Improving diversity in study participation: Patient perspectives on barriers, racial differences and the role of communities

Integrating public preferences to overcome racial disparities in research: findings from a US survey on enhancing trust in research data-sharing practices

Objectives

Data-sharing policies are rapidly evolving toward increased data sharing. However, participants' perspectives are not well understood and could have an adverse impact on participation in research. We evaluated participants' preferences for sharing specific types of data with specific groups, and strategies to enhance trust in data-sharing practices.

Materials and Methods

In March 2023, we conducted a nationally representative online survey with 610 US adults and used logistic regression models to assess sociodemographic differences in their willingness to share different types of data.

Results

Our findings highlight notable racial disparities in willingness to share research data with external entities, especially health policy and public health organizations. Black participants were significantly less likely to share most health data with public health organizations, including mental health (odds ratio [OR]: 0.543, 95% CI, 0.323-0.895) and sexual health/fertility information (OR: 0.404, 95% CI, 0.228-0.691), compared to White participants. Moreover, 63% of participants expressed that their trust in researchers would improve if given control over the data recipients.

Discussion

Participants exhibit reluctance to share specific types of personal research data, emphasizing strong preferences regarding external data access. This highlights the need for a critical reassessment of current data-sharing policies to align with participant concerns.

Conclusion

It is imperative for data-sharing policies to integrate diverse patient viewpoints to mitigate risk of distrust and a potential unintended consequence of lower participation among racial and ethnic minority participants in research.

Why do patients take part in research? An updated overview of systematic reviews of psychosocial barriers and facilitators

BACKGROUND

Efficient, equitable health research depends on understanding why people decide to take part. The aims of this overview were to update the version published in 2020, identifying psychosocial influences on participation and mapping them to recruitment research and psychological theory.

METHODS

Searches were undertaken in February 2024. Qualitative, quantitative, and mixed-methods systematic reviews were identified, without language or date limits. Methodological quality was rated using AMSTAR-2, and low-quality reviews were excluded. Barriers and facilitators were identified inductively and mapped to the Theoretical Domains Framework (TDF) and COM-B model, and to empirical recruitment research.

RESULTS

The update included 70 reviews, including 44 new reviews, covering a breadth of populations and settings, and drawing on 1940 primary studies (1428 unique). We identified 15 facilitators, most commonly: altruism, potential for personal benefit and trust. Incentives and convenient, low-burden research were also facilitators. Another 10 facilitators were new to this update. There were 16 barriers, most commonly: perceived risk, practical difficulties, and distrust of researchers. Many barriers applied to specific designs, particularly randomised trials. Factors that were barriers or facilitators include the influence of others and information quality. Barriers and facilitators were coded to the Motivation and Opportunity components of the TDF, particularly knowledge and social influences; only two factors were coded to a Capability. Psychosocial influences and empirical recruitment research had some overlap, but some barriers and facilitators had not been evaluated.

CONCLUSIONS

Common barriers and facilitators to research participation were identified, some new to this update, which could be addressed through targeted recruitment strategies to increase the efficiency and generalisability of primary research. Factors affecting participation are not only personal; they are also normative and social. The priorities are to change the ways we recruit to research (perhaps tested in SWATs) and identify barriers and facilitators in areas not well covered in current research.

TRIAL REGISTRATION

PROSPERO CRD42017062738. Registered on April 2017.

Developing an Online Community Advisory Board (CAB) of Parents From Social Media to Co-Design an Human Papillomavirus Vaccine Intervention: Participatory Research Study

Background

Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media.

Objective

This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions.

Methods

In May 2020, Twitter was used to recruit parents of children aged 9-14 years, who were active users of the platform and were interested in serving on a CAB focused on child health and online programs. The recruitment campaign included Twitter (rebranded as X in 2023) advertising tools (eg, "interests" and "audience look-a-likes"). A total of 17 parents completed a screening survey and 6 completed a follow-up phone interview. Following phone interviews, 6 parents were invited to join the CAB, where they committed to a 1-year involvement. The CAB participated in eleven 1-hour online meetings in the first year, contributing to monthly feedback through participatory workbooks. Long-term engagement was sustained through icebreakers and casual online interactions, as well as providing real-time updates to demonstrate CAB feedback integration. An anonymous midterm evaluation was conducted at the end of the project's first year to assess processes and identify future growth opportunities.

Results

A total of 6 parents (5 females and 1 male) with children aged 9-14 years from diverse racial and ethnic backgrounds (African American, South Asian American, and White) across 6 states in the United States, representing urban, suburban, and rural areas, agreed to serve as CAB members. All 6 CAB members committed to 1 year of service beginning in July 2020 with 4 extending their participation into a second year (August 2021-August 2022). The CAB provided expert insights and feedback to co-develop the intervention, including character development, narrative content creation, study recruitment, survey development, and intervention delivery. The midterm evaluation showed 100% (6/6) satisfaction among CAB members, who valued the connections with other parents and their contribution to research. While all members felt confident discussing HPV, 83% (5/6) suggested diversifying the group and increasing informal bonding to enhance engagement and inclusivity, especially for differing vaccination views.

Conclusions

This study demonstrates that online CABs are a highly effective model for co-creating and informing online health communication interventions. The engagement of parents from diverse backgrounds and the structured use of online tools (eg, interactive workbooks) creates a constructive and thoughtful environment for incorporating parent contributions to research. This study highlights guiding principles to forming, engaging, and maintaining an online CAB to enhance health research and practice.

Asthma treatment response modified by fine particulate matter, nitrogen dioxide, and ozone among Black children: A reanalysis of the AsthmaNet Best African American Response to Asthma Drugs trial

BACKGROUND

Asthma morbidity significantly affects children of all racial backgrounds; however, Black children experience a greater disease burden than children from other racial groups. Despite the known influence of air pollution on asthma outcomes, its role in the efficacy of asthma treatments remains underexplored.

OBJECTIVE

We sought to examine how exposure to particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) influenced treatment outcomes in the National Institutes of Health AsthmaNet Best African American Response to Asthma Drugs trial.

METHODS

The trial randomized 224 Black children to 4 asthma treatments consisting of an inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) administered in a randomized crossover fashion. Treatment efficacy was assessed by the frequency of asthma exacerbations, percent predicted FEV1, and annualized asthma control days. Residential exposures to PM2.5, NO2, and O3 were estimated using a validated spatiotemporal model. Mixed-effects models were used to evaluate the interaction between pollution exposure and treatment efficacy, adjusting for age, household triggers, and trial site.

RESULTS

PM2.5, NO2, and O3 exposures ranged substantially across participants from 2.28 to 15.3 μg/m3, 2.34 to 63.7 ppm, and 2.57 to 23.7 ppb, respectively. NO2 and PM2.5 exposures were not associated with increased exacerbations post-treatment (P for interaction = .15 and .08, respectively). However, NO2 exposure significantly modified the effect of high-dose ICS+LABA therapy on lung function. Children with below median NO2 exposures while receiving ICS+LABA therapy had a reduction of 5.86 (95% CI 1.16, 10.56) in percent predicted FEV1 compared with children with above median NO2 exposures.

CONCLUSION

Residential high NO2 exposure may significantly attenuate the efficacy of ICS+LABA therapy on lung function in Black children. These findings suggest the need to consider environmental factors in clinical trials and asthma management strategies.

Patient Perspectives on Fixed Dose Combination Therapy for Pulmonary Arterial Hypertension: Exploratory Focus Group Research

Pulmonary arterial hypertension (PAH) requires lifelong medication, with patients taking an average of 12 tablets/day. Several chronic diseases can be treated with a fixed-dose combination (FDC) tablet, decreasing patient pill burden and increasing adherence. This exploratory research, conducted via focus groups, asked 13 patients with PAH for their insights about the use of FDC (2 PAH treatments in a single tablet), its potential benefits, and challenges to its use. At the time of the focus groups (July 2023), no FDC medications were available for PAH and the discussions were therefore hypothetical. Focus group transcripts were analyzed by a qualitative research specialist to identify key themes. Most participants were unfamiliar with FDC prior to taking part in the focus groups; however, during the engagement, 12/13 participants expressed interest in taking FDC as single-tablet therapy for their PAH. In general, participants saw the potential benefits as improved convenience, less time spent navigating insurance coverage, and improved adherence. Participants felt that reducing their tablet count by just one tablet would be meaningful to them. Concerns were raised about the potential difficulty with medication titration and challenges distinguishing between the side effects of two combined medications. This exploratory research provides insight into the perceptions of US patients on the utility of FDC in PAH and highlights an unmet need for patient education on medication adherence in PAH.

Gaps in diversity and inclusion reporting in United States knee injury clinical trials: A systematic review and meta-analysis

Purpose

Diversity and inclusion in clinical trials are critical for increasing the generalizability of research. Our objective was to examine the diversity and inclusion of historically marginalized populations in clinical trials focused on knee injuries in the United States.

Methods

Our systematic review and meta-analysis evaluated the diversity and representation of clinical trials concerning knee injuries published between 2018 and 2023. Published manuscripts of relevant knee injury clinical trials were identified using the medical literature databases MEDLINE (PubMed) and Embase (Elsevier). Two masked authors independently completed data screening and extraction. We evaluated studies using the Clinical trial Diversity Rating framework to assess their inclusion across multiple demographic characteristics.

Results

A total of 13 studies met the inclusion criteria for the final meta-analysis. Only 1 out of 13 (7.7%) received a 'Fair' representation score for race/ethnicity participation, and 1 out of 13 (7.7%) received a 'Poor' representation score. The remaining 11 out of 13 (84.6%) studies did not report information on the race/ethnicity of their participants. Eight out of 13 (61.5%) trials received a 'Good' representation score when evaluating the inclusion of males and females, 3/13 (23.1%) were 'Fair' and 2/13 (15.4%) were 'Poor'. None of the studies reported the number of participants aged ≥65 years.

Conclusion

The results of this study highlight a lack of demographic reporting in knee injury clinical trials, with the included studies consistently failing to report information about the race/ethnicity and age breakdown of participants. The lack of diversity goals and insufficient reporting of racial and ethnic minority populations underscores the necessity for strategic approaches going forward to ensure clinical trials are more inclusive and representative of the incidence of knee injuries in the population.

Level of Evidence

Level III, systematic review and meta-analysis.

Improving participation of culturally and linguistically diverse participants in clinical trials: an expert consultation

BACKGROUND

Diversity and inclusivity have become increasingly important in the design and implementation of clinical trials. However, those from culturally and linguistically diverse (CALD) backgrounds are still underrepresented in the research landscape. Failing to include diverse participants can result in treatments and interventions that are not accessible to all who need them. Researchers in Australia and internationally are innovating new ways to address the barriers to increased participation of people from CALD backgrounds in clinical trials.

CONSULTATION AND REVIEW

We conducted a brief review, augmented by consultation with experts who have engaged CALD communities in research and who hold positions in diversity and inclusivity improvement. Through this, we identified three pillars that must be considered in all areas of design and implementation of trials and research projects: co-design the process of engagement, build trust, invest the time. We also identified seven areas for action where organisations and research teams can focus their activities to improve inclusion and diversity: toolkits and study design, building trust with CALD communities, education and awareness, staff training and communication, language and consent, logistics, resources: funding and time. Importantly, accurate collection of data related to CALD status is also needed to improve inclusivity.

CONCLUSION

Experts provided valuable insights from their own experiences of the most effective methods for improving the inclusion of CALD communities in clinical trials. Early and thorough planning, building long-term, mutually beneficial relationships with CALD communities and top-down changes to funding are all necessary elements to creating effective, sustainable improvements to the diversity of clinical trials.

Development of a novel patient-reported outcome measure for disseminated coccidioidomycosis (valley fever)

BACKGROUND

Coccidioidomycosis (Valley Fever) is a dimorphic fungal infection endemic to the southwest United States, Mexico, Central and South America, which can lead to chronic debilitating illness and death.

OBJECTIVES

This qualitative study was conducted to develop a bespoke patient-reported outcome measure for patients with chronic disseminated coccidioidomycosis to assess health-related quality of life (HRQoL) impacts.

PATIENTS AND METHODS

Online, first-person narratives of patient experiences of disseminated coccidioidomycosis were used to create a patient-centred conceptual model of symptoms and impacts of the condition. Interviews were conducted with expert clinicians, followed by concept elicitation interviews with patients, to generate key symptom and impact concepts from which an initial patient-reported outcome measure was developed. The draft measure was reviewed with clinicians for clinical relevance and further assessed in cognitive debriefing interviews with patients to refine the measure and establish content validity.

RESULTS

A total of 25 patients were interviewed, which identified impacts relating to physical function, activities of daily living, cognitive function, social/role function and emotional function of disseminated coccidioidomycosis. Twenty items were developed simultaneously in English and Spanish to capture the main impacts across these 5 areas. In general, items were clear and well understood by patients, and clinicians found the measure clinically relevant and appropriate for assessing the burden of disseminated coccidioidomycosis on HRQoL.

CONCLUSIONS

Once fully validated, the Valley Fever-Patient Reported Outcome measure may be used in interventional studies to assess HRQoL outcomes, and in clinical practice to monitor patients' HRQoL.

Researcher Perceptions of Inclusion of Study Participants Who Use Languages Other Than English

Importance

Despite constituting 8% of the US population, people who speak languages other than English (LOE) are consistently underrepresented in health-focused research. To make research more inclusive and generalizable, it is crucial to better understand researcher perspectives on barriers to inclusion of participants using LOE and solutions to promote language justice.

Objective

To assess researcher perspectives on barriers to and best practices for inclusion of participants using LOE and to generate strategies to make research more inclusive.

Design, Setting, and Participants

This exploratory cross-sectional survey study used an anonymous digital Qualtrics survey distributed between March 1 and June 30, 2023. The study was conducted among principal investigators (PIs) and research coordinators at the University of Pittsburgh, Pennsylvania. Any PIs or research coordinators who conducted human participant research in the past 5 years were eligible to participate. A convenience sample, using department emails, research electronic mailing lists, a recruitment repository, and word of mouth, was recruited.

Main Outcomes and Measures

Survey questions, drafted with input from community partners, assessed researcher demographics, experience working with participants using LOE, barriers to inclusion, and recommendations to increase research inclusivity. All variables were analyzed using descriptive statistics to calculate means, SDs, and frequencies.

Results

There were 339 respondents who completed the survey (260 cisgender females or women [76.7%]). Of these respondents, 127 (37.5%) were PIs and 212 (62.5%) were research coordinators. In terms of race and ethnicity, 8.8% were Asian; 3.8% were Black, African, or African American; 2.4% were Hispanic, Latino, Latina, Latine, or Latinx; 0.9% were Middle Eastern or North African; 70.5% were White; 6.5% were of other race or ethnicity or were multiracial; 2.7% preferred not to say; and 4.4% had missing data. Most respondents primarily conducted clinical research (239 [70.5%]), and 170 (50.1%) worked with participants using LOE in the prior 5 years. In 188 reported cases in which inclusion occurred, 78 respondents (41.5%) did not proactively include participants using LOE but instead reactively included interested participants after studies had begun. Respondents listed lack of training, time and scheduling challenges around interpreter services, and budget constraints as barriers to inclusion. Recommendations to improve inclusion were made by 272 respondents (80.2%), 265 (78.2%) of whom suggested access to low-cost interpreters and translators, 249 (73.5%) of whom suggested training, and 272 (80.2%) of whom suggested availability of validated measures in different languages.

Conclusions and Relevance

In this survey study of health PIs and research coordinators affiliated with 1 academic institution, respondents faced multiple barriers to including participants who use LOE in their studies. Because a lack of language representation may compromise the quality and applicability of research, purposeful individual and institutional investments are needed to overcome these barriers.

The intersectionality of chronic pain stigma and racial discrimination in Black and White adults with chronic low back pain

OBJECTIVE

We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White US adults with chronic low back pain.

METHODS

Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: (1) high discrimination/high stigma, (2) high discrimination/low stigma, (3) low discrimination/high stigma, and (4) low discrimination/low stigma. White participants were categorized as: (1) any discrimination/high stigma, (2) any discrimination/low stigma, (3) no discrimination/high stigma, and (4) no discrimination/low stigma.

RESULTS

Black participants reported more frequent experiences of racial discrimination than White participants (P < .05), but there was not a racial difference in chronic pain stigma (P > .05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (P < .05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (P < .05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (P > .05).

CONCLUSION

Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.

Patient perceived weight stigma and patient-centered language use preferences: A cross-sectional mixed methods analysis conducted in a large academic medical center

BACKGROUND

Due to the rising prevalence of obesity and its impact on healthcare, patient-specific context is needed to optimize weight management with an emphasis on reducing health care-associated weight stigma. Our survey aimed to explore institution-specific patient experiences of weight stigma and preferences for patient-centered language use regarding weight management care.

METHODS

This cross-sectional analysis adopted a concurrent mixed methods design with a sample of individuals who opted in to complete patient experience surveys after receiving care at a large academic medical center in the United States (U.S.). Categorical and continuous variables were assessed using Chi-squared and analysis of variance. We used classical content analysis to qualitatively analyze free-text data for thematic coding.

RESULTS

After a 1-week survey fielding period, 3,219 of 16,758 patients completed the survey, yielding a response rate of (19.2%) with 2,816 having available electronic health record body mass index (BMI) data. Patients were comfortable discussing weight with their primary care providers but showed variation in the preferred approach and terms. Female patients with higher BMIs reported higher rates of delayed and canceled care due to prior weight stigma (25.6% and 12.2% for patients with class 3 obesity), and preferred a slower, gentler, and less direct approach with term preferences for "healthy eating plan" and against "obesity." Qualitative analysis yielded 27 themes grouped into three domains: Emotional Hinderances, Perceptual Hinderances, and Perceived Helpfulness.

CONCLUSIONS

Findings from our large single institution cohort expand on the existing weight stigma literature by identifying patient language preferences and healthcare experiences according to patient weight class and sex. Given the potential impact of understanding context-specific patient language use preferences to reduce weight stigma, we recommend other healthcare systems use a similar process to address weight stigma as part of a coordinated health system improvement initiative to enhance patient-centered weight management care.

A Systematic Review and Meta-Analysis Assessing Diversity and Representation in Diabetic Retinopathy Clinical Trials in the U.S

PURPOSE

To perform a systematic review and meta-analysis assessing the diversity and representation of diabetic retinopathy (DR) patients in clinical trials conducted in the United States from January 1, 2018, to December 31, 2023.

METHODS

A comprehensive search strategy was conducted on May 28th, 2024 using MEDLINE (PubMed) and Embase (Elsevier) to identify relevant clinical trials. Inclusion criteria included trials published between January 1, 2018 and December 31, 2023, focusing on interventions for DR that were conducted in the United States. Screening and data extraction were independently performed by three reviewers.

RESULTS

Eleven clinical trials met the inclusion criteria and were analyzed for participant representation based on sex, age, and race/ethnicity. Sex representation was rated as good in 9 of the 11 studies. However, age representation was rarely reported (only 1/11 studies) and race/ethnicity representation was poor in 6 of the 11 studies. The findings highlight significant underrepresentation of Asian and Black populations.

CONCLUSION

This study reveals substantial disparities in the demographic representation within DR clinical trials in the United States, emphasizing the critical need for improved inclusion strategies. Enhancing diversity in these trials is essential for producing research findings that are more applicable to the broader population affected by DR, ultimately contributing to more equitable healthcare outcomes and advancing the effectiveness of treatments across diverse demographic groups.

Artificial sweeteners and Type 2 Diabetes Mellitus: A review of current developments and future research directions

While artificial sweeteners are Generally Regarded as Safe (GRAS), the scientific community remains divided on their safety status. The previous assumption that artificial sweeteners are inert within the body is no longer valid. Artificial sweeteners, known for their high intense sweetness and low or zero calories, are extensively used today in food and beverage products as sugar substitutes and are sometimes recommended for weight management and Type 2 Diabetes Mellitus (T2DM) patients. The general omission of information about the concentration of artificial sweeteners on market product labels makes it challenging to determine the amounts of artificial sweeteners consumed by people. Despite regulatory authorization for their usage, such as from the United States Food and Drug Administration (FDA), concerns remain about their potential association with metabolic diseases, such as T2DM, which the artificial sweeteners were supposed to reduce. This review discusses the relationship between artificial sweetener consumption and the risk of developing T2DM. With the increasing number of recent scientific studies adding to the debate on this subject matter, we assessed recent literature and up-to-date evidence. Importantly, we highlight future research directions toward furthering knowledge in this field of study.

Patient and caregiver perspectives on treatment decision-making for stem cell transplantation in multiple myeloma

PURPOSE

Stem cell transplantation (SCT) is considered standard of care for patients with newly diagnosed multiple myeloma (MM) but is still associated with substantial challenges for patients and caregivers. Given the challenging treatment process and availability of other treatment options, it is important to engage patients in treatment decision-making, particularly patients with MM who may have unique goals and preferences.

METHODS

We conducted an exploratory focus-group study to evaluate how patients and caregivers make treatment decisions related to SCT. Fourteen patients who underwent SCT and 3 caregivers participated in three 2-h focus-group sessions. All 17 patients were selected from Janssen's Patient Engagement Research Council. Discussions focused on conversations about SCT, considerations for decision-making, and reflections about the decision to undergo SCT. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

Participants initially had limited knowledge about SCT but received information from their doctors and sought information from various sources. Key considerations during decision-making included long-term health impacts, side effects, and logistical and financial concerns. Most participants reported that they never considered or were never offered other treatment options, highlighting a need for improved education on available treatments for MM. Some participants also shared a desire for more information about the SCT process, particularly the recovery period, which they found more difficult than expected.

CONCLUSION

These findings highlight potential opportunities for improved education to enhance shared decision-making in patients undergoing SCT and their caregivers.

Perspectives on which health settings geriatricians should staff: a qualitative study of patients, care providers and health administrators

BACKGROUND

With a shortage of geriatricians and an aging population, strategies are needed to optimise the distribution of geriatricians across different healthcare settings (acute care, rehabilitation and community clinics). The perspectives of knowledge users on staffing geriatricians in different healthcare settings are unknown. We aimed to understand the acceptability and feasibility (including barriers and facilitators) of implementing a geriatrician-led comprehensive geriatric assessment (CGA) in acute care, rehabilitation, and community clinic settings.

METHODS

A qualitative description approach was used to explore the experience of those implementing (administrative staff), providing (healthcare providers), and receiving (patients/family caregivers) a geriatrician-led CGA in acute care, rehabilitation and community settings. Semi-structured interviews were conducted in Toronto, Canada. The theoretical domains framework and consolidated framework for implementation research informed the interview guide development. Analysis was conducted using a thematic approach.

RESULTS

Of the 27 participants (8 patients/caregivers, 9 physicians, 10 administrators), the mean age was 53 years and 14 participants (52%) identified as a woman (13 [48%] identified as a man). CGAs were generally perceived as acceptable but there was a divergence in opinion about which healthcare setting was most important for geriatricians to staff. Acute care was reported to be most important by some because no other care provider has the intersection of acute medicine skills with geriatric training. Others reported that community clinics were most important to manage geriatric syndromes before hospitalization was necessary. The rehabilitation setting appeared to be viewed as important but as a secondary setting. Facilitators to implementing a geriatrician-led CGA included (i) a multidisciplinary team, (ii) better integration with primary care, (iii) a good electronic patient record system, and (iv) innovative ways to identify patients most in need of a CGA. Barriers to implementing a geriatrician-led CGA included (i) lack of resources or administrative support, (ii) limited team building, and (iii) consultative model where recommendations were made but not implemented.

CONCLUSIONS

Overall, participants found CGAs acceptable yet had different preferences of which setting to prioritise staffing if there was a shortage of geriatricians. The main barriers to implementing the geriatrician-led CGA related to lack of resources.

CLINICAL TRIAL NUMBER

Not applicable.

Speaking Out: Factors Influencing Black Americans' Engagement in COVID-19 Testing and Research

Black communities in the United States (U.S.) have faced stark inequalities in COVID-19 outcomes. The underrepresentation of Black participants in COVID-19 testing research is detrimental to the understanding of the burden of the disease as well as the impact of risk factors for disease acquisition among Black Americans. Prior scholarship notes that the reluctance to engage in medical research among Black people is, in part, due to the exploitation and abuse this community has seen from the medical field and other social institutions. To better understand the barriers and motivations for COVID-19 testing among Black Americans, this study utilized intersectionality as methodological and theoretical frameworks to examine and investigate the barriers and motivations influencing participation in COVID-19 serosurveys (blood test and interview) among the metro-Atlanta Black communities. From May to October 2021, we took a community-based participatory research approach and conducted 52 semi-structured interviews to uncover different Black communities' feelings and opinions towards COVID-19 testing. Key reasons participants agreed to the blood test include (1) curiosity; (2) health upkeep; (3) family/community/social responsibility; and (4) importance of research. Participants' reasons for rejecting the blood test were (1) unnecessary/no benefit; (2) fear (of the known and unknown); (3) fear of needles and/or blood; and (4) discomfort with test setting/procedure. Our findings show that perspectives on willingness to engagement in testing or to not participate varied across gender and age for Black individuals.

Oxidative Stress and Cardiovascular Complications in Type 2 Diabetes: From Pathophysiology to Lifestyle Modifications

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular disease, which is the leading cause of morbidity and mortality among diabetic patients. A central pathophysiological mechanism linking T2DM to cardiovascular complications is oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and the body's antioxidant defenses. Hyperglycemia in T2DM promotes oxidative stress through various pathways, including the formation of advanced glycation end products, the activation of protein kinase C, mitochondrial dysfunction, and the polyol pathway. These processes enhance ROS generation, leading to endothelial dysfunction, vascular inflammation, and the exacerbation of cardiovascular damage. Additionally, oxidative stress disrupts nitric oxide signaling, impairing vasodilation and promoting vasoconstriction, which contributes to vascular complications. This review explores the molecular mechanisms by which oxidative stress contributes to the pathogenesis of cardiovascular disease in T2DM. It also examines the potential of lifestyle modifications, such as dietary changes and physical activity, in reducing oxidative stress and mitigating cardiovascular risks in this high-risk population. Understanding these mechanisms is critical for developing targeted therapeutic strategies to improve cardiovascular outcomes in diabetic patients.

"How Fluent Do I Need to Be to Say I'm Fluent?" Research Experiences of Communities that Speak Languages Other than English

OBJECTIVE

The goal of this study was to partner with community organizations to understand the research experiences of communities who speak languages other than English (LOE).

METHODS

We conducted semi-structured qualitative interviews in Spanish, Nepali, Mandarin, French, or Kizigua with LOE community members and community leaders who completed recruitment and data collection. Audio-recordings of the interviews were transcribed and translated. We conducted qualitative coding using a mixed deductive-inductive analysis approach and thematic analyses using three rounds of affinity clustering. This study occurred in partnership with an established community-academic collaboration.

RESULTS

Thirty community members and six community leaders were interviewed. 83% of LOE participants were born outside of the US and most participants (63%) had never participated in a prior research study. Six themes emerged from this work. Many participants did not understand the concept of research, but those that did thought that inclusion of LOE communities is critical for equity. Even when research was understood as a concept, it was often inaccessible to LOE individuals, particularly because of the lack of language services. When LOE participants engaged in research, they did not always understand their participation. Participants thought that improving research trust was essential and recommended partnering with community organizations and disseminating research results to the community.

CONCLUSION

This study's results can serve as an important foundation for researchers seeking to include LOE communities in future research to be more inclusive and scientifically rigorous.

Top 10 research priorities for congenital diaphragmatic hernia in Australia: James Lind Alliance Priority Setting Partnership

OBJECTIVES

The Gaps in the Congenital Diaphragmatic Hernia (CDH) Journey Priority Setting Partnership (PSP) was developed in collaboration with CDH Australia, James Lind Alliance (JLA) and the Murdoch Children's Research Institute to identify research priorities for people with CDH, their families and healthcare workers in Australasia.

DESIGN

Research PSP in accordance with the JLA standardised methodology.

SETTING

Australian community and institutions caring for patients with CDH and their families.

PATIENTS

CDH survivors, families of children born with CDH (including bereaved) and healthcare professionals including critical care physicians and nurses (neonatal and paediatric), obstetric, surgical, allied health professionals (physiotherapists, speech pathologists and speech therapists) and general practitioners.

MAIN OUTCOME MEASURE

Top 10 research priorities for CDH.

RESULTS

377 questions, from a community-based online survey, were categorised and collated into 50 research questions. Through a further prioritisation process, 21 questions were then discussed at a prioritisation workshop where they were ranked by 21 participants (CDH survivors, parents of children born with CDH (bereaved and not) and 11 multidisciplinary healthcare professionals) into their top 10 research priorities.

CONCLUSION

Stakeholders' involvement identified the top 10 CDH-related research questions, spanning from antenatal care to long-term functional outcomes, that should be prioritised for future research to maximise meaningful outcomes for people with CDH and their families.

Design of and Early Insights From a Generalized Myasthenia Gravis Patient Engagement Research Council

Background and Aims

An exploratory focus group study was conducted to better understand the needs of patients living with generalized myasthenia gravis (gMG).

Methods

US-based adults with gMG and caregivers of patients with gMG participated in a Patient Engagement Research Council between August 2022 and January 2023. The study consisted of a 15-min prework survey, followed by virtual focus groups facilitated using a semi-structured interview guide. Data concepts were identified using conversational analysis and by direct observation. All transcripts were coded based on concepts using a qualitative research analysis program (MaxQDA).

Results

16 participants (13 patients, three caregivers) were recruited. Participants reported impact on daily activities, fatigue, and psychosocial problems. Many participants experienced delayed diagnosis and difficulty accessing specialist care. Participants described multiple barriers related to their gMG, including barriers to treatment, access-related issues, and communication disconnect between patients and healthcare professionals. Achieving stable disease was the most important goal. There was a preference for the autonomy of self-administered medications at home versus infusions. Study insights led to recommendations to guide patient and healthcare professional education.

Conclusion

The study illustrates the need to improve access to specialist care, achieve earlier diagnosis, prioritize patients' preferences in disease management, and develop treatments that improve outcomes without additional burden.

Patient or Public Contribution

The data collected in this study was provided by the focus group participants, which included patients and caregivers of those with myasthenia gravis.

Motivations for and against Participation in Neonatal Research: Insights from Interviews of Diverse Parents Approached for Neonatal Research in the United States

OBJECTIVE

To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation.

STUDY DESIGN

We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation.

RESULTS

Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents often did not differentiate between baseline risks and incremental risk of study participation. Concerns regarding their infant being treated like a "guinea pig" were common among those who declined. Finally, historical abuses and institutional racism were reported as important concerns by some research decliners from minoritized populations.

CONCLUSIONS

Within a diverse sample of parents approached to enroll their infant in neonatal research, motivations for and against participation emerged, which may be targets of future interventions. These motivations included reasons for participation which we may hope to encourage, such as altruism. They also included reasons against participation, which we may hope to, as feasible, eliminate, mitigate, or at least acknowledge. These findings can help clinical trialists, regulators, and funders attempting to improve neonatal research recruitment processes.

Interventions for improving health literacy among older people: a systematic review

BACKGROUND

Health literacy(HL) is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions. Effective interventions to improve older people's HL have become increasingly important. The purpose of this study is to conduct a review of interventions aimed at enhancing the HL of older people.

METHODOLOGY

Relevant information was gathered from various databases including PubMed, Scopus, Cochrane Library, Science Direct, and Web of Science. Additionally, a manual search of related journals and Google Scholar, a search of the reference lists of selected articles, and a search of unpublished sources were also conducted up to 30 August 2024. Reporting quality assessment was performed using CONSORT: 2010, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and "Quality Assessment Criteria for Survey Research Reports".

RESULTS

A total of 21 articles were included in this study. The interventions conducted in high-income countries were found to be more effective compared to those conducted in middle and low-income countries. Furthermore, interventions carried out at the community level were more effective than those performed in nursing homes. Educational interventions were more effective than lifestyle modification interventions, and interventions carried out in a single dimension were more effective than multidimensional interventions. Additionally, interventions that utilized technology were found to be more effective.

CONCLUSION

Based on the findings, community-based interventions that encompass a one-dimensional approach, incorporating the use of technology and considering the duration of the intervention, are more recommended.

Diagnosing, managing, and studying long-COVID syndromes in children and adolescents in rural and underserved populations

The COVID-19 pandemic has arguably had its greatest impact in rural and other historically hard-to-reach populations. Families in rural and underserved communities experienced COVID-19 infections at a higher rate than did their peers in other groups and experienced disproportionate morbidity and mortality. Without careful design and implementation of resources, children in these areas are also at risk of being disproportionately affected by long-term sequelae of SARS-CoV-2 infections, such as "long COVID" syndromes. Increased frequency and severity of COVID-19 infections, decreased access to health care and supporting services, environmental and social structure factors that exacerbate post-acute sequelae of COVID-19, and increased baseline frequency of health disorders that may complicate post-COVID issues, such as higher rates of obesity, asthma, diabetes, and mental health disorders, all place children and adolescents in under-resourced areas at significant risk. Unfortunately, children and adolescents in these areas have been historically under-represented in clinical research. Not only are fewer studies published with participants in rural and underserved communities, but these studies more often exhibit lower quality, with fewer randomized controlled trials and multicenter studies. This gap not only deprives people in rural and underserved areas of the country of access to cutting-edge therapy, but it also risks "evidence-based" solutions that are not generalizable because they cannot be implemented in the areas disproportionately affected by many health conditions such as long COVID. These factors significantly impede our ability to provide appropriate medical care for underserved communities. This review will discuss the impact of COVID-19 in rural and underserved communities and the factors that must be considered in designing evidence-based long-COVID solutions for children and adolescents in these areas.

A comprehensive analysis of health care Inequities in randomized clinical trials following bariatric surgeries

BACKGROUND

Obesity is a global epidemic, leading to an increasing focus on interventions like bariatric surgeries. Despite this, there's a noticeable gap in understanding the demographic distribution of patients in clinical trials for bariatric surgery.

METHODS

We conducted a comprehensive analysis of 117 registered randomized clinical trials related to bariatric surgery on ClinicalTrials.gov. We extracted demographic information, including age, sex, race, and ethnicity, and performed descriptive statistical analyses.

RESULTS

The analysis covered 8,418 participants. The mean age was 43.8 years, with a substantial majority (93.8 ​%) falling within the 18-65 age group. Females comprised 74.9 ​% of participants, surpassing real-world estimates. Racially, 65.3 ​% of participants were White, while African Americans represented 18.5 ​%, Asians 1.2 ​%, Native Hawaiians 0.2 ​%, and American Indians 0.1 ​%, indicating an underrepresentation of diverse racial groups, notably lower compared to real-world demographic data. In terms of ethnicity, only 17.6 ​% were Hispanic.

CONCLUSIONS

This study reveals significant demographic disparities in patients undergoing bariatric surgeries in clinical trials. This suggests a lack of generalizability, emphasizing the need for inclusive recruitment strategies to enhance health equity.

Exploring confidence in financial planning topics among care partners of persons living with dementia

OBJECTIVE

Care partners of persons living with dementia perform significant financial planning in partnership with the person for whom they care. However, research is scarce on care partners' confidence and experiences with financial planning. The purpose of this study was, first, to quantify care partners' confidence across different financial planning topics. We sought to understand whether income, education, relationship type, and years of experience are related to care partners' level of confidence in financial planning. Second, we sought to better understand the reasons for these confidence ratings by examining care partners' experiences of financial planning.

METHODS

We conducted an online survey that asked a combination of quantitative and qualitative questions to understand care partners' confidence and experiences with financial planning. Participants were nationally recruited care partners of persons living with dementia. Multivariate linear regression was used to understand different subgroups' levels of confidence in each financial planning topic. Inductive thematic analysis was used to understand qualitative data.

RESULTS

The financial planning topics in which participants (N = 318) felt the least confident were: options when there is not enough money to provide care; tax deductions available to cut care costs; and sources of money from government programs for which the care recipient is eligible. Differences in confidence were observed among care partners with lower incomes, less experience, and caring for a parent. Qualitatively, participants described the challenges of care budgeting and protecting personal finances; confusion about long-term care insurance and accessing resources; and, among confident care partners, reasons for this sense of preparedness.

CONCLUSIONS

These results underscore the need for tailored interventions and technologies that increase care partners' confidence in specific aspects of financial planning, including long-term care insurance, available financial support, and what to do when money runs out.

Patient and care partner perspectives and preferences related to myasthenia gravis treatment: A qualitative study

Background and Aims

Due to the high symptom and treatment burden in myasthenia gravis (MG), understanding patient and care partner perspectives and preferences is crucial.

Methods

This study used voice analysis and virtual focus groups to understand patient and care partner experiences with MG-related symptoms, treatments, and preferences. The voice analysis via social media listening used artificial intelligence-powered tools to gather and structure public digital conversations on MG. Focus groups included people living with MG and care partners who completed a questionnaire and participated in a 1-h virtual session facilitated using a semi-structured interview guide. Qualitative data were aggregated, transcribed, and thematically analyzed.

Results

The voice analysis examined 11,554 posts from 8321 individuals, discussing MG symptoms, treatments, and burden. Of 7563 symptom-related posts, 5902 (78%) conveyed negative, 1427 (19%) neutral, and 234 (3%) positive sentiment. The most frequently mentioned symptoms were categorized as dysarthria, muscle weakness, and dysphagia. MG treatment sentiment analysis identified 6667 posts (67%) as neutral, 2887 (29%) as negative, and 350 (4%) as positive. For the focus groups, 15 individuals (12 patients and 3 care partners) completed the questionnaire and 14 participated in the virtual focus group sessions. The 15 participants who completed the questionnaire prioritized treatment convenience, symptom control for improved quality of life, and preventing potential MG crises in their current treatment. New treatment expectations included increased effectiveness, less frequent dosing, faster onset, and fewer side effects. Participants were also receptive to wearable medication delivery systems placed on the body and valued direct involvement in treatment decisions.

Conclusion

Patients and care partners are often negatively impacted by MG symptoms and value convenient and fast-acting treatments that control symptoms with minimal side effects. Considering patient preferences may help optimize treatment decisions and improve patients' overall well-being and satisfaction in their care.

'There's Nothing Wrong With You; You Just Need to Lose Weight'-A Qualitative Exploration of Pelvic Floor Dysfunction Among Women With Multiple Sclerosis and Their Interaction in Seeking Pelvic Healthcare

INTRODUCTION

Within 10 years of multiple sclerosis (MS) progression, nearly all women will have experienced symptoms associated with bladder, bowel and/or sexual health. Yet despite the impact these symptoms have on physical, psychological and social well-being, it remains an underserved area within the UK healthcare system.

STUDY AIM

This research employs a participatory research approach framed within the principles of intersectional feminism to collaboratively investigate the lived experiences of pelvic floor dysfunction (PFD) and healthcare interactions among UK-based women with MS.

SETTING AND PARTICIPANTS

Women residing in the United Kingdom with MS were invited to participate in online interviews facilitated by the primary author.

ANALYSIS

A thematic framework analysis offering a structured yet adaptable approach to data collection and interpretation.

RESULTS

One focus group involving four women with MS and seven individual, one-to-one interviews with women with MS provided insights into the challenges associated with navigating both MS and PFD. Four main themes included: Navigating MS and PFD; Cycles of Control; Mind, Mobility and Bladder Embodiment; Silenced Voices: The Impact of Taboos/Stigma/Dismissal on Preventing Access and Resistance through Collective Community. Six subthemes were also identified. Taken together, these themes cumulatively reflect PFD as an unmet healthcare need.

CONCLUSION

Our findings underscore negative healthcare experiences, inadequate information provision and unmet needs related to PFD, emphasising the compounding effects of gender and disability biases.

IMPACT

We hope that these insights can lay the groundwork for developing tailored therapeutic interventions and improved PFD healthcare for women with MS. Potential solutions include using existing MS support communities.

PUBLIC CONTRIBUTIONS

Women with MS were actively involved in co-producing interview scripts for one-to-one interviews. The primary author shared study findings at an MS group event, engaging in discussions with over 30 individuals, including people with MS and their loved ones. MS advocates played a pivotal role in contextualising the study within the broader lived experience of MS.

Evaluating Modern Therapeutic Interventions for Migraine Management: A Systematic Review

This systematic review evaluates the efficacy and safety of contemporary migraine treatments, synthesizing evidence from recent randomized controlled trials (RCTs). The focus is on both pharmacological interventions, such as calcitonin gene-related peptide (CGRP) monoclonal antibodies and non-specific oral migraine preventives, and non-pharmacological approaches like myofascial release. Through a detailed examination of the studies, this review identifies superior strategies for acute and preventive migraine management, assessing their impact on patient-reported outcomes and determining the prevalence of associated adverse events. Findings suggest that while CGRP monoclonal antibodies show promise as first-line treatments due to their efficacy and safety, myofascial release offers considerable benefits for pain and disability in tension-type and cervicogenic headaches. Challenges such as the variability in individual response and potential side effects emphasize the need for personalized treatment plans. This review underscores the importance of integrating new therapeutic discoveries into clinical practice to enhance the quality of care for migraine sufferers.

Interactions Between Gastroesophageal Reflux Disease and Diabetes Mellitus: A Systematic Review of Pathophysiological Insights and Clinical Management Strategies

This systematic review elucidates the complex interplay between gastroesophageal reflux disease (GERD) and diabetes mellitus, integrating findings from various studies to highlight pathophysiological connections and effective clinical management strategies. Our examination reveals that mechanisms such as delayed gastric emptying and autonomic neuropathy significantly contribute to the exacerbation of GERD symptoms in diabetic patients, influencing clinical outcomes and treatment efficacy. The review underscores the necessity of multidisciplinary approaches in treating these comorbid conditions and advocates for therapeutic strategies that simultaneously address GERD and diabetes, such as the use of prokinetic agents and tailored surgical interventions like laparoscopic Roux-en-Y gastric bypass. This synthesis advances our understanding and proposes a foundation for future research and clinical practice, aiming to improve the quality of life and treatment outcomes for affected patients. This work contributes significantly to gastroenterology and endocrinology, providing a comprehensive resource for clinicians and researchers alike.

Harnessing policy to promote inclusive medical product evidence: development of a reference standard and structured audit of clinical trial diversity policies

ABSTRACT

Objective

To develop a reference standard based on US Food and Drug Administration and stakeholder guidance for pharmaceutical companies' policies on diversity in clinical trials and to assess these policies.

Design

Development of a reference standard and structured audit for clinical trial diversity policies.

Setting

50 pharmaceutical companies selected from the top 500 by their market capitalizations in 2021 (the 25 largest companies and 25 non-large companies, randomly selected from the remaining 475 companies).

Population

Data from pharmaceutical company websites and annual reports. Policy guidance from the Pharmaceutical Research and Manufacturers of America, International Federation of Pharmaceutical Manufacturers and Associations, Biotechnology Industry Organization, International Committee of Medical Journal Editors, the US Food and Drug Administration, European Medicines Agency, and World Health Organization, up to 15 May 2023.

Main outcome measures

Multicomponent measure based on distinct themes derived from FDA and stakeholder guidance.

Results

Reviewing FDA and stakeholder guidance identified 14 distinct themes recommended for improving diversity in clinical trials, which were built into a reference standard: (1) enrollment targets that reflect the prevalence of targeted conditions in populations, (2) broad eligibility criteria for trials, (3) diversity in the workforce, (4) identification and remedy of barriers to trial recruitment and retention, (5) incorporation of patient input into trial design, (6) health literacy, (7) multidimensional approaches to diversity, (8) sites with diverse providers and patient populations, (9) data collection after product approval, (10) diverse enrollment in every country where trials are conducted, (11) diverse enrollment should be a focus for all phases of clinical trials, not just later stage or pivotal trials, (12) varied trial design, (13) expanded access, and (14) public reporting of the personal characteristics of participants in trials. Applying this reference standard, 48% (24/50) of companies had no public policy on diversity in clinical trials; among those with policies, content varied widely. Large companies were more likely to have a public policy than non-large companies (21/25, 84% v 5/25, 20%, P<0.001). Large companies most frequently committed to using epidemiological based trial enrollment targets representing the prevalence of indicated conditions in various populations (n=15, 71%), dealing with barriers to trial recruitment (n=15, 71%), and improving patient awareness of trial opportunities (n=14, 67%). The location of the company was not associated with having a public diversity policy (P=0.17). The average company policy had five of the 14 commitments (36%, range 0-8) recommended in FDA and stakeholder guidance.

Conclusions

The findings of the study showed that many pharmaceutical companies did not have public policies on diversity in clinical trials, although policies were more common in large than non-large companies. Policies that were publicly available varied widely and lacked important commitments recommended by stakeholder guidance. The results of the study suggest that corporate policies can be better leveraged to promote representation and fair inclusion in research, and implementation of FDA and stakeholder guidance.

Participant diversity in ACER: 2010-2022

BACKGROUND

Increasing diversity has become a priority for all fields working with human subjects due to historic exclusions and misrepresentations of participants with minoritized identities. To create a more representative and generalizable science of alcohol use, the Research Society on Alcohol (RSA) and its official journal, Alcohol: Clinical and Experimental Research (ACER), have increasingly incorporated diversity and inclusion into their posted values and programming.

METHODS

We analyzed the content of articles published in ACER from 2010 through 2022 (6 years before and after the formation of RSA's Diversity Committee) to assess the reporting of participants' demographic information and whether there has been increased inclusion of diverse samples in alcohol research over time. Our team screened 3292 abstracts for data extraction; studies were included if they were primary analyses of data collected from human subjects (n = 1043).

RESULTS

Reporting of all demographic variables increased over time, with significant increases in reporting for race/ethnicity, sexual orientation, gender identity, socioeconomic status (SES), income, and educational attainment. Demographic variables were also increasingly used in analyses. However, representation of research outside the United States diminished significantly over time.

CONCLUSIONS

We provide recommended journal article reporting standards for ACER to continue the positive progress in reporting demographics in alcohol research and facilitate meta-analyses examining demographic modulation and the impact of social determinants of health.

Amplifying adolescent and emerging adult voices: Development of a pediatric-to-adult transition research advisory council

Background

Adolescents and emerging adults (AEA) with chronic health conditions may face numerous challenges when undergoing the transition from pediatric to adult health care. Despite the need for engagement with AEA in health research, little is known about how researchers operationalize this engagement. In an effort to enhance transparency in the practices of patient engagement, this commentary details the process of developing a pediatric-adult transition-specific youth advisory council in Alberta: the Transition Research Advisory Council (TRAC).

Objectives

We provide an overview of AEA engagement in health research and detail TRAC's recruitment and onboarding strategies. Moreover, TRAC members provided reflections on their motivations and experiences during the onboarding process.

Key recommendations

This commentary provides key recommendations for AEA council development, emphasizing equity, diversity, and inclusion principles, optimizing compensation plans, adopting an iterative engagement approach, fostering capacity-building and mentorship, and promoting empowerment in decision-making.

Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention

Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.

Trust in prenatal exome sequencing for expectant families facing unexplained fetal anomalies

OBJECTIVE

Despite exome sequencing (ES) becoming increasingly incorporated into the prenatal setting, few studies have elucidated motivations for and trust in ES and genomic research among a diverse cohort of patients and their partners.

METHODS

This is a qualitative study that involved semi-structured interviews with pregnant or recently pregnant individuals and their partners, interviewed separately, in the setting of ES performed through research for a fetal structural anomaly. All interview transcripts were coded thematically and developed by a multidisciplinary team.

RESULTS

Thirty-five individuals participated, the majority of whom (66%) self-identified as a racial or ethnic group underrepresented in genomic research. Many patients and their partners expressed trust in the healthcare system and research process and appreciated the extensive testing for information and closure. There were nonetheless concerns about data privacy and protection for individuals, including those underrepresented, who participated in genomic testing and studies.

CONCLUSION

Our findings illustrate important elements of motivation, trust and concern related to prenatal ES performed in the research setting, taking into account the perspectives not only of diverse and underrepresented study participants but also partners of pregnant individuals.

Equity Concerns Across Pediatric Research Recruitment: An Analysis of Research Staff Interviews

BACKGROUND AND OBJECTIVES

Difficulty recruiting individuals from minoritized and underserved populations for clinical research is well documented and has health equity implications. Previously, we reported findings from interviews with research staff about pediatric research recruitment processes. Respondents raised equity concerns related to recruitment and enrollment of participants from minoritized, low resourced, and underserved populations. We therefore decided to perform a secondary coding of the transcripts to examine equity-related issues systematically.

METHODS

We conducted a process of secondary coding and analysis of interviews with research staff involved in recruitment for pediatric clinical research. Through consensus we identified codes relevant to equity and developed a conceptual framework including 5 stages of research.

RESULTS

We analyzed 28 interviews and coded equity-related items. We report 6 implications of our findings. First, inequitable access to clinical care is an upstream barrier to research participation. Second, there is a need to increase research opportunities where underserved and under-represented populations receive care. Third, increasing research team diversity can build trust with patients and families, but teams must ensure adequate support of all research team members. Fourth, issues related to consent processes raise institutional-level opportunities for improvement. Fifth, there are numerous study procedure-related barriers to participation. Sixth, our analysis illustrates that individuals who speak languages other than English face barriers across multiple stages.

CONCLUSIONS

Research staff members identified equity-related concerns and recommended potential solutions across 5 stages of the research process, which may guide those endeavoring to improve research recruitment for pediatric patients from minoritized and underserved populations.

Treating the Uninsured and Underinsured with Migraine in the USA

PURPOSE OF REVIEW

To define, describe, and identify potential solutions for health disparities in the uninsured and underinsured with migraine in the USA.

RECENT FINDINGS

Uninsured and underinsured patients with migraine experience health disparities in diagnosis and treatment of migraine. Migraine patients have higher healthcare costs and higher employment disability, which contribute to a higher likelihood of uninsured or underinsured status. Uninsured or underinsured status, combined with factors such as race, socioeconomic status, geographic location, and care location, are correlated with delays in or decreased migraine diagnosis and treatment. Migraine prevalence is increased in the uninsured and underinsured. Potential solutions include advocacy for policy changes that improve access to care, increasing awareness and representation of underrepresented groups, providing resources to patients to reduce costs, and active patient engagement in migraine care. Continued efforts from all stakeholders have the potential to reduce health disparities in uninsured and underinsured patients with migraine, reducing disability and improving quality of life.

A qualitative study on opportunities to improve research engagement and inclusion of Black adults with systemic lupus erythematosus

In response to racial inequities in systemic lupus erythematosus (SLE), we aimed to identify practical recommendations for increasing engagement and inclusion of Black adults in SLE research. We used a qualitative, interpretive description approach and recruited 30 Black adults diagnosed with SLE in Michigan to participate in semi-structured interviews. Theme development focused on what factors influenced research perceptions and how research did not meet participant needs and expectations. We developed five main themes: (1) Ethical and equitable research. Participants shared how the impacts of past and present-day racism impacted their willingness to participate in research. (2) Trusting researchers to conduct studies and translate findings to health care. Participants had concerns related to researcher intentions and expressed the importance of communicating research outcomes to participants and translating findings to health care. (3) Drug trial beneficence. When considering drug trials, several people did not consider the potential benefits worth the risk of side effects, and some said they would need to consult with their doctor before agreeing to participate. (4) Altruism. Participants explained how the desire to help others was a motivating factor for participating in research and donating biological samples. (5) Research priorities. Participants described a need for better treatments that value their overall health and well-being. Findings indicate that researchers can center the perspectives of Black people with SLE across the research life cycle-beyond a focus on adequate racial diversity among study participants.

Patient diversity and author representation in clinical studies supporting the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock 2021: a systematic review of citations

BACKGROUND

The generalizability of the Surviving Sepsis Campaign (SSC) guidelines to various patient populations and hospital settings has been debated. A quantitative assessment of the diversity and representation in the clinical evidence supporting the guidelines would help evaluate the generalizability of the recommendations and identify strategic research goals and priorities. In this study, we evaluated the diversity of patients in the original studies, in terms of sex, race/ethnicity, and geographical location. We also assessed diversity in sex and geographical representation among study first and last authors.

METHODS

All clinical studies cited in support of the 2021 SSC adult guideline recommendations were identified. Original clinical studies were included, while editorials, reviews, non-clinical studies, and meta-analyses were excluded. For eligible studies, we recorded the proportion of male patients, percentage of each represented racial/ethnic subgroup (when available), and countries in which they were conducted. We also recorded the sex and location of the first and last authors. The World Bank classification was used to categorize countries.

RESULTS

The SSC guidelines included six sections, with 85 recommendations based on 351 clinical studies. The proportion of male patients ranged from 47 to 62%. Most studies did not report the racial/ ethnic distribution of the included patients; when they did so, most were White patients (68-77%). Most studies were conducted in high-income countries (77-99%), which included Europe/Central Asia (33-66%) and North America (36-55%). Moreover, most first/last authors were males (55-93%) and from high-income countries (77-99%).

CONCLUSIONS

To enhance the generalizability of the SCC guidelines, stakeholders should define strategies to enhance the diversity and representation in clinical studies. Though there was reasonable representation in sex among patients included in clinical studies, the evidence did not reflect diversity in the race/ethnicity and geographical locations. There was also lack of diversity among the first and last authors contributing to the evidence.

How can pharmacists better support patients with chronic diseases? The patient perspective

BACKGROUND

Patients' perceptions of their interaction with pharmacists can affect how they use this resource for chronic disease care.

OBJECTIVE

This qualitative study explored pharmacist-patient interactions and patients' perceptions of pharmacists' roles in cardiovascular disease (CVD) and inflammatory bowel disease (IBD).

METHODS

Patient volunteers, recruited through Janssen's Patient Engagement Research Council program, completed a 15-minute prework survey before a 90-minute live virtual focus group session to provide feedback on pharmacist-patient interactions, the pharmacist's role in patient care, and recommendations for improvement.

RESULTS

In total, 27 patients participated. Among patients with CVD (n=18), 56% were female, 61% aged ≥65 years, and 39%/39% Black/White. Of those with IBD (n=9), 56% were female, 89% aged 25-44 years, and 33%/56% Black/White. In the CVD cohort, patients conversed with their pharmacists at least monthly, on average. Patients were generally happy with their relationship with their pharmacist, viewing pharmacists as a trusted resource for medication information. Polypharmacy was common in the CVD cohort (mean, 10.8 medications). For patients with IBD, pharmacist-patient interactions were less frequent, relationships were generally perceived as transactional, patients took fewer medications (mean, 3.2), and felt uncomfortable discussing their disease in public. All patients (CVD and IBD) were unaware of pharmacists' medical training/knowledge. Recommendations included private spaces for sensitive conversations, phone/text support, in-depth regular check-ins, and proactive communication to highlight that the pharmacist's role is to provide patient-centered holistic care.

CONCLUSION

This research demonstrates a lack of understanding of pharmacist training, accessibility and role among patients with chronic disease, and highlights opportunities to amend delivery of care. These insights can be used to inform strategies and approaches tailored to address unique needs of specific patient populations to enhance pharmacist-patient interactions.

Patient perceptions of copay card utilization and policies

BACKGROUND

Copay cards are intended to mitigate patient out-of-pocket (OOP) expenses. This qualitative, exploratory focus group study aimed to capture patient perceptions of copay cards and copay adjustment programs (CAPs; insurers' accumulator and maximizer policies), which redirect the copay card utilization benefits intended for patients' OOP expenses.

METHODS

Patients with chronic conditions were recruited through Janssen's Patient Engagement Research Council program. They completed a survey and attended a live virtual session to provide feedback on copay cards.

RESULTS

Among 33 participants (median age, 49 years [range, 24-78]), the most frequent conditions were cardiovascular-metabolic disease and inflammatory bowel disease. Patients associated copay cards with lessening financial burden, improving general and mental health, and enabling medication adherence. An impact on medication adherence was identified by 10 (63%) White and nine (100%) Black respondents. Some patients were unaware of CAPs despite having encountered them; they recommended greater copay card education and transparency about CAPs.

CONCLUSION

Patients relied on copay cards to help afford their prescribed medication OOP expenses and maintain medication adherence. Use of CAPs may increase patient OOP expenses. Patients would benefit from awareness programs and industry - healthcare provider partnerships that facilitate and ensure access to copay cards.

Race, Racism, and Respiratory Health

The study and practice of pulmonary medicine have been profoundly influenced by race theory, which was ascendant at the time of key developments within the specialty. We explore how, as a social determinant of health, race remains a powerful driver of present-day health disparities in respiratory diseases. Both legacy and contemporary inequities are identified through Dr DR Williams's model of cultural, structural, and interpersonal racism.

Enhancing diversity of clinical trial populations in multiple sclerosis

BACKGROUND

Demographic characteristics, social determinants of health (SDoH), health inequities, and health disparities substantially influence the general and disease-specific health outcomes of people with multiple sclerosis (MS). Participants in clinical trials do not represent all people with MS treated in practice.

OBJECTIVE

To provide recommendations for enhancing diversity and inclusion in clinical trials in MS.

METHODS

We held an international workshop under the Auspices of the International Advisory Committee on Clinical Trials in MS (the "Committee") to develop recommendations regarding diversity and inclusivity of participants of clinical trials in MS. Workshop attendees included members of the Committee as well as external participants. External participants were selected based on expertise in trials, SDoH, health equity and regulatory science, and diversity with respect to gender, race, ethnicity, and geography.

RESULTS

Recommendations include use of diversity plans, community engagement and education, cultural competency training, biologically justified rather than templated eligibility criteria, adaptive designs that allow broadening of eligibility criteria over the course of a trial, and logistical and practical adjustments to reduce study participant burden. Investigators should report demographic and SDoH characteristics of participants.

CONCLUSION

These recommendations provide sponsors and investigators with methods of improving diversity and inclusivity of clinical trial populations in MS.

Tutorial: Using Community Engagement Studios to Enhance Pharmacogenetic Study Design for Maximizing Enrollment of Diverse Children and Pregnant People

Most pharmacogenetic research is conducted in adult, non-pregnant populations of European ancestry. Study of more diverse and special populations is necessary to validate findings and improve health equity. However, there are significant barriers to recruitment of diverse populations for genetic studies, such as mistrust of researchers due to a history of unethical research and ongoing social inequities. Engaging communities and understanding community members' perspectives may help to overcome these barriers and improve research quality. Here, we highlight one method for engaging communities, the Community Engagement Studio (CES), a consultative session that allows researchers to obtain guidance and feedback based on community members' lived experiences. We also provide an example of its use in pharmacogenetic studies. In designing a survey study of knowledge and attitudes around pharmacogenetic testing among children with chronic conditions and pregnant individuals, we sought input from diverse community stakeholders through CESs at Vanderbilt University Medical Center. We participated in two CESs with community stakeholders representing study target populations. Our goals were to learn specific concerns about pharmacogenetic testing and preferred recruitment strategies for these communities. Concerns were expressed about how genetic information would be used beyond the immediate study. Participants emphasized the importance of clarity and transparency in communication to overcome participation hesitancy and mistrust of the study team. Recruitment strategy recommendations ranged from informal notices posted in healthcare settings to provider referrals. The CES enabled us to modify our recruitment methods and research materials to better communicate with populations currently under-represented in pharmacogenetics research.