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Anastasi JK, Capili B, Norton M, McMahon DJ, Marder K. Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations. FRONTIERS IN PAIN RESEARCH 2024; 4:1330937. [PMID: 38606348 PMCID: PMC11006977 DOI: 10.3389/fpain.2023.1330937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024] Open
Abstract
This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.
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Affiliation(s)
- Joyce K. Anastasi
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Bernadette Capili
- Heilbrunn Family Center for Research Nursing, The Rockefeller University, New York, NY, United States
| | - Margaret Norton
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
- Department of Nursing, St. Joseph's University, Brooklyn, NY, United States
| | - Donald J. McMahon
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Karen Marder
- Irving Medical Center, Columbia University, New York, NY, United States
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Gouveia R, Cruz VT, Antão J, Almeida L. Interpersonal Values of Patients Participating in Phase II-III Clinical Trials: Implications for Clinical Trial Representativeness. Pharmaceut Med 2023:10.1007/s40290-023-00479-7. [PMID: 37249821 DOI: 10.1007/s40290-023-00479-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND An individual's personal values strongly influence their immediate and long-term decisions. Psychological heterogeneity in clinical trial populations contributes to selection bias and may affect treatment outcomes and inevitably trial results. OBJECTIVES The objective of this study was to characterize for the first time the main interpersonal values of patients who participated in Phase II and III clinical trials. METHODS This multicenter observational study included 200 participants from 4 different hospitals who participated in a Phase II or III clinical trial. Patients from different therapeutic areas were included in this study. The patients' interpersonal values were studied using the Survey of Interpersonal Values (SIV). The SIV scale is grouped into six subscales that assess specific personal values: (1) support, the need to be treated with kindness and to receive encouragement from other people; (2) conformity, the extent to which one does what is acceptable and considered socially correct; (3) recognition, the need to be highly regarded and admired, to be considered important and recognized by others; (4) independence, the extent to which individuals feel free to make their own decisions; (5) benevolence, the capacity to understand and show generosity towards the less fortunate; and (6) leadership, the value ascribed to coordinating the work of others, being selected for a leadership position, and being in a position to tell others what to do. The results obtained from the patient population were classified using the following categories: "very high" (P95-P99), "high" (P70-90), "medium" (P35-65) low" (P10-30), or "very low" (P1-5), and subsequently compared with those of the Portuguese normative population. RESULTS Compared with the normative population, regardless of the patient's underlying disease, the percentile frequency distributions were significantly higher for the independence (p < 0.001) and benevolence (p < 0.001) subscales, and significantly lower for the leadership (p < 0.001) and recognition (p < 0.001) subscales in the patient population. Patient distribution according to underlying disease differed significantly relative differences in distribution relative to the normative population for the majority of subscales. Non-alcoholic steatohepatitis (NASH), heart failure, myocardial infarction, lung cancer, and rheumatoid arthritis patients were those for which the greatest differences were observed across diseases, while stroke, multiple sclerosis, and HIV patients showed the least differences relative to the normative population. CONCLUSIONS This novel analysis of the interpersonal values of patients that participate in Phase II and III clinical trials revealed that the patients' interpersonal values largely differed from those of the Portuguese normative population. Better understanding the implications of these findings for clinical trial representativeness and outcomes is of crucial importance.
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Affiliation(s)
- Rita Gouveia
- BlueClinical, Ltd, Senhora da Hora, 4460-439, Matosinhos, Portugal.
- Faculty of Medicine, MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
| | - Vitor Tedim Cruz
- Neurology Department, Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Joana Antão
- Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Luís Almeida
- BlueClinical, Ltd, Senhora da Hora, 4460-439, Matosinhos, Portugal
- Faculty of Medicine, MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Adolescent dropout from brief digital mental health interventions within and beyond randomized trials. Internet Interv 2022; 27:100496. [PMID: 35257001 PMCID: PMC8897204 DOI: 10.1016/j.invent.2022.100496] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention reduces the likelihood that adolescents will receive the intervention dosage intended to produce beneficial effects. It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies. METHODS We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels. RESULTS There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X 2 (2, N = 2436) = 583.5, p < 0.05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project. CONCLUSION Adolescents may be more likely to complete a brief digital mental health intervention in a paid, research-based context than in an unpaid, naturalistic context. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.
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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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Martin M, Patterson J, Allison M, O'Connor BB, Patel D. The Influence of Baseline Hemoglobin A1c on Digital Health Coaching Outcomes in Adults With Type 2 Diabetes: Real-World Retrospective Cohort Study. JMIR Diabetes 2021; 6:e24981. [PMID: 34010804 PMCID: PMC8277412 DOI: 10.2196/24981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/11/2020] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Digital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes is yet to be evaluated in a real-world setting. OBJECTIVE The purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline hemoglobin A1c (HbA1c) to better understand which populations may experience the greatest clinical and psychosocial benefit. METHODS A retrospective cohort study design was used to evaluate program effect in a convenience sample of participants in a 12-week digital health coaching program administered by Pack Health. Participants were referred through their health care provider, payer, or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text, and/or email. Self-reported HbA1c and weight were collected at baseline and completion. Physical and mental health were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the Diabetes Distress Scale-2. Changes in HbA1c, weight, BMI, and physical and mental health were analyzed within three participant cohorts stratified by baseline HbA1c level. RESULTS Participants with complete HbA1c data sets (n=226) were included in the analysis. The sample population was 71.7% (162/226) female, with 61.5% (139/226) identifying as white and 34.1% (77/226) as black. Most participants (184/226, 81.4%) reported a baseline HbA1c ≥7%, and 20.3% (46/226) were classified as high risk (HbA1c >9%). Across HbA1c cohorts, the mean baseline BMI was 35.83 (SD 7.79), and the moderate-risk cohort (7% ≤ HbA1c ≤ 9%) reported the highest mean value (36.6, SD 7.79). At 12 weeks, patients reported a significant decrease in HbAlc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate-risk cohort showing the greatest reduction (-0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest-risk cohort showed the greatest improvements in diabetes distress (-0.76; P=.005). CONCLUSIONS Acknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline HbA1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high HbA1c experienced the greatest HbA1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching.
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Affiliation(s)
- Megan Martin
- Medical Affairs, Pack Health, LLC, Birmingham, AL, United States
| | | | - Matt Allison
- Medical Affairs, Pack Health, LLC, Birmingham, AL, United States
| | | | - Dhiren Patel
- Medical Affairs, Pack Health, LLC, Birmingham, AL, United States
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Danila MI, Allison JJ, Goins KV, Chiriboga G, Fischer M, Puliafico M, Mudano AS, Rahn EJ, Merchant J, Lawrence CE, Dunkel L, Israel T, Barton B, Jenoure F, Alexander T, Cruz D, Douglas M, Sims J, Richmond A, Roberson ED, Chambless C, Harris PA, Saag KG, Lemon SC. Development of a multi-component intervention to promote participation of Black and Latinx individuals in biomedical research. J Clin Transl Sci 2021; 5:e134. [PMID: 34367678 PMCID: PMC8327553 DOI: 10.1017/cts.2021.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups. METHODS We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components. RESULTS The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a "storytelling" intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process. CONCLUSIONS The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.
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Affiliation(s)
- Maria I. Danila
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeroan J. Allison
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karin Valentine Goins
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Germán Chiriboga
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Fischer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Puliafico
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy S. Mudano
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Elizabeth J. Rahn
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeanne Merchant
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Colleen E. Lawrence
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leah Dunkel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tiffany Israel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fred Jenoure
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany Alexander
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Danny Cruz
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marva Douglas
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jacqueline Sims
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Al Richmond
- Community Campus Partnerships for Health, Raleigh, NC, USA
| | - Erik D. Roberson
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Carol Chambless
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Paul A. Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth G. Saag
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Stephenie C. Lemon
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Staff and participant perceptions of optimal recruitment and retention strategies for biomedical cohort studies in the Caribbean. Cancer Causes Control 2021; 32:849-857. [PMID: 33961148 PMCID: PMC8103112 DOI: 10.1007/s10552-021-01438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/22/2021] [Indexed: 11/13/2022]
Abstract
Purpose To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations. Methods Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts. Results Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups. Conclusion Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.
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Use of Acupuncture for the Treatment of Sports-Related Injuries in Athletes: A Systematic Review of Case Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218226. [PMID: 33172218 PMCID: PMC7664377 DOI: 10.3390/ijerph17218226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
Acupuncture is one of the representative complementary and alternative medicine treatments used for various types of pain. This systematic review summarized and analyzed clinical case reports/series utilizing acupuncture for treating sports injuries in athletes, thereby providing the basis for further research to establish clinical evidence on acupuncture treatment in sports medicine. A comprehensive literature search was conducted in Embase including MEDLINE up to 21 August 2019 without language and publication date restrictions. Due to the heterogeneity of each study, explanatory and descriptive analyses were performed. As a result, in each case report/series, it was confirmed that acupuncture was applied for treating various types of sports injuries experienced by athletes. Acupuncture can help relieve short-term pain and recover from dysfunction and has been used as a useful, noninvasive, and conservative modality for managing sports injuries such as lateral meniscus rupture, femoral acetabular impingement, ganglion cysts, and sports hernia. In addition, acupuncture has been suggested as a treatment worth trying for diseases such as yips and delayed onset muscle soreness. The included cases showed some potential of acupuncture in the treatment of various types of sports injuries, beyond pain control in musculoskeletal disorders. However, considering that this review was based on case reports/series, a limited understanding of the clinical value of acupuncture in athletes is required. In the future, more specific research questions and hypotheses should be addressed to generate evidence based on experimental research.
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Pratap A, Neto EC, Snyder P, Stepnowsky C, Elhadad N, Grant D, Mohebbi MH, Mooney S, Suver C, Wilbanks J, Mangravite L, Heagerty PJ, Areán P, Omberg L. Indicators of retention in remote digital health studies: a cross-study evaluation of 100,000 participants. NPJ Digit Med 2020; 3:21. [PMID: 32128451 PMCID: PMC7026051 DOI: 10.1038/s41746-020-0224-8] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
Digital technologies such as smartphones are transforming the way scientists conduct biomedical research. Several remotely conducted studies have recruited thousands of participants over a span of a few months allowing researchers to collect real-world data at scale and at a fraction of the cost of traditional research. Unfortunately, remote studies have been hampered by substantial participant attrition, calling into question the representativeness of the collected data including generalizability of outcomes. We report the findings regarding recruitment and retention from eight remote digital health studies conducted between 2014-2019 that provided individual-level study-app usage data from more than 100,000 participants completing nearly 3.5 million remote health evaluations over cumulative participation of 850,000 days. Median participant retention across eight studies varied widely from 2-26 days (median across all studies = 5.5 days). Survival analysis revealed several factors significantly associated with increase in participant retention time, including (i) referral by a clinician to the study (increase of 40 days in median retention time); (ii) compensation for participation (increase of 22 days, 1 study); (iii) having the clinical condition of interest in the study (increase of 7 days compared with controls); and (iv) older age (increase of 4 days). Additionally, four distinct patterns of daily app usage behavior were identified by unsupervised clustering, which were also associated with participant demographics. Most studies were not able to recruit a sample that was representative of the race/ethnicity or geographical diversity of the US. Together these findings can help inform recruitment and retention strategies to enable equitable participation of populations in future digital health research.
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Affiliation(s)
- Abhishek Pratap
- Sage Bionetworks, Seattle, WA USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA USA
| | | | | | - Carl Stepnowsky
- University of California, San Diego, CA USA
- American Sleep Apnea Association, Washington, DC USA
| | | | - Daniel Grant
- Novartis Pharmaceutical Corporation, East Hanover, NJ USA
| | | | - Sean Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA USA
| | | | | | | | | | - Pat Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA USA
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Abu Farha R, Alzoubi KH, Khabour OF, Mukattash TL. Factors Influencing Public Knowledge and Willingness to Participate in Biomedical Research in Jordan: A National Survey. Patient Prefer Adherence 2020; 14:1373-1379. [PMID: 32801667 PMCID: PMC7415452 DOI: 10.2147/ppa.s261903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Recruitment of adequate numbers of research participants is important for advancement in biomedical fields. Awareness and knowledge of the population about biomedical research are expected to enhance willingness to participate in such research. Therefore, in the current study, participants' awareness, knowledge, and willingness to participate in scientific research in Jordan were examined. METHODS This was a survey-based, cross-sectional study conducted from December 2019 to February 2020 among the public in Jordan. After written informed consent had been obtained from study participants, a structured questionnaire was used to survey research participants. The final questionnaire contained three parts: part I was about demographics and general information, part II assessed participants' awareness and willingness to participate in biomedical research, and part III assessed participants' knowledge about biomedical research studies. RESULTS A total of 2,000 subjects agreed to participate, of which 67.4% were female (n=1339). More than half the respondents were aware of biomedical research (58.6%), of which 18.1% had previously participated in biomedical research. In addition, 55.5% reported that they were willing to participate in biomedical research, while a lower proportion (31.1%) were willing to volunteer in a clinical trial. The overall knowledge of participants about biomedical research was deemed moderate (total score 12.9 out of 20). Finally, willingness to participate in biomedical research was associated with being male, being married, having a biomedicine-related degree, and higher knowledge score. CONCLUSION A majority of Jordanians had moderate levels of awareness and knowledge about biomedical research. Such factors as sex, type of education, and knowledge contribute to willingness to participate in biomedical research.
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Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman11931, Jordan
- Correspondence: Rana Abu FarhaDepartment of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman11931, JordanTel +962 6-560-9957 ext 1496Fax +962 5232899 Email
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid22110, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid22110, Jordan
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Amorim KPC, Garrafa V, Melo ADD, Costa AVB, Oliveira GCL, Lopes HG, Pereira EJDS, Fernandes Júnior FA. PARTICIPANTES DE ENSAIOS CLÍNICOS EM ONCOLOGIA: PERFIL E ASPECTOS ENVOLVIDOS NAS SUAS DECISÕES. TRABALHO, EDUCAÇÃO E SAÚDE 2018. [DOI: 10.1590/1981-7746-sol00139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Estudo sobre os participantes de ensaios clínicos na área de oncologia, discutindo o paradoxo entre progresso científico e iniquidade social. Buscou-se conhecer quem são essas pessoas e analisar aspectos envolvidos nas suas decisões, com base em entrevistas e documentos. Houve maior participação feminina. Os participantes tendem a ter poucos anos de estudo formal e baixa renda. A maioria é aposentada e do lar e não tem assistência à saúde privada. Suas decisões giraram em torno da busca pela cura ou melhora, e pela garantia de acesso regular a cuidados integrais de saúde e medicamentos. A assinatura do termo de consentimento livre e esclarecido não garantiu a expressão da autonomia, pois informações essenciais como os objetivos, riscos e cuidados pós-estudo são praticamente desconhecidas. Os participantes da pesquisa tendem a não compreender os objetivos da investigação, ou superestimam os benefícios médicos diretos de sua participação, sem consciência dos riscos envolvidos e do que significa uma pesquisa. Os resultados deveriam incitar ao exercício e ao diálogo mais críticos entre os diferentes atores e instituições envolvidos na área da pesquisa com seres humanos, objetivando promover uma ciência consciente e responsável, que impeça que pessoas sejam colocadas em situação de desigualdade, vulnerabilidade e sofrimento moral.
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van der Zande ISE, van der Graaf R, Hooft L, van Delden JJM. Facilitators and barriers to pregnant women's participation in research: A systematic review. Women Birth 2018; 31:350-361. [PMID: 29373261 DOI: 10.1016/j.wombi.2017.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although there is consensus among many that exclusion of pregnant women from clinical research should be justified, there is uncertainty as to whether and why pregnant women themselves would be willing to participate even if they were found to be eligible. The objective was to identify the reasons why pregnant women participate in clinical research and thereby to distinguish between facilitators and barriers. METHODS We conducted a systematic review of articles regarding pregnant women's reasons for participation in clinical research. We used the PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL databases and retrieved additional articles through manually searching the reference lists. We included all articles that reported on pregnant women's reasons for participation in clinical research. We accumulated all reasons that were mentioned in the total of articles and collated them to themes, classifying these themes as a facilitator or a barrier. RESULTS The search identified thirty articles that met the inclusion criteria. Themes classified as facilitators: aspirational benefits, collateral benefits, direct benefits, third party influence and lack of inconvenience. Themes classified as barriers: inconveniences, risks, randomisation, lack of trust in research enterprise, medical reasons and third party influence. CONCLUSIONS Pregnant women report mostly altruistic and personal reasons for their willingness to participate in clinical research, while barriers primarily relate to inconveniences. It appears that pregnant women's described reasoning is similar to the described reasoning of non-pregnant research subjects. Enhancing the facilitators and overcoming the barriers is the next step to increase the evidence-base underlying maternal and foetal health.
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Affiliation(s)
- Indira S E van der Zande
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Rieke van der Graaf
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, The Netherlands.
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
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Craig SR, Lahey T, Dixit A, Fordham von Reyn C. Altruism, Scepticism, and collective decision-making in foreign-born U.S. residents in a tuberculosis vaccine trial. BMC Public Health 2018; 18:535. [PMID: 29685114 PMCID: PMC5914029 DOI: 10.1186/s12889-018-5460-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15-20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development. METHODS One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States - a poorly studied population - decide to participate, or not, in clinical trials. RESULTS We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how 'informed consent' can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making. CONCLUSIONS This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation. TRIAL REGISTRATION NCT02063555 .
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Affiliation(s)
- Sienna R Craig
- Department of Anthropology, Dartmouth College, 6047 Silsby Hall, Hanover, NH, 03755, USA.
| | - Timothy Lahey
- Geisel School of Medicine, Dartmouth College, Hanover, USA
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Porzsolt F, Rocha NG, Toledo-Arruda AC, Thomaz TG, Moraes C, Bessa-Guerra TR, Leão M, Migowski A, Araujo da Silva AR, Weiss C. Efficacy and effectiveness trials have different goals, use different tools, and generate different messages. Pragmat Obs Res 2015; 6:47-54. [PMID: 27774032 PMCID: PMC5045025 DOI: 10.2147/por.s89946] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The discussion about the optimal design of clinical trials reflects the perspectives of theory-based scientists and practice-based clinicians. Scientists compare the theory with published results. They observe a continuum from explanatory to pragmatic trials. Clinicians compare the problem they want to solve by completing a clinical trial with the results they can read in the literature. They observe a mixture of what they want and what they get. None of them can solve the problem without the support of the other. Here, we summarize the results of discussions with scientists and clinicians. All participants were interested to understand and analyze the arguments of the other side. As a result of this process, we conclude that scientists tell what they see, a continuum from clear explanatory to clear pragmatic trials. Clinicians tell what they want to see, a clear explanatory trial to describe the expected effects under ideal study conditions and a clear pragmatic trial to describe the observed effects under real-world conditions. Following this discussion, the solution was not too difficult. When we accept what we see, we will not get what we want. If we discuss a necessary change of management, we will end up with the conclusion that two types of studies are necessary to demonstrate efficacy and effectiveness. Efficacy can be demonstrated in an explanatory, ie, a randomized controlled trial (RCT) completed under ideal study conditions. Effectiveness can be demonstrated in an observational, ie, a pragmatic controlled trial (PCT) completed under real-world conditions. It is impossible to design a trial which can detect efficacy and effectiveness simultaneously. The RCTs describe what we may expect in health care, while the PCTs describe what we really observe.
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Affiliation(s)
- Franz Porzsolt
- Health Care Research, Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
- Institute of Clinical Economics (ICE) eV, Ulm, Germany
| | - Natália Galito Rocha
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói
| | - Alessandra C Toledo-Arruda
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói
| | - Tania G Thomaz
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói
- Cardiovascular Sciences, Universidade Federal Fluminense, Niterói
| | - Cristiane Moraes
- Cardiovascular Sciences, Universidade Federal Fluminense, Niterói
| | | | - Mauricio Leão
- Institute of Nuclear Medicine, University Hospital Antonio Pedro, Niterói
| | - Arn Migowski
- National Cancer Institute (INCA), Rio de Janeiro, Brazil
- National Institute of Cardiology (INC), Rio de Janeiro, Brazil
| | - André R Araujo da Silva
- Department of Mother and Child, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Christel Weiss
- Institute of Clinical Economics (ICE) eV, Ulm, Germany
- Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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