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Bonus CG, Hatcher D, Northall T, Montayre J. Using a co-design methodological approach to optimize perioperative nursing care for older adult patients from ethnically diverse backgrounds: a study protocol. Int J Qual Stud Health Well-being 2024; 19:2349438. [PMID: 38709958 PMCID: PMC11075656 DOI: 10.1080/17482631.2024.2349438] [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] [Received: 10/24/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.
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Affiliation(s)
- Charmaine G. Bonus
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Blacktown, NSW, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Tiffany Northall
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
- WHO Collaborating Centre for Community Health Services, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
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Churchill V, Schoenberger YM, Carter VL, Chevrin JY, Dean-Colomb W, Matthews R, Rivers D, Sodeke SO, Ezer J, Rivers BM. Addressing Barriers and Facilitators to African Americans' and Hispanics' Participation in Clinical and Genomic Research Through a Bioethical Sensitive Video. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:464-470. [PMID: 38693423 PMCID: PMC11219413 DOI: 10.1007/s13187-024-02433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Research advances on effective methods to prevent, diagnose, and treat cancer continue to emerge through clinical and genomic research. Most clinical trial and genomic research participants identify as White which limits the generalizability of research findings to non-White populations. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of African Americans (AA) and Hispanics in research. This project focused on the creation of a bioethical sensitive education video aimed at increasing participation in clinical trials and genomic research by bringing together experts from the community, healthcare, biomedical research, and public health. The goal was to utilize existing educational resources to create a tailored message to address AA/Hispanics' beliefs, values, and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the framework for the animated video. Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. The final animated video is approximately 5 min in length and covers several topics including the goal of clinical research, disparities in research participation, bioethical concerns, and genomic research regulations. Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials.
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Affiliation(s)
- Victoria Churchill
- Cancer Health Equity Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA.
| | - Yu-Mei Schoenberger
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, 1824 6th Ave S, Birmingham, AL, 35233, USA
| | - Vivian L Carter
- Center for Biomedical Research, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL, 36088, USA
| | - Jamirah Y Chevrin
- Cancer Health Equity Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA
| | - Windy Dean-Colomb
- Center for Biomedical Research, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL, 36088, USA
- Piedmont Cancer Institute, 775 Poplar Rd, Suite 310 Newnan, Newnan, GA, 30265, USA
| | - Roland Matthews
- Cancer Health Equity Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA
| | - Desiree Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA
| | - Stephen O Sodeke
- Center for Biomedical Research, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL, 36088, USA
| | - Jonathan Ezer
- Kindea Labs, 70 Little W St #31E, New York, NY, 10004, USA
| | - Brian M Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA
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Joseph VA. Suicide in Black Females: Response to Mattes. Am J Psychiatry 2024; 181:774-775. [PMID: 39086287 DOI: 10.1176/appi.ajp.20240027r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Victoria A Joseph
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
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Idnay B, Fang Y, Stanley E, Ruotolo B, Chung WK, Marder K, Weng C. Promoting equity in clinical research: The role of social determinants of health. J Biomed Inform 2024; 156:104663. [PMID: 38838949 PMCID: PMC11272440 DOI: 10.1016/j.jbi.2024.104663] [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: 03/22/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE This study aims to investigate the association between social determinants of health (SDoH) and clinical research recruitment outcomes and recommends evidence-based strategies to enhance equity. MATERIALS AND METHODS Data were collected from the internal clinical study manager database, clinical data warehouse, and clinical research registry. Study characteristics (e.g., study phase) and sociodemographic information were extracted. Median neighborhood income, distance from the study location, and Area Deprivation Index (ADI) were calculated. Mixed effect generalized regression was used for clustering effects and false discovery rate adjustment for multiple testing. A stratified analysis was performed to examine the impact in distinct medical departments. RESULTS The study sample consisted of 3,962 individuals, with a mean age of 61.5 years, 53.6 % male, 54.2 % White, and 49.1 % non-Hispanic or Latino. Study characteristics revealed a variety of protocols across different departments, with cardiology having the highest percentage of participants (46.4 %). Industry funding was the most common (74.5 %), and digital advertising and personal outreach were the main recruitment methods (58.9 % and 90.8 %). DISCUSSION The analysis demonstrated significant associations between participant characteristics and research participation, including biological sex, age, ethnicity, and language. The stratified analysis revealed other significant associations for recruitment strategies. SDoH is crucial to clinical research recruitment, and this study presents evidence-based solutions for equity and inclusivity. Researchers can tailor recruitment strategies to overcome barriers and increase participant diversity by identifying participant characteristics and research involvement status. CONCLUSION The findings highlight the relevance of clinical research inequities and equitable representation of historically underrepresented populations. We need to improve recruitment strategies to promote diversity and inclusivity in research.
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Affiliation(s)
- Betina Idnay
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Yilu Fang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Edward Stanley
- Compliance Applications, Information Technology, Columbia University, New York, NY, USA
| | - Brenda Ruotolo
- Institutional Review Board for Human Subjects Research, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Karen Marder
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.
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Fisher KA, Epstein MM, Nguyen N, Fouayzi H, Crawford S, Linas BP, Mazor KM. COVID-19 clinical trials: who is likely to participate and why? J Comp Eff Res 2024; 13:e230181. [PMID: 39045844 PMCID: PMC11287768 DOI: 10.57264/cer-2023-0181] [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: 11/29/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
Aim: To identify factors associated with willingness to participate in a COVID-19 clinical trial and reasons for and against participating. Materials & methods: We surveyed Massachusetts (MA, USA) residents online using the Dynata survey platform and via phone using random digit dialing between October and November 2021. Respondents were asked to imagine they were hospitalized with COVID-19 and invited to participate in a treatment trial. We assessed willingness to participate by asking, "Which way are you leaning" and why. We used multivariate logistic regression to model factors associated with leaning toward participation. Open-ended responses were analyzed using conventional content analysis. Results: Of 1071 respondents, 65.6% leaned toward participating. Multivariable analyses revealed college-education (OR: 1.59; 95% CI: 1.11, 2.27), trust in the healthcare system (OR: 1.32; 95% CI: 1.10, 1.58) and relying on doctors (OR: 1.77; 95% CI: 1.45, 2.17) and family or friends (OR: 1.31; 95% CI: 1.11, 1.54) to make health decisions were significantly associated with leaning toward participating. Respondents with lower health literacy (OR: 0.57; 95% CI: 0.36, 0.91) and who identify as Black (OR: 0.40; 95% CI: 0.24, 0.68), Hispanic (OR: 0.61; 95% CI: 0.38, 0.98), or republican (OR: 0.61; 95% CI: 0.38, 0.97) were significantly less likely to lean toward participating. Common reasons for participating included helping others, benefitting oneself and deeming the study low risk. Common reasons for leaning against were deeming the study high risk, disliking experimental treatments and not wanting to be a guinea pig. Conclusion: Our finding that vulnerable individuals and those with lower levels of trust in the healthcare system are less likely to be receptive to participating in a COVID-19 clinical trial highlights that work is needed to achieve a healthcare system that provides confidence to historically disadvantaged groups that their participation in research will benefit their community.
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Affiliation(s)
- Kimberly A Fisher
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Mara M Epstein
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Ngoc Nguyen
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Hassan Fouayzi
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, & Boston University School of Public Health, Boston, MA 02118, USA
| | - Kathleen M Mazor
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA
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Sim YJ, Townsend RF, Mills S, Stocker R, Stevenson E, McEvoy C, Fairley AM. Understanding engagement in diet and dementia prevention research among British South Asians: a short report of findings from a patient and public involvement group. J Hum Nutr Diet 2024; 37:899-908. [PMID: 38713734 DOI: 10.1111/jhn.13316] [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: 12/18/2023] [Revised: 03/07/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Dementia is a global public health challenge. Evidence suggests that individuals from South Asian communities are an at-risk group for dementia, partly as a result of early and cumulative exposure to known dementia risk factors, such as obesity and type 2 diabetes. There needs to be more culturally appropriate community engagement to increase awareness of dementia and identify better strategies to encourage participation in dementia-related research. METHODS We aimed to better understand the barriers and facilitators towards engaging with, and participating in, diet and dementia related research among British South Asians. This was achieved using a public and patient involvement (PPI) approach. A community-based, engagement event involving information sharing from experts and roundtable discussions with South Asian communities (n = 26 contributors) was held in June 2023 in Newcastle-upon-Tyne, UK. Collaboration from preidentified PPI representatives (n = 3) informed the content and structure of PPI activities, as well as recruitment. Data were synthesised using template analysis, a form of codebook thematic analysis. This involved deductively analysing data using relevant a priori themes, which were expanded upon, or modified, via inductive analysis. RESULTS The findings highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research. Consideration of language barriers, time constraints, social influences and how to embed community outreach activities were reported as driving factors to maximise participation. CONCLUSIONS This PPI work will inform the design and co-creation of a culturally adapted dietary intervention for brain health in accordance with the Medical Research Council and National Institute for Health and Care Research guidance for developing complex interventions.
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Affiliation(s)
- Yi J Sim
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca F Townsend
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susanna Mills
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Stocker
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Stevenson
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire McEvoy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Andrea M Fairley
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Wali N, Huda MN, Gill T, Green J, Renzaho AMN. A systematic review of recruitment and retention of ethnic minorities and migrants in obesity prevention randomised controlled trials. Int J Obes (Lond) 2024; 48:1065-1079. [PMID: 38834795 PMCID: PMC11281904 DOI: 10.1038/s41366-024-01545-z] [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] [Received: 11/14/2023] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Participants' recruitment and retention into community-based interventions can be challenging, especially in research involving ethnic minorities and migrants. Despite known challenges, there are limited reviews that probe recruitment and retention strategies involving ethnic minorities and migrants in the Organisation for Economic Cooperation and Development (OECD) countries. This systematic review aimed to measure recruitment and retention rates and identify the barriers and facilitators to effective recruitment and retention of ethnic minorities and migrants in community-based obesity prevention Randomised Control Trials (RCTs) in OECD countries. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases (CINAHL, Cochrane, Embase, Medline and PsychInfo) were searched from January 2000 to March 2022, in addition to Google and Google Scholar. Methodological quality and risk of bias were assessed, and pooled analysis and meta-ethnographic analysis were conducted on the included studies. RESULTS Twenty-five studies were included in the review. The pooled analysis found a 64% rate of recruitment of ethnic minorities in RCTs, with a retention rate of 71%. Key facilitators identified were-use of multiple communication channels, incentives, recruiting community champions, participant convenience and employing culturally sensitive strategies. Key barriers to participation were limited access to study sites, time constraints, limited trust, perceived fear, and anxiety. CONCLUSION Findings suggest the importance of undertaking culturally appropriate recruitment and retention strategies to minimise barriers and facilitate effective recruitment and retention of low-income ethnic minorities and migrants in community-based research.
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Affiliation(s)
- Nidhi Wali
- School of Social Sciences, Humanitarian and Development Research Initiative (HADRI), Western Sydney University, Sydney, NSW, 2751, Australia.
| | - Md Nazmul Huda
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Timothy Gill
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2050, Australia
| | - Julie Green
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatric, University of Melbourne, Parkville, VIC, 3052, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Andre M N Renzaho
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW, 2560, Australia
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Gaillard T, Shambley-Ebron DZ, Vaccaro JA, Neff DF, Padovano CM, Swagger P, Vieira E, Webb F. Intergenerational Influence of African American, Caribbean and Hispanic/Latino Adults Regarding Decision to Participate in Health-Related Research. Res Aging 2024; 46:414-425. [PMID: 38361310 DOI: 10.1177/01640275241229411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Introduction: Identifying effective strategies to enroll African American, Caribbean, and Hispanic/Latino adults ≥65 years of age in health research is a public health priority. This study aimed to explore intergenerational influence (IGI) among these populations living throughout Florida. Methods: African American, Caribbean, and Hispanic/Latino adults ≥65 years of age and a trusted family member/friend between 25-64 years participated in virtual listening sessions (LS). Culturally matched facilitators used a semi-structured guide to lead LS that was recorded, transcribed, and uploaded into NVivo©. The constant comparative method was used for analysis. Results: 363 African American, Caribbean, and Hispanic/Latino participated in LS. Five (5) themes relate to IGI emerged: (1) parent-child relationships; (2) family caregiving/parental illness experiences; (3) historical research maltreatment; (4) transfer of cultural knowledge; and (5) future generations. Discussion: Our findings support that IGI can be leveraged to increase the participation of African American, Caribbean, and Hispanic/Latino older adults in health research.
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Affiliation(s)
- Trudy Gaillard
- Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA
| | | | - Joan A Vaccaro
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Donna F Neff
- College of Nursing, Academic Health Science Center, University of Central Florida, Orlando, FL, USA
| | - Cynthia Morton Padovano
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Phildra Swagger
- College of Nursing, Academic Health Science Center, University of Central Florida, Orlando, FL, USA
| | - Edgar Vieira
- Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA
| | - Fern Webb
- Department of Surgery, Center for Health Equity & Engagement Research (CHEER), University of Florida, Jacksonville, FL, USA
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Schpero WL, Takvorian SU, Blickstein D, Shafquat A, Liu J, Chatterjee AK, Lamont EB, Chatterjee P. Association Between State Medicaid Policies and Accrual of Black or Hispanic Patients to Cancer Clinical Trials. J Clin Oncol 2024:JCO2301149. [PMID: 39052944 DOI: 10.1200/jco.23.01149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 04/14/2024] [Accepted: 05/10/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE It is unknown whether Medicaid expansion under the Affordable Care Act (ACA) or state-level policies mandating Medicaid coverage of the routine costs of clinical trial participation have ameliorated longstanding racial and ethnic disparities in cancer clinical trial enrollment. METHODS We conducted a retrospective, cross-sectional difference-in-differences analysis examining the effect of Medicaid expansion on rates of enrollment for Black or Hispanic nonelderly adults in nonobservational, US cancer clinical trials using data from Medidata's Rave platform for 2012-2019. We examined heterogeneity in this effect on the basis of whether states had pre-existing mandates requiring Medicaid coverage of the routine costs of clinical trial participation. RESULTS The study included 47,870 participants across 1,353 clinical trials and 344 clinical trial sites. In expansion states, the proportion of participants who were Black or Hispanic increased from 16.7% before expansion to 17.2% after Medicaid expansion (0.5 percentage point [PP] change [95% CI, -1.1 to 2.0]). In nonexpansion states, this proportion increased from 19.8% before 2014 (when the first states expanded eligibility under the ACA) to 20.4% after 2014 (0.6 PP change [95% CI, -2.3 to 3.5]). These trends yielded a nonsignificant difference-in-differences estimate of 0.9 PP (95% CI, -2.6 to 4.4). Medicaid expansion was associated with a 5.3 PP (95% CI, 1.9 to 8.7) increase in the enrollment of Black or Hispanic participants in states with mandates requiring Medicaid coverage of the routine costs of trial participation, but not in states without mandates (-0.3 PP [95% CI, -4.5 to 3.9]). CONCLUSION Medicaid expansion was not associated with a significant increase in the proportion of Black or Hispanic oncology trial participants overall, but was associated with an increase specifically in states that mandated Medicaid coverage of the routine costs of trial participation.
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Affiliation(s)
- William L Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Medical College, Cornell University, New York, NY
- Center for Health Equity, Cornell University, New York, NY
| | - Samuel U Takvorian
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | | | - Jingshu Liu
- Medidata AI, a Dassault Systèmes Company, New York, NY
| | | | | | - Paula Chatterjee
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Bates CR, Gilbert RM, Dean KM, August KJ, Befort CA, Ward S, Gibson M, Dreyer Gillette ML. Tailored approach to participant recruitment and retention to maximize health equity in pediatric cancer research. BMC Med Res Methodol 2024; 24:161. [PMID: 39049026 PMCID: PMC11267736 DOI: 10.1186/s12874-024-02287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Lack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants. METHODS The present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated. RESULTS Results indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup. CONCLUSIONS The findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.
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Affiliation(s)
- Carolyn R Bates
- Department of Pediatrics, University of Kansas Medical Center, 2000 W Olathe Blvd, Mailstop, 4004, Kansas City, KS, 66160, USA.
- University of Kansas Cancer Center, Westwood, KS, USA.
| | - Renee M Gilbert
- Department of Pediatrics, University of Kansas Medical Center, 2000 W Olathe Blvd, Mailstop, 4004, Kansas City, KS, 66160, USA
| | - Kelsey M Dean
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Keith J August
- University of Kansas Cancer Center, Westwood, KS, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Christie A Befort
- University of Kansas Cancer Center, Westwood, KS, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shallyn Ward
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Mary Gibson
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Meredith L Dreyer Gillette
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
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Nwachuku I, Taylor E, Danisa O. The Impact of Diversity, Equity, and Inclusion on Spinal Research - Asking Different Questions. Spine J 2024:S1529-9430(24)00889-1. [PMID: 39053738 DOI: 10.1016/j.spinee.2024.06.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
In recent years, the field of spine surgery has seen significant advancements in surgical techniques alongside a growing emphasis on diversity, equity, and inclusion (DEI). This review explores the significant impact of DEI on spine surgery, recognizing its potential to drive innovation, improve patient outcomes, and address healthcare disparities. Shifting paradigms in research through diverse perspectives is crucial, as they broaden the scope of inquiry and challenge existing standards. Efforts to promote diversity in medicine, including targeted outreach and mentorship initiatives, are essential in cultivating a more inclusive workforce. Despite progress, ongoing challenges such as unconscious biases and systemic barriers persist, underscoring the need for continued commitment to DEI principles. Embracing diverse perspectives and asking unconventional questions pave the way for a comprehensive understanding of spinal health and equitable healthcare delivery.
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Affiliation(s)
- Ikenna Nwachuku
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Erica Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Wake Forest, NC, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA, USA.
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Kwon J, Pelletiers W, Galloway Peña J, van Duin D, Ledbetter L, Baum K, Ruffin F, Knisely JM, Bizzell E, Fowler VG, Chambers HF, Pettigrew MM. Participant Diversity in United States Randomized Controlled Trials of Antibacterials for Staphylococcus aureus Infections, 2000-2021. Clin Infect Dis 2024; 79:141-147. [PMID: 38306502 PMCID: PMC11259209 DOI: 10.1093/cid/ciae049] [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: 11/07/2023] [Revised: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Equitable representation of members from historically marginalized groups is important in clinical trials, which inform standards of care. The goal of this study was to characterize the demographics and proportional subgroup reporting and representation of participants enrolled in randomized controlled trials (RCTs) of antibacterials used to treat Staphylococcus aureus infections. METHODS We examined randomized controlled registrational and strategy trials published from 2000 to 2021 to determine the sex, race, and ethnicity of participants. Participant to incidence ratios (PIRs) were calculated by dividing the percentage of study participants in each demographic group by the percentage of the disease population in each group. Underrepresentation was defined as a PIR < 0.8. RESULTS Of the 87 included studies, 82 (94.2%) reported participant sex, 69 (79.3%) reported participant race, and 20 (23.0%) included ethnicity data. Only 17 (19.5%) studies enrolled American Indian/Alaskan Native participants. Median PIRs indicated that Asian and Black participants were underrepresented in RCTs compared with the incidence of methicillin-resistant S. aureus infections in these subgroups. Underrepresentation of Black participants was associated with a larger study size, international sites, industry sponsorship, and phase 2/3 trials compared with phase 4 trials (P < .05 for each). Black participants had more than 4 times the odds of being underrepresented in phase 2/3 trials compared with phase 4 trials (odds ratio, 4.57; 95% confidence interval: 1.14-18.3). CONCLUSIONS Standardized reporting methods for race and ethnicity and efforts to increase recruitment of marginalized groups would help ensure equity, rigor, and generalizability in RCTs of antibacterial agents and reduce health inequities.
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Affiliation(s)
- Jiye Kwon
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - William Pelletiers
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jessica Galloway Peña
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Leila Ledbetter
- Department of Research and Education, Duke University Medical Center Library & Archives, Durham, North Carolina, USA
| | - Keri Baum
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jane M Knisely
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Erica Bizzell
- Office of Scientific Program and Policy Analysis, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Vance G Fowler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Henry F Chambers
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
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Lee YW, Wang V, Wang MJ, Kim KH. The effects of Asian American Pacific Islander (AAPI) data inequities in gynecologic oncology. Gynecol Oncol 2024; 189:64-67. [PMID: 39029275 DOI: 10.1016/j.ygyno.2024.06.022] [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: 01/19/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/21/2024]
Abstract
Asian American and Pacific Islanders (AAPI) are the fastest growing racial group in the United States. Data on AAPI communities, however, are significantly limited. The oversimplification and underreporting of this ethnically and socioeconomically heterogenous population through the use of aggregated data has deleterious effects and worsens disparities in patient treatment, outcomes, and experiences. Gynecologic oncology disparities do not exist in a vacuum, and are rooted in larger cultural gaps in our understanding and delivery of healthcare. In this paper, we aim to demonstrate how AAPI data inequities have negative downstream effects on research and public health policies and initiatives, and also provide a call to action with specific recommendations on how to improve AAPI data equity within these realms.
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Affiliation(s)
- Yeon Woo Lee
- Division of Gynecologic Oncology, Department of OB/GYN and Reproductive Sciences, University of California San Francisco, 490 Illinois St. Floor 10, Box 0132, San Francisco, CA 94143, USA.
| | - Victoria Wang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Michelle J Wang
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| | - Kenneth H Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 W. 3(rd) St., Suite 290W, Los Angeles, CA 90048, USA
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Ison JM, Jackson JD, Hemley H, Willis A, Siddiqi B, Macklin EA, Ulysse C, Fitts MS, Pham TTH, Afshari M, Agarwal P, Aminoff M, Bissonnette S, Fullard M, Khan TS, Larson DN, Wielinski C, Sanchez AV. Fostering Inclusivity in Research Engagement for Underrepresented Populations in Parkinson's Disease: The FIRE-UP PD study. Contemp Clin Trials 2024; 144:107619. [PMID: 38971301 DOI: 10.1016/j.cct.2024.107619] [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: 02/23/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Members of vulnerable populations are underrepresented in Parkinson's disease (PD) research. A complex web of research barriers perpetuates this gap. Community-based research methods are one approach to addressing this issue. The present PD study was designed to examine the effectiveness of community-based interventions to overcome barriers and increase research participation among underrepresented groups (URGs). METHODS Eight study sites across the US were selected and paired based on proposed interventions with specific URGs. Surveys assessed knowledge and attitudes toward PD research. Finally, researchers examined whether the present study affected recruitment to Fox Insight, an online PD research study also recruiting at each site. RESULTS In total, 474 participants were recruited. At post-intervention for the FIRE-UP PD Study, recruitment increased significantly in intervention compared to control sites among Black and African American non-Hispanic/Latino populations (p = 0.003), White Hispanic/Latino (p = 0.003) populations, and Not Listed Hispanic/Latino populations (p < 0.001) as well as those with an educational attainment of a high school diploma/General Education Diploma (GED) (p = 0.009), and an income <$20,000 (p = 0.005) or between $20,000-$34,999 (p < 0.001). Study surveys measuring changes in awareness and attitudes toward PD research had mixed results. In Fox Insight, 181 participants were passively recruited with a shift toward more diverse participant demographics. CONCLUSION Research participation demographics reflective of the general population are critical to PD investigation and treatment. The FIRE-UP PD Study showed the effectiveness of localized community engagement strategies in increasing URG recruitment to PD research. Therefore, further PD research employing community-based methods to improve diverse participant recruitment is needed.
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Affiliation(s)
- Juliana M Ison
- University of California, Gevirtz Graduate School of Education, Isla Vista, Santa Barbara, CA 93106, USA
| | - Jonathan D Jackson
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Helen Hemley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Allison Willis
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Bernadette Siddiqi
- The Michael J. Fox Foundation, 111 W. 33rd St, New York City, NY 10120, USA
| | - Eric A Macklin
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Christine Ulysse
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Michael S Fitts
- University of Alabama at Birmingham (UAB Libraries), 1700 University Blvd, Birmingham, AL 35233, USA
| | - Tiffany T-H Pham
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Mitra Afshari
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
| | - Pinky Agarwal
- Evergreen Health Care, 12040 NE 128th St, Kirkland, WA 98034, USA
| | - Michael Aminoff
- University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA
| | - Stephanie Bissonnette
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298, USA
| | - Michelle Fullard
- University of Colorado Denver, 1201 Larimer St, Denver, CO 80204, USA
| | - Tarannum S Khan
- Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | | | - Catherine Wielinski
- Park Nicollet Struthers Parkinson's Center, 6701 Country Club Dr, Minneapolis, MN 55427, USA
| | - Angie V Sanchez
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; University of Louisiana at Lafayette, 104 E University Ave, Lafayette, LA 70504, USA.
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15
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Halloway S, Volgman AS, Schoeny ME, Arvanitakis Z, Barnes LL, Pressler SJ, Vispute S, Braun LT, Tafini S, Williams M, Wilbur J. Overcoming Pandemic-Related Challenges in Recruitment and Screening: Strategies and Representation of Older Women With Cardiovascular Disease for a Multidomain Lifestyle Trial to Prevent Cognitive Decline. J Cardiovasc Nurs 2024; 39:359-370. [PMID: 37167428 PMCID: PMC10638460 DOI: 10.1097/jcn.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Recruiting participants with cardiovascular disease into research during the COVID-19 pandemic was challenging, particularly those at risk of health disparities. OBJECTIVE During the pandemic, 12 cohorts of older women with cardiovascular disease were recruited from cardiology clinics into a lifestyle intervention trial to prevent cognitive decline. Objectives were to ( a ) describe the results of modified recruitment/screening strategies to overcome pandemic-related challenges and ( b ) evaluate differences in age, race, and ethnicity between patients recruited/randomized, recruited/not randomized (entered recruitment but not randomized because of being ineligible or not interested), and not recruited (clinic patients who met preliminary criteria but did not enter recruitment). METHODS This was a cross-sectional descriptive analysis. In-person study strategies proposed before the COVID-19 pandemic were modified before study onset (September 2020). Women 65 years or older with cardiovascular disease were recruited from cardiology clinics by clinicians, posted flyers, and letters mailed to patients randomly selected from electronic health record data extractions. Patients were classified as recruited/randomized, recruited/not randomized, and not recruited. RESULTS Of 5719 patients potentially eligible, 1689 patients entered recruitment via referral (49.1%), posted flyers (0.5%), or mailed letters (50.3%), and 253 patients were successfully recruited/randomized. Recruited/randomized participants were, on average, 72.4 years old (range, 65-90 years old), non-Hispanic White (54.2%), non-Hispanic Black (38.3%), Hispanic/Latinx (1.6%), and other/not reported (5.1%). The recruited/randomized group was significantly younger with fewer patients of Hispanic/Latinx ethnicity compared with those not recruited. CONCLUSIONS During the pandemic, all recruitment/screening goals were met using modified strategies. Differences in sociodemographic representation indicate a need for tailored strategies.
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16
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Ward CE, Adelgais KM, Holsti M, Jacobsen KK, Simon HK, Morris CR, Gonzalez VM, Lerner G, Ghaffari K, VanBuren JM, Lerner EB, Shah MI. Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial. Acad Emerg Med 2024; 31:656-666. [PMID: 38450918 DOI: 10.1111/acem.14884] [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: 10/25/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Federal regulations allow exception from informed consent (EFIC) to study emergent conditions when obtaining prospective consent is not feasible. Little is known about public views on including children in EFIC studies. The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) trial implements age-based, standardized midazolam dosing for pediatric seizures. The primary objective of this study was to determine public support for and concerns about the PediDOSE EFIC trial. The secondary objective was to assess how support for PediDOSE varied by demographics. METHODS We conducted a mixed-methods study in 20 U.S. communities. Participants reviewed information about PediDOSE before completing an online survey. Descriptive data were generated. Univariable and multivariable logistic regression analysis identified factors associated with support for PediDOSE. Reviewers identified themes from free-text response data regarding participant concerns. RESULTS Of 2450 respondents, 79% were parents/guardians, and 20% had a child with previous seizures. A total of 96% of respondents supported PediDOSE being conducted, and 70% approved of children being enrolled without prior consent. Non-Hispanic Black respondents were less likely than non-Hispanic White respondents to support PediDOSE with an adjusted odds ratio (aOR) of 0.57 (95% CI 0.42-0.75). Health care providers were more likely to support PediDOSE, with strongest support among prehospital emergency medicine clinicians (aOR 5.82, 95% CI 3.19-10.62). Age, gender, parental status, and level of education were not associated with support of PediDOSE. Common concerns about PediDOSE included adverse effects, legal and ethical concerns about enrolling without consent, and potential racial bias. CONCLUSIONS In communities where this study will occur, most respondents supported PediDOSE being conducted with EFIC and most approved of children being enrolled without prior consent. Support was lowest among non-Hispanic Black respondents and highest among health care providers. Further research is needed to determine optimal ways to address the concerns of specific racial and ethnic groups when conducting EFIC trials.
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Affiliation(s)
- Caleb E Ward
- George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, USA
| | - Kathleen M Adelgais
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Maija Holsti
- University of Utah, Primary Children's Medical Center, Salt Lake City, Utah, USA
| | | | - Harold K Simon
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Claudia R Morris
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Victor M Gonzalez
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Gonzalo Lerner
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | | | - E Brooke Lerner
- University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Manish I Shah
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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17
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Ponzano M, Signori A, Bellavia A, Carbone A, Bovis F, Schiavetti I, Montobbio N, Sormani MP. Race and ethnicity in multiple sclerosis phase 3 clinical trials: A systematic review. Mult Scler 2024; 30:934-967. [PMID: 38849992 DOI: 10.1177/13524585241254283] [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] [Indexed: 06/09/2024]
Abstract
BACKGROUND Distinctive differences in multiple sclerosis (MS) have been observed by race and ethnicity. We aim to (1) assess how often race and ethnicity were reported in clinical trials registered on ClinicalTrials.gov, (2) evaluate whether the population was diverse enough, and (3) compare with publications. METHODS We included phase 3 clinical trials registered with results on ClinicalTrials.gov between 2007 and 2023. When race and/or ethnicity were reported, we searched for the corresponding publications. RESULTS Out of the 99 included studies, 56% reported race and/or ethnicity, of which only 26% of those primarily completed before 2017. Studies reporting race or ethnicity contributed to a total of 33,891 participants, mainly enrolled in Eastern Europe. Most were White (93%), and the median percentage of White participants was 93% (interquartile range (IQR) = 86%-98%), compared to 3% for Black (IQR = 1%-12%) and 0.2% for Asian (IQR = 0%-1%). Four trials omitted race and ethnicity in publications and even when information was reported, some discrepancies in terminology were identified and categories with fewer participants were often collapsed. CONCLUSION More efforts should be done to improve transparency, accuracy, and representativeness, in publications and at a design phase, by addressing social determinants of health that historically limit the enrollment of underrepresented population.
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Affiliation(s)
- Marta Ponzano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alessio Carbone
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Noemi Montobbio
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Ramduny J, Uddin LQ, Vanderwal T, Feczko E, Fair DA, Kelly C, Baskin-Sommers A. Increasing the representation of minoritized youth for inclusive and reproducible brain-behavior associations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.22.600221. [PMID: 38979302 PMCID: PMC11230295 DOI: 10.1101/2024.06.22.600221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Population neuroscience datasets allow researchers to estimate reliable effect sizes for brain-behavior associations because of their large sample sizes. However, these datasets undergo strict quality control to mitigate sources of noise, such as head motion. This practice often excludes a disproportionate number of minoritized individuals. We employ motion-ordering and motion-ordering+resampling (bagging) to test if these methods preserve functional MRI (fMRI) data in the Adolescent Brain Cognitive Development Study ( N = 5,733 ). Black and Hispanic youth exhibited excess head motion relative to data collected from White youth, and were discarded disproportionately when using conventional approaches. Both methods retained more than 99% of Black and Hispanic youth. They produced reproducible brain-behavior associations across low-/high-motion racial/ethnic groups based on motion-limited fMRI data. The motion-ordering and bagging methods are two feasible approaches that can enhance sample representation for testing brain-behavior associations and fulfill the promise of consortia datasets to produce generalizable effect sizes across diverse populations.
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Affiliation(s)
- Jivesh Ramduny
- Department of Psychology, Yale University, New Haven, CT, USA
- Kavli Institute for Neuroscience, Yale University, New Haven, CT, USA
| | - Lucina Q. Uddin
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tamara Vanderwal
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Eric Feczko
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Damien A. Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Clare Kelly
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Arielle Baskin-Sommers
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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Himmerich H, Keeler JL, Davies HL, Tessema SA, Treasure J. The evolving profile of eating disorders and their treatment in a changing and globalised world. Lancet 2024; 403:2671-2675. [PMID: 38705161 DOI: 10.1016/s0140-6736(24)00874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK
| | - Helena L Davies
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark; Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | | | - Janet Treasure
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Caldas B, Portela M, Stelson E, Singer S, Amaral T, Amaral C, Escosteguy C, Martins M, de Andrade CLT, Soares L, Cornish F, Rosenthal M, Aveling EL. Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil. J Clin Epidemiol 2024; 173:111423. [PMID: 38880435 DOI: 10.1016/j.jclinepi.2024.111423] [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: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.
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Affiliation(s)
- Bárbara Caldas
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Margareth Portela
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisabeth Stelson
- Patient-Led Research Collaborative, Calabasas, CA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sara Singer
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Thatiana Amaral
- Center for Health Sciences and Sports, Universidade Federal do Acre (UFAC), Rio Branco, Brazil
| | - Cledir Amaral
- Instituto Federal do Acre (IFAC), Rio Branco, Brazil
| | - Claudia Escosteguy
- Epidemiology Service, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Flora Cornish
- Department of Methodology, London School of Economics and Political Science, London, UK
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Rubin MA, Lewis A, Creutzfeldt CJ, Shrestha GS, Boyle Q, Illes J, Jox RJ, Trevick S, Young MJ. Equity in Clinical Care and Research Involving Persons with Disorders of Consciousness. Neurocrit Care 2024:10.1007/s12028-024-02012-3. [PMID: 38872033 DOI: 10.1007/s12028-024-02012-3] [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: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
People with disorders of consciousness (DoC) are characteristically unable to synchronously participate in decision-making about clinical care or research. The inability to self-advocate exacerbates preexisting socioeconomic and geographic disparities, which include the wide variability observed across individuals, hospitals, and countries in access to acute care, expertise, and sophisticated diagnostic, prognostic, and therapeutic interventions. Concerns about equity for people with DoC are particularly notable when they lack a surrogate decision-maker (legally referred to as "unrepresented" or "unbefriended"). Decisions about both short-term and long-term life-sustaining treatment typically rely on neuroprognostication and individual patient preferences that carry additional ethical considerations for people with DoC, as even individuals with well thought out advance directives cannot anticipate every possible situation to guide such decisions. Further challenges exist with the inclusion of people with DoC in research because consent must be completed (in most circumstances) through a surrogate, which excludes those who are unrepresented and may discourage investigators from exploring questions related to this population. In this article, the Curing Coma Campaign Ethics Working Group reviews equity considerations in clinical care and research involving persons with DoC in the following domains: (1) access to acute care and expertise, (2) access to diagnostics and therapeutics, (3) neuroprognostication, (4) medical decision-making for unrepresented people, (5) end-of-life decision-making, (6) access to postacute rehabilitative care, (7) access to research, (8) inclusion of unrepresented people in research, and (9) remuneration and reciprocity for research participation. The goal of this discussion is to advance equitable, harmonized, guideline-directed, and goal-concordant care for people with DoC of all backgrounds worldwide, prioritizing the ethical standards of respect for autonomy, beneficence, and justice. Although the focus of this evaluation is on people with DoC, much of the discussion can be extrapolated to other critically ill persons worldwide.
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Affiliation(s)
- Michael A Rubin
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Claire J Creutzfeldt
- Harborview Medical Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, Seattle, WA, USA
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Quinn Boyle
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ralf J Jox
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Michael J Young
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neurocritical Care, Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, USA.
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22
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Nooka AK, Kaufman JL, Rodriguez C, Jakubowiak A, Efebera Y, Reeves B, Wildes TM, Holstein SA, Anderson LD, Badros A, Shune L, Chari A, Pei H, Cortoos A, Patel S, Lin TS, Voorhees PM, Usmani SZ, Richardson PG. Post hoc analysis of daratumumab plus lenalidomide, bortezomib and dexamethasone in Black patients from final data of the GRIFFIN study. Br J Haematol 2024; 204:2227-2232. [PMID: 38504552 DOI: 10.1111/bjh.19386] [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: 10/13/2023] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Due in part to racial disparities and underrepresentation in clinical studies, optimal therapies for Black patients with multiple myeloma remain undefined. This final analysis of GRIFFIN by race showed that the addition of daratumumab (D) to lenalidomide/bortezomib/dexamethasone (RVd) provides clinical benefit among both Black and White transplant-eligible newly diagnosed patients compared with RVd alone. However, Black patients were more likely to discontinue ≥1 drug due to treatment-emergent adverse events. In summary, these findings suggest a benefit of D-RVd front-line therapy among Black and White patients and underscore the importance of equitable treatment access for all patients.
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Affiliation(s)
- Ajay K Nooka
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Cesar Rodriguez
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Brandi Reeves
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tanya M Wildes
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Larry D Anderson
- Myeloma, Waldenström's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ashraf Badros
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- University of California at San Francisco, San Francisco, California, USA
| | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | | | - Sharmila Patel
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA
| | - Peter M Voorhees
- Levine Cancer Institute, Atrium Health Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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23
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Mire SS, Truong DM, Sakyi GJ, Ayala-Brittain ML, Boykin JD, Stewart CM, Daniels F, Duran B, Gardner S, Barth AM, Richardson G, McKee SL. A Systematic Review of Recruiting and Retaining Sociodemographically Diverse Families in Neurodevelopmental Research Studies. J Autism Dev Disord 2024; 54:2307-2321. [PMID: 37022579 DOI: 10.1007/s10803-023-05968-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
Underrepresentation of socioeconomically, culturally, and/or linguistically diverse (SCLD) children with neurodevelopmental disorders (NDD) and their families has become a focal point for researchers. This systematic review aimed to identify researchers' strategies for recruiting and retaining SCLD families of children with NDD, published between 1993 and 2018. One hundred twenty-six articles were included, and study samples were categorized as "High SCLD" and "Low SCLD". Chi-square tests of independence were used to determine associations between sample composition (i.e., High/Low SCLD sample) and study characteristics reported. Significant associations were found between sample composition and studies that explicitly stated intention to recruit SCLD families, χ2(1) = 12.70, p < .001, Phi = 0.38 (moderate); and for studies that reported the following participant characteristics: language, χ2(1) = 29.58, p < .001, Phi = 0.48 (moderate-to-large); and race/ethnicity + SES + language, χ2(1) = 19.26, p <. 001, Phi = 0.39 (moderate). However, associations were not found between recruitment and retention approaches and whether studies included High SCLD or Low SCLD samples. Further study of NDD researchers' recruitment and retention approaches that successfully include SCLD families is needed.
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Affiliation(s)
- Sarah S Mire
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA.
- School of Education, Department of Educational Psychology, Baylor University, One Bear Place #97304, Waco, TX, 76798-7304, USA.
| | - Dieu M Truong
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgina J Sakyi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Mycah L Ayala-Brittain
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Jelisa D Boykin
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Christian M Stewart
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Fre'Dasia Daniels
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Brenda Duran
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Scarlett Gardner
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Alexandra M Barth
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Georgette Richardson
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Shannon L McKee
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
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24
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Mendez R, Velazquez E, Gimenez A, Michaud M, Mendez J, Wong M, Quesada J, Márquez-Magaña L, Samayoa C. The Impact of Insider Researcher Trainees in Recruiting and Retaining Latinx in an Outdoor Health Promotion Research Study. J Racial Ethn Health Disparities 2024; 11:1672-1684. [PMID: 37278955 PMCID: PMC10243238 DOI: 10.1007/s40615-023-01642-1] [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: 12/20/2022] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Latinx represent the second largest ethnic group in the USA and remain significantly underrepresented in research studies. Efforts to better include Latinx make use of community-engaged research (CEnR) approaches, peer-navigators, and cultural humility training for research teams. While these efforts have led to slight increases in Latinx participation, studies to identify strategic practices for better inclusion of Latinx participants are needed. The objective of this study was to qualitatively examine factors leading to successful recruitment and retention of Latinx participants in the Promoting Activity and Stress Reduction in the Outdoors (PASITO) intervention. For this intervention, 99 low-income Latinx clients in a local community were contacted and 52 participants were recruited (53%). All were retained in the 3-month intervention. Of these, 12 were interviewed within 6 months of the close of PASITO by bi-cultural and bi-lingual non-research staff. They conducted one-on-one structured telephone interviews. Of the twelve participants, three (25%) were men, nine (75%) were women, and the mean age was 43.7 (SD = 8.7). Four critical themes for the recruitment and retention of Latinx populations emerged from the interviews: (1) importance of insider researchers; (2) sense of community and belonging; (3) responsive programming; and (4) health-promoting activities. These findings support the significant role insider researchers can play, and social identity theory provides a useful framework for understanding the role of insider researchers in recruiting and retaining Latinx, and likely other minoritized groups, in clinical studies. Insider researchers possess the skills, training, community cultural wealth, in-depth understanding of their communities, and structural competencies that position them to carry out more inclusive studies to address the needs of marginalized communities and advance science.
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Affiliation(s)
- Rebecca Mendez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA.
| | - Edgar Velazquez
- Internal Medicine, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Alyssa Gimenez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Midley Michaud
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Jaqueline Mendez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Miriam Wong
- The Latina Center, 3701 Barrett Ave, Richmond, CA, 94805, USA
| | - James Quesada
- Department of Anthropology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Leticia Márquez-Magaña
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Cathy Samayoa
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
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25
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Lloyd SL, Foy CG, Caban-Holt A, Gwathmey T, Williams KL, Starks TD, Mathews A, Vines AI, Richmond A, Byrd GS. Assessing the Role of Trust in Public Health Agencies and COVID-19 Vaccination Status Among a Community Sample of African Americans in North Carolina. J Racial Ethn Health Disparities 2024; 11:1730-1740. [PMID: 37273163 PMCID: PMC10241131 DOI: 10.1007/s40615-023-01646-x] [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: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mistrust of the government and medical establishments are prominent reasons for vaccine hesitancy among African Americans (AAs). As COVID-19 research evolves in real time with some uncertainties remaining, AA communities may be less trusting of public health agencies. The purpose of these analyses was to assess the association between trust in public health agencies that recommend the COVID-19 vaccination and COVID-19 vaccination status among AAs in North Carolina. METHODS A 75-item cross-sectional survey, the Triad Pastors Network COVID-19 and COVID-19 Vaccination survey, was developed and administered to African Americans in North Carolina. Multivariable logistic regression was used to examine the association between levels of trust in public health agencies who recommend the COVID-19 vaccine and COVID-19 vaccination status among AAs. RESULTS Of the 1157 AAs included in these analyses, approximately 14% of AAs had not received the COVID-19 vaccine. These findings indicated that lower levels of trust in public health agencies significantly decreased the odds of getting the COVID-19 vaccination compared to those with higher levels of trust among AAs. The most trusted source for information on COVID-19 included federal agencies among all respondents. Among the vaccinated, primary care physicians were another trusted source of information. Pastors were another trusted source for those willing to be vaccinated. CONCLUSIONS Despite the majority of the respondents in this sample receiving the COVID-19 vaccine, subgroups of AAs remain unvaccinated. Federal agencies have a high level of trust among AA adults; however, innovative approaches are needed to reach AAs who remain unvaccinated.
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Affiliation(s)
- Shawnta L Lloyd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA.
| | - Capri G Foy
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - TanYa Gwathmey
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Kelvin Lamonte Williams
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
| | - Allison Mathews
- COMPASS Initiative® Faith Coordinating Center, Wake Forest University School of Divinity, Winston Salem, NC, 27109, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Alan Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, 27605, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University School of Medicine, 525 Vine Street, Suite # 150, Winston Salem, NC, 27102, USA
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26
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Schwartz JB, Liu RY, Boscardin J, Liu Q, Lau SWJ, Khatri S, Tarn D. Attitudes on participation in clinical drug trials: A nationally representative survey of older adults with multimorbidity. J Am Geriatr Soc 2024; 72:1717-1727. [PMID: 38485469 PMCID: PMC11187642 DOI: 10.1111/jgs.18857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Older adults with multimorbidity are under-represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. METHODS Cross-sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March-April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. RESULTS Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African-American respondents, and those ≥80 years). Sixty-five percent would join all in-person trials, 49% would join all-video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). CONCLUSIONS Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in-person visits are preferred. Proposed changes in trial design to increase enrollment of under-represented older adults may not align with patient-reported preferences.
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Affiliation(s)
- Janice B. Schwartz
- Department of Medicine, Division of Geriatrics and Division of Clinical Pharmacology, University of California, San Francisco, California, USA
| | - Ruey-ying Liu
- Department of Sociology, National Chengchi University, Taipei, Taiwan
| | - John Boscardin
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Qi Liu
- Center for Drug Evaluation and Research, Office of Translational Sciences and Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - S. W. Johnny Lau
- Center for Drug Evaluation and Research, Office of Translational Sciences and Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Sadhna Khatri
- Center for Biologics Evaluation and Research, Office of Compliance Biologics Quality, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Derjung Tarn
- Department of Family Medicine, University of California, Los Angeles, California, USA
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27
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Fedewa SA, Valentino LA, Koo A, Cafuir L, Tran DQ, Antun A, Kempton CL. Race and ethnicity reporting and representation in hemophilia clinical trials. Blood Adv 2024; 8:2351-2360. [PMID: 38547444 PMCID: PMC11127208 DOI: 10.1182/bloodadvances.2024012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
ABSTRACT Racial and ethnic representativeness in clinical trials is crucial to mitigate disparities in outcomes; however, diversity among hemophilia trials is unknown. The aim of this study is to examine the reporting and representation of race and ethnicity in trials of people with hemophilia (PwH). In this cross-sectional study, the ClinicalTrials.gov database was queried in April 2023 for interventional clinical trials involving PwH between 2007 and 2022. The distribution of participants (observed) was compared with expected proportions based on US Hemophilia Treatment Center (HTC) and country-specific census data with observed-to-expected ratios (OERs). Of 129 trials included, 94.6% were industry sponsored, with a mean of 62 participants and mean age of 26.8 years. Overall, 52.0% (n = 66) of trials reported data on race and ethnicity, increasing from 13.9% in 2007-2012 to 22.5% in 2013-2016 to 100% in 2017-2022 (P = .001). Among these 66 trials, 65.8%, 22.8%, 5.1%, 3.9% of participants were White, Asian, Hispanic, and Black, respectively. OERs were 10% to 20% lower for White participants vs US HTC, and US, UK, and Canadian census populations and ∼75% lower for Black or Hispanic participants when compared with US HTC and US census population. OERs for Asian participants were 1.6 to 3 times higher than Canada, US, and UK census populations. The reporting of race and ethnicity in hemophilia trials has drastically improved; however, Black and Hispanic PwH remain especially underrepresented. To address these disparities, stakeholders across the clinical trial enterprise need to implement strategies to ensure equitable participation.
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Affiliation(s)
- Stacey A. Fedewa
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Andee Koo
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Lorraine Cafuir
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | | | - Ana Antun
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
| | - Christine L. Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Hemophilia of Georgia Center for Bleeding and Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA
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28
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Hasan N, Mehrotra K, Danzig CJ, Eichenbaum DA, Ewald A, Regillo C, Momenaei B, Sheth VS, Lally DR, Chhablani J. Screen failures in clinical trials in retina. Ophthalmol Retina 2024:S2468-6530(24)00263-X. [PMID: 38810882 DOI: 10.1016/j.oret.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Disparities in clinical trials are a major problem due to significant underrepresentation of certain gender, racial and ethnic groups. Several factors including stringent eligibility criteria and recruitment strategies hinder our understanding of retinal disease. Thus, we aimed to study the various reasons of screen failures and specific patient and study characteristics among screen failures. DESIGN This is a cross-sectional retrospective study METHODS: Screening data of 87 trials from 6 centers were analyzed. Study characteristics (disease studied, phase of trial, route of drug administration) and patient demographics (age, gender, race, ethnicity, and employment status) were compared among different causes of screen failures. Screen failures were broadly classified into six categories: exclusion due to vision-based criteria, exclusion due to imaging findings, exclusion due to other factors, patient-related criteria, physician related criteria and miscellaneous. Descriptive statistics, Pearson Chi-square test and ANOVA were used for statistical analysis. MAIN OUTCOME MEASURES Determine the prevalence of various reasons for screen failures in multiple trials and its trend among different study and patient characteristics. RESULTS Among 87 trials and 962 patients, 465(48.2%) patients were successfully randomized and 497(51.8%) patients were classified as screen failures. The trials were conducted for various retinal diseases. Mean age was 76.50 ±10.45 years and 59.4% were females. Predominantly whites(93.4%) and unemployed/retired patients(66.6%) were screened. Of the 497 screen failures, most were due to patients not meeting inclusion criteria of imaging findings (n=221[44.5%]) followed by inclusion of vision-based criteria (n=73 [14.7%]), exclusion due to other factors (n=75[15.1%]), patient-related (n=34[6.8%]), physician-related (n=28[5.6%]) and miscellaneous reasons (n= 39[17.8%]). Reason for screen failure was not available for 27(5.4%) patients. A higher proportion of patients screened for surgical trials (15%) declined to participate in the study compared to non-invasive trials involving topical drugs and photobiomodulation (0%).(p=0.02) CONCLUSION: Patients not meeting the imaging and vision-cased criteria were the most common reasons for screen failures. Whites and unemployed patients predominantly participated in clinical trials. Patients are more inclined to continue participation in non-invasive clinical trials compared to surgical trials. Better recruitment strategies and careful consideration of study criteria can aid in decreasing the rate of screen failures.
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Affiliation(s)
- Nasiq Hasan
- Ophthalmology, UPMC, Pittsburgh, PA, United States
| | | | | | - David A Eichenbaum
- Retina Vitreous Associates of Florida, Saint Petersburg, FL; Morsani College of Medicine at the University of South Florida, Tampa, FL, United States
| | - Amy Ewald
- Retina Vitreous Associates of Florida, Saint Petersburg, FL; Morsani College of Medicine at the University of South Florida, Tampa, FL, United States
| | - Carl Regillo
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Bita Momenaei
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Veeral S Sheth
- University Retina and Macula Associates PC, Oak Forest, IL, United States
| | - David R Lally
- New England Retina Associates, Springfield, MA, United States
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29
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Whiting C, Omar D, Millan S, Murdock A, Abdel Azim S, Friedman A. A cross-sectional survey of clinical trials knowledge, participation, and perspectives in an underserved community of Washington, DC. Arch Dermatol Res 2024; 316:226. [PMID: 38787442 DOI: 10.1007/s00403-024-02968-4] [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: 03/22/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
The inclusion of participants from underrepresented and underserved groups is lagging in dermatology clinical trials. Through dissemination of a pilot survey at a community skin health fair, knowledge, participation, and perspectives of clinical trials were evaluated in an urban, medically underserved community in Washington, DC. Clinical trial-related questions were derived from the Health Information National Trends Survey 5 Cycle 4. This cross-sectional survey analyzed responses from 39/55 attendees (71% response rate). Most respondents were female (23/37 [62.2%]), between the ages of 25 and 54 (19/38, [50.0%]), and self-identified as non-white (35/39 [89.7%]) with a majority self-identifying as Black (16/31 [41%]). Most respondents self-reported knowing "little" to "nothing" about clinical trials (26/35 [74.3%]), and even more were unaware of the federal resource clinicaltrials.gov (30/37 [81.1%]). Few respondents discussed clinical trials as a treatment option with their healthcare provider (8/35 [22.9%]), yet having a discussion was significantly correlated with clinical trial participation (p = 0.0302). Self-reported level of knowledge was not significantly associated with participation in a clinical trial (p = 0.3035). Healthcare providers were the preferred first source of clinical trial information, followed by an internet search. Respondents rarely cited mistrust or skepticism as a barrier to participation (2/34 [5.9%]). Subjective positive healthcare experiences were significantly correlated to positive expectations with clinical trial participation (p = 0.0242). The findings of this study suggest the essential role healthcare providers, including dermatologists, play in clinical trial education and recruitment of underrepresented populations, and that patient mistrust may be present but is a rarely cited barrier to clinical trial participation.
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Affiliation(s)
- Cleo Whiting
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Fl. 2 South, Washington, DC, 20037, USA
| | - Deega Omar
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Fl. 2 South, Washington, DC, 20037, USA
| | - Sarah Millan
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Andeulazia Murdock
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Fl. 2 South, Washington, DC, 20037, USA
| | - Sara Abdel Azim
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Fl. 2 South, Washington, DC, 20037, USA
| | - Adam Friedman
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW Fl. 2 South, Washington, DC, 20037, USA.
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Robinson TD. Black Male Veterans' Mental Health: Exploring Their Lived Experiences. SOCIAL WORK IN PUBLIC HEALTH 2024:1-12. [PMID: 38769819 DOI: 10.1080/19371918.2024.2357084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This study delves into the mental health experiences of Black male veterans, bridging their military service with the historical context of Black men's mental health. Amid limited literature on this demographic, qualitative methods, including focus groups, are utilized to gather nuanced insights. Themes such as mental health awareness gaps, diverse therapy encounters, familial and social stigmatization, and lacking support networks emerge. The study underscores the urgent need for heightened attention to this overlooked population within social work research, education, and practice. It advocates for an inclusive, culturally sensitive approach in social work, offering implications for practitioners, educators, and curriculum development tailored to the unique needs of Black male veterans. Despite constraints, this research provides vital perspectives, urging further inquiry and support initiatives to better comprehend and aid the mental well-being of Black male veterans.
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Affiliation(s)
- Tay D Robinson
- U.S. Department of Veteran Affairs, Indianapolis Vet Center, Indianapolis, Indiana, USA
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Hobbs CL, Gadson AK, Sadikman S, Tsai S, Enemuo F, Raker C, Eaton JL. An investigation of racial and ethnic disparities in donor sperm availability in the United States. Fertil Steril 2024:S0015-0282(24)00452-7. [PMID: 38750876 DOI: 10.1016/j.fertnstert.2024.05.142] [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: 02/04/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To determine whether the racial and ethnic distribution of sperm donors contributing to US sperm banks differs from the demographics of the US population and those of US donor sperm recipients undergoing treatment with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). DESIGN Cross-sectional study. SETTING United States donor sperm banks, US Census, and fertility clinics reporting to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. PATIENTS Sperm donors from 18 banks, men aged 18-39 years on the basis of the 2021 Census Current Population Survey, and recipients of donor sperm for IVF and ICSI treatments in clinics reporting to the Assisted Reproductive Technology Clinic Outcome Reporting System from January 1, 2018, to December 31, 2020. INTERVENTION None. MAIN OUTCOME MEASURE Proportions of sperm donors and donor sperm recipients undergoing IVF and ICSI treatments identifying as each racial and ethnic group. RESULTS Eighteen donor sperm banks were identified, encompassing 1,503 donors. Of these donors, 60.9% identified as White compared with 55.1% of the US male population and 67.7% of donor sperm recipients. Proportions of donors identifying as Asian or 2 or more races were larger than those of US men and donor sperm recipients (Asian: 18.6% vs. 6.5%, and 18.6% vs. 10.2%; 2 or more races: 11.6% vs. 2.2%, and 11.6% vs. 1.7%). In contrast, Black donors were underrepresented when compared with the US population of men and donor sperm recipients (2.8% vs. 12.9% and 2.8% vs. 13.0%). Hispanic donors were underrepresented when compared with the US population of men (6.0% vs. 22.2%). The percentages of Hispanic sperm donors and donor sperm recipients were similar (6.0% vs. 7.0%). CONCLUSION The racial and ethnic distribution of sperm donors differs significantly from the demographics of the US male population and donor sperm recipients undergoing IVF and ICSI treatments. These findings suggest a need for targeted recruitment efforts for Black sperm donors.
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Affiliation(s)
- Cassie L Hobbs
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island.
| | - Alexis K Gadson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island
| | - Sophia Sadikman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island
| | - Shelun Tsai
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Franklin Enemuo
- Department of Obstetrics and Gynecology, Division of Research, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christina Raker
- Department of Obstetrics and Gynecology, Division of Research, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer L Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island
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Idnay B, Cordoba E, Ramirez SO, Xiao E, Wood OR, Batey DS, Garofalo R, Schnall R. Social Marketing Perspective on Participant Recruitment in Informatics-Based Intervention Studies. AIDS Behav 2024:10.1007/s10461-024-04355-6. [PMID: 38703337 DOI: 10.1007/s10461-024-04355-6] [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] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Effective recruitment strategies are pivotal for informatics-based intervention trials success, particularly for people living with HIV (PLWH), where engagement can be challenging. Although informatics interventions are recognized for improving health outcomes, the effectiveness of their recruitment strategies remains unclear. We investigated the application of a social marketing framework in navigating the nuances of recruitment for informatics-based intervention trials for PLWH by examining participant experiences and perceptions. We used qualitative descriptive methodology to conduct semi-structured interviews with 90 research participants from four informatics-based intervention trials. Directed inductive and deductive content analyses were guided by Howcutt et al.'s social marketing framework on applying the decision-making process to research recruitment. The majority were male (86.7%), living in the Northeast United States (56%), and identified as Black (32%) or White (32%). Most participants (60%) completed the interview remotely. Sixteen subthemes emerged from five themes: motivation, perception, attitude formation, integration, and learning. Findings from our interview data suggest that concepts from Howcutt et al.'s framework informed participants' decisions to participate in an informatics-based intervention trial. We found that the participants' perceptions of trust in the research process were integral to the participants across the four trials. However, the recruitment approach and communication medium preferences varied between older and younger age groups. Social marketing framework can provide insight into improving the research recruitment process. Future work should delve into the complex interplay between the type of informatics-based interventions, trust in the research process, and communication preferences, and how these factors collectively influence participants' willingness to engage.
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Affiliation(s)
- Betina Idnay
- School of Nursing, Columbia University, New York, NY, USA.
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Evette Cordoba
- School of Nursing, Columbia University, New York, NY, USA
| | | | - Eugenia Xiao
- School of Nursing, Columbia University, New York, NY, USA
| | - Olivia R Wood
- School of Nursing, Columbia University, New York, NY, USA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Robert Garofalo
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine Northwestern University, Chicago, IL, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Irizarry-Pérez CD, Peña ED, Bedore LM, Falcomata TS. A cross-linguistic approach to treating speech sound disorders in bilingual children. CLINICAL LINGUISTICS & PHONETICS 2024; 38:433-452. [PMID: 37282566 DOI: 10.1080/02699206.2023.2219368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
The present study explores generalisation of production skills across languages when treating speech sound disorders in bilingual children. Early work suggests that treating shared sounds across languages may facilitate cross-linguistic generalisation. Thus, selecting shared sounds across languages as targets may have clinical advantages. In this study, we asked if cross-linguistic generalisation can be facilitated for targets using shared sounds in bilingual children with phonological delays from Spanish (L1) into English (L2) when treating only the L1. Two Spanish-English bilingual children between the ages of 5;0-5;3 with speech sound disorders participated in an intervention with shared sounds as targets. Each child received two sessions per week of therapy that included both linguistically-based and motor-based approaches. Accuracy of targets was assessed within and across languages using a single-subject case design. Results show increased accuracy of targets and generalisation of sounds across languages when treatment was administered only in the L1. Specific growth varied per target and child. The implications affect how we select treatment targets in bilingual children. Future studies should explore additional ways to select targets to increase generalisation of skills and replicate with additional participants.
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Affiliation(s)
- Carlos D Irizarry-Pérez
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Elizabeth D Peña
- School of Education, University of California, Irvine, California, USA
| | - Lisa M Bedore
- Department of Communication Science and Disorders, Temple University, Philadelphia, Pennsylvania, USA
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Hecht Ii CJ, Friedl SL, Ong CB, Burkhart RJ, Porto JR, Kamath AF. Are orthopedic clinical trials representative? An analysis of race and ethnicity reported in clinical trials between 2007 and 2022 : Running title: representation of clinical trials in orthopedic surgery. Arch Orthop Trauma Surg 2024; 144:1977-1987. [PMID: 38554209 DOI: 10.1007/s00402-024-05285-7] [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] [Received: 11/27/2023] [Accepted: 03/10/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Prior studies investigating the racial and ethnic representation of orthopedic trial participants have found low rates of reporting, but these studies are dated due to the passing of the National Institutes of Health Final Rule in 2017 requiring the reporting of racial and ethnic data among clinical trials. Therefore, we evaluated the representativeness of orthopedic clinical trials before and after the Final Rule. METHODS A cross-sectional survey of orthopaedic clinical trials registered at ClinicalTrials.gov between October 1, 2007 and May 20, 2023 was conducted. After identifying and screening 23,752 clinical trials, 1564 trials were included in the analysis. Trials started before the implementation of the Final Rule on January 18, 2017 were grouped and compared to trials that began after. Odds ratios (OR) were utilized to identify trial characteristics associated with reporting race/ethnicity data. One-proportion z tests compared the representation of each racial and ethnic category to the 2020 United States Census. RESULTS In total, 34% (544 of 1564) of orthopedic clinical trials evaluated reported the race of participants, while 28% (438 of 1564) reported ethnicity. Trials registered after the Final Rule were more likely to report racial (OR: 5.15, 95%CI: 3.72-7.13, p < 0.001) and ethnic (OR: 3.23, 95%CI: 2.41-4.33, p < 0.001) representation of participants. Compared with the distribution of race and ethnicity reported by the United States 2020 Census, orthopedic trials had 16.6% more White participants (95% CI 16.4%, 16.8%; p < 0.001), 3.2% fewer Black participants (95%CI 3.1%, 3.3%; p < 0.001), and 5.7% fewer Hispanic/Latino participants (95%CI 5.2%, 6.2%; p < 0.001). Trials with enrollment sizes over 100 participants were also more likely to report race and ethnicity, with odds increasing with increased sample size. CONCLUSIONS The Final Rule marginally improved the reporting of race and ethnicity in orthopedic clinical trials, and underrepresentation of Black or African American, Multiracial, and Hispanic populations persists. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christian J Hecht Ii
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Sophia L Friedl
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Christian B Ong
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Robert J Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Joshua R Porto
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
- Center for Hip Preservation Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue Mail code A41, Cleveland, OH, 44195, USA.
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Ramanadhan S, Alemán R, Bradley CD, Cruz JL, Safaeinili N, Simonds V, Aveling EL. Using Participatory Implementation Science to Advance Health Equity. Annu Rev Public Health 2024; 45:47-67. [PMID: 38109515 PMCID: PMC11251496 DOI: 10.1146/annurev-publhealth-060722-024251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Participatory approaches to implementation science (IS) offer an inclusive, collaborative, and iterative perspective on implementing and sustaining evidence-based interventions (EBIs) to advance health equity. This review provides guidance on the principles and practice of participatory IS, which enables academic researchers, community members, implementers, and other actors to collaboratively integrate practice-, community-, and research-based evidence into public health and health care services. With a foundational focus on supporting academics in coproducing knowledge and action, participatory IS seeks to improve health, reduce inequity, and create transformational change. The three main sections of this review provide (a) a rationale for participatory approaches to research in implementation science, (b) a framework for integrating participatory approaches in research utilizing IS theory and methods, and (c) critical considerations for optimizing the practice and impact of participatory IS. Ultimately, participatory approaches can move IS activities beyond efforts to make EBIs work within harmful systems toward transformative solutions that reshape these systems to center equity.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Rosa Alemán
- American Civil Liberties Union-Massachusetts, Boston, Massachusetts, USA
| | - Cory D Bradley
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jennifer L Cruz
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Nadia Safaeinili
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Vanessa Simonds
- College of Education, Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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van Wamelen DJ, Rota S, Hartmann M, Martin NH, Alam AM, Thomas RH, Dodd KC, Jenkins T, Smith CJ, Zandi MS, Easton A, Carr G, Benjamin LA, Lilleker JB, Saucer D, Coles AJ, Wood N, Ray Chaudhuri K, Breen G, Michael BD. Addressing ethnic disparities in neurological research in the United Kingdom: An example from the prospective multicentre COVID-19 Clinical Neuroscience Study. Clin Med (Lond) 2024; 24:100209. [PMID: 38642613 PMCID: PMC11091497 DOI: 10.1016/j.clinme.2024.100209] [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: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Minority ethnic groups have often been underrepresented in research, posing a problem in relation to external validity and extrapolation of findings. Here, we aimed to assess recruitment and retainment strategies in a large observational study assessing neurological complications following SARS-CoV-2 infection. METHODS Participants were recruited following confirmed infection with SARS-CoV-2 and hospitalisation. Self-reported ethnicity was recorded alongside other demographic data to identify potential barriers to recruitment. RESULTS 807 participants were recruited to COVID-CNS, and ethnicity data were available for 93.2%. We identified a proportionate representation of self-reported ethnicity categories, and distribution of broad ethnicity categories mirrored individual centres' catchment areas. White ethnicity within individual centres ranged between 44.5% and 89.1%, with highest percentage of participants with non-White ethnicity in London-based centres. Examples are provided how to reach potentially underrepresented minority ethnic groups. CONCLUSIONS Recruitment barriers in relation to potentially underrepresented ethnic groups may be overcome with strategies identified here.
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Affiliation(s)
- Daniel J van Wamelen
- Institute of Psychiatry, Psychology & Neuroscience; Department of Neuroimaging; King's College London, London, United Kingdom; Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, and King's College London, United Kingdom; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology; Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands; Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, Division of Neuroscience; King's College London, London, United Kingdom.
| | - Silvia Rota
- Institute of Psychiatry, Psychology & Neuroscience; Department of Neuroimaging; King's College London, London, United Kingdom; Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, and King's College London, United Kingdom; Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, Division of Neuroscience; King's College London, London, United Kingdom
| | - Monika Hartmann
- Institute of Psychiatry, Psychology & Neuroscience; Department of Neuroimaging; King's College London, London, United Kingdom
| | - Naomi H Martin
- Institute of Psychiatry, Psychology & Neuroscience; Department of Neuroimaging; King's College London, London, United Kingdom
| | - Ali M Alam
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, United Kingdom
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, United Kingdom
| | - Katherine C Dodd
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester Centre for Clinical Neurosciences, Salford Royal Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Thomas Jenkins
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom; Midland St John of God Hospital and Curtin University, Perth, Western Australia, Australia
| | - Craig J Smith
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester Centre for Clinical Neurosciences, Salford Royal Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom
| | - Michael S Zandi
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ava Easton
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, United Kingdom; Encephalitis Society, Malton, United Kingdom
| | - Georgina Carr
- Neurological Alliance, London WD17 1EU, United Kingdom
| | - Laura A Benjamin
- National Hospital for Neurology and Neurosurgery, London, United Kingdom; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - James B Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - David Saucer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Wood
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - K Ray Chaudhuri
- Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust, and King's College London, United Kingdom; Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, Division of Neuroscience; King's College London, London, United Kingdom
| | - Gerome Breen
- Institute of Psychiatry, Psychology & Neuroscience; Social, Genetic & Developmental Psychiatry Centre; King's College London, London, United Kingdom
| | - Benedict Daniel Michael
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust, Department of Neurology, Liverpool, United Kingdom
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Liu X, Kieffer LA, King J, Boak B, Zgibor JC, Smith KJ, Burke LE, Jakicic JM, Semler LN, Danielson ME, Newman AB, Venditti EM, Albert SM. Program Factors Affecting Weight Loss and Mobility in Older Adults: Evidence From the Mobility and Vitality Lifestyle Program (MOVE UP). Health Promot Pract 2024; 25:492-503. [PMID: 36975377 DOI: 10.1177/15248399231162377] [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] [Indexed: 03/29/2023]
Abstract
Background. The Mobility and Vitality Lifestyle Program (MOVE UP) is a behavioral weight-management intervention for improving mobility among community-dwelling older adults. We examined program factors that affect implementation outcomes and participant-level health outcomes. Methods. The MOVE UP program was implemented in the greater Pittsburgh area from January 2015 to June 2019 to improve lower extremity performance in community-dwelling older adults who were overweight or obese. Thirty-two sessions were delivered over 13 months. All sessions were designed to be 1-hour in length, on-site, group-based, and led by trained and supported community health workers (CHWs). Participants completed weekly Lifestyle Logs for self-monitoring of body weight, diet, and physical activity. We evaluated the MOVE UP program using the RE-AIM framework, and collected quantitative data at baseline, 5-, 9-, and 13-months. Multilevel linear regression models assessed the impacts of program factors (site, CHW, and participant characteristics) on implementation outcomes and participant-level health outcomes. Results. Twenty-two CHWs delivered MOVE UP program to 303 participants in 26 cohorts. Participants were similar to the target source population in weight but differed in some demographic characteristics. The program was effective for weight loss and lower extremity function in both intervention and maintenance periods (ps < .01), with an independent effect for Lifestyle Logs submission but not session attendance. Discussion. CHWs were able to deliver a multi-component weight loss intervention effectively in community settings. CHW and site characteristics had independent impacts on participants' adherence. Lifestyle Log submission may be a more potent measure of adherence in weight loss interventions than attendance.
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Affiliation(s)
- Xinran Liu
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Brandi Boak
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - John M Jakicic
- AdventHealth, Translational Research Institute, Orlando, FL, USA
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Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Dworkin RH, Turk DC, Carman KL, Chambers CT, Cowan P, Edwards RR, Eisenach JC, Farrar JT, Ferguson M, Forsythe LP, Freeman R, Gewandter JS, Gilron I, Goertz C, Grol-Prokopczyk H, Iyengar S, Jordan I, Kamp C, Kleykamp BA, Knowles RL, Langford DJ, Mackey S, Malamut R, Markman J, Martin KR, McNicol E, Patel KV, Rice AS, Rowbotham M, Sandbrink F, Simon LS, Steiner DJ, Vollert J. Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations. Pain 2024; 165:1013-1028. [PMID: 38198239 PMCID: PMC11017749 DOI: 10.1097/j.pain.0000000000003121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.
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Affiliation(s)
- Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Katherine J. Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States
| | - Christin Veasley
- Chronic Pain Research Alliance, North Kingstown, RI, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kristin L. Carman
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - James C. Eisenach
- Departments of Anesthesiology, Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - John T. Farrar
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - McKenzie Ferguson
- Southern Illinois University Edwardsville, School of Pharmacy, Edwardsville, IL, United States
| | - Laura P. Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | | | - Smriti Iyengar
- Division of Translational Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Isabel Jordan
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Cornelia Kamp
- Center for Health and Technology/Clinical Materials Services Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bethea A. Kleykamp
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rachel L. Knowles
- Medical Research Council (part of UK Research and Innovation), London, United Kingdom
| | - Dale J. Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, CA, United States
| | | | - John Markman
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ewan McNicol
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, United States
| | - Kushang V. Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Departments of Anesthesia and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Specialty Care Program Office, Veterans Health Administration, Washington, DC, United States
| | | | - Deborah J. Steiner
- Global Pain, Pain & Neurodegeneration, Eli Lilly and Company, Indianapolis, IN, United States
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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Monahan E, McCrae JS, Arbour M. Participation in Pediatric Primary Care Innovation, DULCE, Increases Caregiver Agency and Resilience and Decreases Impact of Stress. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:685-698. [PMID: 37917335 DOI: 10.1007/s11121-023-01608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
The purpose of the present study was to explore outcomes and heterogeneous effects of an evidence-based, cross-sector pediatric healthcare intervention for families with infants, Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is tailored to allow families' needs and desires to drive DULCE intensity. This is a longitudinal study following families involved with pediatric primary care clinics from infant's birth to 15 months. Multi-level longitudinal modeling was used to compare the program's influence on resilience, parent agency, and the impact of stress on parent functioning among program recipients (n = 172) and non-recipients (n = 170). Study participants were recruited from four health care clinics in California and Florida, and participants completed in-person survey interviews at baseline (infant age 0-6 months) and final (infant age 12-15 months) timepoints, with a minimum of 6 months between baseline and final interview required. Assignment of families to intervention (participated in DULCE) or comparison group (received clinic care as usual) varied by clinic. The cross-sector pediatric primary care intervention screened families at high rates (70-90%), along with referring and connecting families to resources. DULCE participation was associated with increases in parents' agency and resilience. DULCE's positive influence on parent agency and impact of stress was observed with low dosage, and higher-risk families saw additional improvements in resilience at high dosage (high and low risk defined with Latent Profile Analysis). Findings reinforce the importance of examining heterogeneous effects of evidence-based interventions. DULCE's influence on parent agency and impact of stress was observed with low dosage; strengthened resilience among higher-risk families was found at high dosage. These findings document the value of a universal approach to prevention services in pediatric settings with tailoring that allows families to drive their engagement with the intervention.
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Affiliation(s)
- Emma Monahan
- Chapin Hall, University of Chicago, Chicago, IL, USA.
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Vargas S, Siddiqi S, King B, Nguyen C, Diep J, Gilbert L, Nguyen BM. Vietnamese Americans' level of trust in sources of information and willingness to participate in COVID-19 clinical trials. J Clin Transl Sci 2024; 8:e88. [PMID: 38784109 PMCID: PMC11112424 DOI: 10.1017/cts.2024.495] [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: 07/31/2023] [Revised: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 05/25/2024] Open
Abstract
The survey investigates COVID-19 information source trust levels and Vietnamese Americans' willingness to participate in clinical trials. An analysis of 212 completed surveys revealed that trust in coronavirus disease 2019 (COVID-19) clinical trial information from university hospitals and drug companies was associated with willingness to participate in clinical trials. Trust in COVID-19 information from federal governments and state governments was also associated with willingness to participate in clinical trials. However, trust in local health facilities was linked to trial participation reluctance. The results suggest that Vietnamese Americans' participation in clinical trials can be increased by identifying and using trusted sources of information.
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Affiliation(s)
- Shielene Vargas
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Saba Siddiqi
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Ben King
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Celine Nguyen
- Boat People SOS Houston, Houston, TX, USA
- Rice University, Houston, TX, USA
| | | | - Lauren Gilbert
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
| | - Bich-May Nguyen
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
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de Tantillo L, McCabe BE, Zdanowicz M, Ortega J, Gonzalez JM, Chaparro S. Implementing Strategies to Recruit and Retain a Diverse Sample of Heart Failure Patients. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241248144. [PMID: 38646673 DOI: 10.1177/15404153241248144] [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: 04/23/2024]
Abstract
Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants.
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Affiliation(s)
- Lila de Tantillo
- Brooks Rehabilitation College of Healthcare Sciences, Keigwin School of Nursing, Jacksonville University, Jacksonville, FL, USA
| | - Brian E McCabe
- Department of Special Education, Rehabilitation, and Counseling (SERC), Auburn University, Auburn, AL, USA
| | | | - Johis Ortega
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Juan M Gonzalez
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Sandra Chaparro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL, USA
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Asiodu IV, Gay CL, Gates-Burgess B, Negrete G. Access to and interest in human milk research opportunities among Black pregnant and postpartum people. Front Nutr 2024; 11:1274833. [PMID: 38680532 PMCID: PMC11048474 DOI: 10.3389/fnut.2024.1274833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Background Concerns exist regarding biomedical research participation in marginalized and historically disadvantaged communities. Objectives The purpose of this study was to understand critical barriers to participation in human milk research from the perspective of Black pregnant and postpartum people. Methods A national sample of Black pregnant and postpartum people (n = 104) was recruited to complete a cross-sectional online survey informed by the Life Course Perspective. Survey questions assessed research experiences and preferences, particularly related to human milk research, knowledge of historical events/policies targeting Black communities, and demographic characteristics. A socio-economic composite score was calculated as an indicator of socio-economic advantage. Survey data were summarized descriptively and potential correlates of research engagement were evaluated. Results Most (69%, n = 71) respondents reported previous participation in a research study, yet only 8 (8%) reported ever being asked to participate in a breastfeeding/chestfeeding or human milk study, and one respondent was unsure. Despite so few having been asked, 59% (n = 61) of respondents indicated they would donate breast/human milk to research if asked. Respondent characteristics associated with prior research participation included having greater socio-economic advantage (p = 0.027) and greater knowledge of discriminatory historical events/policies (p < 0.001). In contrast, the only respondent characteristic associated with willingness to donate human milk to research was younger age (p = 0.002). Conclusion Our findings suggest that Black pregnant and postpartum people are interested in biomedical research, specifically human milk and lactation research. However, greater intentionality and targeted recruitment of this underrepresented population is needed to increase diversity among human milk and lactation study samples. Structural and community-based interventions, informed by community members, are needed to address concerns and improve participant engagement.
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Affiliation(s)
- Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Caryl L. Gay
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | | | - Gabriela Negrete
- Department of Human Ecology, Human Development & Family Studies, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, United States
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Metlock FE, Addison S, McKoy A, Yang Y, Hope A, Joseph JJ, Zhang J, Williams A, Gray DM, Gregory J, Nolan TS. More than Just a Number: Perspectives from Black Male Participants on Community-Based Interventions and Clinical Trials to Address Cardiovascular Health Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:449. [PMID: 38673360 PMCID: PMC11050149 DOI: 10.3390/ijerph21040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Black Americans remain significantly underrepresented and understudied in research. Community-based interventions have been increasingly recognized as an effective model for reckoning with clinical trial participation challenges amongst underrepresented groups, yet a paucity of studies implement this approach. The present study sought to gain insight into Black male participants' perception of clinical trials before and after participating in a community-based team lifestyle intervention in the United States. METHODS Black Impact, a 24-week community-based lifestyle intervention, applied the American Heart Association's Life's Simple 7 (LS7) framework to assess changes in the cardiovascular health of seventy-four Black male participants partaking in weekly team-based physical activities and LS7-themed education and having their social needs addressed. A subset of twenty participants completed an exit survey via one of three semi-structured focus groups aimed at understanding the feasibility of interventions, including their perceptions of participating in clinical trials. Data were transcribed verbatim and analyzed using a content analysis, which involved systematically identifying, coding, categorizing, and interpreting the primary patterns of the data. RESULTS The participants reported a positive change in their perceptions of clinical trials based on their experience with a community-based lifestyle intervention. Three prominent themes regarding their perceptions of clinical trials prior to the intervention were as follows: (1) History of medical abuse; (2) Lack of diversity amongst research teams and participants; and (3) A positive experience with racially concordant research teams. Three themes noted to influence changes in their perception of clinical trials based on their participation in Black Impact were as follows: (1) Building trust with the research team; (2) Increasing awareness about clinical trials; and (3) Motivating participation through community engagement efforts. CONCLUSIONS Improved perceptions of participating in clinical trials were achieved after participation in a community-based intervention. This intervention may provide a framework by which to facilitate clinical trial participation among Black men, which must be made a priority so that Black men are "more than just a number" and no longer "receiving the short end of the stick".
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Affiliation(s)
- Faith E. Metlock
- Johns Hopkins School of Nursing (Formerly The Ohio State University College of Nursing), Baltimore, MD 21205, USA;
| | - Sarah Addison
- Washington University School of Medicine (Formerly The Ohio State University College of Medicine), St. Louis, MO 63110, USA;
| | - Alicia McKoy
- OhioHealth (Formerly The Ohio State University Center for Cancer Health Equity), Columbus, OH 43202, USA;
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Aarhea Hope
- Nell Hodgson Woodruff School of Nursing (Formerly The Ohio State University College of Nursing), Atlanta, GA 30322, USA;
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Jing Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Darrell M. Gray
- Gray Area Strategies LLC (Formerly The Ohio State University College of Medicine), Columbus, OH 43210, USA;
| | - John Gregory
- The African American Male Wellness Agency, National Center for Urban Solutions, Columbus, OH 43205, USA;
| | - Timiya S. Nolan
- University of Alabama at Birmingham Heersink School of Medicine (Formerly The Ohio State University College of Nursing and The Ohio State University Comprehensive Cancer Center), Birmingham, AL 35233, USA
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Adjei J, Tang M, Lipa S, Oyekan A, Woods B, Mesfin A, Hogan MV. Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States. J Bone Joint Surg Am 2024; 106:631-638. [PMID: 38386767 DOI: 10.2106/jbjs.22.01155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.
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Affiliation(s)
- Joshua Adjei
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaina Lipa
- Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barrett Woods
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Goin-Kochel RP, Lozano I, Duhon G, Marzano G, Daniels A, Law JK, Diehl K, Green Snyder L, Feliciano P, Chung WK. Evidence-based recruitment strategies for clinical research: Study personnel's and research participants' perceptions about successful methods of outreach for a U.S. Autism-Research Cohort. J Clin Transl Sci 2024; 8:e65. [PMID: 38690223 PMCID: PMC11058577 DOI: 10.1017/cts.2024.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Under enrollment of participants in clinical research is costly and delays study completion to impact public health. Given that research personnel make decisions about which strategies to pursue and participants are the recipients of these efforts, we surveyed research staff (n = 52) and participants (n = 4,144) affiliated with SPARK (Simons Foundation Powering Autism for Knowledge) - the largest study of autism in the U.S. - to understand their perceptions of effective recruitment strategies. Methods In Study 1, research personnel were asked to report recruitment strategies that they tried for SPARK and to indicate which ones they would and would not repeat/recommend. In Study 2, SPARK participants were asked to indicate all the ways they heard about the study prior to enrollment and which one was most influential in their decisions to enroll. Results Staff rated speaking with a SPARK-study-team member (36.5%), speaking with a medical provider (19.2%), word of mouth (11.5%), and a live TV news story (11.5%) as the most successful strategies. Participants most often heard about SPARK via social media (47.0%), speaking with a medical provider (23.1%), and an online search (20.1%). Research personnel's and participants' views on effective recruitment strategies often differed, with the exception of speaking with a medical provider. Conclusion Results suggest that a combination of strategies is likely to be most effective in reaching diverse audiences. Findings have implications for the selection of strategies that meet a study's specific needs, as well as recruitment-strategy "combinations" that may enhance the influence of outreach efforts.
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Affiliation(s)
- Robin P. Goin-Kochel
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Ivana Lozano
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Gabrielle Duhon
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Gabriela Marzano
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Amy Daniels
- Simons Foundation, New York, NY, USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - J. Kiely Law
- Simons Foundation, New York, NY, USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharine Diehl
- Simons Foundation, New York, NY, USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pamela Feliciano
- Simons Foundation, New York, NY, USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Wendy K. Chung
- Simons Foundation, New York, NY, USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Shields M, Rivelli A, Molina Y, Ozoani-Lohrer O, Lefaiver C, Ingle M, Fitzpatrick V. Trial staff and community member perceptions of barriers and solutions to improving racial and ethnic diversity in clinical trial participation; a mixed method study. Contemp Clin Trials Commun 2024; 38:101262. [PMID: 38328002 PMCID: PMC10847850 DOI: 10.1016/j.conctc.2024.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Background The lack of racial and ethnic diversity in clinical trials leads to skewed findings, limited generalizability, inequitable health outcomes for people of color, and insufficient access to innovative therapies. Our objective was to compare perceptions of barriers to participation in trials for people of color and trial staff to provide tangible solutions for improving diversity among study participants. Methods This mixed method study utilized semi-structured interviews and surveys to evaluate barriers to participation and solutions to improve racial and ethnic diversity in clinical trials among healthcare system trial staff and community members from the same region. Through thematic analysis via coded transcripts and quantitative analysis via survey data, social support theory constructs were identified to evaluate where perceptions of barriers and solutions overlap and where they diverge. Results A total of 55 trial staff and 75 community members participated in the study. Trial staff identified logistics and patients' unwillingness to receive additional treatments as perceived barriers to participation, while community members stated lack of information and lack of trust in their care team. Both groups identified hesitance toward research as a prominent barrier. Solutions related to informational support demonstrated the most overlap between groups, while instrumental support showed the most discordance. Conclusion Solutions for improving racial and ethnic diversity in clinical trial participation are multi-faceted and have various levels of impact. Overlap and discordance of opinions regarding solutions should be further evaluated, and implementation of solutions should be carefully considered.
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Affiliation(s)
- Maureen Shields
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Anne Rivelli
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | | | - Osondi Ozoani-Lohrer
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Marybeth Ingle
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Veronica Fitzpatrick
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
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Yang M, Samper‐Ternent R, Volpi E, Green A, Lichtenstein M, Araujo K, Borek P, Charpentier P, Dziura J, Gill TM, Galloway R, Greene EJ, Lenoir K, Peduzzi P, Meng C, Reese J, Shelton A, Skokos EA, Summapund J, Unger E, Reuben DB, Williamson JD, Stevens AB. The dementia care study (D-CARE): Recruitment strategies and demographic characteristics of participants in a pragmatic randomized trial of dementia care. Alzheimers Dement 2024; 20:2575-2588. [PMID: 38358084 PMCID: PMC11032530 DOI: 10.1002/alz.13698] [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: 07/18/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS Community-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients. RESULTS Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.
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Affiliation(s)
- Mia Yang
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Rafael Samper‐Ternent
- School of Public Healthand Institute on AgingThe University of Texas Health Science Center in HoustonHoustonTexasUSA
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
| | - Elena Volpi
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
- Sam and Ann Barshop Institute for Longevity and Aging StudiesThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Aval‐Na'Ree Green
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
| | - Maya Lichtenstein
- Department of NeurologyGeisinger Medical CenterWilkes‐BarrePennsylvaniaUSA
| | - Katy Araujo
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - Pamela Borek
- Department of NeurologyGeisinger Medical CenterWilkes‐BarrePennsylvaniaUSA
| | - Peter Charpentier
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - James Dziura
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Thomas M. Gill
- Department of Internal MedicineSection of GeriatricsYale School of MedicineNew HavenConnecticutUSA
| | - Rebecca Galloway
- Sealy Center on AgingThe University of Texas Medical Branch‐ GalvestonGalvestonTexasUSA
| | - Erich J. Greene
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Kristin Lenoir
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Peter Peduzzi
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Can Meng
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Jordan Reese
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
| | - Amy Shelton
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Eleni A. Skokos
- Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Jenny Summapund
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Erin Unger
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - David B. Reuben
- Multicampus Program in Geriatric Medicine & Gerontology, Division of GeriatricsDavid Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Jeff D. Williamson
- Section on Geriatric Medicine & Gerontology and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal MedicineWake Forest School of Medicine, Atrium Health Wake Forest BaptistWinston SalemNorth CarolinaUSA
| | - Alan B. Stevens
- Center for Applied Health ResearchBaylor Scott & White Health & Texas A&M Health Sciences CenterTempleTexasUSA
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Jacobsen E, Lucas H, Moran C, Dixon RG, Ganguli M. Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project. Alzheimer Dis Assoc Disord 2024; 38:160-167. [PMID: 38748658 PMCID: PMC11178142 DOI: 10.1097/wad.0000000000000618] [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: 11/17/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge. METHODS We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies. RESULTS Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups. CONCLUSIONS We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
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Affiliation(s)
- Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Heather Lucas
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Catherine Moran
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | | | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry
- University of Pittsburgh, School of Medicine, Department of Neurology
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology
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Martinez-Ruiz A, Yates S, Cheung G, Cullum S. Living with Dementia in Aotearoa (LiDiA): A Feasibility Study for a Dementia Prevalence Study in Māori and Non-Māori Living in New Zealand. DEMENTIA 2024; 23:343-365. [PMID: 37137731 PMCID: PMC11041074 DOI: 10.1177/14713012231173012] [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] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Recent estimations have projected a threefold increase in dementia prevalence in Aotearoa New Zealand (NZ) by 2050, particularly in Maori and Pacific peoples. However, to date, there are no national data on dementia prevalence, and overseas data are used to estimate the NZ dementia statistics. The aim of this feasibility study was to prepare the groundwork for the first full-scale NZ dementia prevalence study that is representative of Māori, European, Pacific and Asian peoples living in NZ. METHODS The main feasibility issues were: (i) Sampling to ensure adequate community representation from the included ethnic groups, (ii) Preparing a workforce to conduct the fieldwork and developing quality control, (iii) Raising awareness of the study in the communities (iv) Maximizing recruitment by door-knocking, (v) Retaining those we have recruited to the study and (vi) Acceptability of study recruitment and assessment using adapted versions of the 10/66 dementia protocol in different ethnic groups living in South Auckland. RESULTS We found that a probability sampling strategy using NZ Census data was reasonably accurate and all ethnic groups were sampled effectively. We demonstrated that we were able to train up a multi-ethnic workforce consisting of lay interviewers who were able to administer the 10/66 dementia protocol in community settings. The response rate (224/297, 75.5%) at the door-knocking stage was good but attrition at subsequent stages was high and only 75/297 (25.2%) received the full interview. CONCLUSIONS Our study showed that it would be feasible to conduct a population-based dementia prevalence study using the 10/66 dementia protocol in Māori, European and Asian communities living in NZ, utilizing a qualified, skilled research team representative of the families participating in the study. The study has demonstrated that for recruitment and interviewing in Pacific communities a different but culturally appropriate approach is required.
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Affiliation(s)
- Adrian Martinez-Ruiz
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Susan Yates
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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