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Biggs K, Hullock K, Dix C, Lane JA, Green H, Treweek S, Shiely F, Shepherd V, Willis A, Isaacs T, Cooper C. Time to STEP UP: methods and findings from the development of guidance to help researchers design inclusive clinical trials. BMC Med Res Methodol 2024; 24:227. [PMID: 39358688 PMCID: PMC11445965 DOI: 10.1186/s12874-024-02342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND It is important to design clinical trials to include all those who may benefit from the intervention being tested. Several frameworks have been developed to help researchers think about the barriers to inclusion of particular under-served groups when designing a trial, but there is a lack of practical guidance on how to implement these frameworks. This paper describes the ACCESS project, the findings from each phase of the project and the guidance we developed (STEP UP) on how to design more inclusive trials. METHODS Development of the STEP UP guidance had five phases: (1) Scoping literature review, (2) 'roundtable' discussion meetings, (3) redesign of trials, (4) interviews and (5) guidance document development, with input from public contributors and the ACCESS team. RESULTS Over 40 experts contributed to the ACCESS project-patients and the public, clinicians, NHS research staff, trialists and other academics. The scoping review identified several strategies being used to improve inclusion, mostly around recruitment settings, but there was little evaluation of these strategies. The 'roundtable' discussions identified additional strategies being used across the UK and Ireland to improve inclusion, which were grouped into: Communication, Community engagement, Recruitment sites, Patient information, Flexibility, Recruitment settings, Consent process, Monitoring, Training for researchers and Incentives. These strategies were used to redesign three existing trials by applying one of the three INCLUDE frameworks (ethnicity, socioeconomic disadvantage, impaired capacity to consent) to one trial each, to produce the key recommendations for the guidance. Issues around implementation were explored in stakeholder interviews and key facilitators were identified: funders requesting information on inclusion, having the time and funding to implement strategies, dedicated staff, flexibility in trial protocols, and considering inclusion of under-served groups at the design stages. The STEP UP guidance is freely available at http://step-up-clinical-trials.co.uk . CONCLUSION Researchers should consider inclusivity to shape initial trial design decisions. Trial teams and funders need to ensure that trials are given both the resources and time needed to implement the STEP UP guidance and increase the opportunities to recruit a diverse population.
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Affiliation(s)
- K Biggs
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Sheffield, UK.
| | - K Hullock
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Sheffield, UK
| | - C Dix
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Sheffield, UK
| | - J A Lane
- Bristol Medical School, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - H Green
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- COUCH Health, Manchester, UK
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - F Shiely
- HRB Clinical Research Facility and School of Public Health, University College Cork, Cork, Ireland
| | - V Shepherd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - A Willis
- HRB Clinical Research Facility and School of Public Health, University College Cork, Cork, Ireland
| | - T Isaacs
- IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - C Cooper
- Clinical Trials Research Unit, Division of Population Health, University of Sheffield, Sheffield, UK
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Sadaf MI, Akbar UA, Nasir K, Hanif B, Virani SS, Patel KV, Khan SU. Cardiovascular Health and Disease in the Pakistani American Population. Curr Atheroscler Rep 2024; 26:205-215. [PMID: 38669004 DOI: 10.1007/s11883-024-01201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/28/2024]
Abstract
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.
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Affiliation(s)
- Murrium I Sadaf
- Department of Cardiology, University of Arkansas Medical Center, Little Rock, AR, USA
- John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA
| | - Usman Ali Akbar
- West Virginia University-Camden Clark Medical Center, Parkersburg, WV, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Bashir Hanif
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan
- Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
| | - Kershaw V Patel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Biggs K, Dix C, Shiely F, Treweek S, Shepherd V, Lane A, Green H, Isaacs T, Willis A, Cooper C. Effective interventions to increase representation of under-served groups in randomised trials in UK and Ireland: a scoping literature review. NIHR OPEN RESEARCH 2024; 4:12. [PMID: 39297143 PMCID: PMC11408910 DOI: 10.3310/nihropenres.13524.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 09/21/2024]
Abstract
Background Participants in clinical trials often do not reflect the populations that could benefit from the treatments being investigated. There are known barriers to trial participation for under-served groups, but limited evidence on strategies to alleviate these barriers to improve representation. This scoping review aimed to identify effective interventions and design features that improve the representation `of under-served groups in trials, focusing on the UK and Ireland. Methods We included methodological research studies that reported interventions to improve representation of ethnic minority groups, socioeconomically disadvantaged groups, older people, or those with impaired capacity to consent to randomised controlled trials, conducted in the UK and Ireland, published between 2000-2021. Systematic searches were conducted in November 2021 and data were independently extracted by two authors and narratively synthesised. Results Seven studies were included: one randomised controlled study embedded in five trials, one mixed-methods study, and five studies reporting 'lessons learnt' from one trial. We categorised the 47 reported interventions or strategies into nine broad themes: Recruitment sites, recruitment settings, community engagement, and communication with participants, incentives, inclusion criteria, flexibility, patient documentation, and the consent process. Only 28/47 interventions were evaluated, 23 of which were comparison of recruitment pathways.The randomised study found that a £100 incentive mentioned in the invitation letter increased positive responses overall across drug trials in cardiovascular disease and hypertension, but not for older people or those living in the most deprived areas. Invitation letters via GPs and working with communities were reported as successful recruitment pathways in recruiting different under-served populations. Conclusions Interventions aiming to improve the recruitment of under-served groups in the UK and Ireland were reported across seven papers, but their effectiveness was rarely rigorously evaluated. Included studies were context specific. Using a variety of recruitment methods is likely to help achieve a more diverse cohort.
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Affiliation(s)
- Katie Biggs
- Clinical Trials Research Unit, Division of Population Health, The University of Sheffield, Sheffield, England, S1 4DA, UK
| | - Caroline Dix
- Clinical Trials Research Unit, Division of Population Health, The University of Sheffield, Sheffield, England, S1 4DA, UK
| | - Frances Shiely
- HRB Clinical Research Facility and School of Public Health, University College Cork, Cork, County Cork, T12 WE28, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Victoria Shepherd
- Centre for Trials Research, Cardiff University, Cardiff, Wales, CF14 4YS, UK
| | - Athene Lane
- Bristol Trials Centre, University of Bristol, Bristol, England, BS8 1NU, UK
| | - Heidi Green
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
- COUCH Health, Manchester, M1 3HF, UK
| | - Talia Isaacs
- Institute of Education (IOE), Faculty of Education and Society, University College London, London, England, WC1H 0NS, UK
| | - Andrew Willis
- HRB Clinical Research Facility and School of Public Health, University College Cork, Cork, County Cork, T12 WE28, Ireland
| | - Cindy Cooper
- Clinical Trials Research Unit, Division of Population Health, The University of Sheffield, Sheffield, England, S1 4DA, UK
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Bessell E, Markovic TP, Caterson ID, Hendy C, Burk J, Picone T, Fuller NR. Cost-effectiveness analysis of recruitment strategies in a large diabetes prevention trial conducted across two sites in Sydney, Australia. Contemp Clin Trials 2024; 137:107421. [PMID: 38145712 DOI: 10.1016/j.cct.2023.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Diabetes prevention trials require large samples and community-based recruitment, which can be protracted and expensive. We analysed the cost-effectiveness of recruitment strategies used in a randomised placebo-controlled supplement trial in adults with prediabetes and overweight or obesity conducted in Sydney, Australia. METHODS Recruitment strategies included advertising through local radio stations and newspapers, television news coverage, online advertising and editorials, advertising in and referral from primary care settings, university- and hospital-based advertising, and attending or hosting local events. For each strategy, the number of expressions of interest, screenings booked, and randomised participants were collated. The percentage contribution from each strategy, overall cost, and cost per participant were calculated. RESULTS Of 4498 expressions of interest, 551 (12%) were eligible for onsite screening and 401 (9%) were randomised. Recruitment costs totalled AU$218,501, averaging AU$545 per participant. The recruitment strategy was recorded for 49% who expressed interest in the trial, and for 75% randomised into the trial. From these data, advertising on local radio stations was the most cost-effective strategy, contributing 46% of participants at AU$286 per participant, then advertising in and referral from primary care settings (57 participants [19%], AU$1438 per participant). The least cost-effective strategy was television news coverage, which was not targeted to the Sydney-based audience, contributing only six participants (AU$10,000 per participant). CONCLUSION Radio advertising and recruitment through healthcare were the most effective recruitment strategies in this trial. Recruitment strategies should be location-specific and appropriate for the target population, prioritising low-effort high-yield strategies. Trial investigators should seek opportunities for free advertising.
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Affiliation(s)
- Erica Bessell
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia.
| | - Tania P Markovic
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia; Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ian D Caterson
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia; Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Chelsea Hendy
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia
| | - Jessica Burk
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia
| | - Tegan Picone
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia
| | - Nicholas R Fuller
- The University of Sydney, The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, NSW, Australia
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Gala K, Ghusn W, Tariq R, Abu Dayyeh BK, Chedid V. Demographic Disparities in Recruitment for Clinical Trials Focused on Endoscopic Bariatric Therapies. Obes Surg 2023; 33:3699-3702. [PMID: 37798510 DOI: 10.1007/s11695-023-06854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Studies have shown that there are multiple disparities in the recruitment for clinical trials across medical specialties, which makes it challenging to translate research findings to the real world. We performed a systematic review of RCTs focused on EBTs and examined the sex, racial, and ethnic background and age of participants. METHODS A systematic search of trials pertaining to EBTs was performed. Demographic details from all trials were abstracted and recorded and compared to real-world demographics of obesity in the United States, as reported in the NHANES 2017-March 2020. RESULTS A total of 11 trials were included. Mean age of all patients was 43.50 ± 9.25, which differs from the age distribution of obesity in the population (35% between 40 and 59 years). Mean female representation was 89%, which is higher than real-world estimates (50%). A mean of 74% of participants were white, with underrepresentation of African American (21%) and Hispanic (10%) participants as compared to real-world estimates. CONCLUSION Populations affected by obesity are not equitably reflected in clinical trials focused on endoscopic bariatric therapies.
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Affiliation(s)
- Khushboo Gala
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Wissam Ghusn
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Raseen Tariq
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Victor Chedid
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Chattopadhyay K, Mishra P, Singh K, Singh K, Harris T, Hamer M, Greenfield SM, Manjunath NK, Nair R, Mukherjee S, Tandon N, Lewis SA, Kinra S, Prabhakaran D. Yoga Programme for Type 2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India: A Multicenter Feasibility Randomized Controlled Trial. Diabetes Ther 2023:10.1007/s13300-023-01395-4. [PMID: 37002475 PMCID: PMC10066010 DOI: 10.1007/s13300-023-01395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Many Indians are at high risk of type 2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YOGA-DP), a 24-week structured lifestyle education and exercise (Yoga) program that included 27 group Yoga sessions and self-practice of Yoga at home. In this study, the feasibility of undertaking a definitive randomized controlled trial (RCT) was explored that will evaluate the intervention's effectiveness among high-risk individuals in India. METHODS A multicenter, two-arm, parallel-group, feasibility RCT was conducted in India. The outcome assessors and data analysts were blinded. Adults with a fasting blood glucose level of 100-125 mg/dL (i.e., at high risk of T2DM) were eligible. Participants were randomized centrally using a computer-generated randomization schedule. In the intervention group, participants received YOGA-DP. In the control group, participants received enhanced standard care. RESULTS In this feasibility trial, the recruitment of participants took 4 months (from May to September 2019). We screened 711 people and assessed 160 for eligibility. Sixty-five participants (33 in the intervention group and 32 in the control group) were randomized, and 57 (88%) participants were followed up for 6 months (32 in the intervention group and 25 in the control group). In the intervention group, the group Yoga sessions were continuously attended by 32 (97%) participants (median (interquartile range, IQR) number of sessions attended = 27 (3)). In the intervention group, Yoga was self-practiced at home by 30 (91%) participants (median (IQR) number of days per week and minutes per day self-practiced = 2 (2) and 35 (15), respectively). In the control group, one (3%) participant attended external Yoga sessions (on Pranayama) for 1 week during the feasibility trial period. There was no serious adverse event. CONCLUSIONS The participant recruitment and follow-up and adherence to the intervention were promising in this feasibility study. In the control group, the potential contamination was low. Therefore, it should be feasible to undertake a definitive RCT in the future that will evaluate YOGA-DP's effectiveness among high-risk people in India. FEASIBILITY TRIAL REGISTRATION Clinical Trials Registry-India (CTRI) CTRI/2019/05/018893; registered on May 1, 2019.
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Affiliation(s)
- Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, University of Nottingham, Nottingham, UK.
| | | | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Tess Harris
- Population Health Research Institute, St. George's University of London, London, UK
| | - Mark Hamer
- Division of Surgery and Interventional Science, Institute of Sport, Exercise and Health, University College London, London, UK
| | | | | | - Rukamani Nair
- Bapu Nature Cure Hospital and Yogashram, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India
| | - Sarah Anne Lewis
- Lifespan and Population Health Academic Unit, University of Nottingham, Nottingham, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Lip S, Dempster G, Jain S, Brooksbank K, Ghouri N, McCallum L, Padmanabhan S. Underrepresentation of ethnic minorities in hypertension research-a survey of enablers and barriers among South Asian and African communities in Glasgow. Trials 2022; 23:609. [PMID: 35906700 PMCID: PMC9335986 DOI: 10.1186/s13063-022-06542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is the biggest contributor to the global cardiovascular burden with evidence for ethnic differences in treatment response and outcomes. Under-representation of ethnic minorities in clinical research is well known, and despite wide-ranging public engagement events by the Glasgow Blood Pressure Clinic team, there was a lack of participation of ethnic minorities in both engagement activities and clinical trials conducted by them. This study aims to explore the awareness and knowledge of hypertension and the facilitators and barriers to participation in hypertension clinical research among South Asian (SA) and African (AFR) communities in Glasgow. METHODS A survey questionnaire was co-developed with representatives from South Asian (SA) and African (AFR) patients and community members in Glasgow to understand awareness and knowledge of hypertension and enablers and barriers to participation in clinical research. The survey was distributed to adults (aged > 18) years of SA or AFR ancestry at public engagement events at venues that were frequently visited by these two communities in Glasgow. RESULTS The survey response rate was 337 (67.4%) consisting of 242 (71.8%) South Asian (SA) and 56 (16.9%) African (AFR) respondents. Thirty-nine questionnaires were excluded because of incompletion. Most of the respondents were not born in the UK and were in the 35-53-year group (AFR 29 (51%), SA 113 (47%)). The proportion living in the most deprived (SIMD 1) and least deprived (SIMD 5) was respectively 26 (12.4%) and 34 (16.2%) for SA and 20 (42.6%) and 2 (4.3%) for AFR. There was a considerable recognition that treatment needs to be ethnicity-specific (SA/AFR = 107 (48%)/23 (45.1%)) and that current cardiovascular disease treatment guidelines were not tailored for different ethnicities 84 (38.5%)/23 (45.1%). The key enablers encouraging research participation are enhanced health information, conducting aspects of their clinical research visits/appointments at a location they frequently visited and allowing a family member to accompany them. Barriers included concerns about the use of personal information and side effects of the new treatment. CONCLUSION Our survey confirmed enablers and barriers to ethnic minority participation in research. We find improving and evolving awareness and beliefs among the ethnic minority population including community leaders. Thus, continual review of researchers' beliefs and attitudes is also essential to ensure engagement activities keep up with these changing perceptions.
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Affiliation(s)
- Stefanie Lip
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Georgia Dempster
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sahil Jain
- Department of Rheumatology and General Internal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Bhatnagar P, Foster C, Shaw A. Barriers and facilitators to physical activity in second-generation British Indian women: A qualitative study. PLoS One 2021; 16:e0259248. [PMID: 34731201 PMCID: PMC8565737 DOI: 10.1371/journal.pone.0259248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
AIM To understand the barriers to and motivations for physical activity among second-generation British Indian women. SUBJECT Approximately 50% of British South Asians are UK-born, and this group is increasing as the second-generation also have children. Previous research into the barriers to and facilitators for physical activity has focused on migrant, first-generation populations. Qualitative research is needed to understand a) how we might further reduce the gap in physical activity levels between White British women and British Indian women and b) the different approaches that may be required for different generations. METHODS Applying a socioecological model to take into account the wider social and physical contexts, we conducted semi-structured interviews with 28 Indian women living in Manchester, England. Interviews with first-generation British Indian women were also included to provide a comparator. Interviews were audio-recorded, transcribed, thematically coded and analysed using a grounded theory approach. RESULTS Ways of socialising, concerns over appearance while being physically active, safety concerns and prioritising educational attainment in adolescence were all described as barriers to physical activity in second-generation British Indian women. Facilitators for physical activity included acknowledging the importance of taking time out for oneself; religious beliefs and religious groups promoting activity; being prompted by family illness; positive messages in both the media and while at school, and having local facilities to use. CONCLUSIONS Barriers to physical activity in second-generation Indian women were very similar to those already reported for White British women. Public health measures aimed at women in the general population may also positively affect second-generation Indian women. First-generation Indian women, second-generation children and Muslim women may respond better to culturally tailored interventions.
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Affiliation(s)
- Prachi Bhatnagar
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Alison Shaw
- Institute of Social and Cultural Anthropology, University of Oxford, Oxford, United Kingdom
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Davidson EM, Krasuska M, Jenum AK, Gill JMR, Beune E, Stronks K, van Valkengoed IGM, Diaz E, Sheikh A. Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Diabet Med 2021; 38:e14584. [PMID: 33838051 DOI: 10.1111/dme.14584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
AIMS Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'. METHODS We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework. RESULTS We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers). CONCLUSIONS This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.
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Affiliation(s)
| | | | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Erik Beune
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esperanza Diaz
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Qureshi SA, Igland J, Møen K, Gele A, Kumar B, Diaz E. Effect of a community-based intervention to increase participation in cervical cancer screening among Pakistani and Somali women in Norway. BMC Public Health 2021; 21:1271. [PMID: 34193096 PMCID: PMC8243573 DOI: 10.1186/s12889-021-11319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norway implemented a regular cervical cancer screening program based on triennial screening in 1995, recommending participation of all women between 25 and 69 years of age. Somali and Pakistani women have the lowest participation in cervical cancer screening in Norway. This study evaluates the effect of a community-based intervention aimed at increasing participation in the screening program among women from these two groups. METHODS The intervention consisted of an oral 20-25 min presentation in Urdu and Somali on cervical cancer and screening and practical information on how to make an appointment and payment for the test. The participants were invited to pose questions related to the topic after the presentation. This study was carried out in four geographical areas surrounding the capital Oslo between February and October 2017, among women aged 25-69 years from Pakistan and Somalia. We recruited women in the intervention group directly from different community institutions, households, and religious sites. Women from Pakistan and Somalia residing in Oslo were the controls. The absolute intervention effect was measured as difference in absolute proportion of women screened and estimated as the interaction between time and group allocation in a generalized estimation equation model with binomial distribution and identity link function. RESULTS The percentage of women screened in the intervention group increased, from 46 to 51%. The corresponding increase in proportion in the control group was from 44 to 45.5%. After adjustment for potential confounders the intervention group showed a significant larger increase in participation in the screening program as compared to the control group with an absolute difference in change in proportion screened of 0.03 (95% CI; 0.02- 0.06). CONCLUSIONS Our findings suggest that theory-based, culturally and linguistically sensitive educational interventions can raise awareness and motivate immigrant women to participate in cervical cancer screening program. In addition, approaching health professionals as well as immigrant women, might improve participation even more. TRIAL REGISTRATION NCT03155581 . Retrospectively registered, on 16 May 2017.
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Affiliation(s)
- Samera Azeem Qureshi
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, 0213, Oslo, Norway.
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kathy Møen
- The Norwegian Research Centre (NORCE) Alrek Helseklynge, Årstadveien 17, 5009, Bergen, Norway
| | - Abdi Gele
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Bernadette Kumar
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration & Health, Norwegian Institute of Public Health (NIPH), P.O. Box 222, Skøyen, 0213, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway
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11
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Kapadia SJ, Gao Y, Cumming E. A remotely-delivered community action project to promote a diabetes lifestyle intervention programme in northwest London: basis, process and outcomes. Health Promot Perspect 2021; 11:250-255. [PMID: 34195049 PMCID: PMC8233682 DOI: 10.34172/hpp.2021.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/13/2021] [Indexed: 11/09/2022] Open
Abstract
Background : The prevalence of type 2 diabetes mellitus (T2DM) in London is rising, obesity being a major driver. As part of a primary care placement, the authors (two medical students and a lead general practitioner) directly promoted the Reducing Weight with Intensive Dietary Support (REWIND) programme to patients in Northwest London and collected feedback on the promotion. Methods : The team developed and delivered three remote interventions: a redesigned patient-facing information leaflet, phone calls and text messages, and a live, interactive webinar, to directly engage patients and raise awareness about REWIND. Feedback was collected pre and post-webinar using an anonymised, online survey (essentially functioning as a 'teaching' evaluation). Results : Mean interest in REWIND had increased from 2.7 (pre-promotion) to 4.7 (post-promotion), knowledge about REWIND had increased from 2.1 to 4, and self-reported likelihood of enrolling had increased from 2.6 to 4.2 (P<0.01 in all cases). The reported usefulness of the leaflet and webinar was scored 3.7 and 4.4 respectively. Within two weeks of the webinar, two of these patients had joined REWIND. Conclusion : Feedback from the patients and GP revealed that the project successfully raised awareness, improved knowledge, and increased the likelihood of enrolment in REWIND. Diabetes programmes and organisations are encouraged to adapt the methods of this project to their own contexts, especially in light of COVID-19 where remote interventions will remain essential.
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Affiliation(s)
| | - Yu Gao
- Imperial College School of Medicine, London, UK
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12
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Vaja I, Umeh KF, Abayomi JC, Patel T, Newson L. A grounded theory of type 2 diabetes prevention and risk perception. Br J Health Psychol 2021; 26:789-806. [PMID: 33448543 DOI: 10.1111/bjhp.12503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Type 2 diabetes (T2D) prevention programmes should target high-risk groups. Previous research has highlighted minimal engagement in such services from South Asian (SA) people. Given SA's elevated risk of T2D, there is a need to understand their perceptions, risks, and beliefs about T2D. DESIGN This study aimed to assess T2D risk perception within a community sample of SA people using Grounded Theory methodology. Specifically, health beliefs were assessed, and we explored how these beliefs affected their T2D risk perceptions. METHOD Twenty SA participants (mean age = 38 years) without a diagnosis of T2D were recruited from community and religious settings across the North West of England. In line with grounded theory (Strauss & Corbin, 1990, Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications), data collection and analysis coincided. RESULTS The superordinate category of Culturally Situated Risk Perception incorporated a complex psychological understanding of the formation of T2D risk perception, which takes into account the social, cultural, and community-based environmental factors. This superordinate category was explained via two core categories (1) Diminished Responsibility, informed by sub-categories of Destiny and Heredity, and (2) Influencing Healthy Lifestyle Behaviours, informed by sub-categories of Socio-cultural and Environmental. CONCLUSION This study investigated risk perception of T2D within the SA community. When considering health prevention in the context of an individual's culture, we need to consider the social context in which they live. Failure to acknowledge the cultural-situated T2D risk perception relevant to health promotion and illness messages may account for the issues identified with health care engagement in the SA population.
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Affiliation(s)
- Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Kanayo F Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Julie C Abayomi
- Faculty of Health and Social Care, Edgehill University, Liverpool, UK
| | - Tasneem Patel
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
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13
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Koipuram A, Carroll S, Punthakee Z, Sherifali D. Diabetes knowledge, risk perception, and quality of life among South Asian caregivers in young adulthood. BMJ Open Diabetes Res Care 2020; 8:8/2/e001268. [PMID: 33168524 PMCID: PMC7654120 DOI: 10.1136/bmjdrc-2020-001268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Persons of South Asian descent have a higher prevalence of type 2 diabetes mellitus (T2DM). The management of T2DM in the South Asian community has required the support of adult children, potentially impacting the quality of life, diabetes-related knowledge, and risk perception among these caregivers. RESEARCH DESIGN AND METHODS To investigate diabetes-related knowledge, quality of life, risk perception, and actual risk of developing diabetes among South Asian young adults whose parents are living with T2DM. A cross-sectional study was conducted (n=150). An online survey was administered. Data were analyzed with descriptive and inferential statistics. RESULTS There was a statistically significant difference in diabetes-related knowledge between males and females (p<0.001). Males (in comparison to females) had a lower risk perception of developing diabetes (p=0.06). Further, risk perception and diabetes-related knowledge were positively associated with caregiver's physical health (p=0.002). CONCLUSION Findings highlight the importance of providing gender-specific and culturally tailored diabetes educational interventions.
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Affiliation(s)
- Angela Koipuram
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Carroll
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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14
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Prinjha S, Miah N, Ali E, Farmer A. Including 'seldom heard' views in research: opportunities, challenges and recommendations from focus groups with British South Asian people with type 2 diabetes. BMC Med Res Methodol 2020; 20:157. [PMID: 32539718 PMCID: PMC7296709 DOI: 10.1186/s12874-020-01045-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/09/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The inclusion of 'seldom heard' groups in health and social care research is increasingly seen as important on scientific, policy and ethical grounds. British South Asians, the largest minority ethnic group in the United Kingdom (UK), are under-represented in health research yet over-represented in the incidence of certain conditions such as type 2 diabetes. With the growing requirement of patient involvement in research and the inclusion of diverse populations, methodological guidance on how to include, engage and conduct research with UK South Asian populations is essential if services and interventions are to be relevant and impactful. However, such guidance for researchers is limited. METHODS The aim of the paper is to reflect on our experiences of conducting focus groups with UK South Asian communities with type 2 diabetes, which involved experienced community partners and researchers working closely together. We discuss the factors that aided the successful delivery of the project, the challenges that we encountered, how we dealt with these, and recommendations. RESULTS Our study suggests ways to involve and conduct focus groups with UK South Asian populations. Key considerations are categorised under four headings: co-working with community partners; linguistic competency; cultural competency and awareness; and reflexivity, power and acknowledgement. Having an experienced team of researchers and community experts - with the relevant linguistic and cultural competencies and different kinds of knowledge and skills - was key to the successful delivery of the study. Working collaboratively enabled us to recruit a diverse sample, to navigate the challenges of recruitment, to be present at every discussion which helped contribute to data richness, and to reflect on our own roles in the research process. CONCLUSIONS Focus groups with UK South Asian communities can be a useful way of exploring new topics and involving seldom heard views. While a useful method, focus groups are only one way of exploring a research topic and provide an insight into context-specific attitudes and views. Future research should explore British South Asian participants' views on how they would like to be involved in research, including new methods of collecting data and coproducing research.
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Affiliation(s)
- Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Nasima Miah
- Centre for BME Health, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW UK
| | - Ebrahim Ali
- Bangladesh Youth & Cultural Shomiti (BYCS), 30-32 Biddulph Street, Leicester, LE2 1BF UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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15
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Kivelä J, Wikström K, Virtanen E, Georgoulis M, Cardon G, Civeira F, Iotova V, Karuranga E, Ko W, Liatis S, Makrilakis K, Manios Y, Mateo-Gallego R, Nanasi A, Rurik I, Tankova T, Tsochev K, Van Stappen V, Lindström J. Obtaining evidence base for the development of Feel4Diabetes intervention to prevent type 2 diabetes - a narrative literature review. BMC Endocr Disord 2020; 20:140. [PMID: 32164690 PMCID: PMC7066732 DOI: 10.1186/s12902-019-0468-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Feel4Diabetes was a school and community based intervention aiming to promote healthy lifestyle and tackle obesity for the prevention of type 2 diabetes among families in 6 European countries. We conducted this literature review in order to guide the development of evidence-based implementation of the Feel4Diabetes intervention. We focused on type 2 diabetes prevention strategies, including all the phases from risk identification to implementation and maintenance. Special focus was given to prevention among vulnerable groups and people under 45 years. METHODS Scientific and grey literature published between January 2000 and January 2015 was searched for relevant studies using electronic databases. To present the literature review findings in a systematic way, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A complementary literature search from February 2015 to December 2018 was also conducted. RESULTS The initial review included 27 studies with a follow-up ≥12 months and 9 studies with a follow-up ≥6 months and with a participant mean age < 45 years. We found out that interventions should be targeted at people at risk to improve recruiting and intervention effectiveness. Screening questionnaires (primarily Finnish Diabetes Risk Score FINDRISC) and blood glucose measurement can both be used for screening; the method does not appear to affect intervention effectiveness. Screening and recruitment is time-consuming, especially when targeting lower socioeconomic status and age under 45 years. The intervention intensity is more important for effectiveness than the mode of delivery. Moderate changes in several lifestyle habits lead to good intervention results. A minimum of 3-year follow-up seemed to be required to show a reduction in diabetes risk in high-risk individuals. In participants < 45 years, the achieved results in outcomes were less pronounced. The complementary review included 12 studies, with similar results regarding intervention targets and delivery modes, as well as clinical significance. CONCLUSION This narrative review highlighted several important aspects that subsequently guided the development of the Feel4Diabetes high-risk intervention. Research on diabetes prevention interventions targeted at younger adults or vulnerable population groups is still relatively scarce. Feel4Diabetes is a good example of a project aiming to fill this research gap. TRIAL REGISTRATION clinicaltrials.gov NCT02393872, registered 20th March 2015.
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Affiliation(s)
- Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Eeva Virtanen
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Fernando Civeira
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | | | - Winne Ko
- International Diabetes Federation, Brussels, Belgium
| | - Stavros Liatis
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Rocío Mateo-Gallego
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Anna Nanasi
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, Varna, Bulgaria
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jaana Lindström
- Department of Public Health Solutions, National Institute for Health and Welfare, PO BOX 27, 00300 Helsinki, Finland
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16
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Withall J, Greaves CJ, Thompson JL, de Koning JL, Bollen JC, Moorlock SJ, Fox KR, Western MJ, Snowsill T, Medina-Lara A, Cross R, Ladlow P, Taylor G, Zisi V, Clynes J, Gray S, Agyapong-Badu S, Guralnik JM, Rejeski WJ, Stathi A. The Tribulations of Trials: Lessons Learnt Recruiting 777 Older Adults Into REtirement in ACTion (REACT), a Trial of a Community, Group-Based Active Aging Intervention Targeting Mobility Disability. J Gerontol A Biol Sci Med Sci 2020; 75:2387-2395. [PMID: 32147709 PMCID: PMC7662171 DOI: 10.1093/gerona/glaa051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention. METHODS The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated. RESULTS The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. CONCLUSIONS REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials.
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Affiliation(s)
- Janet Withall
- Department for Health, University of Bath, UK,Address correspondence to: Janet Withall, PhD, Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK
| | | | - Tristan Snowsill
- Institute of Health Research, College of Medicine and Health, South Cloisters, University of Exeter, St Luke’s Campus, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, UK
| | - Vasiliki Zisi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Selena Gray
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Bristol, UK
| | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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17
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Kumar K, Stack RJ, Adebajo A, Adams J. Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Rheumatol Adv Pract 2019; 3:rkz042. [PMID: 31768498 PMCID: PMC6862933 DOI: 10.1093/rap/rkz042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Methods We used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis. Results Three emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations. Conclusion For the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.
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Affiliation(s)
- Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Rebecca J Stack
- Department of Psychology, Nottingham Trent University, Nottingham
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
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18
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Kakumanu S, Manns BJ, Tran S, Saunders-Smith T, Hemmelgarn BR, Tonelli M, Tsuyuki R, Ivers N, Southern D, Bakal J, Campbell DJT. Cost analysis and efficacy of recruitment strategies used in a large pragmatic community-based clinical trial targeting low-income seniors: a comparative descriptive analysis. Trials 2019; 20:577. [PMID: 31590686 PMCID: PMC6781395 DOI: 10.1186/s13063-019-3652-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE One of the most challenging parts of running clinical trials is recruiting enough participants. Our objective was to determine which recruitment strategies were effective in reaching specific subgroups. STUDY DESIGN AND SETTING We assessed the efficacy and costs of the recruitment strategies used in the Assessing Outcomes of Enhanced Chronic Disease Care Through Patient Education and a Value-based Formulary Study (ACCESS) in Alberta, Canada. RESULTS Twenty percent of the study budget ($354,330 CAD) was spent on recruiting 4013 participants, giving an average cost per enrolled of $88 CAD. Pharmacies recruited the most participants (n = 1217), at a cost of $128/enrolled. "Paid media" had the highest cost ($806/enrolled), whereas "word of mouth" and "unpaid media" had the lowest (~$3/enrolled). Participants enrolled from "seniors outreach" had the lowest baseline quality of life and income, while participants from "word of mouth" had the lowest educational attainment. CONCLUSION The "health care providers" strategies were especially successful - at a moderate cost per enrolled. The "media" strategies were less effective, short lasting, and more costly. No strategy was singularly effective in recruiting our targeted groups, emphasizing the importance of utilizing a variety of strategies to reach recruitment goals. TRIAL REGISTRATION ClinicalTrials.gov, NCT02579655 . Registered on 19 October 2015.
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Affiliation(s)
- Sravya Kakumanu
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sophia Tran
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Terry Saunders-Smith
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ross Tsuyuki
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Noah Ivers
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Danielle Southern
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeff Bakal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, TRW 3E33, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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19
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Bracken K, Keech A, Hague W, Allan C, Conway A, Daniel M, Gebski V, Grossmann M, Handelsman DJ, Inder WJ, Jenkins A, McLachlan R, Robledo KP, Stuckey B, Yeap BB, Wittert G. A high-volume, low-cost approach to participant screening and enrolment: Experiences from the T4DM diabetes prevention trial. Clin Trials 2019; 16:589-598. [PMID: 31581816 DOI: 10.1177/1740774519872999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Participant recruitment to diabetes prevention randomised controlled trials is challenging and expensive. The T4DM study, a multicentre, Australia-based, Phase IIIb randomised controlled trial of testosterone to prevent Type 2 diabetes in men aged 50-74 years, faced the challenge of screening a large number of prospective participants at a small number of sites, with few staff, and a limited budget for screening activities. This article evaluates a high-volume, low-cost, semi-automated approach to screen and enrol T4DM study participants. METHODS We developed a sequential multi-step screening process: (1) web-based pre-screening, (2) laboratory screening through a network of third-party pathology centres, and (3) final on-site screening, using online data collection, computer-driven eligibility checking, and automated, email-based communication with prospective participants. Phone- and mail-based data collection and communication options were available to participants at their request. The screening process was administered by the central coordinating centre through a central data management system. RESULTS Screening activities required staffing of approximately 1.6 full-time equivalents over 4 years. Of 19,022 participants pre-screened, 13,108 attended a third-party pathology collection centre for laboratory screening, 1217 received final, on-site screening, and 1007 were randomised. In total, 95% of the participants opted for online pre-screening over phone-based pre-screening. Screening costs, including both direct and staffing costs, totalled AUD1,420,909 (AUD75 per subject screened and AUD1411 per randomised participant). CONCLUSION A multi-step, semi-automated screening process with web-based pre-screening facilitated low-cost, high-volume participant enrolment to this large, multicentre randomised controlled trial. Centralisation and automation of screening activities resulted in substantial savings compared to previous, similar studies. Our screening approach could be adapted to other randomised controlled trial settings to minimise the cost of screening large numbers of participants.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Ann Conway
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Mark Daniel
- University of Canberra, Canberra, ACT, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mathis Grossmann
- The Austin Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Bronwyn Stuckey
- Keogh Institute of Medical Research and The University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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20
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Qureshi SA, Gele A, Kour P, Møen KA, Kumar B, Diaz E. A community-based intervention to increase participation in cervical cancer screening among immigrants in Norway. BMC Med Res Methodol 2019; 19:147. [PMID: 31299912 PMCID: PMC6626362 DOI: 10.1186/s12874-019-0795-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The attendance to cervical cancer screening is low among immigrants in many high-income countries. Although several interventions have been experimentally tested,implementation remains a challenge. Several factors are an impediment, including the lack of methodological descriptions of the development and implementation of such interventions. In this paper,we present in detail the development, methodological challenges and practical implementation of a community based intervention aimed to increase the participation of immigrant women in cervical cancer screening in Norway. METHODS This study was initially designed as a cluster randomized trial to be carried out in four geographical areas near Oslo between Feb-October 2017. Participants were immigrant women aged 25-69 years from Pakistan and Somalia. This paper describes the theoretical background for the development of the intervention,followed by challenges,the changes in the original design and solutions adopted related to the study design,recruitment and implementation of the intervention. The intervention was developed based on two theoretical frameworks, the Ecological and the Heron's six categories intervention framework. An oral 20-25 min presentation in the language of participants encompassing topics of cervical cancer and screening was given according to the needs detected in focus groups conducted at the beginning of the study,followed by an opportunity to raise questions and answering a short questionnaire. RESULTS Contrary to the initial study design, this had to be converted into a non-randomised trial due to the difficulties associated with randomization of immigrant families who are finely scattered in heavily populated towns and a high risk of contamination. We therefore adopted a pragmatic approach and recruited women in the intervention areas through a variety of channels and institutions. Neighboring areas were considered to be non-randomised controls. Female researchers with Pakistani and Somali background invited as many women as possible in the intervention areas. Among the women who were invited to participate,42% of the Pakistani and 78% of Somali attended the meetings. CONCLUSION Despite the careful development of a culturally adapted health intervention in collaboration with the community; randomization and recruitment of immigrants for community trials remains challenging. Nevertheless, sharing strategies to overcome specific challenges related to promoting health interventions for immigrants, can be of potential help to scale-up interventions and for building new research projects. TRIAL REGISTRATION NCT03155581 . Retrospectively registered, on 16 May 2017.
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Affiliation(s)
- Samera A Qureshi
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway.
| | - Abdi Gele
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway
| | - Prabhjot Kour
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O.Box 104, 2381, Brumunddal, Norway
| | - Kathy A Møen
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, P.O.Box 7804, N-5020, Bergen, Norway
| | - Bernadette Kumar
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway
| | - Esperanza Diaz
- Norwegian Centre for Migrant & Minority Health (NAKMI), Norwegian Institute of Public Health (NIPH), P.O.Box 222 Skøyen, 0213, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, P.O.Box 7804, N-5020, Bergen, Norway
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21
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Bracken K, Hague W, Keech A, Conway A, Handelsman DJ, Grossmann M, Jesudason D, Stuckey B, Yeap BB, Inder W, Allan C, McLachlan R, Robledo KP, Wittert G. Recruitment of men to a multi-centre diabetes prevention trial: an evaluation of traditional and online promotional strategies. Trials 2019; 20:366. [PMID: 31217024 PMCID: PMC6585027 DOI: 10.1186/s13063-019-3485-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Effective interventions are required to prevent the current rapid increase in the prevalence of Type 2 diabetes. Clinical trials of large-scale interventions to prevent Type 2 diabetes are essential but recruitment is challenging and expensive, and there are limited data regarding the most cost-effective and efficient approaches to recruitment. This paper aims to evaluate the cost and effectiveness of a range of promotional strategies used to recruit men to a large Type 2 diabetes prevention trial. Methods An observational study was conducted nested within the Testosterone for the Prevention of Type 2 Diabetes (T4DM) study, a large, multi-centre randomised controlled trial (RCT) of testosterone treatment for the prevention of Type 2 diabetes in men aged 50–74 years at high risk of developing diabetes. Study participation was promoted via mainstream media—television, newspaper and radio; direct marketing using mass mail-outs, publicly displayed posters and attendance at local events; digital platforms, including Facebook and Google; and online promotions by community organisations and businesses. For each strategy, the resulting number of participants and the direct cost involved were recorded. The staff effort required for each strategy was estimated based on feedback from staff. Results Of 19,022 men screened for the study, 1007 (5%) were enrolled. The most effective recruitment strategies were targeted radio advertising (accounting for 42% of participants), television news coverage (20%) and mass mail-outs (17%). Other strategies, including radio news, publicly displayed posters, attendance at local events, newspaper advertising, online promotions and Google and Facebook advertising, each accounted for no more than 4% of enrolled participants. Recruitment promotions cost an average of AU$594 per randomised participant. The most cost-effective paid strategy was mass mail-outs by a government health agency (AU$745 per participant). Other paid strategies were more expensive: mail-out by general practitioners (GPs) (AU$1104 per participant), radio advertising (AU$1081) and newspaper advertising (AU$1941). Conclusion Radio advertising, television news coverage and mass mail-outs by a government health agency were the most effective recruitment strategies. Close monitoring of recruitment outcomes and ongoing enhancement of recruitment activities played a central role in recruitment to this RCT. Trial registration ANZCTR, ID: ACTRN12612000287831. Registered on 12 March 2012. Electronic supplementary material The online version of this article (10.1186/s13063-019-3485-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Ann Conway
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - David J Handelsman
- Anzac Research Institute, and Andrology Department, Concord Hospital, Sydney, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine, the University of Melbourne, and Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | | | - Bronwyn Stuckey
- Department of Endocrinology and Diabetes, Keogh Institute of Medical Research, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Medical School, University of Western Australia and Fiona Stanley Hospital, Perth, WA, Australia
| | - Warrick Inder
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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22
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Kanaya AM, Chang A, Schembri M, Puri-Taneja A, Srivastava S, Dave SS, Vijayakumar EN, Qamar Z, Naik HD, Siddiqui F, Kandula NR. Recruitment and retention of US South Asians for an epidemiologic cohort: Experience from the MASALA study. J Clin Transl Sci 2019; 3:97-104. [PMID: 31660232 PMCID: PMC6802417 DOI: 10.1017/cts.2019.371] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group. METHODS We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017-2018. We assessed the yields from different methods of recruitment and retention. RESULTS A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield. CONCLUSION Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
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Affiliation(s)
- Alka M. Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ann Chang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael Schembri
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Shweta Srivastava
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Swapna S. Dave
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Zubaida Qamar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Family, Interiors, Nutrition and Apparel Department, San Francisco State University, San Francisco, California, USA
| | - Hemalatha D. Naik
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Faiza Siddiqui
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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John C, Reeve NF, Free RC, Williams AT, Ntalla I, Farmaki AE, Bethea J, Barton LM, Shrine N, Batini C, Packer R, Terry S, Hargadon B, Wang Q, Melbourne CA, Adams EL, Bee CE, Harrington K, Miola J, Brunskill NJ, Brightling CE, Barwell J, Wallace SE, Hsu R, Shepherd DJ, Hollox EJ, Wain LV, Tobin MD. Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED). Int J Epidemiol 2019; 48:678-679j. [PMID: 31062032 PMCID: PMC6659362 DOI: 10.1093/ije/dyz073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola F Reeve
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Robert C Free
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Ioanna Ntalla
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London Medical School, Queen Mary University of London, Charterhouse Square, London, UK
| | - Aliki-Eleni Farmaki
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Jane Bethea
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Linda M Barton
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chiara Batini
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Packer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Terry
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Beverley Hargadon
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Qingning Wang
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl A Melbourne
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma L Adams
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine E Bee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kyla Harrington
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - José Miola
- Leicester Law School, University of Leicester, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences University of Leicester, Leicester, UK
| | - Christopher E Brightling
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Julian Barwell
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Susan E Wallace
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ron Hsu
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David J Shepherd
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Edward J Hollox
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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24
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Harris T, Kerry S, Victor C, Iliffe S, Ussher M, Fox-Rushby J, Whincup P, Ekelund U, Furness C, Limb E, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Normansell R, Beighton C, Morgan K, Wahlich C, Sanghera S, Cook D. A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT. Health Technol Assess 2019; 22:1-274. [PMID: 29961442 DOI: 10.3310/hta22370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. OBJECTIVES To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. DESIGN Parallel three-arm trial, cluster randomised by household. SETTING Seven London-based general practices. PARTICIPANTS A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. INTERVENTIONS Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. MAIN OUTCOME MEASURES The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. RESULTS Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. LIMITATIONS The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. CONCLUSIONS A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. FUTURE WORK Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. TRIAL REGISTRATION Current Controlled Trials ISRCTN98538934. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cheryl Furness
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, London, UK
| | - Judith Ibison
- Population Health Research Institute, St George's, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, UK
| | - Emma Howard
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Dale
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jaime Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George's, University of London, London, UK
| | - Katy Morgan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sabina Sanghera
- Health Economics Research Group, Brunel University London, London, UK
| | - Derek Cook
- Population Health Research Institute, St George's, University of London, London, UK
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25
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Systematic Review of the Effect of Lifestyle Interventions on the Components of the Metabolic Syndrome in South Asian Migrants. J Immigr Minor Health 2019; 20:231-244. [PMID: 27766507 DOI: 10.1007/s10903-016-0515-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A systematic review was undertaken to identify lifestyle intervention studies in South Asian migrant populations to determine the effect on the components of the metabolic syndrome. A total of seven studies were identified, of which six focused on educational advice and the seventh on intensive exercise intervention. Four studies were Randomised Controlled Trials of which two studies reported significant reductions in waist circumference. One of these studies focused on home based education with cooperation of the home cook (adjusted waist reduction of 1.9 cm, 95 % CI 0.52-3.3 cm; p = 0.007) and the other entailed an intensive physical activity program (adjusted waist reduction 3.4 cm, 95 % CI 2.0-4.7 cm). The evidence whether lifestyle intervention studies in South Asians can improve components of the metabolic system is not clear. Further lifestyle interventions for South Asians should be culturally adapted, involve friends and family, especially those with cooking responsibilities.
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26
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Participation of Turkish Migrants in an Epidemiological Study: Does the Recruitment Strategy Affect the Sample Characteristics? J Immigr Minor Health 2018; 21:811-819. [DOI: 10.1007/s10903-018-0788-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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27
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Chu JTW, Wan A, Stewart SM, Ng KT, Lam TH, Chan SS. Recruitment and Lessons Learned from a Community-Based Intervention Program: The Learning Families Project in Hong Kong. Front Public Health 2018; 6:16. [PMID: 29450196 PMCID: PMC5799230 DOI: 10.3389/fpubh.2018.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Recruitment is central to any research project, and recruitment itself should be well documented and researched. We describe our recruitment efforts for a community-based research project-entitled the Learning Families Project-conducted in Hong Kong. Methods In collaboration with community stakeholders, residents from a public housing estate were recruited to participate in family programs aimed at enhancing family well-being. Various recruitment strategies were employed including the distribution of 19,200 leaflets, 688 posters, a banner, a kick-off ceremony, 10 promotion activities, 1,000 direct calls, word of mouth, 51 mobile counters, and 10 door-to-door visits. Drawing on field notes, research logs, short questionnaires, and focus group conducted with our community partners and residents, we describe and discuss our recruitment strategies, challenges, and lessons learned. Results Over a 9-month period, 980 participants were recruited and participated in our study, exceeding our recruitment goal (860 participants). Several observations were made including active recruitment strategies (i.e., door-to-door and mobile counter) being more effective than passive strategies (i.e., posters and leaflets); the importance of raising project awareness to facilitate recruitment; and the challenges encountered (i.e., burn-out and loss of motivation of staff, decreased community capacity in collaborating in research projects). Conclusion The lessons learned include the importance of engaging Chinese communities, utilizing a positive outreach approach, and setting realistic expectations. Although similar recruitment strategies have been reported the West, a number of cultural differences should be taken into account when working with Chinese population. Further research is needed to examine the effectiveness of tailoring recruitment strategies to various populations.
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Affiliation(s)
- Joanna T W Chu
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Alice Wan
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sunita M Stewart
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
| | - Kwok Tung Ng
- Christian Family Service Centre, Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sophia S Chan
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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28
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Kerry SM, Morgan KE, Limb E, Cook DG, Furness C, Carey I, DeWilde S, Victor CR, Iliffe S, Whincup P, Ussher M, Ekelund U, Fox-Rushby J, Ibison J, Harris T. Interpreting population reach of a large, successful physical activity trial delivered through primary care. BMC Public Health 2018; 18:170. [PMID: 29361929 PMCID: PMC5781315 DOI: 10.1186/s12889-018-5034-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 01/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Failure to include socio-economically deprived or ethnic minority groups in physical activity (PA) trials may limit representativeness and could lead to implementation of interventions that then increase health inequalities. Randomised intervention trials often have low recruitment rates and rarely assess recruitment bias. A previous trial by the same team using similar methods recruited 30% of the eligible population but was in an affluent setting with few non-white residents and was limited to those over 60 years of age. Methods PACE-UP is a large, effective, population-based walking trial in inactive 45-75 year-olds that recruited through seven London general practices. Anonymised practice demographic data were available for all those invited, enabling investigation of inequalities in trial recruitment. Non-participants were invited to complete a questionnaire. Results From 10,927 postal invitations, 1150 (10.5%) completed baseline assessment. Participation rate ratios (95% CI), adjusted for age and gender as appropriate, were lower in men 0.59 (0.52, 0.67) than women, in those under 55 compared with those ≥65, 0.60 (0.51, 0.71), in the most deprived quintile compared with the least deprived 0.52 (0.39, 0.70) and in Asian individuals compared with whites 0.62 (0.50, 0.76). Black individuals were equally likely to participate as white individuals. Participation was also associated with having a co-morbidity or some degree of health limitation. The most common reasons for non-participation were considering themselves as being too active or lack of time. Conclusions Conducting the trial in this diverse setting reduced overall response, with lower response in socio-economically deprived and Asian sub-groups. Trials with greater reach are likely to be more expensive in terms of recruitment and gains in generalizability need to be balanced with greater costs. Differential uptake of successful trial interventions may increase inequalities in PA levels and should be monitored. Trial registration ISRCTN.com ISRCTN98538934. Registered 2nd March 2012.
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Affiliation(s)
- Sally M Kerry
- Pragmatic Clinical Trials Unit, Queen Mary's University of London, London, SE 1 2AT, UK.
| | - Katy E Morgan
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Cheryl Furness
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Iain Carey
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Steve DeWilde
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Christina R Victor
- Gerontology and Health Services Research Unit, Brunel University, London, UB8 3PH, UK
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College, London, NW3 2PF, UK
| | - Peter Whincup
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, PO Box 4014, 0806, Oslo, Norway.,MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 OQQ, UK
| | - Julia Fox-Rushby
- Department of Public Health Sciences, Kings College London, London, SE1 1UL, UK
| | - Judith Ibison
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, SW17 ORE, UK
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Quay TAW, Frimer L, Janssen PA, Lamers Y. Barriers and facilitators to recruitment of South Asians to health research: a scoping review. BMJ Open 2017; 7:e014889. [PMID: 28576896 PMCID: PMC5541387 DOI: 10.1136/bmjopen-2016-014889] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/17/2017] [Accepted: 03/31/2017] [Indexed: 01/15/2023] Open
Abstract
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.
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Affiliation(s)
- Teo AW Quay
- The Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
- Food Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Leora Frimer
- Departments of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Patricia A Janssen
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - Yvonne Lamers
- Food Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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Mahmood B, Afshar R, Tang TS. Recruitment and Retention of South Asian Ethnic Minority Populations in Behavioral Interventions to Improve Type 2 Diabetes Outcomes. Curr Diab Rep 2017; 17:25. [PMID: 28321765 DOI: 10.1007/s11892-017-0850-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW South Asian (SA) immigrants have a higher burden of type 2 diabetes, report poor self-management, and remain a hard-to-engage group in behavioral interventions. The purpose of this review was to characterize recruitment and retention of SAs in behavioral interventions. RECENT FINDINGS We identified 14 studies with limited information regarding recruitment and retention. Overall recruitment rates were low: 12 studies had a mean recruitment rate of 44% among those screened, and 9 studies with complete information on eligibility had a mean recruitment rate of 65.8% among those eligible. Mean retention rate was 79.4% across all 14 studies. Although unstandardized and inconsistent reporting limited our ability to draw any conclusions regarding the best strategies to maximize recruitment and retention, we were able to highlight some novel and effective strategies. There is a need for consistent and standardized reporting of recruitment and retention-related information to encourage meaningful research and guide researchers in efficient allocation of resources and a successful conclusion of future interventions.
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Affiliation(s)
- Bushra Mahmood
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Rowshanak Afshar
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Tricia S Tang
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Maynard M, Baker G, Harding S. Exploring childhood obesity prevention among diverse ethnic groups in schools and places of worship: Recruitment, acceptability and feasibility of data collection and intervention components. Prev Med Rep 2017; 6:130-136. [PMID: 28316908 PMCID: PMC5345967 DOI: 10.1016/j.pmedr.2017.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 01/21/2017] [Accepted: 02/18/2017] [Indexed: 11/22/2022] Open
Abstract
Small-scale, detailed exploration of the recruitment, assessment, and evaluation processes of obesity intervention among minority ethnic children. The study took place in schools and places of worship during 2008–2010 in London, UK. Measures included 3-day food diaries, 24 h dietary recalls, the Youth Physical Activity Questionnaire, accelerometry, and diet and physical activity self-efficacy questionnaires. Potential intervention components were evaluated via observation, questionnaires, and focus group discussions. Schools and places of worship that reflected the ethnic and religious diversity of inner city London populations (Hindus, Muslims and Christians) were targeted. Telephone invitations to 12 schools achieved recruitment of five schools (42% response); 181 invitations to 94 places of worship, recruited eight organisations (9%). Multi-strategy approaches were required to build relationships with faith organisations. Sixty-five children aged 8–13 years participated in the testing of measures. High completion rates were achieved for 24 h recalls, diet and PA self-efficacy questionnaires (ranging from 89% to 100%), with more consistent quality in schools. Dietary assessment highlighted inadequacies in composition data for minority ethnic foods. Intervention sessions were tested among 155 children in all five schools, and 33 children in a church, temple and mosque. Evaluation coverage was more consistent in these places of worship than in schools. Schools may logistically be more straightforward settings for delivery of interventions but, despite complex issues (engagement strategies; cultural foodways), places of worship provide opportunities for effective reach of children, families and communities. We suggest community based participatory research between researchers, schools and community organisations to harness culturally-specific support. Diverse strategies were required to recruit places of worship. Schools were logistically more straightforward for intervention delivery. Evaluation coverage was more consistent in places of worship. Places of worship also provide opportunities to reach children's families. Findings will be built on in a pilot trial in school-faith organisation coalitions.
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Affiliation(s)
- Maria Maynard
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
| | - Graham Baker
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
| | - Seeromanie Harding
- Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK
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Siddiqui F, Kurbasic A, Lindblad U, Nilsson PM, Bennet L. Effects of a culturally adapted lifestyle intervention on cardio-metabolic outcomes: a randomized controlled trial in Iraqi immigrants to Sweden at high risk for Type 2 diabetes. Metabolism 2017; 66:1-13. [PMID: 27923444 DOI: 10.1016/j.metabol.2016.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/16/2016] [Accepted: 10/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Middle-Eastern immigrants constitute a growing proportion of the Swedish population and are at high risk for Type 2 diabetes. This calls for a more proactive preventive approach for dealing with diabetes risk in this target group. The aim was to test the effect of a culturally adapted lifestyle intervention programme on changes in lifestyle habits and cardio-metabolic outcomes comparing an intervention group with a control group receiving usual care. METHODS Citizens of Malmö, Sweden born in Iraq and at high risk for Type 2 diabetes (n=636) were invited. Participation rate was 15.1%. In all, 96 participants were randomized to the intervention group (n=50) or to the control group (n=46). The intervention group was offered seven group sessions addressing healthy diet and physical activity including one cooking class. Changes in body weight, physical activity levels and cardio-metabolic outcomes were evaluated using linear mixed-effects models. RESULTS The mean follow-up time was 3.9 and 3.5months in the intervention and control groups, respectively. The drop-out rate from baseline to the last visit was 30.0% in the intervention group (n=15) and 30.4% in the control group (n=14). The mean insulin sensitivity index increased significantly at follow-up in the intervention group compared to the control group (10.9% per month, p=0.005). The intervention group also reached a significant reduction in body weight (0.4% per month, p=0.004), body mass index (0.4% per month, p=0.004) and LDL-cholesterol (2.1% per month, p=0.036) compared to the control group. In total, 14.3% in the intervention group reached the goal to lose ≥5% of body weight versus none in the control group. CONCLUSIONS This culturally adapted lifestyle intervention programme shows a beneficial effect on insulin action, body weight reduction, as well as LDL-cholesterol reduction, in Middle-Eastern immigrants. The programme adapted to resources in primary health care provides tools for improved primary prevention and reduced cardio-metabolic risk in this high-risk group for Type 2 diabetes.
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Affiliation(s)
- Faiza Siddiqui
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Azra Kurbasic
- Genetic and molecular epidemiology unit, Lund University, Malmö, Sweden
| | - Ulf Lindblad
- Department of Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Louise Bennet
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden.
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Khunti K, Bellary S, Karamat MA, Patel K, Patel V, Jones A, Gray J, Shepherd P, Hanif W. Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes. Diabet Med 2017; 34:64-68. [PMID: 26926478 DOI: 10.1111/dme.13103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/18/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Abstract
AIMS Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based. METHODS We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally. RESULTS Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%. CONCLUSIONS Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality.
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Affiliation(s)
- K Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - S Bellary
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - M A Karamat
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - V Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Jones
- SB Communications Group, London, UK
| | - J Gray
- SB Communications Group, London, UK
| | | | - W Hanif
- University Hospital Birmingham, Birmingham, UK
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Willis A, Roshan M, Patel N, Gray LJ, Yates T, Davies M, Khunti K. A community faith centre based screening and educational intervention to reduce the risk of type 2 diabetes: A feasibility study. Diabetes Res Clin Pract 2016; 120:73-80. [PMID: 27522562 DOI: 10.1016/j.diabres.2016.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/22/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
Abstract
AIMS People of South Asian origin experience higher rates of diabetes and complications of diabetes compared to white Europeans. Therefore, it is important to identify those with undiagnosed diabetes and those at high risk of developing diabetes, in order to intervene with lifestyle intervention to reduce risk and prevent complications. We conducted a study to assess the feasibility of delivering a faith centre based pathway for screening and referral to group education for high risk individuals to increase screening uptake and reduce diabetes risk. METHODS Opportunistic screening and early intervention strategy for people at risk of diabetes and cardiovascular disease in local faith centres. The screening consisted of a diabetes risk assessment tool and a near patient test for HbA1c. Participants found to be at high risk of diabetes (HbA1c 6-6.4%/42-46mmol/mol) were offered a 'Walking Away from Diabetes' group educational intervention aimed at increasing exercise levels and reducing diabetes risk. RESULTS 252 participants were screened during four screening events. 202 participants (80.2%) gave consent for their data to be included in the analysis. 72.4% of participants were found to have a high diabetes risk score. 32 participants (15.8%) had a HbA1c result (6-6.4%/42-46mmol/mol). Eight participants (4.0%) had a (HbA1c ⩾6.5%/⩾47mmol/mol). Of those eligible for the diabetes prevention education programme, 18 participants (56.3%) attended. CONCLUSIONS This study confirms that screening followed by group education within faith centre settings is feasible and acceptable to participants. The strategies chosen were effective in achieving a high screening yield and high uptake of group education.
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Affiliation(s)
- A Willis
- Diabetes Research Centre, University of Leicester, UK; NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, UK.
| | - M Roshan
- Diabetes Research Centre, University of Leicester, UK
| | - N Patel
- Diabetes Research Centre, University of Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, UK
| | - T Yates
- Diabetes Research Centre, University of Leicester, UK; NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, UK
| | - M Davies
- Diabetes Research Centre, University of Leicester, UK; NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, UK; NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, UK
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Jayaprakash M, Puri-Taneja A, Kandula NR, Bharucha H, Kumar S, Dave SS. Qualitative Process Evaluation of a Community-Based Culturally Tailored Lifestyle Intervention for Underserved South Asians. Health Promot Pract 2016; 17:802-813. [PMID: 27225217 DOI: 10.1177/1524839916650165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There are few examples of effective cardiovascular disease prevention interventions for South Asians (SAs). We describe the results of a process evaluation of the South Asian Heart Lifestyle Intervention for medically underserved SAs implemented at a community-based organization (CBO) using community-based participatory research methods and a randomized control design (n = 63). Method Interviews were conducted with 23 intervention participants and 5 study staff using a semistructured interview guide focused on participant and staff perceptions about the intervention's feasibility and efficacy. Data were thematically analyzed. Results Intervention success was attributed to trusted CBO setting, culturally concordant study staff, and culturally tailored experiential activities. Participants said that these activities helped increase knowledge and behavior change. Some participants, especially men, found that self-monitoring with pedometers helped motivate increased physical activity. Participants said that the intervention could be strengthened by greater family involvement and by providing women-only exercise classes. Staff identified the need to reduce participant burden due to multicomponent intervention and agreed that the CBO needed greater financial resources to address participant barriers. Conclusion Community-based delivery and cultural adaptation of an evidence-based lifestyle intervention were effective and essential components for reaching and retaining medically underserved SAs in a cardiovascular disease prevention intervention study.
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Affiliation(s)
| | | | | | | | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, USA
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Baron J, Hirani S, Newman S. Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study. Telemed J E Health 2016; 22:400-9. [DOI: 10.1089/tmj.2015.0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justine Baron
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Shashivadan Hirani
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Centre for Health Services Research, School of Health Sciences, City University London, London, United Kingdom
| | - Stanton Newman
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Centre for Health Services Research, School of Health Sciences, City University London, London, United Kingdom
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Lawton J, Snowdon C, Morrow S, Norman JE, Denison FC, Hallowell N. Recruiting and consenting into a peripartum trial in an emergency setting: a qualitative study of the experiences and views of women and healthcare professionals. Trials 2016; 17:195. [PMID: 27066777 PMCID: PMC4827233 DOI: 10.1186/s13063-016-1323-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/01/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Recruiting and consenting women to peripartum trials can be challenging as the women concerned may be anxious, in pain, and exhausted; there may also be limited time for discussion and decision-making to occur. To address these potential difficulties, we undertook a qualitative evaluation of the internal pilot of a trial (Got-it) involving women who had a retained placenta (RP). We explored the experiences and views of women and staff about the information and consent pathway used within the pilot, in order to provide recommendations for use in future peripartum trials involving recruitment in emergency situations. METHODS In-depth interviews were undertaken with staff (n = 27) and participating women (n = 22). Interviews were analysed thematically. The accounts of women and staff were compared to identify differences and similarities in their views about recruitment and consent procedures. RESULTS Women and staff regarded recruitment as having been straightforward and facilitated by the use of simplified (verbal and written) summaries of trial information. Both parties, however, conveyed discordant views about whether fully informed consent had been obtained. These differences in perspectives appeared to arise from the different factors and considerations impinging on women and staff at the time of recruitment. While staff placed emphasis on promoting understanding in the emergency situation of RP by imparting information in clear and succinct ways, women highlighted the experiential realities of their pre- and post-birthing situations, and how these had led to quick decisions being made without full engagement with the potential risks of trial participation. To facilitate informed consent, women suggested that trial information should be given during the antenatal period, and, in doing so, articulated a rights-based discourse. Staff, however, voiced opposition to this approach by emphasising a duty of care to all pregnant women, and raising concerns about causing undue distress to the majority of individuals who would not subsequently develop a RP. CONCLUSIONS By drawing upon the perspectives of women and staff involved in the same trial we have shown that they may operate within different experiential and ethical paradigms. In doing so, we argue for the potential benefits of drawing upon multiple perspectives when developing information and consent pathways used in future (peripartum) trials. TRIAL REGISTRATION ISCRTN 88609453 .
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Affiliation(s)
- Julia Lawton
- />Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Snowdon
- />Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Morrow
- />Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane E. Norman
- />MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Fiona C. Denison
- />MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- />Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Associations between weight change and biomarkers of cardiometabolic risk in South Asians: secondary analyses of the PODOSA trial. Int J Obes (Lond) 2016; 40:1005-11. [PMID: 26927315 PMCID: PMC4892347 DOI: 10.1038/ijo.2016.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES The association of weight changes with cardiometabolic biomarkers in South Asians has been sparsely studied. SUBJECTS/METHODS We measured cardiometabolic biomarkers at baseline and after 3 years in the Prevention of Diabetes and Obesity in South Asians Trial. We investigated the effect of a lifestyle intervention on biomarkers in the randomized groups. In addition, treating the population as a single cohort, we estimated the association between change in weight and change in biomarkers. RESULTS Complete data were available at baseline and after 3 years in 151 participants. At 3 years, there was an adjusted mean reduction of 1·44 kg (95% confidence interval (95% CI): 0.18-2.71) in weight and 1.59 cm (95% CI: 0.08-3.09) in waist circumference in the intervention arm as compared with the control arm. There was no clear evidence of difference between the intervention and control arms in change of mean value of any biomarker. As a single cohort, every 1 kg weight reduction during follow-up was associated with a reduction in triglycerides (-1.3%, P=0.048), alanine aminotransferase (-2.5%, P=0.032), gamma-glutamyl transferase (-2.2%, P=0.040), leptin (-6.5%, P<0.0001), insulin (-3.7%, P=0.0005), fasting glucose (-0.8%, P=0.0071), 2-h glucose (-2.3%, P=0.0002) and Homeostatic Model Assessment of insulin resistance (HOMA-IR: -4.5%, P=0.0002). There was no evidence of associations with other lipid measures, tissue plasminogen activator, markers of inflammation or blood pressure. CONCLUSIONS We demonstrate that modest weight decrease in SAs is associated with improvements in markers of total and ectopic fat as well as insulin resistance and glycaemia in South Asians at risk of diabetes. Future trials with more intensive weight change are needed to extend these findings.
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The objective measurement of physical activity and sedentary behaviour in 2-3 year olds and their parents: a cross-sectional feasibility study in the bi-ethnic Born in Bradford cohort. BMC Public Health 2015; 15:1109. [PMID: 26556469 PMCID: PMC4641382 DOI: 10.1186/s12889-015-2481-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background The reported lower physical activity (PA) levels of British South Asians (SA) are suggested as a key influence in their increased risk of non-communicable diseases compared to their White British peers. Differences in objectively measured PA and sedentary behaviour (SB) between these ethnic groups have been observed during childhood (ages: 8–10 years). However, no information exists on objectively measured PA/SB in younger children, or how early in life differences in these behaviours emerge. Assessing PA/SB in the Born in Bradford (BIB) cohort study provides an opportunity to address such gaps in the literature, but previous studies have found recruiting and retaining SA participants challenging, and the feasibility of using accelerometers with SA children and parents is unknown. This study investigated the feasibility of recruiting and objectively measuring the habitual PA/SB of 2–3 year old SA and White British children and parents from the BIB study. Methods Families were informed about the study during routine BIB assessments. Consenting families were visited at home for anthropometry measurements, interviews, material delivery and collection. Participants (child and parents) were instructed to wear the ActiGraph GT3X+ for 8 days. Descriptive statistics were computed, and ethnic differences tested (Chi-square) for recruitment uptake and compliance. Results 160 families (30 % SA) provided contact details, and 97 (22 % SA) agreed to enter the study. White British families showed lower refusal and higher intake into the study than SA (p = 0.006). Of 89 children issued with an accelerometer, 34 % complied with the 8-day protocol (significantly less SA; p = 0.015) and 75 % provided enough days (≥3) to assess habitual PA/SB (no ethnic differences). Parental rates of compliance with the protocol did not differ between ethnicities. Issues experienced with the protocol and accelerometer use, and successful implementation strategies/procedures are presented. Conclusions Although greater efforts may be required to recruit SA, those consenting to participate were as likely as White British to provide enough data to assess habitual PA/SB. The issues and successful strategies reported in this feasibility study represent valuable information for planning future studies, and enhance recruitment and compliance with accelerometer protocols in SA and White British toddlers and parents. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2481-z) contains supplementary material, which is available to authorized users.
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Raising the issue of overweight and obesity with the South Asian community. Br J Gen Pract 2015; 64:417-9. [PMID: 25071053 DOI: 10.3399/bjgp14x681145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Waheed W, Husain N, Allen G, Atif N, Aseem S, Waquas A, Garrett C, Sheikh S, Syed A, Gask L, Bower P. Recruitment strategies for British South Asians in 5 depression trials: A mixed method study. J Affect Disord 2015. [PMID: 26202166 DOI: 10.1016/j.jad.2015.06.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the United Kingdom, ethnic minority group's particularly British South Asian women have higher rates of depression than their white counterparts. Despite this they remain under represented in mental health trials. Whilst the US legislation mandates the inclusion of ethnic minorities into research, there are no similar initiatives in the UK. Barriers in recruiting these hard to reach ethnic groups are cited as major reasons behind this under representation. Once these barriers are encountered it becomes a challenge for the researchers to overcome them. As there is paucity of research in this specific area through this paper we want to share our strategies in recruiting British South Asians thus encouraging other researchers to consider ethnic minority inclusion into research. METHODS Our published systematic review on the barriers to recruitment of ethnic minority participants into mental health research developed a typology of thirty three ethnic recruitment barriers described under five themes. We aimed to find strategies to overcome these barriers from five depression trials for British South Asians conducted by our research group. Firstly we extracted data on recruitment strategies from the published papers. Later researchers involved in these five trials formed a working group to add to these extracted strategies. Finally these strategies were matched to the individual barriers described in the typology. RESULTS Multiple recruitment strategies were described by the researchers. These strategies were matched to all but two recruitment barriers related to psychopathology/substance misuse by the participants and paucity of healthcare related resources. Multiple strategies were found to be effective against each barrier and appropriate ones could be selected by the researchers after considering available resources at hand. CONCLUSIONS Findings from this paper have implications for the design of recruitment strategies for hard to recruit ethnic minority groups to health care research. There is need for wider training and support of researchers to give them the skills to recruit these ethnic groups. Further development and evaluation of these strategies will lead to increased recruitment accruals.
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Affiliation(s)
- Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK; Lancashire Care NHS Foundation Trust, Preston, UK
| | - Nusrat Husain
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Lancashire Care NHS Foundation Trust, Preston, UK
| | - Gill Allen
- Department of Psychology, University of Bolton, Bolton, UK
| | - Najia Atif
- Institute of Population Health, The University of Manchester, Manchester, UK
| | - Saadia Aseem
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | - Charlotte Garrett
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Saima Sheikh
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Aleena Syed
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - Linda Gask
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK; MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Manchester, UK
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Ranjani H, Weber MB, Anjana RM, Lakshmi N, Narayan KMV, Mohan V. Recruitment challenges in a diabetes prevention trial in a low- and middle-income setting. Diabetes Res Clin Pract 2015; 110:51-59. [PMID: 26321102 DOI: 10.1016/j.diabres.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/02/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To describe recruitment challenges in a randomized controlled translational trial (RCTT) of diabetes prevention in India. METHODS The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a RCTT, comparing standard of care to a step-wise model of diabetes prevention. Overweight adults with prediabetes were identified through a two-step screening process (1) field-based screening: minimal testing with a random capillary glucose measurement and (2) clinic-based screening including an Oral Glucose Tolerance Test (OGTT). RESULTS Individuals from the community (n=19377) were screened at residential locations, offices, educational institutions, places of worship, parks and beaches. Of these, 3535 (18.2%) 'high-risk' participants based on capillary glucose values were eligible for step 2 screening with OGTT. However, only 21.5% participated. An additional 521 participants directly entered step 2 via direct referrals from our clinical/research databases, study participant referrals and targeted advertisements. Of the 1285 individuals who underwent an OGTT, 710 (55.3%) were eligible for randomization, and 602 (84.8%) were randomized into the trial. The ratio of participants entering from step 1 to step 2 was 25:1 (3.9%) and from step 2 to randomization 2:1 (47%). Average staff time for recruitment was 350 h per week for an 11-person team. CONCLUSIONS Nearly 55 people needed to be screened with a questionnaire plus capillary glucose test to randomize one participant with prediabetes. Using a 2-step strategy requires additional staff time, but considerably reduces the need for OGTT's, thereby minimizing participant burden and study costs.
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Affiliation(s)
- H Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
| | - M B Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - N Lakshmi
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - V Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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van Valkengoed IGM, Vlaar EMA, Nierkens V, Middelkoop BJC, Stronks K. The Uptake of Screening for Type 2 Diabetes and Prediabetes by Means of Glycated Hemoglobin versus the Oral Glucose Tolerance Test among 18 to 60-Year-Old People of South Asian Origin: A Comparative Study. PLoS One 2015; 10:e0136734. [PMID: 26317417 PMCID: PMC4552828 DOI: 10.1371/journal.pone.0136734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/30/2015] [Indexed: 12/25/2022] Open
Abstract
Background Direct comparisons of the effect of a glycated haemoglobin measurement or an oral glucose tolerance test on the uptake and yield of screening in people of South Asian origin have not been made. We evaluated this in 18 to 60-year-old South Asian Surinamese. Materials and Methods We invited 3173 South Asian Surinamese for an oral glucose tolerance test between June 18th 2009- December 31st 2009 and 2012 for a glycated hemoglobin measurement between April 19th 2010-November 11th, 2010. Participants were selected from 48 general practices in The Hague, The Netherlands. We used mixed models regression to analyse differences in response and participation between the groups. We described differences in characteristics of participants and calculated the yield as the percentage of all cases identified, if all invitees had been offered screening with the specified method. Results The response and participation in the glycated hemoglobin group was higher than in the group offered an oral glucose tolerance test (participation 23.9 vs. 19.3; OR: 1.30, 95%-confidence interval1.01–1.69). After adjustment for age and sex, characteristics of participants were similar for both groups. Overall, glycated hemoglobin identified a similar percentage of type 2 diabetes cases but a higher percentage of prediabetes cases, in the population than the oral glucose tolerance test. Conclusion We found that glycated hemoglobin and the oral glucose tolerance test may be equally efficient for identification of type 2 diabetes in populations of South Asian origin. However, for programs aimed at identifying people at high risk of type 2 diabetes (i.e. with prediabetes), the oral glucose tolerance test may be a less efficient choice than glycated hemoglobin.
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Affiliation(s)
- Irene G. M. van Valkengoed
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Everlina M. A. Vlaar
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Vera Nierkens
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Barend J. C. Middelkoop
- Department of Public Health, Leiden University Medical Centre, Leiden, The Netherlands
- Public Health Service, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Troughton J, Chatterjee S, Hill SE, Daly H, Martin Stacey L, Stone MA, Patel N, Khunti K, Yates T, Gray LJ, Davies MJ. Development of a lifestyle intervention using the MRC framework for diabetes prevention in people with impaired glucose regulation. J Public Health (Oxf) 2015; 38:493-501. [PMID: 26311822 PMCID: PMC5072159 DOI: 10.1093/pubmed/fdv110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We report development of a group-based lifestyle intervention, Let's Prevent, using the UK Medical Research Council (MRC) framework, and delivered by structured education to prevent type 2 diabetes mellitus (T2DM) in people with impaired glucose regulation (IGR) in a UK multi-ethnic population. Methods Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is the first national T2DM programme that meets National Institute for Health and Care Excellence criteria and formed the basis for Let's Prevent. An iterative cycle of initial development, piloting, collecting and collating qualitative and quantitative data, and reflection and modification, was used to inform and refine lifestyle intervention until it was fit for evaluation in a definitive randomized controlled trial (RCT). The programme encouraged IGR self-management using simple, non-technical language and visual aids. Results Qualitative and quantitative data suggested that intervention resulted in beneficial short-term behaviour change such as healthier eating patterns, improved health beliefs and greater participant motivation and empowerment. We also demonstrated that recruitment strategy and data collection methods were feasible for RCT implementation. Conclusions Let's Prevent was developed following successful application of MRC framework criteria and the subsequent RCT will determine whether it is feasible, reliable and transferable from research into a real-world NHS primary healthcare setting. Trial Registration ISRCTN80605705.
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Affiliation(s)
- Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Sudesna Chatterjee
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Siân E Hill
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Heather Daly
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Lorraine Martin Stacey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Margaret A Stone
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Naina Patel
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Laura J Gray
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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Lawton J, Kirkham J, White D, Rankin D, Cooper C, Heller S. Uncovering the emotional aspects of working on a clinical trial: a qualitative study of the experiences and views of staff involved in a type 1 diabetes trial. Trials 2015; 16:3. [PMID: 25566971 PMCID: PMC4326295 DOI: 10.1186/1745-6215-16-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background The perspectives and experiences of trial staff are increasingly being investigated as these can be used to improve recruitment, adherence to trial protocols and support given to future staff. We interviewed staff working on a type 1 diabetes trial in order to aid interpretation of trial findings, inform recommendations for the rollout of the treatments investigated and provide recommendations for the conduct of future trials. However, our interviews uncovered aspects of trial work erstwhile unrecognised or underreported in the trials literature, and it is these which form the focus of this paper. Methods In-depth interviews were conducted with (n = 18) staff, recruited from seven centres, who were involved in recruitment and trial delivery. Data were analysed thematically. Results Alongside logistical and practical issues which made trial work challenging, staff often talked spontaneously and at length about how trial work had affected them emotionally. Staff not only described the emotional stresses arising from having to meet recruitment targets and from balancing research roles with clinical responsibilities, they also discussed having to emotionally manage patients and their colleagues. The emotional aspects of trial work particularly came to the fore when staff notified patients about their treatment allocation. On such occasions, staff described having to employ emotional strategies to pre-empt and manage potential patient disappointment and anger. Staff also described having to manage their own emotions when patients withdrew from the trial or were not randomised to the treatment arm which, in their clinical judgment, would have been in their best interests. To help address the emotional challenges they encountered, staff highlighted a need for more practical, emotional and specialist psychological support. Conclusions More attention should be paid to the emotional aspects of trial work to help ensure trial staff are adequately supported. Such support could comprise: increased training for staff to improve their own and patients’ understandings of randomization, role-play to develop techniques to manage patient anger and disappointment, sharing of good practice, formalised team support with psychological input and access to specialist psychological support to troubleshoot complex emotional and ethical issues.
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Affiliation(s)
- Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
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Morris SE, Heinssen RK. Informed consent in the psychosis prodrome: ethical, procedural and cultural considerations. Philos Ethics Humanit Med 2014; 9:19. [PMID: 25403748 PMCID: PMC4289308 DOI: 10.1186/1747-5341-9-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/24/2014] [Indexed: 05/12/2023] Open
Abstract
Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.
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Affiliation(s)
- Sarah E Morris
- />Division of Adult Translational Research, National Institute of Mental Health, 6001 Executive Blvd, North Bethesda, MD 20892 USA
| | - Robert K Heinssen
- />Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, North Bethesda, MD 20892 USA
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Penn L, Dombrowski SU, Sniehotta FF, White M. Perspectives of UK Pakistani women on their behaviour change to prevent type 2 diabetes: qualitative study using the theory domain framework. BMJ Open 2014; 4:e004530. [PMID: 25005595 PMCID: PMC4091164 DOI: 10.1136/bmjopen-2013-004530] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a debilitating disease, highly prevalent in UK South Asians, and preventable by lifestyle intervention. The 'New life, New you' (NLNY) physical activity (PA) and dietary intervention for T2D prevention was culturally adapted to better engage minority ethnic populations and tested for feasibility. OBJECTIVES To investigate Pakistani female participants' perspectives of their behaviour change and of salient intervention features. SETTING A community-based 8-week programme of group delivered PA sessions with behavioural counselling and dietary advice, culturally adapted for ethnic minority populations, in an area of socioeconomic deprivation. Participants to NLNY were recruited through screening events in community venues across the town. PARTICIPANTS Interviews were conducted with 20 Pakistani female NLNY participants, aged 26-45 (mean 33.5) years, from different parts of town. RESULTS Within the a priori Theoretical Domains Framework (intentions and goals, reinforcement, knowledge, nature of the activity, social role and identity, social influences, capabilities and skills, regulation and decision, emotion and environment), we identified the importance of social factors relating to participants' own PA and dietary behaviour change. We also identified cross-cutting themes as collateral benefits of the intervention including participants' 'psychological health'; 'responsibility' (for others' health, especially family members included in the new PA and diet regimes) and 'inclusion' (an ethos of accommodating differences). CONCLUSIONS Our findings suggest that culturally adapted interventions for Pakistani women at risk of T2D, delivered via group PA sessions with counselling and dietary advice, may encourage their PA and dietary behaviour change, and have collateral health and social benefits. The NLNY intervention appeared to be acceptable. We plan to evaluate recruitment, retention and likely effect of the intervention on participant behaviour prior to definitive evaluation.
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Affiliation(s)
- Linda Penn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health
| | - Martin White
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health
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Recruiting South Asians into a UK Mental Health Randomised Controlled Trial: Experiences of Field Researchers. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Risk perception is not associated with attendance at a preventive intervention for type 2 diabetes mellitus among South Asians at risk of diabetes. Public Health Nutr 2014; 18:1109-18. [PMID: 24913375 DOI: 10.1017/s1368980014001086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes. DESIGN An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors. SETTING The Hague, the Netherlands. SUBJECTS Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18-60 years from a lifestyle-versus-control intervention for the prevention of diabetes. RESULTS In total, 68·2% attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2% of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant. CONCLUSIONS Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programme.
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Reiss K, Dragano N, Ellert U, Fricke J, Greiser KH, Keil T, Krist L, Moebus S, Pundt N, Schlaud M, Yesil-Jürgens R, Zeeb H, Zimmermann H, Razum O, Jöckel KH, Becher H. Comparing sampling strategies to recruit migrants for an epidemiological study. Results from a German feasibility study. Eur J Public Health 2014; 24:721-6. [PMID: 24872519 DOI: 10.1093/eurpub/cku046] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling strategies and to test different approaches to recruit migrants for an epidemiological study. METHODS Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents' registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire. RESULTS Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff. PARTICIPATION When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% (n = 668 participants) and the community-oriented recruitment resulted in 722 participants. CONCLUSION Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.
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Affiliation(s)
- Katharina Reiss
- 1 Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, 33501 Bielefeld, Germany
| | - Nico Dragano
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany 3 Institute for Medical Sociology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany
| | - Ute Ellert
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Julia Fricke
- 5 German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Thomas Keil
- 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Lilian Krist
- 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Susanne Moebus
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Noreen Pundt
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Martin Schlaud
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany
| | - Rahsan Yesil-Jürgens
- 4 Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany 6 Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Hajo Zeeb
- 7 Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS GmbH, 28359 Bremen, Germany
| | - Heiko Zimmermann
- 8 Institute of Public Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Oliver Razum
- 1 Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, 33501 Bielefeld, Germany
| | - Karl-Heinz Jöckel
- 2 Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122 Essen, Germany
| | - Heiko Becher
- 8 Institute of Public Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
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