Health Coaches. Between March and December 2017, we recruited a convenience sample of sexually-active women ages 14-21 years who initiated a new contraceptive in the prior 14 days from three urban pediatric clinics in Philadelphia, Pennsylvania. At baseline, participants completed a socio-demographic questionnaire, contraceptive needs assessment interview, and prioritized reproductive topics to learn more about. We synthesized these data into a coaching plan that guided the monthly coaching sessions which occurred for 6 months following contraceptive initiation. We assessed method adherence and continuation with monthly follow-up questionnaires and corroborated the findings through electronic medical record and pharmacy refill data review. Exit interviews assessed program acceptability. Feasibility outcomes measured throughout the protocol administration included recruitment and retention success. We used descriptive statistics to assess baseline and follow up questionnaire measures and audio-recorded and transcribed exit interviews verbatim. Two independent coders used deductive and inductive content analysis coding approaches to identify themes related to program acceptability.

RESULTS

Of 92 women approached for the longitudinal intervention, 33 enrolled. Participants' mean age was 17.4 ± 2.1 years. Most were Black (n = 24), in high school (n = 23), and single/never-married (n = 31). Twenty-one completed ≥4 coaching sessions. Among the 23 for whom 6-month contraceptive continuation could be determined, 20 continued their baseline method, 2 switched methods without a gap in use, and 1 discontinued contraceptive use. Five were lost to follow up after enrollment; continuation status was indeterminant for the remaining five. Among the 22 who completed exit interviews, all expressed high program acceptability citing that it provided knowledge-based benefits, nonknowledge-based benefits, and an opportunity to develop a positive, supportive relationship with a reproductive health expert. Participants provided feedback on logistical aspects of the program they enjoyed and made suggestions for improvements prior to embarking on a larger efficacy trial.

DISCUSSION

Health coaching is a new approach for promoting contraceptive continuation in young women. The conceptual framework, program structure, and feasibility findings demonstrate strong support for the program among participants. Subsequent research must explore program effects on contraceptive continuation and prevention of unintended pregnancy.

Theory, methods, and operational results of the Young Women's Health History Study: a study of young-onset breast cancer incidence in Black and White women

Purpose

The etiology of young-onset breast cancer (BC) is poorly understood, despite its greater likelihood of being hormone receptor-negative with a worse prognosis and persistent racial and socioeconomic inequities. We conducted a population-based case–control study of BC among young Black and White women and here discuss the theory that informed our study, exposures collected, study methods, and operational results.

Methods

Cases were non-Hispanic Black (NHB) and White (NHW) women age 20–49 years with invasive BC in metropolitan Detroit and Los Angeles County SEER registries 2010–2015. Controls were identified through area-based sampling from the U.S. census and frequency matched to cases on study site, race, and age. An eco-social theory of health informed life-course exposures collected from in-person interviews, including socioeconomic, reproductive, and energy balance factors. Measured anthropometry, blood (or saliva), and among cases SEER tumor characteristics and tumor tissue (from a subset of cases) were also collected.

Results

Of 5,309 identified potentially eligible cases, 2,720 sampled participants were screened and 1,812 completed interviews (682 NHB, 1140 NHW; response rate (RR): 60%). Of 24,612 sampled control households 18,612 were rostered, 2,716 participants were sampled and screened, and 1,381 completed interviews (665 NHB, 716 NHW; RR: 53%). Ninety-nine% of participants completed the main interview, 82% provided blood or saliva (75% blood only), and SEER tumor characteristics (including ER, PR and HER2 status) were obtained from 96% of cases.

Conclusions

Results from the successfully established YWHHS should expand our understanding of young-onset BC etiology overall and by tumor type and identify sources of racial and socioeconomic inequities in BC.

Supplementary Information

The online version of this article contains supplementary material available (10.1007/s10552-021-01461-x).

Recruitment and retention of underrepresented and vulnerable populations to research

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Development and Feasibility of an Obesity Prevention Intervention for Black Adolescent Daughters and Their Mothers

Black female adolescents and women have disproportionately higher rates of obesity than their racial/ethnic counterparts. There is an urgent need to address obesity prevention in Black adolescent females through interventions that enhance lifestyle physical activity and improve dietary behaviors. Middle adolescence presents an important opportunity to strengthen the daughter-mother bond and improve healthy behaviors such as physical activity and dietary intake. Because of the intersection of adolescent development, culture and structural racism, it is essential to include mothers; however, this approach is understudied in the literature. This pre-pilot proof of concept study, Black Girls Move, was conducted using a 12-week pre-post within-subjects design to assess feasibility of conducting and delivering the BGM intervention, program satisfaction, and ability to obtain outcome measures in Black ninth and tenth grade daughters and their mothers. Twenty-two dyads were recruited and 14 dyads completed baseline assessments; however, only eight daughters and their mothers attended the first session and remained for the entire study. All dyads had valid objective and self-reported physical activity data. However, two of eight daughters and one mother provided self-reported dietary data that were considered invalid. All individual sessions were rated highly. Excellent attendance, retention, and satisfaction among participants suggest that we succeeded in developing an accepted, culturally relevant intervention. This lifestyle intervention would be strengthened by modifications to recruitment and retention, as well as incorporation of a computerized dietary assessment tool, a tailored dietary app for self-monitoring, and increased photo-based and group homework activities.

Lessons learned from eight teams: The value of pilot and feasibility studies in self-management science

Designing and conducting effective intervention research is an important domain of nursing science. Nurse scientists have long recognized people with chronic conditions need effective self-management strategies across the lifespan, so they have led the way in establishing theoretical and practical grounds for the science of self-management. Guidance from pilot and feasibility research for self-management interventions is scarce. Documented exemplars of successes and failures in pilot and feasibility study designs are scant in the literature. The purpose of this paper is to illustrate methodological approaches using pilot and feasibility examples. To maximize collective lessons learned in self-management science study design, features of our pilot and feasibility research strategies that yielded both desirable and undesirable outcomes are described, analyzed, and paired with alternative solutions. A National Institute of Nursing Research P30 grant center, awarded grants to 8 pilot investigators to pilot self-management interventions. A wide variety of chronic conditions were addressed, including heart failure, chronic kidney disease, multiple sclerosis, diabetes, and HIV. The investigators provided their experiences of study implementation. Common themes across the studies were identified. There were four lessons learned from these studies: 1) maximize resources and develop enough evidence for subsequent studies; 2) embed patient-centered feasibility within implementation testing with new patient populations; 3) develop a flexible participant recruitment plan to allow for adjustments when unexpected barriers arise; and 4) define study-specific data collection procedures to demonstrate feasibility. Researchers conducting preliminary small-scale self-management intervention research must balance resources to develop and implement interventions to meet pilot and feasibility objectives.

Implementation of a Stress Intervention with Latino Immigrants in a Non-traditional Migration City

Stress negatively impacts health outcomes across all racial and ethnic groups, but the health disparities experienced by Latino immigrants in nontraditional migration cities are exacerbated by undeveloped infrastructure and weak social support networks. Immigrants in new migration cities can be difficult to engage in health interventions and are therefore underrepresented in the very research where their inclusion is most crucial. To effectively engage Latino immigrants, a team of academic and community researchers collaborated on a community-based participatory research project to design and implement a stress and coping intervention. Top stressors reported were family, children, and work, but health was most commonly identified as the primary stressor. Participants overwhelmingly chose physical activity goals for stress reduction. Pre- to post- intervention results revealed significant improvements in social support and stress management. Results demonstrate the effectiveness of a peer-led, community-partnered approach to implementing a stress intervention with Latino immigrants in a nontraditional migration city.

Feasibility and acceptability of a Mediterranean-style diet intervention to reduce cardiovascular risk for low income Hispanic American women

OBJECTIVE

Evidence for the cardioprotective effects of a Mediterranean-style (Med-style) diet is strong, however few Med-style dietary interventions have been developed for and tested among Hispanic Americans (HAs), especially younger HAs of reproductive age whose dietary habits may strongly influence dietary intake for all family members.

DESIGN

We adapted a previously tested and evidence-informed lifestyle intervention to reduce CVD risk and evaluated its feasibility, acceptability, and effects on self-reported lifestyle behaviors in this study enrolling low-income HA women attending a Title X family planning clinic in eastern North Carolina. The 3-month long intervention, given to all participants, promoted a Med-style dietary pattern with a focus on increasing consumption of foods commonly consumed by HA that have high quality dietary fats (polyunsaturated and monounsaturated fats primarily from plant sources and fish) and carbohydrates (fruits, vegetables, and whole grains). The intervention also recommended increasing physical activity and was given during 2 face-to-face counseling sessions and 2 telephone counseling sessions. Major outcomes were engagement with study activities and intervention acceptability; lifestyle behavior change at 3-month follow-up is also reported.

RESULTS

Baseline characteristics (n = 36) were: mean age 33 years, 35 (97%) without health insurance, 32 (89%) born in Mexico, and mean BMI 30 kg/m2. Engagement was high among the 36 participants with 33 (92%) completing the intervention and follow-up measures. At follow-up, most participants thought the intervention was helpful (range: 85-100%) and acceptable (100% agreed 'I would recommend the program to others'). The mean dietary fat quality score improved by 0.5 units (95% CI: 0.0-1.1) and the mean fruit-vegetable servings/day improved by 0.7/day (95% CI: 0.1-1.3).

CONCLUSION

Intervention engagement and acceptability were high and there was improvement in self-reported dietary behaviors. This type of Med-style dietary pattern intervention should be evaluated in randomized trials enrolling HAs at risk for CVD.

Recruitment of hard to contact, hard to engage child populations in clinics and schools

Recruiting children with chronic disease or subgroups of children (low income, obese, specific ages, types of cancer) from clinics and schools for research studies may be particularly difficult. While some have deemed such groups as hard to reach, these groups may be more accurately described as either hard to contact or hard to engage. This is not because children are unknown to the school or clinic but because the researcher's ability to communicate directly with targeted children prior to enrollment is limited. The purpose of this paper is to describe barriers and possible strategies for recruiting hard to contact or hard to engage subgroups of children. Barriers identified in recruiting these children were: naïve to research, communication style and technology, parent/guardian burden, parental conditions and concerns, child stressors and distractions, and research setting. Possible strategies include: pre-consent education, information sheets about study, identifying preferred method of communication, meaningful and appropriate incentives, coordinating recruitment visit with regularly scheduled clinic appointments or school schedule, demonstrating research equipment, informing staff about research study, negotiating creatively for space for research, and emphasizing confidentiality of data. Consideration of barriers to recruitment and utilization of strategies to counteract these barriers is critical to the success of a study involving subgroups of children.

Latino/Hispanic Participation in Community Nutrition Research: An Interplay of Decisional Balance, Cultural Competency, and Formative Work

BACKGROUND

Latinos/Hispanics are among the populations at high risk of nutrition disparities. Adequate participation of this group in community nutrition research is necessary to better understand such disparities and propose sensible solutions.

OBJECTIVE

To identify factors influencing participation and strategies to effectively reach Latinos/Hispanics for community nutrition research.

DESIGN

In-depth interviews with experienced community nutrition researchers across the United States, conducted from February to June 2013.

PARTICIPANTS/SETTING

Nine academics, including four registered dietitian nutritionists with extensive experience in community nutrition research with Latino/Hispanic groups, were interviewed in person (n=3) or via telephone/Skype (n=6).

MAIN OUTCOME MEASURES

Perceived participation barriers, facilitators, and structural factors affecting Latino/Hispanic participation were explored. Successful and unsuccessful recruitment strategies to reaching this group were identified.

ANALYSIS

A Grounded Theory approach was applied for inductive identification of relevant concepts and deductive interpretation of patterns and relationships among themes.

RESULTS

Formative work, cultural competency, and decisional balance emerged as the three interdependent factors influencing participation of Latinos/Hispanics in community nutrition research. Several approaches to influence participation were reported to be operationalized at the interpersonal, community and settings, and systems levels of influence. Trust, time, and tailoring were central concepts, postulated to moderate the relationship between the main themes and influence the effectiveness of recruitment tactics.

CONCLUSIONS

Experienced community nutrition researchers identified actions ascribed to formative work as the bedrock of successful reach of Latinos/Hispanics. A robust formative work plan is necessary to achieving a functional level of trust, time, and tailoring tactics, which appear to critically influence participation.

Acupuncture in reproductive medicine: the motivations of infertile women to participate in a randomised controlled trial

INTRODUCTION

Randomised controlled trials are the gold standard in medical research and are challenging to conduct successfully since high numbers of participants are needed to produce robust results. Therefore, it is important to understand what motivates patients to participate in one, particularly in Reproductive Medicine where the conduct of RCTs is rare. Just as it is important to evaluate medical interventions, it is equally important that adjuvant therapies are properly assessed. There has been an increased interest in adding acupuncture to in vitro fertilisation (IVF) in the hope of increasing the chance of pregnancy and a live birth. However, evidence that acupuncture assists IVF outcomes is conflicted and insight into the experiences and motivations of infertile women is important. This paper describes how an invitation to participate in an RCT of acupuncture as an adjuvant to IVF was received by infertile women and how they processed their decision to participate.

METHODS

In-depth interviews were conducted with 50 infertile women recruited from the RCT sample cohort. Recruitment aimed for maximum variation in social demographics. The data were saturated. Data pertaining to the theme of motivations to participate in an RCT were subjected to semantic thematic analysis.

RESULTS

Two subthemes contained categories related to (a) the reasons women put forward for participation in an RCT, and (b) the rationale that underpinned and surrounded their decision. Women described themselves as active agents searching for a better outcome for their infertility or improved outcomes for women in the future. Their decision to participate in an RCT was motivated by factors such as opportunity, novelty and a value of science and was made after weighing various risks and benefits.

CONCLUSIONS

The decision to participate in an RCT was an informed one. Infertile women in a stressful treatment situation participated in an RCT in the hope of finding a therapy to improve IVF outcomes for themselves and for other infertile women.

Schools as Sites for Recruiting Participants and Implementing Research

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.

Engaging African American Adolescents and Stakeholders to Adapt Interpersonal Psychotherapy for Weight Gain Prevention

Developing culturally appropriate obesity prevention programs for African American (AA) adolescent girls that account for psychological risk factors is paramount to addressing health disparities. The current study was part of an investigation utilizing a community-based participatory research framework to gather qualitative data from urban AA girls, their caregivers, and community health liaisons to develop a novel obesity prevention program based on interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). In the current study with urban AAs, data from seven focus groups (total sample size, N = 40) were analyzed using thematic analysis. Participants identified problematic eating behaviors, including binge or loss of control eating; highlighted the importance of interpersonal relationships, mood functioning, and eating; and supported the tenets of IPT-WG. While features of IPT-WG generally resonated with participants, culturally based modifications were suggested. These data will be used to inform the development of a culturally relevant IPT-WG program.

Preferred intervention strategies to improve dietary and physical activity behaviors among African-American mothers and daughters

OBJECTIVE

The objective of this study was to identify cultural- and age-appropriate intervention strategies to improve dietary and physical activity (PA) behaviors in African-American adolescent daughters and their mothers.

DESIGN AND SAMPLE

A convergent parallel mixed methods design with interactive quantitative and qualitative measures was used. Twenty-four 9th- and 10th-grade African-American daughters from a large urban high school and their mothers participated.

MEASURES

Measures included the 2013 Youth Risk Behavior Surveillance System dietary and PA questions, 2013 Behavioral Risk Factor Surveillance System dietary and PA questions, and BMI. Focus group questions covered preferred intervention formats and strategies for delivering a dietary and PA intervention.

RESULTS

Fifty-five percent of daughters and 92% of mothers were overweight/obese. Mothers tended to prefer the group format (mothers/daughters together or mothers together) for delivering a dietary and PA intervention, while the daughters' delivery preferences were mixed. Top mother/daughter dyad strategy preferences for both dietary and PA were goal setting and use of rewards/prizes.

CONCLUSIONS

These findings suggest several dietary and PA obesity intervention strategies that can guide obesity prevention efforts for African-American daughters and their mothers.

Ethical considerations for involving Latina adolescents in mental health research

TOPIC

US Latina adolescents experience significant mental health disparities, such as depressive symptoms and suicidal ideation and, therefore, should be involved in research studies focused on minimizing these health disparities. However, researchers must consider the specific ways this population is vulnerable and provide adequate protections to reduce risks related to these vulnerabilities.

PURPOSE

The purpose of this article is to describe the different ways that Latina adolescents with mental health problems can be vulnerable research participants, identify strategies to protect this population during a research study, and describe steps taken to apply these strategies in an ongoing qualitative study examining depression in Latina adolescents.

SOURCES USED

Kipnis's (2003) article describes seven ways that children can be vulnerable research participants. These seven vulnerabilities are used to describe the vulnerabilities of Latina adolescents with mental health problems. Specific strategies to protect this population are synthesized to provide a list of strategies that can be used by researchers to reduce the risks associated with the vulnerabilities of this group.

CONCLUSIONS

In order to minimize risks for Latina adolescents, researchers must be engaged in Latino/a communities, use culturally and linguistically appropriate consent processes, and implement strategies to protect the confidentiality of Latina adolescent participants.

Recruiting African American Children for Research: An Ecological Systems Theory Approach

With health disparities still pervasive and persistent in the United States, medical researchers and social scientists continue to develop recruitment strategies to increase the inclusion of racial/ethnic minority groups in research and interventions. Effective methods for recruiting samples of African American participants for pediatric research may be best understood when situated within an overarching conceptual model-one that serves to organize and explain effective recruitment strategies. A theoretical framework well suited for this purpose is Bronfenbrenner's ecological systems theory, which views individuals as influencing and being influenced by (both directly and indirectly) a series of interconnected social systems. Based on the ecological systems theory and on previous research from multiple domains (e.g., medicine, psychology, public health, social work), in the current article, we review strategies for effective recruitment of African American children and adolescents for research.

A successful approach to minimizing attrition in racial/ethnic minority, low-income populations

BACKGROUND

Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition.

METHODS

The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition.

RESULTS

Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P <0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk=1.5; 95% confidence interval, 1.1-2.0).

CONCLUSIONS

A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.

Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials

The underrepresentation of ethnically diverse populations in cancer clinical trials results in the inequitable distribution of the risks and benefits of this research. Using a case study approach, we apply a conceptual framework of factors associated with the participation of diverse population groups in cancer clinical trials developed by Dr. Jean Ford and colleagues to increase understanding of the specific strategies, and barriers and promoters addressed by these strategies, that resulted in marked success in accrual of racially and ethnically diverse populations in cancer clinical research. Results indicate that the studies presented were able to successfully engage minority participants due to the creation and implementation of multilevel, multifaceted strategies that included: culturally and linguistically appropriate outreach, education, and research studies that were accessible in local communities; infrastructure to support engagement of key stakeholders, clinicians, and organizations serving minority communities; testimonials by ethnically diverse cancer survivors; availability of medical interpretation services; and providing infrastructure that facilitated the engagement in clinical research of clinicians who care for minority patient populations. These strategic efforts were effective in addressing limited awareness of trials, lack of opportunities to participate, and acceptance of engagement in cancer clinical trials. Careful attention to the context and population characteristics in which cancer clinical trials are conducted will be necessary to address disparities in research participation and cancer outcomes. These studies illustrate that progress on minority accrual into clinical research requires intentional efforts to overcome barriers at all three stages of the accrual process: awareness, opportunity, and acceptance of participation.

Advancing methods for US transgender health research

PURPOSE OF REVIEW

This article describes methodological challenges, gaps, and opportunities in US transgender health research.

RECENT FINDINGS

Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of sex affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities.

SUMMARY

Transgender health research faces challenges that include standardization of lexicon, agreed upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population.

Embedding clinical interventions into observational studies

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed.

Recruitment and retention strategies in clinical studies with low-income and minority populations: Progress from 2004-2014

More than 20years have passed since the NIH 1993 Act was initiated, and while progress has been made toward better representation of minorities and women in clinical research studies, as this review will show, there is still tremendous room for improvement. The purpose of this review was to identify the current state of literature on recruitment and retention strategies in clinical studies of low-income and minority populations. We identified 165 studies published in English between 2004 and 2014. Data extracted included information on the study type (descriptive or analytical), study design, study focus (recruitment, retention, both recruitment and retention), health outcome, specific minority group, special population or age group, if specific recruitment/retention techniques were tested, and key research findings. Particular attention was given to articles that statistically analyzed the effectiveness of recruitment and retention strategies on enrollment/retention rates. Effective recruitment and retention strategies for low-income and minority groups, differential effectiveness across groups, and implications for future research are discussed.

Recruitment strategies and the retention of obese urban racial/ethnic minority adolescents in clinical trials: the FIT families project, Michigan, 2010-2014

Introduction

The successful recruitment and retention of participants is integral to the translation of research findings. We examined the recruitment and retention rates of racial/ethnic minority adolescents at a center involved in the National Institutes of Health Obesity Research for Behavioral Intervention Trials (ORBIT) initiative by the 3 recruitment strategies used: clinic, informatics, and community.

Methods

During the 9-month study, 186 family dyads, each composed of an obese African American adolescent and a caregiver, enrolled in a 6-month weight-loss intervention, a sequential multiple assignment randomized trial. We compared recruitment and retention rates by recruitment strategy and examined whether recruitment strategy was related to dyad baseline characteristics.

Results

Of the 186 enrolled families, 110 (59.1%) were recruited through clinics, 53 (28.5%) through informatics, and 23 (12.4%) through community. Of those recruited through community, 40.4% enrolled in the study, compared with 32.7% through clinics and 8.2% through informatics. Active refusal rate was 3%. Of the 1,036 families identified for the study, 402 passively refused to participate: 290 (45.1%) identified through informatics, 17 (29.8%) through community, and 95 (28.3%) through clinics. Recruitment strategy was not related to the age of the adolescent, adolescent comorbidities, body mass index of the adolescent or caregiver, income or education of the caregiver, or retention rates at 3 months, 7 months, or 9 months. Study retention rate was 87.8%.

Conclusion

Using multiple recruitment strategies is beneficial when working with racial/ethnic minority adolescents, and each strategy can yield good retention. Research affiliated with health care systems would benefit from the continued specification, refinement, and dissemination of these strategies.

Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

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.