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Loo S, Brady KJS, Ragavan MI, Griffith KN. Validation of the Clinicians' Cultural Sensitivity Survey for Use in Pedatric Primary Care Settings. J Immigr Minor Health 2023:10.1007/s10903-023-01469-2. [PMID: 36966449 PMCID: PMC10330110 DOI: 10.1007/s10903-023-01469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/27/2023]
Abstract
Incorporating cultural sensitivity into healthcare settings is important to deliver high-quality and equitable care, particularly for marginalized communities who are non-White, non-English speaking, or immigrants. The Clinicians' Cultural Sensitivity Survey (CCSS) was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients; however, this instrument has not been adapted for use in pediatric primary care. Our objective was to examine the validity and reliability of a modified CCSS that was adapted for use with parents of pediatric patients. A convenience sampling approach was used to identify eligible parents during well-child visits at an urban pediatric primary care clinic. Parents were administered the CCSS via electronic tablet in a private location. We first conducted exploratory factor analyses (EFAs) to explore the dimensionality of survey responses in the adapted CCSS, and then conducted a series of confirmatory factor analyses (CFAs) using maximum likelihood estimation based on the results of the EFAs. Exploratory and confirmatory factor analyses (N = 212 parent surveys) supported a three-factor structure assessing racial discrimination ([Formula: see text]=0.96), culturally-affirming practices ([Formula: see text]=0.86), and causal attribution of health problems ([Formula: see text]=0.85). In CFAs, the three-factor model also outperformed other potential factor structures in terms of fit statistics including scaled root mean square error approximation (0.098), Tucker-Lewis Index (0.936), Comparative Fit Index (0.950), and demonstrated adequate fit according to the standardized root mean square residual (0.061). Our findings support the internal consistency, reliability, and construct validity of the adapted CCSS for use in a pediatric population.
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Affiliation(s)
- Stephanie Loo
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Keri J S Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Maya I Ragavan
- Department of Pediatrics, University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Kevin N Griffith
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
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Vella E, White VM, Livingston P. Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature. NURSE EDUCATION TODAY 2022; 118:105500. [PMID: 35964378 DOI: 10.1016/j.nedt.2022.105500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/02/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the impact of cultural competence training for health professionals on patient outcomes. METHOD A systematic review of cultural competence training interventions for healthcare workers including papers published January 2010 to January 2021, identified through MEDLINE, CINAHL, ERIC and APA PsychINFO. Health conditions were not specified, however, only studies reporting patient outcomes were included. Training frameworks and delivery, measures of health professional cultural competence, and patient outcomes were reviewed. RESULTS Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. RESULTS Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. PRACTICE IMPLICATIONS To ascertain the benefits of health professional cultural competence training on patient outcomes, research needs to address the issues of definition, theoretical frameworks and implementation approaches to training.
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Affiliation(s)
| | - Victoria M White
- School of Psychology, Faculty of Health, Deakin University, Burwood 3125, Australia
| | - Patricia Livingston
- School of Psychology, Faculty of Health, Deakin University, Burwood 3125, Australia
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Rollins A, Wandell G, Epstein S, Bonilla-Velez J. Evaluating Patient and Family Experience Among Spanish-Speaking and LatinX Patients: a Scoping Review of Existing Instruments. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01371-x. [PMID: 35913545 DOI: 10.1007/s40615-022-01371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION LatinX populations are rapidly growing in the USA, but still report lower levels of patient centered care and satisfaction when compared to their non-LatinX white counterparts. This review encompasses literature which describes patient experience instruments that (1) evaluate LatinX experience, (2) have validated Spanish versions, or (3) measure language-concordant care experiences. METHODS A scoping review of literature in Ovid Medline, CINAHL, and PsycINFO was conducted. Articles were excluded if they were not applicable to the health care industry, did not include a patient experience instrument, or did not include LatinX or Spanish-speaking individuals within their study population. Data extraction was performed for concepts measured, study size, population, health care setting, and languages validated. RESULTS This review identified 224 manuscripts. Of these, 81 met full inclusion criteria and represented 60 unique instruments. These covered six categories: general patient experience (43%, n = 26/60), experiences of discrimination/mistrust (12%, n = 7/60), cultural factors (10%, n = 6/60), patient-provider relationship (10%, n = 6/60), and communication (8%, n = 5/60). The remaining instruments measured multiple categories (17%, n = 10/60). Just over one third of instruments (n = 24, 5 pediatric, 19 adult) were validated in Spanish and an additional 14 (23%) were validated in English alone. Finally, 4 (7%) instruments were identified which were developed for use in a language concordant setting. CONCLUSION Many instruments were identified which evaluate LatinX patient experience; however, none was both validated in Spanish and measured in all key categories of experience described above. Additionally, few instruments were developed for holistic evaluation of patient experience in pediatric or language concordant care settings.
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Affiliation(s)
- Allison Rollins
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Grace Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA. .,Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail Stop OA.9.220, Seattle, WA, 98105, USA. .,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
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Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality. Acad Pediatr 2020; 20:234-240. [PMID: 31857250 PMCID: PMC8177736 DOI: 10.1016/j.acap.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents' perspectives about the extent to which their children's pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality. METHODS We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians' Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality. RESULTS Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (-0.49; CI: -0.89, -0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22). CONCLUSIONS Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.
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Aghajari P, Valizadeh L, Zamanzadeh V, Ghahramanian A, Foronda C. Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method. Scand J Caring Sci 2019; 33:609-620. [PMID: 30628722 DOI: 10.1111/scs.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing. AIMS The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran. METHODS The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed. RESULTS In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing. CONCLUSION With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.
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Affiliation(s)
- Parvaneh Aghajari
- Department of Pediatric Nursing, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Cynthia Foronda
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Amirehsani KA, Hu J, Wallace DC, Silva ZA, Dick S, West-Livingston LN, Hussami CR. US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis. J Community Health Nurs 2018; 34:126-135. [PMID: 28767292 DOI: 10.1080/07370016.2017.1340556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hispanics in the United States experience significant health disparities. Using focus groups conducted in Spanish, we explored the perspectives of 172 Hispanic adults regarding their healthcare experiences. Many participants were women (64.5%) and primarily from Mexico (80%). Four major qualitative themes emerged: (a) provide us with information, (b) want attentive and respectful relationships, (c) want better care, and (d) perceived discrimination. Suboptimal patient-provider interactions were described. Research is needed to explore interventions that address these issues. Incorporating person-centered care principles and practices such as clear and understandable communication, culturally competent care, and customer service skills may benefit provider interactions with Hispanics.
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Affiliation(s)
- Karen A Amirehsani
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Jie Hu
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Debra C Wallace
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Zulema A Silva
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Sarah Dick
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Lauren N West-Livingston
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
| | - Christina R Hussami
- a School of Nursing , The University of North Carolina at Greensboro , Greensboro , North Carolina
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Ghiasuddin A, Wong J, Siu AM. Ethnicity, traditional healing practices, and attitudes towards complementary medicine of a pediatric oncology population receiving healing touch in Hawaii. Asia Pac J Oncol Nurs 2015; 2:227-231. [PMID: 27981117 PMCID: PMC5123507 DOI: 10.4103/2347-5625.158015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: Cultural competence among healthcare providers is becoming increasingly important. Hawai’i is an ethnically diverse island state that has a high rate of traditional and complementary medicine use. We previously reported on the feasibility of delivering Healing Touch (HT) to pediatric oncology patients, and its impact on pain, distress and fatigue. Our current objective is to examine the ethnic and cultural characteristics of this patient population, including traditional health related beliefs. Methods: Demographic data and feedback from subjects and their families from the 2009-2010 HT study conducted in Honolulu were analyzed. Results: The majority of the participants were Asian American and/or Native Hawaiian or other Pacific Islander. Almost half of the participants were more than one race. Traditional cultural health related beliefs, as reported by patients and families, sometimes aligned with patient's experiences with HT, however, degree of acculturation/time living in the United States seemed to play a role as well, with younger generation perhaps being less “traditional”. Common health related themes/values across the predominant cultures were 1) emphasis on family/clan and 2) mind/body connection. Conclusions: HT appeared to be well accepted by subjects from a variety of ethnic backgrounds. Several patients had attitudes/beliefs around healthcare that were rooted in their traditional cultural values, but this was not universal. Knowledge of different cultural attitudes on health, and traditional/complementary medicine, will improve patient care. Future areas of research could examine the acceptance of HT among pediatric oncology patients in geographic areas with differing cultural demographics (i.e., continentalUnited States or internationally).
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Affiliation(s)
- Asad Ghiasuddin
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Joyce Wong
- Department of Child Life, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Andrea M Siu
- Research Institute, Hawaii Pacific Health, Honolulu, HI, USA
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Stewart AL, Thrasher AD, Goldberg J, Shea JA. A framework for understanding modifications to measures for diverse populations. J Aging Health 2012; 24:992-1017. [PMID: 22495768 PMCID: PMC3768261 DOI: 10.1177/0898264312440321] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Research on health disparities and determinants of health disparities among ethnic minorities and vulnerable older populations necessitates use of self-report measures. Most established instruments were developed on mainstream populations and may need adaptation for research with diverse populations. Although information is increasingly available on various problems using these measures in diverse groups, there is little guidance on how to modify the measures. A framework of issues to consider when modifying measures for diverse populations is presented. METHODS The authors describe reasons for considering modifications, the types of information that can be used as a basis for making modifications, and the types of modifications researchers have made. Recommendations are made to test modified measures to assure their appropriateness, and suggestions are provided on reporting modifications in publications using the measures. DISCUSSION The issues open a dialogue about what appropriate guidelines would be for researchers adapting measures in studies of ethnically diverse populations.
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Affiliation(s)
- Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 502-5207,
| | - Angela D Thrasher
- Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, 315 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440, Phone: 919-843-9293,
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle VA and the University of Washington School of Public Health, Box 359780, 1730 Minor Avenue, Suite 1760, Seattle, WA 98105-1597, Phone: 206 543-4667,
| | - Judy A. Shea
- University of Pennsylvania, School of Medicine, Division of General Internal Medicine, 1223 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, Phone: 215 573-5111,
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Pharmacists' provision of information to Spanish-speaking patients: a social cognitive approach. Res Social Adm Pharm 2012; 9:4-12. [PMID: 22554399 DOI: 10.1016/j.sapharm.2012.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hispanics with limited English proficiency face communication challenges that affect medication use and outcomes. Pharmacists are poised to help patients' use medications safely and effectively; however, scant research has explored factors that may impact pharmacists' communication with Spanish-speaking patients (SSPs). OBJECTIVE Guided by social cognitive theory (SCT), the purpose of this study was to examine the relationships between pharmacy environmental factors, pharmacists' cognition, and pharmacists' communication with SSPs. METHODS A cross-sectional survey used a vignette to quantify the amount of information pharmacists would provide to an SSP. Pharmacy environmental factors (language-assistance resources, Spanish-speaking staff, and number of SSPs) and pharmacists' cognition (self-efficacy beliefs and cultural sensitivity) that may influence communication also were assessed. The relationships between environmental factors, cognition, and pharmacists' communication with SSPs, including indirect relationships, were examined using composite indicator structural equation (CISE) modeling. RESULTS Of the 183 respondents, most were white (91%) and male (63%) with a mean age of 47 years (SD = 12.77). The CISE modeling revealed that the number of SSPs served by the pharmacy and the pharmacist's self-efficacy in communicating with SSPs were significantly directly associated with pharmacist's provision of information to SSPs. Two environmental factors (presence of interpreter services and Spanish-speaking staff) operated indirectly through self-efficacy to significantly impact the provision of information. CONCLUSIONS Study findings identify both environmental factors and cognition that could contribute to pharmacists' communication behavior with SSPs. Thus, future interventions to improve pharmacists' communication with SSPs may include training pharmacists to integrate interpretative services and Spanish-speaking staff into service delivery and strengthening pharmacists' self-efficacy beliefs.
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Santoyo-Olsson J, Phan L, Stewart AL, Kaplan C, Moreno-John G, Nápoles AM. A randomized trial to assess the effect of a research informational pamphlet on telephone survey completion rates among older Latinos. Contemp Clin Trials 2012; 33:624-7. [PMID: 22449837 DOI: 10.1016/j.cct.2012.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/05/2012] [Accepted: 03/10/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE OF THE STUDY To assess the effects of receiving a research informational pamphlet produced by the federal Office for Human Research Protections on telephone survey participation rates of older Latinos, and illustrate the feasibility of nesting recruitment studies within other funded studies when stand alone funding for recruitment studies is limited. DESIGN AND METHODS Latino patients aged ≥50 with ≥1 visit during the preceding year (N=1314) were sampled from three community clinics and a multi-specialty medical group. Patients were randomly assigned to receive or not receive a pamphlet that contained information on research participation in the initial mailing for the telephone survey study. Survey participation rates were compared between the pamphlet and no pamphlet groups. RESULTS In a multivariate model, women (OR=1.4; 95% CI 1.1, 1.8), and those with public insurance (vs. no insurance; OR=1.7; 95% CI 1.1, 2.5) were more likely to participate, while those age 65+ (vs. age 50-54; OR=0.6; 95% CI 0.4, 0.8) were less likely to participate; there was no significant difference by pamphlet group (OR=0.8; 95% CI 0.7, 1.1). Nesting of the randomized trial of the recruitment pamphlet within the funded study required minimal additional resources. IMPLICATIONS Recruitment methods that are more intensive than a pamphlet may be needed to enhance survey participation rates among older Latinos. Nesting recruitment trials within funded studies is a promising and efficient approach for testing recruitment strategies.
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Affiliation(s)
- Jasmine Santoyo-Olsson
- Medical Effectiveness Research Center for Diverse Populations, the Center for Aging in Diverse Communities, Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94118-0856, USA.
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Tritter J. Editorial. Health Expect 2012; 15:1-2. [DOI: 10.1111/j.1369-7625.2012.00776.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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