1
|
Loughran KJ, Emerson J, Avery L, Suri S, Flynn D, Kaner E, Rapley T, Martin D, McPhee J, Fernandes-James C, Harrison SL. Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:240003. [PMID: 38925795 PMCID: PMC11216689 DOI: 10.1183/16000617.0003-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/19/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. METHODS A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored. RESULTS 34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12 s, 95% CI -1.69- -0.55 s, 95% PI -2.78-0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72-3.77 s, 95% PI 2.64-3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2). CONCLUSION Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.
Collapse
Affiliation(s)
- Kirsti J Loughran
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jonathan Emerson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Leah Avery
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Sophie Suri
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- NIHR Applied Research Collaboration, North East and North Cumbria, Middlesbrough, UK
| | - Darren Flynn
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Community Wellbeing and Education, Northumbria University, Newcastle upon Tyne, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jamie McPhee
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Caroline Fernandes-James
- Respiratory Department, University Hospital of North Tees, North Tees & Hartlepool NHS Foundation Trust, Hardwick, UK
| | | |
Collapse
|
2
|
Honushefsky A, Wagner ES, Sheridan K, Spickard KM, LeMasters WR, Walter CN, Beaver T, Lennon AM, Papadopoulos N, Rahm AK, Buchanan AH. Real-time evaluation and adaptation to facilitate rapid recruitment in a large, prospective cohort study. BMC Health Serv Res 2024; 24:336. [PMID: 38481315 PMCID: PMC10938733 DOI: 10.1186/s12913-024-10750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Recruiting large cohorts efficiently can speed the translation of findings into care across a range of scientific disciplines and medical specialties. Recruitment can be hampered by factors such as financial barriers, logistical concerns, and lack of resources for patients and clinicians. These and other challenges can lead to underrepresentation in groups such as rural residents and racial and ethnic minorities. Here we discuss the implementation of various recruitment strategies for enrolling participants into a large, prospective cohort study, assessing the need for adaptations and making them in real-time, while maintaining high adherence to the protocol and high participant satisfaction. METHODS While conducting a large, prospective trial of a multi-cancer early detection blood test at Geisinger, an integrated health system in central Pennsylvania, we monitored recruitment progress, adherence to the protocol, and participants' satisfaction. Tracking mechanisms such as paper records, electronic health records, research databases, dashboards, and electronic files were utilized to measure each outcome. We then reviewed study procedures and timelines to list the implementation strategies that were used to address barriers to recruitment, protocol adherence and participant satisfaction. RESULTS Adaptations to methods that contributed to achieving the enrollment goal included offering multiple recruitment options, adopting group consenting, improving visit convenience, increasing the use of electronic capture and the tracking of data and source documents, staffing optimization via leveraging resources external to the study team when appropriate, and integrating the disclosure of study results into routine clinical care without adding unfunded work for clinicians. We maintained high protocol adherence and positive participant experience as exhibited by a very low rate of protocol deviations and participant complaints. CONCLUSION Recruiting rapidly for large studies - and thereby facilitating clinical translation - requires a nimble, creative approach that marshals available resources and changes course according to data. Planning a rigorous assessment of a study's implementation outcomes prior to study recruitment can further ground study adaptations and facilitate translation into practice. This can be accomplished by proactively and continuously assessing and revising implementation strategies.
Collapse
Affiliation(s)
| | - Eric S Wagner
- Geisinger, 549 Fair Street, Bloomsburg, PA, 17815, USA
| | | | | | | | | | - Taryn Beaver
- Geisinger, 549 Fair Street, Bloomsburg, PA, 17815, USA
| | | | | | | | | |
Collapse
|
3
|
Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
Collapse
Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
4
|
Morgan SE, Harrison TR, Wright KO, Jia X, Deal B, Malova K. The role of perceived expertise and trustworthiness in research study and clinical trial recruitment: Perspectives of clinical research coordinators and African American and Black Caribbean patients. PLoS One 2023; 18:e0275770. [PMID: 37342999 DOI: 10.1371/journal.pone.0275770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/11/2023] [Indexed: 06/23/2023] Open
Abstract
This study investigates the role of source credibility on minority participant recruitment, particularly African American and Black Caribbean patients. A total of nine focus groups (N = 48 participants) were conducted with both patient groups and clinical research coordinators (CRCs). Using the elaboration likelihood model as a guiding framework for analysis, this study found that the credibility of research coordinators (or other professionals who recruit for research studies and clinical trials) was instrumental in shaping attitudes of prospective participants. The perspectives of patients and CRCs aligned closely, with few exceptions. For both groups, professionalism and professional displays (clothing, institutional artifacts) enhanced perceived expertise, a core component of credibility. Trustworthiness, another important component of credibility, was fostered through homophily between recruiter and patient, expressions of goodwill and assuaging anxiety about CRCs' financial motivations for recruitment. Additionally, CRCs believed that credibility was supported when CRCs could emphasize transparency and truthfulness in communication. The importance of these findings for the development of empirically-based training programs to improve communication practices in recruitment contexts is discussed.
Collapse
Affiliation(s)
- Susan E Morgan
- Communication Studies Department, School of Communication, University of Miami, Coral Gables, FL, United States of America
| | - Tyler R Harrison
- Communication Studies Department, School of Communication, University of Miami, Coral Gables, FL, United States of America
| | - Kallia O Wright
- Communication Studies Department, School of Communication, University of Miami, Coral Gables, FL, United States of America
| | - Xiaofeng Jia
- School of Communication, University of Miami, Coral Gables, FL, United States of America
| | - Bonnie Deal
- School of Communication, University of Miami, Coral Gables, FL, United States of America
| | - Kate Malova
- Simon Business School, University of Rochester, Rochester, NY, United States of America
| |
Collapse
|
5
|
Elam AR, Mobolaji I, Flaharty K, Niziol LM, Woodward MA, Zhang J, Musch DC, Johnson L, Kershaw M, Bicket AK, Saaddine J, John D, Newman-Casey PA. Engagement in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program: Comparing the Effect of Clinic versus Community-Based Recruitment Strategies. Ophthalmol Glaucoma 2023; 6:266-276. [PMID: 36332906 PMCID: PMC10149556 DOI: 10.1016/j.ogla.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE To determine the effectiveness of adding community-based recruitment to clinic-based recruitment to engage participants in a glaucoma detection program. DESIGN Prospective cohort study. SUBJECTS Anyone ≥ 18 years of age who does not meet exclusion criteria. METHODS The Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program tests a novel way of improving glaucoma detection in communities with populations at high risk for disease, including people who identify as Black and Hispanic and those living with low socioeconomic status. The MI-SIGHT program is conducted in a free clinic (Ypsilanti, MI) and in a federally qualified health center (FQHC) (Flint, MI). Community engagement methods were used to identify outreach strategies to enhance recruitment. Participants were asked "How did you hear about the MI-SIGHT program?" and responses were summarized overall and by clinic and compared between clinic-based and community-based recruitment strategies. MAIN OUTCOME MEASURES Proportion recruited by location, within or outside of the clinic. RESULTS In total, 647 participants were recruited in the first 11 months of the study, 356 (55.0%) at the free clinic over 11 months and 291 (45.0%) at the FQHC over 6 months. Participants were on average 54.4 years old (standard deviation = 14.2); 60.9% identified as female, 45.6% identified as Black, 37.8% identified as White, 9.6% identified as Hispanic, and 10.9% had less than high school education. Participants reported hearing about the MI-SIGHT program from a clinic phone call (n = 168, 26.1%), a friend (n = 112, 17.4%), nonmedical clinic staff (n = 100, 15.5%), a clinic doctor (n = 77, 11.9%), an in-clinic brochure or flyer (n = 51, 7.9%), a community flyer (n = 44, 6.8%), the clinic website or social media (n = 28, 4.3%), or an "other" source (n = 65, 10.1%). Recruiting from the community outside the medical clinics increased participation by 265% at the free clinic and 46% at the FQHC. CONCLUSIONS The Community Advisory Board recommendation to use community-based recruitment strategies in addition to clinic-based strategies for recruitment resulted in increased program participation. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | | | | | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
6
|
Paixão C, Almeida S, Ferreira PG, Mendes MA, Brooks D, Marques A. Lifestyle integrated functional exercise for people with interstitial lung disease (iLiFE): A mixed-methods feasibility study. Heart Lung 2023; 60:20-27. [PMID: 36878103 DOI: 10.1016/j.hrtlng.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND People with interstitial lung disease (ILD) present low levels of physical activity (PA) and spend most of their time at home, especially in advanced stages of the disease. The Lifestyle Integrated Functional Exercise for people with ILD (iLiFE) embedding PA in patients' daily routines was developed and implemented. OBJECTIVES This study aimed to explore the feasibility of iLiFE. METHODS A pre/post mixed-methods feasibility study was conducted. Feasibility of iLiFE was determined by participant recruitment/retention, adherence, feasibility of outcome measures and adverse events. Measures of PA, sedentary behaviour, balance, muscle strength, functional performance/capacity, exercise capacity, impact of the disease, symptoms (i.e., dyspnoea, anxiety, depression, fatigue and cough) and health-related quality of life were collected at baseline and post-intervention (12-weeks). Semi-structured interviews with participants were conducted in-person immediately after iLiFE. Interviews were audio-recorded, transcribed and analysed by deductive thematic analysis. RESULTS Ten participants (5♀, 77±3y; FVCpp 77.1 ± 4.4, DLCOpp 42.4 ± 6.6) were included, but only nine completed the study. Recruitment was challenging (30%) and retention high (90%). iLiFE was feasible, with excellent adherence (84.4%) and no adverse events. Missing data were associated with one dropout and non-compliance with the accelerometer (n = 1). Participants reported that iLiFE contributed to (re)gain control in their daily life, namely through improving their well-being, functional status and motivation. Weather, symptoms, physical impairments and lack of motivation were identified as threats to keep an active lifestyle. CONCLUSIONS iLiFE seems to be feasible, safe and meaningful for people with ILD. A randomised controlled trial is needed to strengthen these promising findings.
Collapse
Affiliation(s)
- Cátia Paixão
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Sara Almeida
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Pedro G Ferreira
- ILD Outpatient Clinic, Pulmonology Department - Centro Hospitalar Universitario de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine of University of Coimbra (FMUC), Coimbra, Portugal- Coimbra, Portugal
| | - M Aurora Mendes
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada - Hamilton, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
| |
Collapse
|
7
|
Neffa-Creech D, Aggarwal R, Stowell C, Menon U, George S, Plant A, Langbaum JB. Understanding Barriers and Facilitators to Signing Up for a Mobile-Responsive Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies. J Prev Alzheimers Dis 2023; 10:865-874. [PMID: 37874109 PMCID: PMC10884139 DOI: 10.14283/jpad.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) disproportionately affects Black/African American and Hispanic/Latino adults, yet they are underrepresented in AD studies. Recruitment challenges for these populations limit generalizability of findings. OBJECTIVES This study explores barriers and facilitators to signing up for an AD participant recruitment registry website intended to optimize recruitment of these adults. The registry is geared toward recruitment on smartphones and tablets (mobile devices), as research suggests that mobile-first approaches may be more successful within these populations. DESIGN In 2020, we conducted four focus groups (n = 39) and an online survey (n = 1010) with Black/African American and Hispanic/Latino adults. The survey also included Whites as a comparison group. SETTING Focus groups were in-person at research facilities in New Orleans, Louisiana, and Los Angeles, California. The online survey was distributed by a survey panel company to participants nationwide. PARTICIPANTS Black/African American (n = 360), Hispanic/Latino (n = 359), or White (n = 330) individuals, 45-75 years old, who self-reported not having mild cognitive impairment (MCI), dementia, or AD. MEASUREMENTS Barriers and facilitators explored in the focus groups and survey were related to health and AD (e.g., AD-related concerns and past participation/willingness to participate in health or AD studies); current use of mobile devices (e.g., comfort using devices and receptivity to the AD recruitment registry); and participant characteristics and beliefs (e.g., demographics, health literacy level, and trust in government and the scientific community). RESULTS The focus groups and survey revealed similar findings. Participants commonly use mobile devices to go online and perform health-related activities. They were aware of AD, expressed concerns with developing it, and were willing to participate in AD-related studies (motivated by personal connection to AD, altruism, and compensation). When presented with the AD recruitment registry, most provided positive feedback (e.g., easy to use and informative) and shared an interest in joining. Barriers to joining the registry with a mobile device included complex or multistep enrollment processes, beliefs that studies are primarily for those with a specific disease, and confusion about how studies can prevent AD among those low-risk for AD. The focus groups also revealed that Black/African American participants expressed more hesitation than Hispanic/Latinos in joining the registry due to greater distrust in the government and scientific community. CONCLUSIONS Recruiting more Black/African American and Hispanic/Latino participants into AD studies is vitally important. This mixed methods study suggests that adults in these underrepresented groups are motivated to prevent AD and willing to sign up for an AD participant recruitment registry using mobile devices. Most barriers to joining a registry can be addressed through slight modifications to the registry's design and functionality and by adding content. These findings can help enhance the appeal of joining AD recruitment registries to ultimately enroll more diverse, representative groups of participants and increase the generalizability of AD study findings.
Collapse
Affiliation(s)
- D Neffa-Creech
- Jessica Langbaum, Banner Alzheimer's Institute, 901 E. Willetta Street, Phoenix, AZ 85006, USA,
| | | | | | | | | | | | | |
Collapse
|
8
|
LeCroy MN, Potter LN, Bandeen-Roche K, Bianco ME, Cappola AR, Carter EB, Dayan PS, Eckstrom E, Edwards DF, Farabi SS, Fisher SD, Giordano J, Hanson HA, Jenkins E, Juhn Y, Kaskel F, Stake CE, Reeds DN, Schleiss MR, Wafford QE, McColley SA. Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic. J Clin Transl Sci 2022; 7:e38. [PMID: 36845306 PMCID: PMC9947617 DOI: 10.1017/cts.2022.510] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.
Collapse
Affiliation(s)
- Madison N. LeCroy
- Department of Pediatrics, Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lindsey N. Potter
- Center for Health Outcomes and Population Equity (HOPE), Department of Population Health Sciences, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Monica E. Bianco
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University, School of Medicine, St. Louis, MO, USA
| | - Peter S. Dayan
- Department of Emergency Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Eckstrom
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy F. Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research and Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Health Sciences Learning Center, Madison, WI, USA
| | - Sarah S. Farabi
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Sheehan D. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Judy Giordano
- University of Rochester Medical Center, Rochester, NY, USA
| | - Heidi A. Hanson
- Department of Surgery and Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Emerald Jenkins
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Young Juhn
- Precision Population Science Lab and Artificial Intelligence Program, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederick Kaskel
- Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, NY, USA
| | - Christine E. Stake
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Dominic N. Reeds
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Mark R. Schleiss
- Department of Pediatrics, Division of Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Q. Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susanna A. McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
9
|
DeFilippis EM, Echols M, Adamson PB, Batchelor WB, Cooper LB, Cooper LS, Desvigne-Nickens P, George RT, Ibrahim NE, Jessup M, Kitzman DW, Leifer ES, Mendoza M, Piña IL, Psotka M, Senatore FF, Stein KM, Teerlink JR, Yancy CW, Lindenfeld J, Fiuzat M, O’Connor CM, Vardeny O, Vaduganathan M. Improving Enrollment of Underrepresented Racial and Ethnic Populations in Heart Failure Trials: A Call to Action From the Heart Failure Collaboratory. JAMA Cardiol 2022; 7:540-548. [PMID: 35319725 PMCID: PMC9098689 DOI: 10.1001/jamacardio.2022.0161] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Despite bearing a disproportionate burden of heart failure (HF), Black and Hispanic individuals have been poorly represented in HF clinical trials. Underrepresentation in clinical trials limits the generalizability of the findings to these populations and may even introduce uncertainties and hesitancy when translating trial data to the care of people from underrepresented groups. The Heart Failure Collaboratory, a consortium of stakeholders convened to enhance HF therapeutic development, has been dedicated to improving recruitment strategies for patients from diverse and historically underrepresented groups. Observations Despite federal policies from the US Food and Drug Administration and National Institutes of Health aimed at improving trial representation, gaps in trial enrollment proportionate to the racial and ethnic composition of the HF population have persisted. Increasing trial globalization with limited US enrollment is a major driver of these patterns. Additional barriers to representative enrollment include inequities in care access, logistical issues in participation, restrictive enrollment criteria, and English language requirements. Conclusions and Relevance Strategies for improving diverse trial enrollment include methodical study design and site selection, diversification of research leadership and staff, broadening of eligibility criteria, community and patient engagement, and broad stakeholder commitment. In contemporary HF trials, diverse trial enrollment is not only feasible but can be efficiently achieved to improve the generalizability and translation of trial knowledge to clinical practice.
Collapse
Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Melvin Echols
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Richard T. George
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Eric S. Leifer
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Mendoza
- Office of Minority Health, US Department of Health and Human Services (HHS), Bethesda, Maryland
| | | | | | - Fortunato Fred Senatore
- Center for Drug Evaluation and Research, Food and Drug Administration, Division of Cardiovascular and Renal Products, Silver Spring, Maryland
| | | | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | | | - Mona Fiuzat
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Christopher M. O’Connor
- Inova Heart and Vascular Institute, Falls Church, Virginia
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Orly Vardeny
- Department of Medicine, University of Minnesota, Minneapolis VA Health Care System, Minneapolis
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
10
|
Alhalel J, Francone N, Post S, O'Brian CA, Simon MA. How Should Representation of Subjects With LEP Become More Equitable in Clinical Trials? AMA J Ethics 2022; 24:E319-325. [PMID: 35405059 PMCID: PMC9052781 DOI: 10.1001/amajethics.2022.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Underrepresentation of individuals with limited English proficiency (LEP) who speak Spanish is ongoing in phase 3 biomedical clinical trials and exacerbates health inequity. This article suggests strategies for increasing representation of Spanish speakers in clinical rials by emphasizing the importance of early engagement with Spanish language communities, inclusive participant recruitment, and collaborative trial design and implementation. Although investigators and institutions administering government-funded research must meet federal requirements for language assistance, journal editors, peer reviewers, institutional review board members, academic health centers, and all beneficiaries of the biomedical and behavioral research enterprise in the United States must motivate linguistic inclusion.
Collapse
Affiliation(s)
- Jonathan Alhalel
- Fourth-year medical student at the Northwestern University Feinberg School of Medicine in Chicago, Illinois
| | - Nicolás Francone
- Fourth-year medical student the Northwestern University Feinberg School of Medicine in Chicago, Illinois
| | - Sharon Post
- Scientific editor at the Center for Health Equity Transformation in the Feinberg School of Medicine at Northwestern University in Chicago, Illinois
| | - Catherine A O'Brian
- Scientific editor at the Center for Health Equity Transformation in the Feinberg School of Medicine at Northwestern University in Chicago, Illinois
| | - Melissa A Simon
- The George H. Gardner, MD, Professor of Clinical Gynecology and vice chair of research in the Department of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois
| |
Collapse
|
11
|
Pelletier É, Desmeules P, Lacasse Y, Tanguay S, Milot J, Morissette MC, Maltais F. Antibody Response to Severe Acute Respiratory Syndrome Coronavirus-2 Vaccination in COPD: A Cohort Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:591-595. [PMID: 35925027 PMCID: PMC9718581 DOI: 10.15326/jcopdf.2022.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article does not contain an abstract.
Collapse
Affiliation(s)
- Éliane Pelletier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| | - Philippe Desmeules
- Centre Hospitalier Universitaire de Québec, Site IUCPQ, Université Laval, Québec, Canada
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| | - Sophie Tanguay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| | - Julie Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| | - Mathieu C. Morissette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada,Département de Médecine et Faculté de Médecine, Montréal, Canada
| |
Collapse
|
12
|
Epps F, Brewster G, Phillips JS, Nash R, Shah RC, Hepburn K. Using a Warm Hand-Off Approach to Enroll African American Caregivers in a Multi-Site Clinical Trial: The Handshake Protocol. J Appl Gerontol 2022; 41:142-147. [PMID: 33567942 PMCID: PMC8353002 DOI: 10.1177/0733464821992920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
"Testing Tele-Savvy" was a three-arm randomized controlled trial that recruited participants from four National Institute on Aging (NIA)-funded Alzheimer's Disease Centers with Emory University serving as the coordinating center. The enrollment process involved each center providing a list of eligible caregivers to the coordinating center to consent. Initially, the site proposed to recruit primarily African American caregivers generated a significant amount of referrals to the coordinating center, but a gap occurred in translating them into enrolled participants. To increase the enrollment rate, a "Handshake Protocol" was established, which included a warm handoff approach. During preset phone calls each week, the research site coordinator introduced potential participants to a culturally congruent co-investigator from the coordinating center who then completed the consent process. Within the first month of implementation, the team was 97% effective in meeting its goals. This protocol is an example of a successful, innovative approach to enrolling minority participants in multi-site clinical trials.
Collapse
Affiliation(s)
| | | | - Judy S Phillips
- Rush Alzheimer's Disease Center, Rush University University Medical Center, Chicago, IL, USA
| | | | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University University Medical Center, Chicago, IL, USA
| | | |
Collapse
|
13
|
Cho L, Vest AR, O'Donoghue ML, Ogunniyi MO, Sarma AA, Denby KJ, Lau ES, Poole JE, Lindley KJ, Mehran R. Increasing Participation of Women in Cardiovascular Trials: JACC Council Perspectives. J Am Coll Cardiol 2021; 78:737-751. [PMID: 34384555 DOI: 10.1016/j.jacc.2021.06.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Although some progress has been made in the last 3 decades to increase the number of women in clinical cardiology trials, review of recent cardiovascular literature demonstrates that women and underrepresented minority women are still underrepresented in most clinical cardiology trials. This is especially notable in trials of patients with coronary artery disease, heart failure with reduced ejection fraction, and arrhythmia studies, especially those involving devices and procedures. Despite the call from National Institutes of Health, Food and Drug Administration, Institute of Medicine, and various professional societies, the gap remains. This paper seeks to identify the barriers for low enrollment and retention from patient, clinician, research team, study design, and system perspectives, and offers recommendations to improve recruitment and retention in the current era.
Collapse
Affiliation(s)
- Leslie Cho
- Cleveland Clinic Heart, Vascular, Thoracic Institute, Cleveland, Ohio, USA.
| | | | | | | | - Amy A Sarma
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara J Denby
- Cleveland Clinic Heart, Vascular, Thoracic Institute, Cleveland, Ohio, USA
| | - Emily S Lau
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle, Washington, USA
| | | | | |
Collapse
|
14
|
Kee D, O'Conor R, Wisnivesky JP, Wolf MS, Federman AD. Patient characteristics associated with retention in an asthma self-management trial for older adults. J Asthma 2021; 59:1652-1660. [PMID: 34112032 DOI: 10.1080/02770903.2021.1941090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE New self-management interventions are being developed for older adults who suffer from worse asthma morbidity than their younger counterparts, but high rates of study drop out have hampered these efforts and there is limited literature on what factors may influence retention in behavioral intervention studies with older adults. This study analyzed illness beliefs and patient characteristics that may contribute to retention in an asthma self-management trial for older adults. METHODS This is a secondary analysis of data from a randomized controlled trial of a self-management support intervention for adults 60 years and older with persistent, uncontrolled asthma. Multivariable logistic regression was used to evaluate the association of medication and illness beliefs, and other subject characteristics with study retention, which was defined as completion of the research study interview at 6 and 12 months. RESULTS The randomized trial enrolled 388 individuals; 261 (67.3%) completed the 12-month interview. Higher perceived threat of chronic diseases relative to asthma was associated with higher study retention (OR = 1.11, 95% CI = 1.00-1.24) at 12 months. Other variables including asthma beliefs, age, cognitive function, health literacy, and asthma symptoms were not significantly associated with retention. CONCLUSIONS Concern about non-asthma chronic conditions, but no other illness beliefs, or patient characteristics, were associated with retention in an asthma self-management support intervention. Further research, including qualitative studies, is needed to better understand why patients drop out of asthma behavioral intervention studies.
Collapse
Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
15
|
[The roles of patients in healthcare provision, training and research: A French perspective]. Rev Epidemiol Sante Publique 2021; 69:307-313. [PMID: 34020854 DOI: 10.1016/j.respe.2021.04.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 01/05/2023] Open
Abstract
In 2002, patients were transformed into users of the French health system. As this opinion piece demonstrates, in 2021 they may at least potentially participate more actively than before. They can convey their knowledge of a disease and its treatments, and voluntarily share their experience. They can intervene in user representation and therapeutic patient education, the objective being to increase the autonomy of one and all, patients and public, in the training of professionals, clinical research and evolution of the health system. The rationale for the involvement of patients and their roles in provision of care, training and clinical research are analyzed from a French perspective. The obstacles to overcome and improvements to be achieved are reviewed, the objective being to promote enhanced health democracy through increased patient engagement. In 2021, however, the role of patients in the design and implementation of therapeutic patient education (TPE) and in the development of medical studies curricula remains limited if not restricted; this is due not only to a lack of information, but also to the resistance of health professionals and universities. Patients could and should assume a major role, fostering evolution toward a more just and effective health care system.
Collapse
|
16
|
Alghamdi SM, Rajah AMA, Aldabayan YS, Aldhahir AM, Alqahtani JS, Alzahrani AA. Chronic Obstructive Pulmonary Disease Patients' Acceptance in E-Health Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5230. [PMID: 34069028 PMCID: PMC8156037 DOI: 10.3390/ijerph18105230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Telehealth (TH) interventions with Chronic Obstructive Pulmonary Disease (COPD) management were introduced in the literature more than 20 years ago with different labeling, but there was no summary for the overall acceptance and dropout rates as well as associated variables. OBJECTIVE This review aims to summarize the acceptance and dropout rates used in TH interventions and identify to what extent clinical settings, sociodemographic factors, and intervention factors might impact the overall acceptance and completion rates of TH interventions. METHODS We conducted a systematic search up to April 2021 on CINAHL, PubMed, MEDLINE (Ovid), Cochrane, Web of Sciences, and Embase to retrieve randomized and non-randomized control trials that provide TH interventions alone or accompanied with other interventions to individuals with COPD. RESULTS Twenty-seven studies met the inclusion criteria. Overall, the unweighted average of acceptance and dropout rates for all included studies were 80% and 19%, respectively. A meta-analysis on the pooled difference between the acceptance rates and dropout rates (weighted by the sample size) revealed a significant difference in acceptance and dropout rates among all TH interventions 51% (95% CI 49% to 52; p < 0.001) and 63% (95% CI 60% to 67; p < 0.001), respectively. Analysis revealed that acceptance and dropout rates can be impacted by trial-related, sociodemographic, and intervention-related variables. The most common reasons for dropouts were technical difficulties (33%), followed by complicated system (31%). CONCLUSIONS Current TH COPD interventions have a pooled acceptance rate of 51%, but this is accompanied by a high dropout rate of 63%. Acceptance and dropout levels in TH clinical trials can be affected by sociodemographic and intervention-related factors. This knowledge enlightens designs for well-accepted future TH clinical trials. PROSPERO registration number CRD4201707854.
Collapse
Affiliation(s)
- Saeed M. Alghamdi
- Department of Respiratory Care, College of Applied Health Science, Umm Al Qura University, Makkah 21955, Saudi Arabia;
- National Heart and Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Ahmed M. Al Rajah
- Respiratory Care Department, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (A.M.A.R.); (Y.S.A.)
| | - Yousef S. Aldabayan
- Respiratory Care Department, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (A.M.A.R.); (Y.S.A.)
| | - Abdulelah M. Aldhahir
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | - Jaber S. Alqahtani
- UCL Respiratory, University College London, London WC1E 6BT, UK;
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Abdulaziz A. Alzahrani
- Department of Respiratory Care, College of Applied Health Science, Umm Al Qura University, Makkah 21955, Saudi Arabia;
- Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| |
Collapse
|
17
|
McPhillips MV, Petrovsky DV, Brewster GS, Li J, Gooneratne NS, Hodgson NA, Sefcik JS. Recruiting Persons with Dementia and Caregivers in a Clinical Trial: Dyads Perceptions. West J Nurs Res 2021; 44:557-566. [PMID: 33870784 DOI: 10.1177/01939459211008563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recruitment for dementia research is challenging and costly. Using Ajzen's Theory of Planned Behavior we explored attitudes, perceived norms, and perceived behavioral control of persons living with dementia (PLWD) and their caregivers who participated in one clinical trial to better understand factors that influence dyads' decisions to enroll. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers and utilized directed content analysis. Categories connected with positive attitudes about study enrollment were personal desires of wanting to learn and in-person meetings with knowledgeable staff. Additionally, participants said the money always helps in terms of the financial incentive. Participants reported enrolling to support another person (perceived norm). Study requirements were thought to be easy (perceived behavioral control). Participants highlighted the importance of flexible scheduling and study tasks being completed at their home. Findings can inform future recruitment efforts and should be investigated as effective recruitment methods in other clinical trials.
Collapse
Affiliation(s)
| | | | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
18
|
Nelson LA, Williamson SE, LeStourgeon LM, Mayberry LS. Retaining diverse adults with diabetes in a long-term trial: Strategies, successes, and lessons learned. Contemp Clin Trials 2021; 105:106388. [PMID: 33812991 DOI: 10.1016/j.cct.2021.106388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
Background Retention can be difficult in longitudinal trials, especially among minoritized groups and individuals with low socioeconomic status (SES) who may experience more barriers to research participation. Organized retention strategies may help; however, limited research has reported on this in detail. Methods We employed several strategies throughout a 15-month randomized controlled trial to encourage retention among a diverse sample of adults with type 2 diabetes. Participants were randomized to receive mobile health support for diabetes self-care for 12 months or an attention control. Participants completed assessments at 3, 6, 12, and 15 months post-baseline. We used three main categories of retention strategies: flexibility in participation (e.g., multiple methods for data collection), communication (e.g., tracking contacts), and community building (e.g., study branding, newsletters). We monitored participants' use of strategies and examined associations between participant characteristics and retention. Results Retention remained high (≥90%) at each follow-up assessment. Participants used various methods for survey completion: online (34%), in-person (31%), and mail (30%). Most (73%) used a mail-in A1c kit at least once. Multiple completion methods were important for retaining minoritized and lower SES participants who completed assessments in-person more frequently. Communication also facilitated retention; 39% of participants used a study Helpline and tracking systems helped maintain contact. Conclusions Retaining disadvantaged patients in clinical trials is necessary so findings generalize to and can benefit these populations. Retention strategies that reduce barriers to participation and engage participants and community partners can be successful. Future studies should assess the impact of retention strategies.
Collapse
Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
19
|
Masese RV, DeMartino T, Bonnabeau E, Burns EN, Preiss L, Varughese T, Nocek JM, Lasley P, Chen Y, Davila C, Nwosu C, Scott S, Bowman L, Gordon L, Clesca C, Peters-Lawrence M, Melvin C, Shah N, Tanabe P. Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC). J Immigr Minor Health 2020; 23:725-732. [PMID: 33034793 PMCID: PMC8032811 DOI: 10.1007/s10903-020-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/27/2022]
Abstract
Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15-45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
Collapse
Affiliation(s)
- Rita V Masese
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Terri DeMartino
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Emily Bonnabeau
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Ebony N Burns
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | | - Taniya Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Judith M Nocek
- Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Yumei Chen
- University of California, San Francisco, Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | - Samantha Scott
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Latanya Bowman
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cindy Clesca
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marlene Peters-Lawrence
- Division of Blood Diseases and Resources, National Institute of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Paula Tanabe
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | |
Collapse
|
20
|
Daly A, Reid A. Recruiting migrant workers in Australia for Public Health surveys: how sampling strategy make a difference in estimates of workplace hazards. BMC Res Notes 2020; 13:473. [PMID: 33028419 PMCID: PMC7542909 DOI: 10.1186/s13104-020-05320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives One third of the Australian work force are immigrants. Relatively little is known about working conditions for specific migrant groups. The objectives of this paper are to describe and compare the sampling strategies used to recruit migrant workers from specific migrant groups working in Australia into a cross-sectional study designed to produce population estimates of workplace hazards and self-reported health. Results Two cross sectional telephone surveys were conducted with immigrants currently working in Australia. Survey 1 used quota sampling from lists provided by a sample broker. Survey 2 used a combination of probability and non-probability sampling, including random sampling from telephone lists. Data from the surveys were weighted and comparisons made with unweighted data. While weighting adjusted for most differences across the sample sources, the likelihood of exposure to workplace hazards depended on exposure types and sampling strategies. We concluded that by using a combination of sampling strategies it is possible to recruit immigrants from specific migrant groups and provide a balanced view of working conditions, although no one strategy was best for all types of measures. Access to a robust sample source for migrants would enable a better perspective to migrant populations’ working conditions.
Collapse
Affiliation(s)
- Alison Daly
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Alison Reid
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| |
Collapse
|
21
|
Bruhl RJ, Perkison WB, Hanania NA, McNeill LH, Oluyomi AO, Fiesinger EB, Minard CG, Solomon A, Hamilton WJ, Butler B, Caldwell J, Crosby E, Davis C, Galvan H, Harris R, Lacour-Chestnut F, Martin C, Pannell S, Phipps K, Richardson G, Solomon A, White W, Boles J, Rangel A, Virk R, Brock M, Guffey D, Ramamurthy U, Persse D, Maffei S, Chan W, Reyes B. Design of a home-based intervention for Houston-area African-American adults with asthma: Methods and lessons learned from a pragmatic randomized trial. Contemp Clin Trials 2020; 91:105977. [PMID: 32151753 DOI: 10.1016/j.cct.2020.105977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults-a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.
Collapse
Affiliation(s)
- Rebecca Jensen Bruhl
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - William Brett Perkison
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abiodun O Oluyomi
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ellen Baskin Fiesinger
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Abida Solomon
- College of Nursing, Prairie View A&M University, Houston, TX, United States
| | - Winifred J Hamilton
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Brian Butler
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - James Caldwell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Eunice Crosby
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Cellie Davis
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Hope Galvan
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Rachel Harris
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Carol Martin
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Shereda Pannell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Kathy Phipps
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Adriene Solomon
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - William White
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Jamie Boles
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Adriana Rangel
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ritupreet Virk
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Melissa Brock
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Uma Ramamurthy
- Office of Research Information Technology, Baylor College of Medicine, Houston, TX, United States
| | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States; Emergency Medical Services, Houston Fire Department, City of Houston, TX, United States
| | - Salvador Maffei
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Brenda Reyes
- U.S. Department of Housing & Urban Development, Washington, DC, United States
| |
Collapse
|
22
|
Taani MH, Zabler B, Fendrich M, Schiffman R. Lessons learned for recruitment and retention of low-income African Americans. Contemp Clin Trials Commun 2020; 17:100533. [PMID: 32211558 PMCID: PMC7083755 DOI: 10.1016/j.conctc.2020.100533] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 11/26/2022] Open
Abstract
Recruitment and retention of low-income African Americans in clinical trials is challenging. This paper reports recruitment and retention strategies that yielded high rates for both in a clinical trial pilot to improve hypertension self-management among low-income African Americans. The study successfully recruited 96.7% (59 of 61 participants) within a seven month period. Retention rates for the 1, 3, and 6-month post-baseline assessment visits were 91.5%, 88.1%, and 83.1%, respectively. Recruitment and retention strategies include two grounded in previous literature: a culturally sensitive and diverse research team and use of incentives. Four additional strategies were developed for this study to meet the needs of the study site and participants, which included: study site collaboration; ongoing communications; responding to the clinical environment; and addressing participants’ health literacy levels. A discussion of key recruitment and retention strategies and suggestions for future studies focused on low-income African American participants ensues.
Collapse
Affiliation(s)
- Murad H Taani
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, United States
| | - Bev Zabler
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, United States
| | - Michael Fendrich
- School of Social Work, University of Connecticut, 38 Prospect Street, Harford, CT, 06103, United States
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, United States
| |
Collapse
|