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Wang L, Zhang R, Liu J, Xu R, Zhao L, Li E, Zhang Y. An online survey on public awareness of drug clinical trials in inland cities of northern China. Front Public Health 2024; 12:1276536. [PMID: 38665243 PMCID: PMC11043599 DOI: 10.3389/fpubh.2024.1276536] [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: 09/19/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Objective The aims of this survey were to investigate the public awareness of drug clinical trials (DCTs) and willingness to participate the DCTs, and provide references for propaganda and science popularization of DCTs. Methods A self-designed questionnaire named "an online survey questionnaire on public awareness of DCTs" was used to conduct an online survey from January to March 2022. The demographic characteristics and the response of participants to the awareness and willingness to participate the DCTs were collected. The factors affecting the public awareness of DCTs were analyzed by single factor and binary logistic regression analysis. Results One thousand three hundred eighty valid questionnaires were collected, and the respondents' awareness rate of DCTs was 61.1%. Thirteen demographic characteristics including age, gender, education, occupation, work fields, household type, marital status, city type, income, medical insurance, medical expenditure, pressure to seek medical care, financial pressure, both significantly affected the qualified rate of participants' awareness of DCTs (p < 0.001) by single factor analysis. Binary logistic regression analysis indicated that education level, work fields, city type, medical insurance, and medical expenditure affected independently the participants' awareness rate of DCTs (p < 0.001). 52.9% of the participants were willing to take part in DCTs. "to promote medical progress" (54.4%) or "believe doctors" (31.1%) were the most frequent reasons for subjects participating in DCTs. Conclusion The public awareness rate of DCTs and the willingness to participate in drug clinical were significantly affected by the demographic characteristics of subjects. Thus, targeting the needs of the public, propaganda, and science popularization of DCTs should be carried out and served public health.
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Affiliation(s)
- Li Wang
- Department of Scientific Research, Faculty of General Family Medicine, the First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
- Department of Health Statistics, Faculty of Public Health, Shaanxi University of Chinese Medicine, Xi’an, Shannxi, China
| | - Ruiguang Zhang
- Xi’an Evidence Based Pharmaceutical Technology Co., Ltd, Xi’an, China
| | - Jingxuan Liu
- Department of Health Statistics, Faculty of Public Health, Shaanxi University of Chinese Medicine, Xi’an, Shannxi, China
| | - Rui Xu
- Department of Scientific Research, Faculty of General Family Medicine, the First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Lili Zhao
- Department of Scientific Research, Faculty of General Family Medicine, the First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Enze Li
- Department of Scientific Research, Faculty of General Family Medicine, the First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Yurong Zhang
- Department of Scientific Research, Faculty of General Family Medicine, the First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
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Hawke LJ, Nelson E, O'Brien P, Crossley KM, Choong PF, Bunzli S, Dowsey MM. Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review. Contemp Clin Trials Commun 2024; 38:101283. [PMID: 38456181 PMCID: PMC10918492 DOI: 10.1016/j.conctc.2024.101283] [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: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
Background Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment. Objectives To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation. Material and methods Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework. Results Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders. Conclusion The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.
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Affiliation(s)
- Lyndon J. Hawke
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Elizabeth Nelson
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Kay M. Crossley
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter F. Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Michelle M. Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Tan SH, King TL, Tan SSN, Lai WH, Bujang MA, Voon PJ. Development and validation of Join Clinical Trial Questionnaire (JoinCT). Asia Pac J Clin Oncol 2023. [PMID: 37943536 DOI: 10.1111/ajco.14034] [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: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
AIM Participant recruitment has always been a major challenge in clinical trials. This study aimed to develop and validate the Join Clinical Trial Questionnaire (JoinCT), exploring the willingness to join a clinical trial and associated factors in patients. METHODS This questionnaire development study involved four phases: (i) exploring and understanding the subject matter, (ii) questionnaire development, (iii) content validity testing, and lastly, (iv) field-testing of the questionnaire. For the field-testing phase, a cross-sectional self-administered survey of JoinCT was conducted among cancer patients with various socio-demographic backgrounds and medical conditions. Besides content validity, Cronbach's alpha was used to evaluate the internal consistency of domains, and confirmatory factor analysis was used to evaluate the model fit of the JoinCT framework. RESULTS A total of 389 respondents participated in the survey. Based on the results obtained from a field data collection phase, JoinCT consisted of four independent variables domains, namely "knowledge", "perception of benefits", "perception of risks", and "confidence". The only dependent variable was the willingness to participate in a clinical trial. The minimum Cronbach's alpha was 0.937, and the model fit for the overall framework of JoinCT is also excellent with Comparative Fit Index (> 0.90), root mean square error approximation (< 0.08), and Standardized Root Mean Square Residual (< 0.08). CONCLUSIONS The Join Clinical Trial Questionnaire (JoinCT) was successfully validated with excellent reliability and validity, and a good model fit. The main factors that contribute to willingness to participate in clinical trials are knowledge, perception of benefits, perception of risks, and confidence.
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Affiliation(s)
- Shirin Hui Tan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Teck Long King
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Shirley Siang Ning Tan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Wei Hong Lai
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy and Oncology, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Hu WT, Bergren SM, Dychtwald DK, Ma Y, Dong X. Variations in racial and ethnic groups' trust in researchers associated with willingness to participate in research. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:466. [PMID: 38650745 PMCID: PMC11034911 DOI: 10.1057/s41599-023-01960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/24/2023] [Indexed: 04/25/2024]
Abstract
Low enrollment in U.S. biomedical research by non-White adults has historically been attributed to mistrust, but few studies have simultaneously examined dimensions of trust in three or more racial/ethnic groups. Leveraging the racial/ethnic diversity of New Jersey, we prospectively recruited 293 adults (72% women, 38% older than 54 years of age) between October 2020 and February 2022 to complete two anonymous surveys in English or one of the common languages (e.g., Spanish, Mandarin Chinese). The first consisted of 12 Likert Scale questions related to trust in biomedical researchers (according to safety, equity, transparency), and the second assessed willingness to consider participation in eight common research activities (health-related survey, blood collection, genetic analysis, medication study, etc). Participants self-reported as Hispanic (n=102), Black (n=49), Chinese (n=48), other Asian (n=53), or White (n=41) race/ethnicity. Factor analysis showed three aspects related to trust in researchers: researchers as fiduciaries for research participants, racial/ethnic equity in research, and transparency. Importantly, we observed differences in the relationship between mistrust and willingness to participate. Whereas Chinese respondents' low trust in researchers mediated their low interest in research involving more than health-related surveys, Hispanic respondents' low trust in research equity did not deter high willingness to participate in research involving blood and genetic analysis. We caution that a generic association between trust and research participation should not be broadly assumed, and biomedical researchers should prospectively assess this relationship within each minoritized group to avoid hasty generalization.
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Affiliation(s)
- William T Hu
- Rutgers Institute for Health, Health Care Policy, and Aging Research, USA
| | | | - Dana K Dychtwald
- Rutgers Institute for Health, Health Care Policy, and Aging Research, USA
| | - Yiming Ma
- Rutgers Institute for Health, Health Care Policy, and Aging Research, USA
| | - XinQi Dong
- Rutgers Institute for Health, Health Care Policy, and Aging Research, USA
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Rodriguez DK, Hewage SA, Periyakoil VS. Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review. J Am Geriatr Soc 2023; 71:1974-1991. [PMID: 37013348 PMCID: PMC10258132 DOI: 10.1111/jgs.18264] [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] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited. DESIGN This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States. METHODS Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles. RESULTS Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers. CONCLUSIONS Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.
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Affiliation(s)
- Dulce K Rodriguez
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Sumali A Hewage
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
- Veterans Affairs Palo Alto Health Care Center, Palo Alto, California, USA
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Randal FT, Lozano P, Qi S, Maene C, Shah S, Mo Y, Ratsimbazafy F, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Loperena R, Mayo K, Mockrin S, Ohno-Machado L, Schully S, Ramirez AH, Aschebrook-Kilfoy B, Ahsan H, Lam H, Kim KE. Achieving a Representative Sample of Asian Americans in Biomedical Research Through Community-Based Approaches: Comparing Demographic Data in the All of Us Research Program With the American Community Survey. J Transcult Nurs 2023; 34:59-67. [PMID: 36398985 DOI: 10.1177/10436596221130796] [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: 11/21/2022] Open
Abstract
BACKGROUND Underrepresented persons are often not included in biomedical research. It is unknown if the general Asian American population is being represented in All of Us. The purpose of this study was to compare the Asian demographic data in the All of Us cohort with the Asian nationally representative data from the American Community Survey. METHOD Demographic characteristics and health literacy of Asians in All of Us were examined. Findings were qualitatively compared with the Asian data in the 2019 American Community Survey 1-year estimate. RESULTS Compared with the national composition of Asians, less All of Us participants were born outside the United States (64% vs 79%), were younger, and had higher levels of education (76% vs 52%). Over 60% of All of Us participants reported high levels of health literacy. CONCLUSION This study had implications for the development of strategies that ensure diverse populations are represented in biomedical research.
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Affiliation(s)
| | | | - Siya Qi
- Asian Health Coalition, Chicago, IL, USA
| | | | | | - Yicklun Mo
- Asian Health Coalition, Chicago, IL, USA
| | | | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, USA
| | | | | | | | - Kelly Gebo
- Johns Hopkins University School of Medicine, Bethesda, MD, USA
| | | | - Kelsey Mayo
- Vanderbilt University Medical Center, Nashville, TN, USA
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Gupta SK, Biswkarma V, Rohatgi N, Saxena R. Knowledge, attitudes, and perception of 398 cancer patients toward participation in clinical trials: A single-center study from New Delhi, India. Perspect Clin Res 2022; 13:43-47. [PMID: 35198428 PMCID: PMC8815669 DOI: 10.4103/picr.picr_177_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/30/2020] [Accepted: 03/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Clinical trials are considered to be the gold standard research methodology for evaluating the efficacy and safety of healthcare interventions. Materials and Methods: A cross-sectional study was conducted using standardized self-administered questionnaires prepared by the research team and statistician. The questionnaires were offered to cancer patients presented at a tertiary care center. Results: We surveyed 398 cancer patients, 193 (48.5%) males and 205 (51.5%) females with a mean (±standard deviation) 55.39 (±13.59) of age in years. Out of total, only 59 (14.82%) had the prior knowledge of the clinical trial. Forty-three (10.80%) participants were willing to participate in clinical trials. Conclusion: Cancer patients had preconceived notions and myths that linger in our society that clinical trial participation will harm them. The researchers/oncologists need to explore the rationale, objectives, and benefits of taking part in clinical trials and make it easy to understand by cancer patients.
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Davies L, Beard D, Cook JA, Price A, Osbeck I, Toye F. The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography. Trials 2021; 22:678. [PMID: 34620194 PMCID: PMC8495989 DOI: 10.1186/s13063-021-05403-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Randomised controlled trials in surgery can be a challenge to design and conduct, especially when including a non-surgical comparison. As few as half of initiated surgical trials reach their recruitment target, and failure to recruit is cited as the most frequent reason for premature closure of surgical RCTs. The aim of this qualitative evidence synthesis was to identify and synthesise findings from qualitative studies exploring the challenges in the design and conduct of trials directly comparing surgical and non-surgical interventions. METHODS A qualitative evidence synthesis using meta-ethnography was conducted. Six electronic bibliographic databases (Medline, Central, Cinahl, Embase and PsycInfo) were searched up to the end of February 2018. Studies that explored patients' and health care professionals' experiences regarding participating in RCTs with a surgical and non-surgical comparison were included. The GRADE-CERQual framework was used to assess confidence in review findings. RESULTS In total, 3697 abstracts and 49 full texts were screened and 26 published studies reporting experiences of patients and healthcare professionals were included. The focus of the studies (24/26) was primarily related to the challenge of recruitment. Two studies explored reasons for non-compliance to treatment allocation following randomisation. Five themes related to the challenges to these types of trials were identified: (1) radical choice between treatments; (2) patients' discomfort with randomisation: I want the best treatment for me as an individual; (3) challenge of equipoise: patients' a priori preferences for treatment; (4) challenge of equipoise: clinicians' a priori preferences for treatment and (5) imbalanced presentation of interventions. CONCLUSION The marked dichotomy between the surgical and non-surgical interventions was highlighted in this review as making recruitment to these types of trials particularly challenging. This review identified factors that increase our understanding of why patients and clinicians may find equipoise more challenging in these types of trials compared to other trial comparisons. Trialists may wish to consider exploring the balance of potential factors influencing patient and clinician preferences towards treatments before they start recruitment, to enable issues specific to a particular trial to be identified and addressed. This may enable trial teams to make more efficient considered design choices and benefit the delivery of such trials.
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Affiliation(s)
- Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK.
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | | | - Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Rodríguez-Torres E, González-Pérez MM, Díaz-Pérez C. Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemp Clin Trials Commun 2021; 23:100829. [PMID: 34401599 PMCID: PMC8358641 DOI: 10.1016/j.conctc.2021.100829] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.
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Affiliation(s)
| | | | - Clemente Díaz-Pérez
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, USA
- The Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, USA
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Osarfo J, Adjei RO, Magnussen P, Tagbor HK. Participation of Ghanaian pregnant women in an antimalarial drug trial: willingness, experiences and perceptions. Trans R Soc Trop Med Hyg 2021; 115:714-719. [PMID: 33137818 PMCID: PMC8169309 DOI: 10.1093/trstmh/traa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/11/2020] [Accepted: 10/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With increasing orientation towards including pregnant women in clinical trials, investigators must conduct culturally acceptable research to aid recruitment and retention. There is limited information on experiences and meanings that pregnant women make of trial participation in Africa. This study reports experiences and perceptions of Ghanaian pregnant women regarding their participation in a clinical trial. METHODS From October to December 2012, 45 in-depth interviews were conducted among pregnant women and their male partners regarding their experiences and perceptions of clinical trial processes as part of an antimalarial drug safety and efficacy trial in pregnant women in the Ashanti region of Ghana. Analysis was by predetermined themes and inductive analysis. RESULTS Familiarity with the disease studied in the trial and trust in health workers favoured participation with the latter underlying acceptance of study drugs in the absence of symptoms. Adverse drug events were perceived as intrinsic sickness exhibited on the path to wellness. There were no cultural barriers to blood sampling during home visits but hospital-based sampling was preferred. Home visits were linked to participants having HIV infection. CONCLUSION This study contributes knowledge on sociocultural matters underpinning pregnant women's decisions regarding trial participation in an era of increasing drug trials involving pregnant women.
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Affiliation(s)
- Joseph Osarfo
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rose O Adjei
- Department of Health Education, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Magnussen
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Harry K Tagbor
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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12
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Fiordelli M, Fadda M, Amati R, Albanese E. Older adults' motivations to participate or not in epidemiological research. Qualitative inquiry on a study into dementia in Switzerland. PLoS One 2021; 16:e0247141. [PMID: 33577607 PMCID: PMC7880484 DOI: 10.1371/journal.pone.0247141] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/01/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION High participation in epidemiological studies is crucial for both external and internal validity. Because response rates have declined in recent years, there is an increasing need to understand the drivers and the barriers to research participation. This study aims to uncover the motivations in favour and against participation of older adults to an epidemiological study on health and dementia. METHODS Twenty-two older adults, who already took part to the preliminary phase of an epidemiological study in Switzerland, agreed to participate to semi-structured, face-to- face interviews. An experienced researcher carried out all interviews in a quiet place of choice of the interviewee either at their domicile or the university, between November 2019 and January 2020. The interviews were audio and video taped, transcribed verbatim, and thematically analysed by two independent researchers. RESULTS We identified three main themes for the motivations in favour of participation (i.e. personal, related to the outcomes of research, and altruistic motivations), and we highlighted subthemes for each theme (e.g. personal motivations: curiosity; civic engagement; interest in the topic; trust in science; everyone counts; openness; play the game). Motivations against participation reflected the first two themes, while there was no counterpart for altruistic motivations. CONCLUSIONS Our thematic analysis revealed that older adults hold specular motivations in favour and against participation to research. Studying jointly motivations in favour and against provides information for recruitment strategies and to overcome barriers to participation, respectively. Participatory action research can inform the design and conduction of and should precede epidemiological studies in older adults, and can potentially contribute to attain high response rates.
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Affiliation(s)
- Maddalena Fiordelli
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- * E-mail:
| | - Marta Fadda
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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13
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Teo I, Tan YP, Finkelstein EA, Yang GM, Pan FT, Lew HYF, Tan EKW, Ong SYK, Cheung YB. The Feasibility and Acceptability of a Cognitive Behavioral Therapy-Based Intervention for Patients With Advanced Colorectal Cancer. J Pain Symptom Manage 2020; 60:1200-1207. [PMID: 32574657 DOI: 10.1016/j.jpainsymman.2020.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Advanced colorectal cancer and its treatment can bring about challenges associated with psychological distress. OBJECTIVES The primary aims of this study were to examine the feasibility and acceptability of a cognitive behavioral therapy (CBT)-based intervention to improve coping with the disease. The secondary aim is to evaluate preliminary intervention efficacy. METHODS Patients with advanced colorectal cancer in Singapore (N = 60) were randomized to either receive a four-session CBT intervention immediately or be waitlisted. Intervention feasibility (i.e., recruitment and intervention adherence) and acceptability (i.e., participant satisfaction and cultural sensitivity) were assessed. Changes in psychological distress and self-efficacy were examined. RESULTS The study successfully recruited the intended sample (mean age 61; 62% men). A proportion (12%) reported Hospital Anxiety and Depression Scale scores indicative of distress at baseline. Most (88%) completed all sessions. Participants reported high rates of satisfaction (97%), helpfulness (96%), and cultural sensitivity (95%) of the intervention. The intervention group did not show decrease in psychological distress; however, self-efficacy in cancer-related coping (information seeking: effect size [ES] = 0.64; 95% CI = 0.17, 0.85; coping with side effects: ES = 0.69; 95% CI = 0.33, 0.82; and maintaining positive attitude: ES = 0.45; 95% CI = 0.19, 0.79) increased in the intervention group compared with the waitlisted group. CONCLUSION The CBT-based intervention was feasible and acceptable to patients in Singapore. There is no sufficient evidence to warrant a larger trial in this sample with low baseline distress. Future work should identify and target those who are most in need of support.
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Affiliation(s)
- Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore; Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore.
| | - Yee Pin Tan
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Grace Meijuan Yang
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Fang Ting Pan
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | | | - Yin Bun Cheung
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Centre for Child Health Research, Tampere University, Finland
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14
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Sheridan R, Martin-Kerry J, Hudson J, Parker A, Bower P, Knapp P. Why do patients take part in research? An overview of systematic reviews of psychosocial barriers and facilitators. Trials 2020; 21:259. [PMID: 32164790 PMCID: PMC7069042 DOI: 10.1186/s13063-020-4197-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 02/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding why people take part in health research is critical to improve research efficiency and generalisability. The aim of this overview of systematic reviews was to identify psychosocial determinants of research participation and map them to psychological theory and empirical recruitment research, to identify effective strategies to increase research participation. METHODS Qualitative and quantitative systematic reviews were systematically identified. No date or language limits were applied. Two reviewers independently selected reviews. Methodological quality was rated using AMSTAR, and poor-quality reviews (scoring 0-3) were excluded. Barriers and facilitators were coded to psychological theory (Theoretical Domains Framework) and empirical recruitment research (recruitment interventions that had been subjected to randomised controlled trial evaluation). RESULTS We included 26 systematic reviews (429 unique primary studies), covering a wide range of patient populations and health settings. We identified five groups of facilitators, of which three were dominant (potential for personal benefit, altruism, trust) and appear to be relevant across research setting and design. We identified nine groups of barriers, which were more dependent on the particular study (context, population, design). Two determinants (participant information, social influences) were found to be both barriers and facilitators. Barriers and facilitators could be coded to the Motivation and Opportunity components of the Theoretical Domains Framework; only one was coded to a Capability component. There was some overlap between psychosocial determinants and empirical recruitment research, but some barriers and facilitators had not been tested at all. CONCLUSIONS Identifying effective recruitment strategies could increase the efficiency and generalisability of primary research. We identified a number of barriers and facilitators that could be addressed by researchers. There is a need for more research to identify effective recruitment strategies that draw on the psychosocial facilitators and barriers identified in this overview.
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Affiliation(s)
| | | | | | | | | | - Peter Knapp
- University of York and the Hull York Medical School, York, UK
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15
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Saadi A, Kim AY, Menkin JA, Carrillo CA, Reyes CE, Sarkisian CA. Mistrust of Researchers Correlates with Stroke Knowledge among Minority Seniors in a Community Intervention Trial. J Stroke Cerebrovasc Dis 2019; 29:104466. [PMID: 31734125 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104466] [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] [Received: 05/29/2019] [Revised: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medical mistrust influences patients' treatment seeking, adherence, health behaviors, and minority participation in research studies. However, medical mistrust remains understudied within neurological diseases like stroke despite disproportionately affecting minority populations. OBJECTIVE This study examines the relationship of medical mistrust with stroke knowledge among Black, Latino, Korean, and Chinese-Americans. METHODS Subjects greater than 60 years were enrolled from senior centers to test a culturally-tailored educational curriculum around stroke risk reduction in a randomized controlled trial. A Trust Physician Scale and a modified Trust of Medical Researchers Scale measured medical mistrust. The Stroke Action Test instrument measured stroke knowledge, focusing on intent to call 911 appropriately when presented with stroke symptoms. RESULTS Of 225 subjects, 69.5% were female (n = 157) with an average age of 73.7 years (standard deviation 6.7). Blacks had highest trust scores of physicians relative to Latino/a, Korean or Chinese subjects (P< .05). In multivariable analysis, decreased stroke knowledge was associated with decreased researcher trust at baseline (<.05), but not physician trust, when controlling for covariates. Among Latino/a, Korean, and Chinese groups, mainstream acculturation reduced the association between researcher trust and stroke knowledge. A mediation model showed no evidence of physician trust mediating researcher trust. CONCLUSIONS Among minority seniors participating in a randomized controlled trial, decreased trust of researchers, not physicians, was associated with low baseline knowledge of stroke symptoms. Those least acculturated to US culture may be a particular focus for trust building intervention. Future studies should examine whether researcher mistrust is disproportionately preventing those with the largest knowledge gaps from participating in trials.
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Affiliation(s)
- Altaf Saadi
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA.
| | | | - Josephine A Menkin
- David Geffen School of Medicine at University of California Los Angeles, Division of Geriatrics, Department of Medicine, Los Angeles, California
| | - Carmen A Carrillo
- David Geffen School of Medicine at University of California Los Angeles, Division of Geriatrics, Department of Medicine, Los Angeles, California; David Geffen School of Medicine at UCLA, Division of Geriatrics, Department of Medicine & Department of Public Health, Los Angeles County Department of Public Health
| | - Carmen E Reyes
- David Geffen School of Medicine at University of California Los Angeles, Division of Geriatrics, Department of Medicine, Los Angeles, California
| | - Catherine A Sarkisian
- David Geffen School of Medicine at University of California Los Angeles, Division of Geriatrics, Department of Medicine, Los Angeles, California; David Geffen School of Medicine at UCLA, Division of Geriatrics, Department of Medicine, Los Angeles, CA; David Geffen School of Medicine at UCLA, Division of Geriatrics, Department of Medicine, & VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA
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16
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Gillies K, Chalmers I, Glasziou P, Elbourne D, Elliott J, Treweek S. Reducing research waste by promoting informed responses to invitations to participate in clinical trials. Trials 2019; 20:613. [PMID: 31661029 PMCID: PMC6819580 DOI: 10.1186/s13063-019-3704-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
Poor recruitment to, and retention in, clinical trials is a source of research waste that could be reduced by more informed choices about participation. Barriers to effective recruitment and retention can be wide-ranging but relevance of the questions being addressed by trials and the outcomes that they are assessing are key for potential participants. Decisions about trial participation should be informed by general and trial-specific information and by considering broader assessments of 'informedness' and how they impact on both recruitment and retention. We suggest that more informed decisions about trial participation should encourage personally appropriate decisions, increase recruitment and retention, and reduce research waste and increase its value.
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Affiliation(s)
- Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZB,, UK.
| | - Iain Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | | | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HY,, UK
| | - Jim Elliott
- Health Research Authority, Skipton House, London, SE1 6LH,, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZB,, UK
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17
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Browne JL, Rees CO, van Delden JJM, Agyepong I, Grobbee DE, Edwin A, Klipstein-Grobusch K, van der Graaf R. The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review. Trop Med Int Health 2019; 24:264-279. [PMID: 30565381 PMCID: PMC6850431 DOI: 10.1111/tmi.13195] [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] [Indexed: 11/29/2022]
Abstract
Objectives To systematically review reasons for the willingness to participate in biomedical human subjects research in low‐ and middle‐income countries (LMICs). Methods Five databases were systematically searched for articles published between 2000 and 2017 containing the domain of ‘human subjects research’ in ‘LMICs’ and determinant ‘reasons for (non)participation’. Reasons mentioned were extracted, ranked and results narratively described. Results Ninety‐four articles were included, 44 qualitative and 50 mixed‐methods studies. Altruism, personal health benefits, access to health care, monetary benefit, knowledge, social support and trust were the most important reasons for participation. Primary reasons for non‐participation were safety concerns, inconvenience, stigmatisation, lack of social support, confidentiality concerns, physical pain, efficacy concerns and distrust. Stigmatisation was a major concern in relation to HIV research. Reasons were similar across different regions, gender, non‐patient or patient participants and real or hypothetical study designs. Conclusions Addressing factors that affect (non‐)participation in the planning process and during the conduct of research may enhance voluntary consent to participation and reduce barriers for potential participants.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie O Rees
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Accra, Ghana.,Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ama Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Harapan H, Mudatsir M, Yufika A, Nawawi Y, Wahyuniati N, Anwar S, Yusri F, Haryanti N, Wijayanti NP, Rizal R, Fitriani D, Maulida NF, Syahriza M, Ikram I, Fandoko TP, Syahadah M, Asrizal FW, Jamil KF, Rajamoorthy Y, Wagner AL, Groneberg DA, Kuch U, Müller R, Sasmono RT, Imrie A. Willingness to Participate and Associated Factors in a Zika Vaccine Trial in Indonesia: A Cross-Sectional Study. Viruses 2018; 10:E648. [PMID: 30453663 PMCID: PMC6266114 DOI: 10.3390/v10110648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
One of the crucial steps during trials for Zika and other vaccines is to recruit participants and to understand how participants' attitudes and sociodemographic characteristics affect willingness to participate (WTP). This study was conducted to assess WTP, its explanatory variables, and the impact of financial compensation on WTP in Indonesia. A health facility-based cross-sectional study was conducted in eleven regencies in the Aceh and West Sumatra provinces of Indonesia. Participants were recruited via a convenience sampling method and were interviewed. The associations between explanatory variables and WTP were assessed using a two-step logistic regression analysis. A total of 1,102 parents were approached, and of these 956 (86.8%) completed the interview and were included in analysis. Of those, 144 (15.1%) were willing to participate in a Zika vaccine trial without a financial compensation. In the multivariate analysis, WTP was tied to an age of more than 50 years old, compared to 20⁻29 years (odds ratio (OR): 5.0; 95% confidence interval (CI): 2.37⁻10.53), to being female (OR: 2.20; 95% CI: 1.11⁻4.37), and to having heard about Zika (OR: 2.41; 95% CI: 1.59⁻3.65). Participants' WTP increased gradually with higher financial compensation. The rate of WTP increased to 62.3% at the highest offer (US$ 350.4), and those who were still unwilling to participate (37.7%) had a poorer attitude towards childhood vaccination. This study highlights that pre-existing knowledge about Zika and attitudes towards childhood vaccination are important in determining community members being willing to participate in a vaccine trial. Financial incentives are still an important factor to enhance participant recruitment during a vaccine trial.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia.
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Yusuf Nawawi
- Department of Family Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Nur Wahyuniati
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Fitria Yusri
- School of Medicine, Malikussaleh University, Lhokseumawe, Aceh 24352, Indonesia.
| | - Novi Haryanti
- Community Health Centre of Meurah Mulia, North Aceh, Aceh 24372, Indonesia.
| | | | - Rizal Rizal
- Bunda Hospital, Lhokseumawe, Aceh 24351, Indonesia.
| | - Devi Fitriani
- Community Health Centre of Teunom, Aceh Jaya, Aceh 23653, Indonesia.
| | | | - Muhammad Syahriza
- Department of Public Health and Community Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Ikram Ikram
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Try Purwo Fandoko
- Community Health Centre of Gunung, Padang Panjang, West Sumatera 27122, Indonesia.
| | - Muniati Syahadah
- Community Health Centre of Lima Kaum, Tanah Datar, West Sumatera 27211, Indonesia.
| | | | - Kurnia F Jamil
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
- Department of Internal Medicine, School of Medicine, Syiah Kuala University, Banda Aceh, Aceh 23111, Indonesia.
| | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor 43000, Malaysia.
| | - Abram Luther Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main 60323, Germany.
- Unit of Medical Entomology, Institute of Tropical Medicine, Antwerp 2000, Belgium.
| | - R Tedjo Sasmono
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia.
| | - Allison Imrie
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia.
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Hennessy M, Hunter A, Healy P, Galvin S, Houghton C. Improving trial recruitment processes: how qualitative methodologies can be used to address the top 10 research priorities identified within the PRioRiTy study. Trials 2018; 19:584. [PMID: 30359293 PMCID: PMC6202834 DOI: 10.1186/s13063-018-2964-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/04/2018] [Indexed: 11/24/2022] Open
Abstract
How can we improve recruitment to trials? In their recently published paper, Healy et al. outline the top 10 prioritised questions for trial recruitment research identified by the PRioRiTy study. The challenge now is for researchers to answer these questions; but how best can these be answered? In this commentary, we illustrate how qualitative research can be utilised to generate in-depth insight into trial recruitment issues, either as a stand-alone methodology, or through a mixed-methods approach. Consideration is given to how different forms of qualitative research can be used to address these priorities and to help researchers set out an agenda to optimise its value.
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Affiliation(s)
- Marita Hennessy
- Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Andrew Hunter
- Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Health Research Board—Trials Methodology Research Network, Galway, Ireland
| | - Sandra Galvin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Health Research Board—Trials Methodology Research Network, Galway, Ireland
| | - Catherine Houghton
- Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Health Research Board—Trials Methodology Research Network, Galway, Ireland
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20
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Recruitment challenges in clinical research: Survey of potential participants in a diagnostic study of ovarian cancer. Gynecol Oncol 2017; 146:470-476. [DOI: 10.1016/j.ygyno.2017.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 06/14/2017] [Accepted: 06/17/2017] [Indexed: 11/21/2022]
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21
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Gu C, Ye M, Wang X, Yang M, Wang H, Khoshnood K. Nurse researchers' perspectives on research ethics in China. Nurs Ethics 2017; 26:798-808. [PMID: 28812946 DOI: 10.1177/0969733017720848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In China, research ethics is a subject of increasingly formal regulation. However, little is known about how nursing researchers understand the concept of research ethics and the ways in which they can maintain ethical standards in their work. AIM The aim of this study is to examine nursing researchers' perspectives on research ethics in China. RESEARCH DESIGN We conducted a descriptive qualitative study. Qualitative research methods enabled us to gain an in-depth understanding of nursing researchers' views on research ethics. PARTICIPANTS AND RESEARCH CONTEXT We carefully selected and extensively interviewed 28 nursing researchers, nursing faculty, and clinical nurses who had been involved in research or who may undertake research in the future. We collected data between October 2014 and March 2015. ETHICAL CONSIDERATIONS This study was approved by the institutional review boards of Yale University and Central South University. FINDINGS We grouped the data into five categories based on the interviewees' responses: (1) perceptions of ethics, bioethics, and research ethics; (2) perception of the ethics review process; (3) perception of the function of institutional review boards; (4) the need for comprehensive ethical guidelines for future studies; and (5) ethical challenges faced by the interviewees. DISCUSSION AND CONCLUSION This study contributes new insights into nursing researchers' views on research ethics in China and finds considerable shortcomings in researchers' understanding and implementation of ethical principles. Intensive educational efforts are needed to provide nursing researchers, institutional review board members, and even study subjects with accurate and up-to-date information and guidance on research ethics. In addition, while Western research ethics theoretically have guided Chinese clinical research for several years, the ways in which nursing researchers have implemented these ethical standards highlight the differences between the Eastern and Western ethical paradigms. This finding suggests the need for ethical standards that are more tailored to the Chinese context.
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Harapan H, Anwar S, Bustaman A, Radiansyah A, Angraini P, Fasli R, Salwiyadi S, Bastian RA, Oktiviyari A, Akmal I, Iqbalamin M, Adil J, Henrizal F, Darmayanti D, Pratama R, Fajar JK, Setiawan AM, Imrie A, Kuch U, Groneberg DA, Sasmono RT, Dhimal M, Müller R. Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia. PLoS One 2016; 11:e0159139. [PMID: 27404663 PMCID: PMC4942142 DOI: 10.1371/journal.pone.0159139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/28/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy. METHODOLOGY/PRINCIPAL FINDINGS A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman's rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36-3.90] and 3.73 [95% CI: 2.24-6.21], respectively). CONCLUSION/SIGNIFICANCE The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Syiah Kuala University, Banda Aceh, Indonesia
| | - Aslam Bustaman
- Department of Biology, Faculty of Teacher Training and Education, Syiah Kuala University, Banda Aceh, Indonesia
| | - Arsil Radiansyah
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Pradiba Angraini
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Riny Fasli
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Salwiyadi Salwiyadi
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Reza Akbar Bastian
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Ade Oktiviyari
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Imaduddin Akmal
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Muhammad Iqbalamin
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Jamalul Adil
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Fenni Henrizal
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Darmayanti Darmayanti
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Rovy Pratama
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Jonny Karunia Fajar
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Abdul Malik Setiawan
- Department of Microbiology, Faculty of Medicine and Health Sciences, State Islamic University Maulana Malik Ibrahim, Malang, Indonesia
| | - Allison Imrie
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | | | - Meghnath Dhimal
- Nepal Health Research Council (NHRC), Ministry of Health Complex, Kathmandu, Nepal
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
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Thornton LR, Amorrortu RP, Smith DW, Mainous AG, Vernon SW, Tilley BC. Exploring Willingness of Elder Chinese in Houston to Participate in Clinical Research. Contemp Clin Trials Commun 2016; 4:33-38. [PMID: 27458608 PMCID: PMC4957552 DOI: 10.1016/j.conctc.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and objectives Inadequate minority participation in clinical research can threaten the applicability and strength of scientific findings. Previous research suggests that trial participation rates are lowest among Asian Americans, compared to other groups. This study explored barriers to clinical research participation among elder Chinese living in Houston, Texas. Additionally we administered the Trust in Medical Researchers Scale (TIMRS), used previously in researching trust in medical researchers as related to research participation. Design In this mixed methods study, a semi-structured interview, including the TIMRS were administered to 30 adults of Chinese ancestry aged 50 years or older recruited from a Chinese community center. Interviews were conducted in English, Mandarin and Cantonese and independently coded and analyzed using thematic content analysis. TIMRS scores were calculated for participants. Results Participants were 70% female, 70% were 60 or elder, all were foreign born and on average lived in the US for 21.8 years. Participants perceived risks to research participation and preferred language concordant research staff. Interviewees were more willing to participate if they perceived personal and community health-related benefits. The overall TIMRS score was 23.9 (±5.0), lower than the overall TIMRS for Whites in a previous study (P < 0.001). Conclusions The barriers and facilitators to research participation confirmed previous research among Asians. Our participant TIMRS scores were consistent with decreased levels of trust observed in the original TIMRS study for African Americans as compared and lower than Whites. Employing strategies that utilize language concordant staff who build trust with participants may aid in recruiting elder Chinese, especially if the research is personally relevant to those being recruited.
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Affiliation(s)
- Logan R Thornton
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Department of Health Promotion and Behavioral Sciences, 1200 Hermann Pressler, Houston TX USA 77030
| | - Rossybelle P Amorrortu
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Department of Biostatistics, 1200 Hermann Pressler, Houston TX USA 77030
| | - Daniel W Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 100 Doughty Street, Charleston SC USA 29425
| | - Arch G Mainous
- University of Florida, Department of Health Services Research, Management and Policy, Health Science Center, PO Box 100195 Gainesville FL 32610
| | - Sally W Vernon
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Department of Health Promotion and Behavioral Sciences, 1200 Hermann Pressler, Houston TX USA 77030
| | - Barbara C Tilley
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Department of Biostatistics, 1200 Hermann Pressler, Houston TX USA 77030
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Rubincam C, Lacombe-Duncan A, Newman PA. Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies. Expert Rev Vaccines 2015; 15:331-47. [PMID: 26560332 DOI: 10.1586/14760584.2016.1118349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A substantial gap exists between widespread acknowledgement of the importance of incorporating cultural sensitivity in biomedical HIV prevention trials and empirical evidence to guide the operationalization of cultural sensitivity in these trials. We conducted a systematic literature search and qualitative meta-synthesis to explore how culture is conceptualized and operationalized in global biomedical HIV prevention trials. Across 29 studies, the majority (n = 17) were conducted in resource-limited settings. We identified four overarching themes: (1) semantic cultural sensitivity - challenges in communicating scientific terminology into local vernaculars; (2) instrumental cultural sensitivity - understanding historical experiences to guide tailoring of trial activities; (3) budgetary, logistical, and personnel implications of operationalizing cultural sensitivity; and (4) culture as an asset. Future investigations should address how sociocultural considerations are operationalized across the spectrum of trial preparedness, implementation, and dissemination in particular sociocultural contexts, including intervention studies and evaluations of the effectiveness of methods used to operationalize culturally sensitive practices.
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Affiliation(s)
- Clara Rubincam
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
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25
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Hughes-Morley A, Young B, Waheed W, Small N, Bower P. Factors affecting recruitment into depression trials: Systematic review, meta-synthesis and conceptual framework. J Affect Disord 2015; 172:274-90. [PMID: 25451427 DOI: 10.1016/j.jad.2014.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is common and clinical trials are crucial for evaluating treatments. Difficulties in recruiting participants into depression trials are well-documented, yet no study has examined the factors affecting recruitment. This review aims to identify the factors affecting recruitment into depression trials and to develop a conceptual framework through systematic assessment of published qualitative research. METHODS Systematic review and meta-synthesis of published qualitative studies. Meta-synthesis involves a synthesis of themes across a number of qualitative studies to produce findings that are "greater than the sum of the parts". ASSIA, CINAHL, Embase, Medline and PsychInfo were searched up to April 2013. Reference lists of included studies, key publications and relevant reviews were also searched. Quality appraisal adopted the "prompts for appraising qualitative research". RESULTS 7977 citations were identified, and 15 studies were included. Findings indicate that the decision to enter a depression trial is made by patients and gatekeepers based on the patient׳s health state at the time of being approached to participate; on their attitude towards the research and trial interventions; and on the extent to which patients become engaged with the trial. Our conceptual framework highlights that the decision to participate by both the patient and the gatekeeper involves a judgement between risk and reward. LIMITATIONS Only English language publications were included in this review. CONCLUSIONS Findings from this review have implications for the design of interventions to improve recruitment into depression trials. Such interventions may aim to diminish the perceived risks and increase the perceived rewards of participation.
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Affiliation(s)
- Adwoa Hughes-Morley
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Nicola Small
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, 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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Ma GX, Tan Y, Blakeney NC, Seals BF, Ma XS, Zhai S, Liu A, Tai Y, Michaels M. The impact of a community-based clinical trial educational intervention among underrepresented Chinese Americans. Cancer Epidemiol Biomarkers Prev 2013; 23:424-32. [PMID: 24092627 DOI: 10.1158/1055-9965.epi-13-0773] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical trials are a critical resource for the discovery of new prevention, diagnostic, and treatment methods for cancer. The most effective prevention and treatment modalities are based on previous clinical trial results. However, participation in clinical trials is underrepresented by racial/ethnic minority populations, Asian Americans in particular. Asian Americans are the least represented of any ethnic groups in clinical trials. The purpose of this study is to develop and evaluate a culturally and linguistically appropriate community-based educational intervention to increase knowledge of and intent to participate in cancer clinical trials among underrepresented Chinese Americans. METHODS Community-Based Participatory Research approach was used to guide the development, cultural tailoring, implementation, and evaluation of clinical trial intervention. First, 22 Asian community representatives were recruited as community health educators (CHE) who received 12-hour training on clinical trial education. Second, 262 members were recruited from 11 Chinese community organizations. Of those recruited, a total of 247 eligible Chinese enrolled and participated in the clinical trial education delivered by trained CHEs. Participants completed pretest before and posttest after the intervention. RESULTS Fifteen of 21 measures of clinical trial knowledge showed significant changes post the intervention (P < 0.05). Education remained the sole demographic factor increasing clinical trial knowledge in multivariate analysis. CONCLUSION Clinical trial education should emphasize both benefits to science and the larger Asian community. This community-based clinical trial intervention demonstrated promising results and has potential to enhance recruitment and participation in clinical trial research among the underrepresented Asian Americans. IMPACT Improving clinical trial participation in the fast-growing Asian American population is key to dissemination of health innovations targeted to diminish health disparities.
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Affiliation(s)
- Grace X Ma
- Authors' Affiliations: Center for Asian Health, Department of Public Health, College of Health Professions, School of Medicine, Temple University; Asian Health Trilogy, Philadelphia, Pennsylvania; Education Network to Advance Cancer Clinical Trials (NACCT), Bethesda, Maryland; and Boston University School of Public Health, Boston, Massachusetts
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