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Rhodes RL, Cummings-Vaughn LA, Lundebjerg NE, Hardi A, Obrusniak EE, Yeo G. Diversity in research on aging: A new series. J Am Geriatr Soc 2024. [PMID: 38594955 DOI: 10.1111/jgs.18880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
This editorial comments on the article by Gilmore et al.
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Affiliation(s)
- Ramona L Rhodes
- Division of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Angela Hardi
- School of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | - Gwen Yeo
- Stanford University School of Medicine, Stanford, California, USA
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Rodriguez DK, Hewage SA, Periyakoil VS. Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review. J Am Geriatr Soc 2023; 71:1974-1991. [PMID: 37013348 PMCID: PMC10258132 DOI: 10.1111/jgs.18264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited. DESIGN This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States. METHODS Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles. RESULTS Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers. CONCLUSIONS Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.
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Affiliation(s)
- Dulce K Rodriguez
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Sumali A Hewage
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
- Veterans Affairs Palo Alto Health Care Center, Palo Alto, California, USA
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Huie EZ, Escudero A, Saito N, Harvey D, Nguyen ML, Lucot KL, LaGrande J, Mungas D, DeCarli C, Lamar M, Schneider JA, Kapasi A, Rissman RA, Teich AF, Dugger BN. TDP-43 Pathology in the Setting of Intermediate and High Alzheimer's Disease Neuropathologic Changes: A Preliminary Evaluation Across Ethnoracial Groups. J Alzheimers Dis 2023; 91:1291-1301. [PMID: 36617779 PMCID: PMC9974776 DOI: 10.3233/jad-220558] [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: 01/10/2023]
Abstract
BACKGROUND Transactive Response DNA Binding Protein 43 kDa (TDP-43) pathology is frequently found in cases with Alzheimer's disease (AD). TDP-43 pathology is associated with hippocampal atrophy and greater AD severity denoted by cognition and clinical representation. Current TDP-43 pathology studies are predominantly based on non-Hispanic White cohorts. OBJECTIVE We sought to evaluate the presence of TDP-43 pathology across ethnoracial groups utilizing the National Alzheimer's Coordinating Center; a database containing data from over 29 institutions across the United States. Cases (N = 1135: Hispanics/Latinos = 29, African Americans/Black Americans = 51, Asians/Asian Americans = 10, American Indians/Alaskan Natives = 2, non-Hispanic White = 1043) with intermediate/high AD having data on TDP-43 pathology in the amygdala, hippocampus, entorhinal cortex, and neocortex were included. METHODS TDP-43 pathology frequency in each neuroanatomic region among ethnoracial groups were compared using generalized linear mixed effects models with center as a random effect adjusting for age at death, education, and gender. RESULTS Although groups were imbalanced, there was no significant difference across ethnoracial groups based on TDP-43 pathology (p = 0.84). With respect to neuroanatomical regions evaluated, there were no significant differences across ethnoracial groups (p-values > 0.06). There were also no significant differences for age at death and gender ratios across ethnoracial groups based on TDP-43 pathology. Although not statistically significant, TDP-43 pathology was present less often in Hispanic/Latinos (34%) when compared to non-Hispanic Whites (46%). CONCLUSION While this is a preliminary evaluation, it highlights the need for diverse cohorts and on TDP-43 pathology research across ethnoracial groups. This is the first study to our knowledge having a focus on the neuroanatomical distribution of TDP-43 deposits in Hispanic/Latino decedents with AD.
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Affiliation(s)
- Emily Z. Huie
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Anthony Escudero
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Katherine L. Lucot
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Jayne LaGrande
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Dan Mungas
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Charles DeCarli
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Melissa Lamar
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Alifiya Kapasi
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Robert A. Rissman
- Department of Neurosciences, University of California San Diego, San Diego, La Jolla, California
| | - Andrew F. Teich
- Taub Institute for Research on Alzheimer’s Disease and Aging Brain, Department of Neurology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Brittany N. Dugger
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
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Nguyen ML, Huie EZ, Whitmer RA, George KM, Dugger BN. Neuropathology Studies of Dementia in US Persons other than Non-Hispanic Whites. FREE NEUROPATHOLOGY 2022; 3. [PMID: 35425946 PMCID: PMC9007571 DOI: 10.17879/freeneuropathology-2022-3795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia are two of the most prevalent dementias that afflict the aging population in the United States (US). Studies have made great strides in understanding the neuropathology of these diseases; however, many studies are conducted in the context of non-Hispanic whites (NHWs), and few include the rapidly growing underrepresented populations that reside in the US. We sought to characterize current knowledge of the neuropathologic landscape of AD and vascular dementia of the largest growing US minority groups, namely Latinos/Hispanics, Black Americans, and Asian Americans, compared with NHWs being the majority group. It is vital to note these historic categories are social constructs and cultural and social associations may underlie differences. We conducted a literature search utilizing specific criteria to yield neuropathology papers that addressed the demographics and neuropathologies of relevance, then collated the findings into this review. We reveal that while there has been much progress in neuropathological research involving Latinos/Hispanics and Black Americans in the past decade, no cohesive conclusions could be extrapolated from the existing data due to the dearth of minority participants and even smaller amount of information related to the heterogeneity within each minority group, especially Latinos/Hispanics. Furthermore, we reveal an even greater scarcity in neuropathological studies involving Asian Americans, also a very heterogeneous group. We hope the presented findings will illuminate the paucity of minority representation in not just neuropathological research but the field of clinical research overall and serve to inspire clinicians and researchers to help reduce the health disparities underrepresented groups in the US face.
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Affiliation(s)
- My-le Nguyen
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Emily Z Huie
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California, Davis
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Fujiwara A, Watanabe T. Effective Recruitment of Engineers From Other Companies: Whether to Pull Individuals or Teams? INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2021. [DOI: 10.1142/s0219877021400162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study empirically analyzes effective conditions for cross-border “learning by hiring” in the electronics industry. Many previous studies have indicated that the mobility of engineers serves as a conduit for knowledge diffusion and that knowledge is more likely transferred when the geographical distance is short, that is, when the conduit is short. However, the relationship between conduit thickness and density and the knowledge spillover effect has only rarely discussed. The findings of this study suggest that it is more effective to hire multiple people simultaneously for learning by hiring from companies in other countries.
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Rorai VO, Perry TE, Whitney SE, Gianfermi HC, Mitchell JA, Key KD, Lichtenberg PA, Taylor RJ, Ilardo JL, Knurek SM, Conyers CS. "It Takes Some Empathy, Sympathy, and Listening": Telephone Outreach to Older Detroiters in a Pandemic as a Modality to Gain an Understanding of Challenges and Resiliency. J Urban Health 2021; 98:91-102. [PMID: 34518983 PMCID: PMC8437335 DOI: 10.1007/s11524-021-00564-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/16/2022]
Abstract
This manuscript describes a telephone outreach project for members of a research registry program for older adults in Detroit, Michigan. From April until December 2020, the Healthier Black Elders Center designed and implemented a telephone outreach program, calling 1204 older adults utilizing 15 staff and volunteers. The calls served to check in on registry members and collect data on mental health, coping mechanisms, access to services, masks, testing, and tele-health. This paper details the methods of developing and implementing an innovative engagement program that collected time-sensitive data from older Black adults that has directly been applied to create virtual health education programs, share resource information, and create a program to reduce social isolation.
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Affiliation(s)
- Vanessa O Rorai
- Institute of Gerontology, Wayne State University, Detroit, MI, USA.
| | - Tam E Perry
- School of Social Work, Wayne State University, Detroit, USA
| | | | | | | | - Kent D Key
- College of Human Medicine, Michigan State University, East Lansing, USA
| | - Peter A Lichtenberg
- Institute of Gerontology, Psychology, Wayne State University, Detroit, USA
- Program for Research on Black Americans, Institute for Social Research, Social Work, University of Michigan, Ann Arbor, USA
| | - Robert Joseph Taylor
- Program for Research on Black Americans, Institute for Social Research, Social Work, University of Michigan, Ann Arbor, USA
- Research Initiatives, College of Human Medicine, Michigan State University, East Lansing, USA
| | - Joan L Ilardo
- Research Initiatives, College of Human Medicine, Michigan State University, East Lansing, USA
| | - Sean M Knurek
- Michigan State University Extension, East Lansing, USA
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Landry AM, Brown I, Blomkalns AL, Wolfe RE. The role of an academic emergency department in advancing equity and justice. Acad Emerg Med 2021; 28:1087-1090. [PMID: 33125762 DOI: 10.1111/acem.14164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/22/2020] [Accepted: 10/26/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Alden M. Landry
- Office Diversity Inclusion and Community PartnershipHarvard Medical School Boston MA USA
- Emergency Medicine at Beth Israel Deaconess Medical Center Boston MA USA
| | - Italo Brown
- Department of Emergency Medicine at Stanford University Stanford CA USA
| | | | - Richard E. Wolfe
- Emergency Medicine at Beth Israel Deaconess Medical Center Boston MA USA
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Pugh E, Robinson A, De Vito AN, Bernstein JPK, Calamia M. Representation of U.S. Black Americans in neuropsychology research: how well do our reporting practices show that Black lives matter? Clin Neuropsychol 2021; 36:214-226. [PMID: 34348590 DOI: 10.1080/13854046.2021.1958923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Black American individuals comprise about 13% of the population in the United States (U.S.). It is estimated by 2045, approximately 50% of U.S. residents will belong to an ethnic minority group underscoring the importance of the provision of culturally competent services. The present study provides a critical/systematic review of the literature to examine the representation of Black Americans in recent neuropsychological research in U.S. neuropsychology journals. We examined the representation of U.S. Black American individuals across journals, year of study, and by study sample. METHOD We evaluated 1,151 journal articles published in 4 neuropsychology journals published in 2011, 2014, 2017 and 2019. Articles were coded for reporting of age, sex/gender, years of education, ethnicity/race, and if race was a focus of the study. We also recorded sample size and type of sample. RESULTS Out of the 397 articles meeting inclusion criteria, 37.5% did not report ethnic or racial demographic information. Additionally, 96% of the articles were not racially/ethnically focused. Black participants comprised 10.7% of participants in articles that reported race/ethnicity. The proportion of Black participants increased by 3.7% between 2011 and 2019. CONCLUSION Our results demonstrate the underrepresentation of U.S. Black Americans in neuropsychological research over the targeted years. This highlights our shortcomings as a field in demonstrating the importance of including Black Americans in research.
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Affiliation(s)
- Erika Pugh
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Alyssa N De Vito
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Gonzales KL, Jiang L, Garcia-Alexander G, Jacob MM, Chang J, Williams DR, Bullock A, Manson SM. Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention. J Aging Health 2021; 33:18S-30S. [PMID: 34167349 PMCID: PMC8647809 DOI: 10.1177/08982643211013188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14 kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06 mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.
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Affiliation(s)
- Kelly L. Gonzales
- Oregon Health & Science University-Portland State University joint School of Public Health, Portland, OR, USA
| | - Luohua Jiang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | | | | | - Jenny Chang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - David R. Williams
- Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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Grunberg VA, Bannon SM, Reichman M, Popok PJ, Vranceanu AM. Psychosocial treatment preferences of persons living with young-onset dementia and their partners. DEMENTIA 2021; 21:41-60. [PMID: 34151598 DOI: 10.1177/14713012211027007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons living with young-onset dementia and their partners often experience elevated emotional distress as they cope with an unexpected progressive illness during an active life stage (typically ages 45-64 years). Despite their heightened emotional distress, psychosocial resources are both limited and lack the specificity to meet the unique needs of both partners. Our aim was to gain an in-depth understanding of the psychosocial treatment preferences of persons with young-onset dementia and their partners-an important first step in developing a tailored intervention. We conducted semi-structured dyadic interviews with persons with young-onset dementia and their partners (N = 23) and used a hybrid deductive-inductive approach to thematic analysis. We identified 12 themes across four domains: (1) perceptions of available and lacking resources, (2) preferences for program content, (3) preferences for program format, and (4) barriers and facilitators to participation. Couples indicated there is a lack of specific and family-oriented resources, which can create more stress and relationship strain. Couples endorsed support for a virtual, dyadic intervention delivered shortly after diagnosis focused on providing tools to cope with difficult emotions and symptom progression and enhance communication and meaningful daily living. They also identified potential barriers to program participation and offered suggestions to promote engagement. By using a qualitative approach, we were able to gather nuanced information that can be used to directly inform a feasible, accepted, and person-centered psychosocial intervention for persons with young-onset dementia and their partners.
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Affiliation(s)
- Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
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Arasu K, Chang CY, Wong SY, Ong SH, Yang WY, Chong MHZ, Mavinkurve M, Khoo EJ, Chinna K, Weaver CM, Chee WSS. Design and strategies used for recruitment and retention in a double blind randomized controlled trial investigating the effects of soluble corn fiber on bone indices in pre-adolescent children (PREBONE-Kids study) in Malaysia. Contemp Clin Trials Commun 2021; 22:100801. [PMID: 34195468 PMCID: PMC8233130 DOI: 10.1016/j.conctc.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recruitment and retention in longitudinal nutrition intervention studies among children is challenging and scarcely reported. This paper describes the strategies and lessons learned from a 1-year randomized double-blind placebo-controlled trial among pre-adolescent children on the effects of soluble corn fiber (SCF) on bone indices (PREBONE-Kids). Methods Participants (9–11 years old) were recruited and randomized into 4 treatment groups (600 mg calcium, 12 g SCF, 12 g SCF plus 600 mg calcium and placebo). Interventions were consumed as a fruit-flavored powdered drink for 1-year. School-based recruitment was effective due to support on study benefits from parents and teachers, peer influence and a 2-weeks study run-in for participants to assess their readiness to commit to the study protocol. Retention strategies focused on building rapport through school-based fun activities, WhatsApp messaging, providing health screening and travel reimbursements for study measurements. Compliance was enhanced by providing direct on-site school feeding and monthly non-cash rewards. Choice of 2 flavors for the intervention drinks were provided to overcome taste fatigue. Satisfaction level on the manner in which the study was conducted was obtained from a voluntary sub-set of participants. Results The study successfully enrolled 243 participants within 6 months and retained 82.7% of the participants at the end of 1 year, yielding a drop-out rate of 17.3%. Compliance to the intervention drink was 85% at the start and remained at 78.7% at the end of 1 year. More than 95% of the participants provided good feedback on intervention drinks, rapport building activities, communication and overall study conduct. Conclusion Successful strategies focused on study benefits, rapport building, frequent communication using social media and non-cash incentives helped improved compliance and retention rate. The lessons learned to maintain a high retention and compliance rate in this study provide valuable insights for future studies in a similar population. PREBONE-Kids contributes to evidence on the effect of soluble corn fiber on bone indices in pre-adolescent Asian children. School-based recruitment, study nature, perceived benefits and study run-in were effective strategies for recruitment. Rapport building, direct on-site feeding and rewarding protocol adherence were critical for good retention and compliance.
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Key Words
- 25-OHD, serum 25-hydroxyvitamin D
- BAP, bone-specific alkaline phosphatase
- BMC, bone mineral content
- BMD, bone mineral density
- CTX, carboxy-terminal collagen crosslinks
- Calcium
- Compliance
- DXA, dual-energy X-ray absorptiometry
- MET, total metabolic equivalent
- OC, osteocalcin
- P1NP, procollagen type 1 amino-terminal propeptide
- PBM, peak bone mass
- Pre-adolescent children
- SCF, soluble corn fibre
- Soluble corn fiber
- Study retention
- iPTH, intact parathyroid hormone
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Affiliation(s)
- Kanimolli Arasu
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Chung Yuan Chang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Soon Yee Wong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Shu Hwa Ong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Wai Yew Yang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Megan Hueh Zan Chong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Meenal Mavinkurve
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Erwin Jiayuan Khoo
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Karuthan Chinna
- Faculty of Health & Medical Sciences, School of Medicine, Taylor's University, No 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Winnie Siew Swee Chee
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
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Reporting of Demographic Variables in Neuropsychological Research: An Update of O'Bryant et al.'s Trends in the Current Literature. J Int Neuropsychol Soc 2021; 27:497-507. [PMID: 33176898 DOI: 10.1017/s1355617720001083] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Demographic trends and the globalization of neuropsychology have led to a push toward inclusivity and diversity in neuropsychological research in order to maintain relevance in the healthcare marketplace. However, in a review of neuropsychological journals, O'Bryant et al. found systematic under-reporting of sample characteristics vital for understanding the generalizability of research findings. We sought to update and expand the findings reported by O'Bryant et al. METHOD We evaluated 1648 journal articles published between 2016 and 2019 from 7 neuropsychological journals. Of these, 1277 were original research or secondary analyses and were examined further. Articles were coded for reporting of age, sex/gender, years of education, ethnicity/race, socioeconomic status (SES), language, and acculturation. Additionally, we recorded information related to sample size, country, and whether the article focused on a pediatric or adult sample. RESULTS Key variables such as age and sex/gender (both over 95%) as well as education (71%) were frequently reported. Language (20%) and race/ethnicity (36%) were modestly reported, and SES (13%), and acculturation (<1%) were more rarely reported. SES was more commonly reported in pediatric than adult samples, and the opposite was true for education. There were differences between the present results and those of O'Bryant et al., though the same general trends remained. CONCLUSIONS Reporting of demographic data in neuropsychological research appears to be slowly changing toward greater comprehensiveness, though clearly more work is needed. Greater systematic reporting of such data is likely to be beneficial for the generalizability and contextualization of neurocognitive function.
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Indorewalla KK, O’Connor MK, Budson AE, Guess (DiTerlizzi) C, Jackson J. Modifiable Barriers for Recruitment and Retention of Older Adults Participants from Underrepresented Minorities in Alzheimer's Disease Research. J Alzheimers Dis 2021; 80:927-940. [PMID: 33612540 PMCID: PMC8150544 DOI: 10.3233/jad-201081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/05/2023]
Abstract
Clinical Alzheimer's disease (AD) trials currently face a critical shortfall of thousands of eligible participants, which inflates the duration and cost of the clinical study as well as threatens the scientific merit of promising clinical interventions. This recruitment crisis is further compounded by the fact that underrepresented and marginalized populations-particularly those identifying as a racial or ethnic minority, those with low socioeconomic status, or living in rural areas-have been historically underrepresented in ongoing AD clinical trials despite overwhelming evidence that such populations are at increased risk for developing dementia. As a result of various recruitment barriers, current AD clinical studies frequently reflect a decreasingly representative segment of the US population, which threatens the overall generalizability of these findings. The current narrative review provides an updated examination and critique of common recruitment barriers and potential solutions, as well as a discussion of theoretical approaches that may address barriers disproportionately experienced by underrepresented communities. AD clinical researchers are encouraged to take purposive action aimed at increasing diversity of enrolled AD clinical trial cohorts by actively identifying and quantifying barriers to research participation-especially recruitment barriers and health disparities that disproportionately prevent underrepresented and marginalized populations from participating in research. Furthermore, researchers are encouraged to closely track which individuals who express interest in AD research ultimately enroll in research studies to examine whether AD research participation is appropriately representative of the intended population for whom these new and novel AD interventions are being designed.
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Affiliation(s)
| | - Maureen K. O’Connor
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Andrew E. Budson
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Christina Guess (DiTerlizzi)
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Jackson
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- CARE Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Portacolone E, Palmer NR, Lichtenberg P, Waters CM, Hill CV, Keiser S, Vest L, Maloof M, Tran T, Martinez P, Guerrero J, Johnson JK. Earning the Trust of African American Communities to Increase Representation in Dementia Research. Ethn Dis 2020; 30:719-734. [PMID: 33250619 DOI: 10.18865/ed.30.s2.719] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Black/African American populations are underrepresented as participants in dementia research. A major barrier to participation of African American older adults in dementia research is a tendency to distrust research institutions owing to both historical and contemporary racism. Building on the Ford framework, the objective of our study was to examine factors that influence participation in dementia research among African American older adults and caregivers, with an emphasis on understanding factors related to trust. Data were collected during January 2019 and March 2020 from 10 focus groups with African American older adults (n=91), 5 focus groups with caregivers (n=44), and interviews with administrators of community-based organizations (n=11), and meetings with our Community Advisory Board. Inductive/deductive content analysis was used to identify themes. The results identified an overall tension between distrust of researchers and a compelling desire to engage in dementia research. This overarching theme was supported by six themes that provided insights about the multiple layers of distrust, as well as expectations about the appropriate conduct of researchers and academic institutions. Strong commitment to the community was identified as a priority. The findings suggest that a paradigm shift is needed to increase the representation of African Americans in dementia research. In this new paradigm, earning the trust of African American communities becomes a systemic endeavor, with academic, state, and national institutions deeply committed to earning the trust of African American communities and guiding researchers in this endeavor. The findings also generated actionable recommendations to help improve representation of African American older adults in dementia research.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging; University of California San Francisco, CA
| | - Nynikka R Palmer
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital,University of California San Francisco, San Francisco, CA
| | - Peter Lichtenberg
- Department of Psychology, Institute of Gerontology, Michigan Center for Urban African American Research, Wayne State University, Detroit, MI
| | - Catherine M Waters
- School of Nursing, University of California San Francisco, San Francisco, CA
| | | | - Sahru Keiser
- Institute for Health & Aging; University of California San Francisco, CA
| | - Leah Vest
- Institute for Health & Aging; University of California San Francisco, CA
| | | | - Thi Tran
- Institute for Health & Aging; University of California San Francisco, CA
| | - Paula Martinez
- Institute for Health & Aging; University of California San Francisco, CA
| | - Javier Guerrero
- Institute for Health & Aging; University of California San Francisco, CA
| | - Julene K Johnson
- Institute for Health & Aging; University of California San Francisco, CA
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Stewart AL, Nápoles AM, Piawah S, Santoyo-Olsson J, Teresi JA. Guidelines for Evaluating the Feasibility of Recruitment in Pilot Studies of Diverse Populations: An Overlooked but Important Component. Ethn Dis 2020; 30:745-754. [PMID: 33250621 PMCID: PMC7683033 DOI: 10.18865/ed.30.s2.745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In health disparities research, studies often fall short of their recruitment goals. Conducting a pilot feasibility study of recruitment in which data are collected systematically on recruitment processes can help investigators refine methods for the larger study. However, there are few guidelines for conducting pilot feasibility studies, and recruitment methods are seldom the focus. Feasibility indicators differ from traditional reports of recruitment results by focusing on the extent to which recruitment goals are met. Methods We present an organizing framework for assessing the feasibility of recruitment that includes eight steps, briefly: 1) specify recruitment goals; 2) specify recruitment processes; 3) establish a tracking system for each individual; 4) establish a tracking database for monitoring processes and results; 5) implement recruitment and track each individual's progress; 6) summarize recruitment results; 7) calculate and interpret feasibility measures - were goals met; and 8) if goals were not met, utilize tracking data to modify methods for the larger study. We describe methods within each step, with added details for steps 2-5 (the specific processes). The framework draws from a small literature on recruitment feasibility with a focus on health disparities populations. The guidelines blend well-known methods of recruitment with additional information on calculating feasibility indicators. Conclusions These guidelines provide a first step in thinking systematically about recruitment feasibility, to advance the field of measuring feasibility. Feasibility indicators also can be used to track the effectiveness of innovative recruitment strategies as part of building the science of recruitment, especially in disparities populations.
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Affiliation(s)
- Anita L. Stewart
- Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, CA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sorbarikor Piawah
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, CA
| | - Jasmine Santoyo-Olsson
- Department of Medicine, Division of Internal Medicine, University of California San Francisco, and School of Public Health, University of California Berkeley, CA
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute and Columbia Center for Interdisciplinary Research on Alzheimer’s Disease Disparities (CIRAD), New York, NY
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Johnson JK, Stewart AL, Acree M, Nápoles AM, Flatt JD, Max WB, Gregorich SE. A Community Choir Intervention to Promote Well-Being Among Diverse Older Adults: Results From the Community of Voices Trial. J Gerontol B Psychol Sci Soc Sci 2020; 75:549-559. [PMID: 30412233 PMCID: PMC7328053 DOI: 10.1093/geronb/gby132] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To test effects of the Community of Voices choir intervention on the health, well-being, and health care costs of racial/ethnically diverse older adults. METHOD Twelve Administration-on-Aging-supported senior centers were cluster randomized into two groups: the intervention group started the choir immediately and a wait-list control group began the choir 6 months later. The choir program was designed for community-dwelling adults aged 60 years and older. The multimodal intervention comprises activities that engage participants cognitively, physically, and socially. Outcome measures assessed these three domains as well as health care utilization and costs. The intention-to-treat comparison was at 6 months. RESULTS The sample (N = 390) had a mean age of 71.3 years (SD = 7.2); 65% were nonwhite. Six-month retention was 92%. Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size [ES = 0.34] and interest in life (p = .008, ES = 0.39). No significant group differences were observed for cognitive or physical outcomes or for health care costs. DISCUSSION Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. Further efforts need to examine the mechanisms by which engagement in choirs improves aspects of well-being and reduces health disparities among older adults, including potential longer-term effects. CLINICALTRIALS.GOV REGISTRATION NCT01869179 registered January 9, 2013.
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Affiliation(s)
- Julene K Johnson
- Institute for Health & Aging, University of California San Francisco, Bethesda, Maryland
- Center for Aging in Diverse Communities, University of California San Francisco, Bethesda, Maryland
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, Bethesda, Maryland
- Center for Aging in Diverse Communities, University of California San Francisco, Bethesda, Maryland
| | - Michael Acree
- Osher Center for Integrative Medicine, University of California San Francisco, Bethesda, Maryland
| | - Anna M Nápoles
- Intramural Research Program, National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Jason D Flatt
- Institute for Health & Aging, University of California San Francisco, Bethesda, Maryland
| | - Wendy B Max
- Institute for Health & Aging, University of California San Francisco, Bethesda, Maryland
| | - Steven E Gregorich
- Center for Aging in Diverse Communities, University of California San Francisco, Bethesda, Maryland
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
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Nickell A, Stewart SL, Burke NJ, Guerra C, Cohen E, Lawlor C, Colen S, Cheng J, Joseph G. Engaging limited English proficient and ethnically diverse low-income women in health research: A randomized trial of a patient navigator intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:1313-1323. [PMID: 30772115 PMCID: PMC8846431 DOI: 10.1016/j.pec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Evaluate a community-based navigator intervention to increase breast cancer patients' and survivors' access to information about health research participation opportunities. METHODS In the context of a Community Based Participatory Research collaboration, we conducted a prospective randomized controlled trial of the Health Research Engagement Intervention with pre- and post-intervention surveys (n = 133). The primary outcome was health research information-seeking behavior. Secondary outcomes were health research knowledge, willingness to participate in health research, and health empowerment. Qualitative interviews (n = 11) elucidated participant perspectives on the intervention. RESULTS There was no statistically significant difference between intervention and control groups' information-seeking behavior. Knowledge that not all health research studies are about drugs or treatments increased significantly from pre- to post-test among intervention group participants (32% to 48%, p = 0.012), but not in the control group (43% to 30%, p = 0.059); the difference between arms was statistically significant (p = 0.0012). Although survey responses indicated willingness to participate, qualitative interviews identified competing priorities that limited participants' motivation to seek enrollment information. CONCLUSIONS AND PRACTICE IMPLICATIONS Community-based navigators are a trusted, and therefore promising link between health research and low-income underserved communities. However, systemic barriers in health research infrastructures need to be addressed to include low income, LEP and immigrant populations.
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Affiliation(s)
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, USA
| | - Nancy J Burke
- Public Health University of California, Merced, USA; Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Claudia Guerra
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Elly Cohen
- BreastCancerTrials.org, San Francisco, USA
| | | | | | - Janice Cheng
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA.
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Brewster P, Barnes L, Haan M, Johnson JK, Manly JJ, Nápoles AM, Whitmer RA, Carvajal-Carmona L, Early D, Farias S, Mayeda ER, Melrose R, Meyer OL, Zeki Al Hazzouri A, Hinton L, Mungas D. Progress and future challenges in aging and diversity research in the United States. Alzheimers Dement 2018; 15:995-1003. [PMID: 30240574 DOI: 10.1016/j.jalz.2018.07.221] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 12/31/2022]
Abstract
In 2016, the UC Davis Latino Aging Research Resource Center and UC Davis Alzheimer's Disease Center brought together experts from across the country to consolidate current knowledge and identify future directions in aging and diversity research. This report disseminates the research priorities that emerged from this conference, building on an earlier Gerontological Society of America preconference. We review key racial/ethnic differences in cognitive aging and dementia and identify current knowledge gaps in the field. We advocate for a systems-level framework for future research whereby environmental, sociocultural, behavioral, neuropathological, genetic, and psychometric levels of analysis are examined together to identify pathways and mechanisms that influence disparities. We then discuss steps to increase the recruitment and retention of racial/ethnic minorities in aging studies, as none of the recommendations will be possible without strong collaboration between racial/ethnic minority communities and researchers. This approach is consistent with the National Institute on Aging Health Disparities Research Framework.
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Affiliation(s)
- Paul Brewster
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, USA.
| | - Lisa Barnes
- Rush Alzheimer's Disease Center and Departments of Neurological Sciences and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA
| | - Julene K Johnson
- Institute for Health & Aging, UC San Francisco, San Francisco, CA, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anna María Nápoles
- Center for Aging in Diverse Communities, UC San Francisco, San Francisco, CA, USA
| | - Rachel A Whitmer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Luis Carvajal-Carmona
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Davis, CA, USA
| | - Dawnte Early
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Sarah Farias
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA; University of California, Los Angeles Department of Epidemiology, Los Angeles, CA, USA
| | - Rebecca Melrose
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Oanh L Meyer
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Adina Zeki Al Hazzouri
- Division of Epidemiology and Population Health, Department of Public Health Science, University of Miami, Miami, FL, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA
| | - Dan Mungas
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
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20
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Moore EG, Roche M, Rini C, Corty EW, Girnary Z, O'Daniel JM, Lin FC, Corbie-Smith G, Evans JP, Henderson GE, Berg JS. Examining the Cascade of Participant Attrition in a Genomic Medicine Research Study: Barriers and Facilitators to Achieving Diversity. Public Health Genomics 2018; 20:332-342. [PMID: 30086550 DOI: 10.1159/000490519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/26/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Recent genomic medicine initiatives underscore the importance of including diverse participants in research. Considerable literature has identified barriers to and facilitators of increasing diversity, yet disparities in recruiting and retaining adequate numbers of participants from diverse groups continue to limit the generalizability of clinical genomic research. METHODS The North Carolina Clinical Genomic Evaluation by Next-gen Exome Sequencing study employed evidence-based strategies to enhance the participation of under-represented minority patients. In this study, we evaluate the impact of our efforts by systematically analyzing the "cascade" of attrition of participants throughout study interactions. RESULTS Although successful in recruiting a cohort that included ~30% non-Caucasian patients overall, the study still enrolled and retained a lower proportion of minorities compared to the pool of eligible patients who were nominated. We evaluated sociodemographic characteristics and related variables as potential factors associated with attrition throughout these phases of the study. CONCLUSIONS These results suggest that varied approaches will be needed to increase participation in genomic medicine research. Our findings highlight factors to consider when developing strategies to address this critical need. Failing to include a broad range of populations in research studies will exacerbate existing disparities in the translation of genomic sequencing to medical care.
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Affiliation(s)
- Elizabeth G Moore
- Blue Cross Blue Shield of North Carolina, Durham, North Carolina, USA
| | - Myra Roche
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine Rini
- Hackensack Meridian Health Network, Hackensack, New Jersey, USA
| | - Edward W Corty
- School of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Zahra Girnary
- School of Medicine, University of South Carolina, Durham, South Carolina, USA
| | - Julianne M O'Daniel
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Giselle Corbie-Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James P Evans
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gail E Henderson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan S Berg
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Winter SS, Page-Reeves JM, Page KA, Haozous E, Solares A, Nicole Cordova C, Larson RS. Inclusion of special populations in clinical research: important considerations and guidelines. J Clin Transl Res 2018; 4:56-69. [PMID: 30873495 PMCID: PMC6410628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Trials that involve human participants call for experiments or observations that are performed in a clinical research setting. Currently, there are over 16,000 clinical trials open in the United States. Despite continuing efforts to include "special populations" in clinical trials, there are gaps in participation for people who are either minors or elderly adults, are from historically under-represented minorities, or live in rural communities. The inclusion of these special populations in clinical trials research is essential for conclusions that benefit all populations. Data suggest that study partic-ipation rates for special populations have fallen to levels that could endanger the successful performance of some types of research. This is particularly concerning in the 21st century, where demographic trends in the United States continue to shift towards an older and Hispanic population with fewer rural dwellers. Trends in New Mexico and other minority-majority states mirror many of these shifts. RELEVANCE FOR PATIENTS In this review, we highlight improvement strategies for enhanced clinical trial participation by members of special populations. Key drivers for disparate clinical trials participation and outcomes often include differences in genetics, physiology, and perceptions of mistrust towards researchers. To overcome these barriers, we focus on best practices in recruitment strategies from the perspectives of the participants, the researchers and the institutions that support clinical trials.
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Affiliation(s)
- Stuart S. Winter
- 1Children's Minnesota Research Institute, Minneapolis, MN, United States
| | - Janet M. Page-Reeves
- 2Department of Family and Community Medicine, University of New Mexico, Albuquerque, United States
| | - Kimberly A. Page
- 3Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, United States
| | - Emily Haozous
- 4UNM College of Nursing, University of New Mexico, Albuquerque, United States
| | - Angelica Solares
- 5University of New Mexico School of Law, University of New Mexico, Albuquerque, United States
| | - Carla Nicole Cordova
- 6UNM Clinical and Translational Science Center, University of New Mexico, Albuquerque, United States
| | - Richard S. Larson
- 6UNM Clinical and Translational Science Center, University of New Mexico, Albuquerque, United States
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Gonzales KL, Garcia GE, Jacob MM, Muller C, Nelson L, Manson SM. Patient-provider relationship and perceived provider weight bias among American Indians and Alaska Natives. Obes Sci Pract 2018; 4:76-84. [PMID: 29479467 PMCID: PMC5818742 DOI: 10.1002/osp4.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The objective of this study was to examine patient-provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health. Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations. Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation. Conclusion These findings point to the importance of a positive patient-provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.
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Affiliation(s)
- K. L. Gonzales
- Oregon Health Sciences University‐Portland State University School of Public HealthPortland State UniversityPortlandORUSA
| | - G. E. Garcia
- Department of SociologyPortland State UniversityPortlandORUSA
| | - M. M. Jacob
- Department of Education Studies, College of EducationUniversity of OregonEugeneORUSA
| | - C. Muller
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - L. Nelson
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - S. M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado DenverAuroraCOUSA
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Lee RE, Reese-Smith JY, Mama SK, Medina AV, Wolfe KL, Estabrooks PA. Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis. Transl Behav Med 2017; 7:106-114. [PMID: 27256575 DOI: 10.1007/s13142-016-0385-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values < .05). This study showed moderate levels of reach but overrepresented higher educated, wealthier, and older women at the completion of the study. Representativeness can change over the course of the study and impact the practicality of translating research to practice.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA.
| | - Jacqueline Y Reese-Smith
- Department of Psychology, Jackson State University, 1400 J.R. Lynch Street, LIB Rm 232, Jackson, MS, 39217, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Ashley V Medina
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Kristin L Wolfe
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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Johnson JK, Gregorich SE, Acree M, Nápoles AM, Flatt JD, Pounds D, Pabst A, Stewart AL. Recruitment and baseline characteristics of the Community of Voices choir study to promote the health and well-being of diverse older adults. Contemp Clin Trials Commun 2017; 8:106-113. [PMID: 29399643 PMCID: PMC5791898 DOI: 10.1016/j.conctc.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To describe the recruitment and baseline results of the Community of Voices study that aims to examine the effect of a community choir intervention on the health and well-being of older adults from diverse racial/ethnic and socioeconomic backgrounds. Method Using community-based participatory research methods, we recruited adults age 60 and over from 12 Administration on Aging-supported senior centers in San Francisco into a 2-arm cluster-randomized controlled trial of the community choir intervention. Multiple outreach methods were used. We tracked outreach, screening, and recruitment metrics and collected demographics and baseline outcomes via community-based, interviewer-administered surveys and performance measures of cognition, physical function, and psychosocial variables. Results The study contacted 819 individuals, screened 636, and enrolled 390 diverse older adults over a 42-month, phased recruitment period. The mean age was 71.2 (SD = 7.3), and the majority were women. Two-thirds of the sample are non-white, and 20% of participants reported having financial hardship. Discussion Outreach and recruitment methods used in the Community of Voices trial facilitated enrollment of a large proportion of minority and lower-SES older adults in the final sample. Similar recruitment approaches could serve as a model for recruiting diverse racial/ethnic and socioeconomic older adults into research.
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Affiliation(s)
- Julene K Johnson
- Institute for Health & Aging, University of California, San Francisco, CA, USA.,Center for Aging in Diverse Communities, University of California, San Francisco, CA, USA
| | - Steven E Gregorich
- Center for Aging in Diverse Communities, University of California, San Francisco, CA, USA.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michael Acree
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA
| | - Anna M Nápoles
- Center for Aging in Diverse Communities, University of California, San Francisco, CA, USA.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jason D Flatt
- Institute for Health & Aging, University of California, San Francisco, CA, USA.,Center for Aging in Diverse Communities, University of California, San Francisco, CA, USA
| | - Dana Pounds
- Institute for Health & Aging, University of California, San Francisco, CA, USA
| | - Alexandria Pabst
- Department of Cognitive and Information Sciences, University of California, Merced, CA, USA
| | - Anita L Stewart
- Institute for Health & Aging, University of California, San Francisco, CA, USA.,Center for Aging in Diverse Communities, University of California, San Francisco, CA, USA
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Northridge ME, Shedlin M, Schrimshaw EW, Estrada I, De La Cruz L, Peralta R, Birdsall S, Metcalf SS, Chakraborty B, Kunzel C. Recruitment of racial/ethnic minority older adults through community sites for focus group discussions. BMC Public Health 2017; 17:563. [PMID: 28599637 PMCID: PMC5466755 DOI: 10.1186/s12889-017-4482-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Despite a body of evidence on racial/ethnic minority enrollment and retention in research, literature specifically focused on recruiting racially/ethnically diverse older adults for social science studies is limited. There is a need for more rigorous research on methodological issues and the efficacy of recruitment methods. Cultural obstacles to recruitment of racial/ethnic minority older adults include language barriers, lack of cultural sensitivity of target communities on the part of researchers, and culturally inappropriate assessment tools. Methods Guided by the Consolidated Framework for Implementation Research (CFIR), this study critically appraised the recruitment of racial/ethnic minority older adults for focus groups. The initial approach involved using the physical and social infrastructure of the ElderSmile network, a community-based initiative to promote oral and general health and conduct health screenings in places where older adults gather, to recruit racial/ethnic minority adults for a social science component of an interdisciplinary initiative. The process involved planning a recruitment strategy, engaging the individuals involved in its implementation (opinion leaders in senior centers, program staff as implementation leaders, senior community-based colleagues as champions, and motivated center directors as change agents), executing the recruitment plan, and reflecting on the process of implementation. Results While the recruitment phase of the study was delayed by 6 months to allow for ongoing recruitment and filling of focus group slots, the flexibility of the recruitment plan, the expertise of the research team members, the perseverance of the recruitment staff, and the cultivation of change agents ultimately resulted in meeting the study targets for enrollment in terms of both numbers of focus group discussions (n = 24) and numbers of participants (n = 194). Conclusions This study adds to the literature in two important ways. First, we leveraged the social and physical infrastructure of an existing program to recruit participants through community sites where older adults gather. Second, we used the CFIR to guide the appraisal of the recruitment process, which underscored important considerations for both reaching and engaging this underserved population. This was especially true in terms of understanding the disparate roles of the individuals involved in implementing and facilitating the recruitment plan.
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Affiliation(s)
- Mary E Northridge
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 433 First Avenue, 7th Floor, Room 726, New York, NY, 10010, USA. .,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. .,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA. .,Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Michele Shedlin
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Eric W Schrimshaw
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ivette Estrada
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Leydis De La Cruz
- Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Rogelina Peralta
- Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
| | - Stacia Birdsall
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Sara S Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Bibhas Chakraborty
- Duke-National University of Singapore (Duke-NUS) Medical School, Centre for Quantitative Medicine, Singapore, Singapore
| | - Carol Kunzel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University College of Dental Medicine, Section of Population Oral Health, New York, NY, USA
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Johnson JK, Nápoles AM, Stewart AL, Max WB, Santoyo-Olsson J, Freyre R, Allison TA, Gregorich SE. Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults. BMC Public Health 2015; 15:1049. [PMID: 26463176 PMCID: PMC4603966 DOI: 10.1186/s12889-015-2395-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/06/2015] [Indexed: 11/12/2022] Open
Abstract
Background Older adults are the fastest growing segment of the United States population. There is an immediate need to identify novel, cost-effective community-based approaches that promote health and well-being for older adults, particularly those from diverse racial/ethnic and socioeconomic backgrounds. Because choral singing is multi-modal (requires cognitive, physical, and psychosocial engagement), it has the potential to improve health outcomes across several dimensions to help older adults remain active and independent. The purpose of this study is to examine the effect of a community choir program (Community of Voices) on health and well-being and to examine its costs and cost-effectiveness in a large sample of diverse, community-dwelling older adults. Method/design In this cluster randomized controlled trial, diverse adults age 60 and older were enrolled at Administration on Aging-supported senior centers and completed baseline assessments. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). We describe the nature of the study including the cluster randomized trial study design, sampling frame, sample size calculation, methods of recruitment and assessment, and primary and secondary outcomes. Discussion The study involves conducting a randomized trial of an intervention as delivered in “real-world” settings. The choir program was designed using a novel translational approach that integrated evidence-based research on the benefits of singing for older adults, community best practices related to community choirs for older adults, and the perspective of the participating communities. The practicality and relatively low cost of the choir intervention means it can be incorporated into a variety of community settings and adapted to diverse cultures and languages. If successful, this program will be a practical and acceptable community-based approach for promoting health and well-being of older adults. Trial registration ClinicalTrials.gov NCT01869179 registered 9 January 2013.
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Affiliation(s)
- Julene K Johnson
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. .,Center for Aging in Diverse Communities, University of California, San Francisco, USA.
| | - Anna M Nápoles
- Center for Aging in Diverse Communities, University of California, San Francisco, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
| | - Anita L Stewart
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. .,Center for Aging in Diverse Communities, University of California, San Francisco, USA.
| | - Wendy B Max
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA.
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
| | - Rachel Freyre
- Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA.
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA. .,Department of Family and Community Medicine, University of California, San Francisco, USA.
| | - Steven E Gregorich
- Center for Aging in Diverse Communities, University of California, San Francisco, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA.
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Samus QM, Amjad H, Johnston D, Black BS, Bartels SJ, Lyketsos CG. A Multipronged, Adaptive Approach for the Recruitment of Diverse Community-Residing Elders with Memory Impairment: The MIND at Home Experience. Am J Geriatr Psychiatry 2015; 23:698-708. [PMID: 25771267 PMCID: PMC5226267 DOI: 10.1016/j.jagp.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To provide a critical review of a multipronged recruitment approach used to identify, recruit, and enroll a diverse community-based sample of persons with memory disorders into an 18-month randomized, controlled dementia care coordination trial. METHODS Descriptive analysis of a recruitment approach comprised five strategies: community liaison ("gatekeepers") method, letters sent from trusted community organizations, display and distribution of study materials in the community, research registries, and general community outreach and engagement activities. Participants were 55 community organizations and 63 staff of community organizations in Baltimore, Maryland. Participant referral sources, eligibility, enrollment status, demographics, and loss to follow-up were tracked in a relational access database. RESULTS In total, 1,275 referrals were received and 303 socioeconomically, cognitively, and racially diverse community-dwelling persons with cognitive disorders were enrolled. Most referrals came from letters sent from community organizations directly to clients on the study's behalf (39%) and referrals from community liaison organizations (29%). African American/black enrollees were most likely to come from community liaison organizations. CONCLUSION A multipronged, adaptive approach led to the successful recruitment of diverse community-residing elders with memory impairment for an intervention trial. Key factors for success included using a range of evidence-supported outreach strategies, forming key strategic community partnerships, seeking regular stakeholder input through all research phases, and obtaining "buy-in" from community stakeholders by aligning study objectives with perceived unmet community needs.
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Affiliation(s)
- Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
| | - Halima Amjad
- Department of Gerontology and Geriatric Medicine, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Betty S Black
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Community & Family Medicine, The Dartmouth Medical School, Lebanon, NH
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
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Nickell A, Burke NJ, Cohen E, Caprio M, Joseph G. Educating low-SES and LEP survivors about breast cancer research: pilot test of the Health Research Engagement Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:746-52. [PMID: 24744119 PMCID: PMC4428555 DOI: 10.1007/s13187-014-0650-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Health Research Engagement Intervention (HREI) aims to reduce information and access disparities for breast cancer research opportunities among low-socioeconomic status (SES) and limited English proficient (LEP) breast cancer survivors by providing neutral, non-trial-specific information about health research via a trusted patient navigator. Qualitative methods in the context of a community-based participatory research design were used to iteratively design the HREI in collaboration with community-based care navigators from a trusted community organization, Shanti Project, and to locate appropriate research studies in collaboration with a web-based trial-matching service, BreastCancerTrials.org (BCT). Navigators were first trained in clinical trials and health research and then to deliver the HREI, providing feedback that was incorporated into both the HREI design and BCT's interface. Our intervention pilot with low SES and LEP survivors (n = 12) demonstrated interest in learning about "health research." All 12 participants opted to obtain more information when offered the opportunity. Post-intervention questionnaires showed that three of 11 (27 %) participants independently pursued additional information about research opportunities either online or by phone in the week following the intervention. Post-intervention navigator questionnaires indicated that navigators could confidently and efficiently deliver the intervention. LEP patients who pursued information independently faced language barriers. The HREI is a promising and potentially scalable intervention to increase access to neutral information about breast cancer research opportunities for low-SES and LEP individuals. However, in order for it to be effective, systems barriers to participation such as language accessibility at sources of health research information must be addressed.
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Affiliation(s)
- Alyssa Nickell
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Nancy J. Burke
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
| | - Elly Cohen
- BreastCancerTrials.org., San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, USA
| | - Maria Caprio
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
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Odierna DH, Bero LA. Retaining Participants in Outpatient and Community-Based Health Studies: Researchers and Participants in Their Own Words. SAGE OPEN 2014; 4:1-11. [PMID: 25599003 PMCID: PMC4296571 DOI: 10.1177/2158244014554391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Loss to follow-up can introduce bias into research, making it difficult to develop inclusive evidence-based health policies and practice guidelines. We aimed to deepen understanding of reasons why participants leave or remain in longitudinal health studies. We interviewed 59 researchers and current and former research participants in six focus groups (n = 55) or interviews (n = 4) at three study centers in a large academic research institution. We used minimally structured interview guides and inductive thematic analysis to explore participant-level, study-level, and contextual participation barriers and facilitators. Four main themes emerged: transportation, incentives and motivation, caregiver concerns, and the social and physical environment. Themes shared crosscutting issues involving funding, flexibility, and relationships between researchers and research participants. Study-level and contextual factors appear to interact with participant characteristics, particularly socioeconomic status and disease severity to affect participant retention. Participants' characteristics do not seem to be the main cause of study dropout. Researchers and funders might be able to address contextual and study factors in ways that reduce barriers to participation.
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Kim R, Hickman N, Gali K, Orozco N, Prochaska JJ. Maximizing retention with high risk participants in a clinical trial. Am J Health Promot 2013; 28:268-74. [PMID: 23875989 DOI: 10.4278/ajhp.120720-quan-355] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe effective retention strategies in a clinical trial with a high risk, low-income, and vulnerable patient population with serious mental illness. DESIGN Follow-up assessments were conducted for a randomized clinical tobacco treatment trial at 3, 6, and 12 months postbaseline. Initial follow-up rates of <40% at 3 months led to implementation of proactive retention strategies including obtaining extensive contact information; building relationships with case managers and social workers; contacting jails and prisons; text messaging, e-mailing, and messaging via social networking sites; identifying appointments via electronic medical record; and field outreach to treatment facilities, residences, and parks. SETTING Large urban public hospital. SUBJECTS Participants were current smokers recruited from 100% smoke-free locked psychiatry units. MEASURES Assessments covered demographics, substance use, and mental health functioning. ANALYSIS Retention rates were plotted over time in relation to key retention strategies. Chi-square and t-tests were used to examine participant predictors of retention at each follow-up. At the 12-month follow-up, the retention strategies that most frequently led to assessment completion were identified. RESULTS The sample (N = 100) was 65% male; age x = 39.5 years (SD = 11.3); 44% non-Hispanic white; 46% on Medicaid and 34% uninsured; 79% unemployed; and 48% unstably housed. Proactive retention strategies dramatically increased follow-up rates, concluding at 3 months = 82.65%, 6 months = 89.69%, and 12 months = 92.78%. Married and divorced/separated/widowed participants, those with higher income, and participants with alcohol or illicit drug problems had increased retention from 3- to 12-month follow-up. CONCLUSION Follow-up rates improved as proactive methods to contact participants were implemented. Dedicated research staff, multiple methods, community networking, and outreach within drug treatment settings improved retention.
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McHenry JC, Insel KC, Einstein GO, Vidrine AN, Koerner KM, Morrow DG. Recruitment of Older Adults: Success May Be in the Details. THE GERONTOLOGIST 2012; 55:845-53. [PMID: 22899424 DOI: 10.1093/geront/gns079] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/02/2012] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. RESULTS Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%. IMPLICATIONS The projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings.
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Affiliation(s)
| | | | - Gilles O Einstein
- Department of Psychology, Furman University Greenville, South Carolina
| | | | | | - Daniel G Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign
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Friedman DB, Johnson KM, Owens OL, Thomas TL, Dawkins DS, Gansauer L, Bartelt S, Waddell NM, Talley PJ, Bearden JD, Hébert JR. Developing partnerships and recruiting dyads for a prostate cancer informed decision making program: lessons learned from a community-academic-clinical team. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:243-9. [PMID: 22528633 PMCID: PMC3352970 DOI: 10.1007/s13187-012-0353-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Prostate cancer (PrCA) is the most commonly diagnosed non-skin cancer among men. PrCA mortality in African-American (AA) men in South Carolina is ~50% higher than for AAs in the U.S as a whole. AA men also have low rates of participation in cancer research. This paper describes partnership development and recruitment efforts of a Community-Academic-Clinical research team for a PrCA education intervention with AA men and women that was designed to address the discordance between high rates of PrCA mortality and limited participation in cancer research. Guided by Vesey's framework on recruitment and retention of minority groups in research, recruitment strategies were selected and implemented following multiple brainstorming sessions with partners having established community relationships. Based on findings from these sessions culturally appropriate strategies are recommended for recruiting AA men and women for PrCA education research. Community-based research recruitment challenges and lessons learned are presented.
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Affiliation(s)
- Daniela B Friedman
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC 29208, USA.
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