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Britez Ferrante E, Blady S, Sheu D, Maitra MR, Drakes J, Lieberman A, Mussell A, Bair EF, Hearn CM, Thorbecke L, Zhu J, Kohn R. Operationalizing Equity, Inclusion, and Access in Research Practice at a Large Academic Institution. J Gen Intern Med 2024; 39:1037-1047. [PMID: 38302812 DOI: 10.1007/s11606-023-08539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Healthcare advances are hindered by underrepresentation in prospective research; sociodemographic, data, and measurement infidelity in retrospective research; and a paucity of guidelines surrounding equitable research practices. OBJECTIVE The Joint Research Practices Working Group was created in 2021 to develop and disseminate guidelines for the conduct of inclusive and equitable research. METHODS Volunteer faculty and staff from two research centers at the University of Pennsylvania initiated a multi-pronged approach to guideline development, including literature searches, center-level feedback, and mutual learning with local experts. RESULTS We developed guidelines for (1) participant payment and incentives; (2) language interpretation and translation; (3) plain language in research communications; (4) readability of study materials; and (5) inclusive language for scientific communications. Key recommendations include (1) offer cash payments and multiple payment options to participants when required actions are completed; (2) identify top languages of your target population, map points of contact, and determine available interpretation and translation resources; (3) assess reading levels of materials and simplify language, targeting 6th- to 8th-grade reading levels; (4) improve readability through text formatting and style, symbols, and visuals; and (5) use specific, humanizing terms as adjectives rather than nouns. CONCLUSIONS Diversity, inclusion, and access are critical values for research conduct that promotes justice and equity. These values can be operationalized through organizational commitment that combines bottom-up and top-down approaches and through partnerships across organizations that promote mutual learning and synergy. While our guidelines represent best practices at one time, we recognize that practices evolve and need to be evaluated continuously for accuracy and relevance. Our intention is to bring awareness to these critical topics and form a foundation for important conversations surrounding equitable and inclusive research practices.
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Affiliation(s)
- Emma Britez Ferrante
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shira Blady
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Dorothy Sheu
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Medha Romee Maitra
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
- University of Georgia, Athens, GA, USA
| | - Josiah Drakes
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
- Xavier University of Louisiana, New Orleans, LA, USA
| | - Adina Lieberman
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Mussell
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth F Bair
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Caleb M Hearn
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leo Thorbecke
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Digital Health, Penn Medicine Center for Health Care Innovation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Kohn
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Torres P, Guitelman J, Lucio A, Rini C, Molina Y. Medical Advocacy among Latina Women Diagnosed with Breast Cancer. Int J Environ Res Public Health 2024; 21:495. [PMID: 38673406 PMCID: PMC11049890 DOI: 10.3390/ijerph21040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Medical advocacy has continued to significantly impact quality of life and survivorship outcomes among Latina breast cancer survivors in the United States. However, little is known about the unique experiences of Latina survivors, including the perceived value, process, and context in which they practice medical advocacy. To help address this gap, we conducted a qualitative, secondary analysis of semi-structured focus groups with 18 Latina breast cancer survivors from Chicago, Illinois. Eligible women had to self-identify as (1) female, (2) Latina, (3) 18 years or older, and (4) having a breast cancer diagnosis 5 years ago or more. In total, 61% of participants were 50-59 years old, 83% were born in Mexico, and 100% spoke Spanish. The three emergent themes from the focus groups were (1) the cultural need for Latina advocates and support groups; (2) the process and experiences of becoming a community advocate within Latine culture; and (3) the cultural contexts for advocacy by Latina breast cancer survivors. Latina survivor advocates share strengths of receiving ongoing health education, peer support, and access to resources when being linked to a support group furthering their exposure to role models, increasing their awareness of opportunities in medical advocacy, and providing an entry to participate in medical advocacy.
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Affiliation(s)
- Paola Torres
- University of Illinois Cancer Center, University of Illinois, Chicago, IL 60612, USA;
| | - Judith Guitelman
- Asociación Latina de Asistencia y Prevención del Cáncer de Mama (ALAS-WINGS), Chicago, IL 60657, USA;
| | | | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yamilé Molina
- University of Illinois Cancer Center, University of Illinois, Chicago, IL 60612, USA;
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
- Hospital & Health Sciences Systems Mile Square Health Center, University of Illinois, Chicago, IL 60612, USA
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Shaaban CE, Lin HS, Terry M, Ren D, Lingler JH. COVID-19 pandemic's relationship with enrollment at US Alzheimer's Disease Research Centers. Alzheimers Dement 2024; 20:2408-2419. [PMID: 38298163 PMCID: PMC11032582 DOI: 10.1002/alz.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We aimed to characterize the COVID-19 pandemic's relationship with enrollment in US Alzheimer's Disease Research Centers (ADRCs). METHODS Using data on 10,105 participants from 30 ADRCs, we conducted interrupted time series analyses to assess the relationship of the pandemic with enrollment and calculate projected dates of enrollment recovery. RESULTS Participants enrolled during the pandemic (vs pre-pandemic) were more likely to have dementia and be referred by health professionals. The pandemic was associated with a 77% drop in enrollment, with projected trend recovery in March 2024 and 100% recovery in September 2024. COVID was associated with a 91% drop in Black/African American participants, compared to 71% in White participants. Enrollment of both Hispanic and female participants was declining 1.4% and 0.3%/month pre-pandemic. DISCUSSION Funders and researchers should account for ongoing COVID-19 impact on ADRD research enrollment. Strategies to speed enrollment recovery are needed, especially for Black/African American and Hispanic groups. HIGHLIGHTS Tested COVID pandemic association with enrollment at Alzheimer's Disease Research Centers. During versus pre-pandemic enrollees differed on demographic and clinical variables. Interrupted time series analyses: immediate 77% drop in enrollment related to COVID. Recovery projections: trend recovery in March 2024, 100% recovery in September 2024. Enrollment of African American and Hispanic participants should be prioritized.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Hsing‐Hua Sylvia Lin
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Anesthesiology & Perioperative MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Melita Terry
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Neurology, School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dianxu Ren
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jennifer H. Lingler
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
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Rao BR, Dickert NW, Morris AA. Ethical Complexity of Medical Treatment Affordability and Clinical Trial Diversity in Heart Failure. Circ Cardiovasc Qual Outcomes 2024; 17:e010227. [PMID: 38377226 DOI: 10.1161/circoutcomes.123.010227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Birju R Rao
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
| | - Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.)
| | - Alanna A Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
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Pollock KG, Dickerson C, Kainth M, Lawton S, Hurst M, Sugrue DM, Arden C, Davies DW, Martin AC, Sandler B, Gordon J, Farooqui U, Clifton D, Mallen C, Rogers J, Hill NR, Camm AJ, Cohen AT. Undertaking multi-centre randomised controlled trials in primary care: learnings and recommendations from the PULsE-AI trial researchers. BMC Prim Care 2024; 25:7. [PMID: 38166641 PMCID: PMC10759575 DOI: 10.1186/s12875-023-02246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Conducting effective and translational research can be challenging and few trials undertake formal reflection exercises and disseminate learnings from them. Following completion of our multicentre randomised controlled trial, which was impacted by the COVID-19 pandemic, we sought to reflect on our experiences and share our thoughts on challenges, lessons learned, and recommendations for researchers undertaking or considering research in primary care. METHODS Researchers involved in the Prediction of Undiagnosed atriaL fibrillation using a machinE learning AlgorIthm (PULsE-AI) trial, conducted in England from June 2019 to February 2021 were invited to participate in a qualitative reflection exercise. Members of the Trial Steering Committee (TSC) were invited to attend a semi-structured focus group session, Principal Investigators and their research teams at practices involved in the trial were invited to participate in a semi-structured interview. Following transcription, reflexive thematic analysis was undertaken based on pre-specified themes of recruitment, challenges, lessons learned, and recommendations that formed the structure of the focus group/interview sessions, whilst also allowing the exploration of new themes that emerged from the data. RESULTS Eight of 14 members of the TSC, and one of six practices involved in the trial participated in the reflection exercise. Recruitment was highlighted as a major challenge encountered by trial researchers, even prior to disruption due to the COVID-19 pandemic. Researchers also commented on themes such as the need to consider incentivisation, and challenges associated with using technology in trials, especially in older age groups. CONCLUSIONS Undertaking a formal reflection exercise following the completion of the PULsE-AI trial enabled us to review experiences encountered whilst undertaking a prospective randomised trial in primary care. In sharing our learnings, we hope to support other clinicians undertaking research in primary care to ensure that future trials are of optimal value for furthering knowledge, streamlining pathways, and benefitting patients.
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Affiliation(s)
| | | | | | - Sarah Lawton
- School of Medicine, Keele University, Staffordshire, UK
| | - Michael Hurst
- Bristol Myers Squibb Pharmaceutical Ltd, Uxbridge, UK
| | | | - Chris Arden
- University Hospital Southampton, Southampton, UK
| | | | - Anne-Céline Martin
- Service de Cardiologie, Université de Paris, Innovative Therapies in Haemostasis, INSERM, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, France
| | | | - Jason Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK.
| | | | - David Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | | | | | - Nathan R Hill
- Bristol Myers Squibb Pharmaceutical Ltd, Uxbridge, UK
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Alexander T Cohen
- Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, King's College London, London, UK
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6
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Warner E, Marron JM, Peppercorn JM, Abel GA, Hantel A. Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research. J Clin Ethics 2024; 35:8-22. [PMID: 38373334 PMCID: PMC10983799 DOI: 10.1086/728144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.
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Eberts JD, Zimmer-Harwood P, Elsey JWB, Fraser-Urquhart A, Smiley T. Volunteering for Infection: Participant Perspectives on a Hepatitis C Virus Controlled Human Infection Model. Clin Infect Dis 2023; 77:S224-S230. [PMID: 37579204 PMCID: PMC10425139 DOI: 10.1093/cid/ciad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Ethical human subjects research requires participants to be treated safely and respectfully, yet much bioethical debate takes place without participants. We aim to address this gap in the context of controlled human infection model (CHIM) research. Based upon our own experience as study participants, and bolstered by a survey of 117 potential hepatitis C virus CHIM participants, we present ideas to inform efficient, ethical, and scientifically useful study design. We advocate for full protocol transparency, higher compensation, commitment to the rapid dissemination of study results, and proactive efforts to detail risk-minimization efforts as early as possible in the recruitment process, among other measures. We encourage researchers to proactively partner with volunteer advocacy organizations that promote collective representation of volunteers to maximize their agency, and guard against ethical issues arising from healthy human subjects research.
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Affiliation(s)
| | - Paul Zimmer-Harwood
- 1Day Sooner, Lewes, Delaware, USA
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - James W B Elsey
- Surveys and Data Analysis Department, Rethink Priorities, San Francisco, California, USA
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Croft RL, Byrd CT. A pilot study of an online self-compassion intervention for adults who stutter. Int J Speech Lang Pathol 2023:1-14. [PMID: 37572047 DOI: 10.1080/17549507.2023.2236813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
PURPOSE The primary aim of this pilot study was to determine the preliminary effectiveness of an online self-compassion intervention for improving self-compassion and quality of life in adults who stutter. A secondary aim was to determine intervention acceptability and participant satisfaction. METHOD Participants included adults who stutter who completed an online self-compassion module once a week for six consecutive weeks. Pre- and post-intervention measures included the Self-Compassion Scale-Trait and the Overall Assessment of the Speaker's Experience of Stuttering. Participants also completed acceptability questionnaires weekly and post-intervention via quantitative and qualitative reports. RESULT Ten participants completed all six intervention modules, as well as pre- and post-intervention measures. Participants reported increased self-compassion and improved quality of life at post-intervention, as well as high intervention acceptability with regard to delivery format, content, duration, and relevance to stuttering and daily life. Individual variation was also observed across acceptability domains. CONCLUSION The present study provides pilot data supporting the use of online modules to increase self-compassion and decrease the negative impact of stuttering on the quality of life among adults who stutter. Future studies should employ larger sample sizes, compare outcomes to a control group, and determine if gains are maintained over time.
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Affiliation(s)
- Robyn L Croft
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Courtney T Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, USA
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Gabel M, Denny A, Llibre-Guerra J, Morris JC, Phillips J, Vaidyanathan A. Remuneration and Recruitment of Study Participants for AD Cohort Studies From the General Public and From Minority Communities. Alzheimer Dis Assoc Disord 2023; 37:107-112. [PMID: 37145978 PMCID: PMC10239367 DOI: 10.1097/wad.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/12/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Offering remuneration for participation in studies of aging and Alzheimer Disease (AD) may improve recruitment, particularly among minoritized and low-income groups. But remuneration may also raise ethical problems and reduce altruistic motivations for participation. METHODS A nationally representative sample of Americans (N=2030) with large (N=500) Black and Hispanic oversamples was asked about willingness to participate in a longitudinal AD cohort study after random assignment of remuneration ($0, $50/visit, $100/visit). Respondents were then asked about their perceived burden, risks, and societal contribution from participation. RESULTS An offer of remuneration increased willingness to participate, with no difference between $50 and $100. The increase was similar across racial, ethnic, and income groups. Remuneration did not affect perceived risks or altruistic benefits. Compensation caused Whites and Hispanics, but not Blacks, to lower the perceived burden. DISCUSSION Modest levels of remuneration are likely to improve recruitment to AD research studies without causing collateral ethical or motivation problems. Remuneration does not differentially enhance minority recruitment.
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Kusunose M, Muto K. Public attitudes toward cloud computing and willingness to share personal health records (PHRs) and genome data for health care research in Japan. Hum Genome Var 2023; 10:11. [PMID: 36990988 PMCID: PMC10060394 DOI: 10.1038/s41439-023-00240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 03/31/2023] Open
Abstract
Japan's government aims to promote the linkage of medical records, including medical genomic testing data and personal health records (PHRs), via cloud computing (the cloud). However, linking national medical records and using them for health care research can be controversial. Additionally, many ethical issues with using cloud networks with health care and genome data have been noted. However, no research has yet explored the Japanese public's opinions about their PHRs, including genome data, being shared for health care research or the use of the cloud for storing and analyzing such data. Therefore, we conducted a survey in March 2021 to clarify the public's attitudes toward sharing their PHRs, including genome data and using the cloud for health care research. We analyzed data to experimentally create digital health basic literacy scores (BLSs). Our results showed that the Japanese public had concerns about data sharing that overlapped with structural cloud computing issues. The effect of incentives on changes in participants' willingness to share data (WTSD) was limited. Instead, there could be a correlation between WTSD and BLSs. Finally, we argue that it is vital to consider not only researchers but also research participants as value cocreators in health care research conducted through the cloud to overcome both parties' vulnerability.
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Affiliation(s)
- Mayumi Kusunose
- The Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan.
- The Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan.
| | - Kaori Muto
- The Department of Public Policy, The Institute of Medical Sciences, The University of Tokyo, Tokyo, Japan
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Jimenez DE, Weinstein ER, Batsis J. You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men. Pilot Feasibility Stud 2023; 9:32. [PMID: 36855194 PMCID: PMC9972624 DOI: 10.1186/s40814-023-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Older Latinos living with the human immunodeficiency virus (HIV) have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. These health disparities are largely related to lifestyle and are either preventable or amenable to early detection or intervention. Despite existing resources to deliver an intervention to reduce this compounded health disparity, there is little information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. The Happy Older Latinos are Active (HOLA) intervention is an innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the HOLA health promotion intervention for older HIV-positive Latino men. METHODS/DESIGN HOLA, which is informed by Behavioral Activation and Social Learning theory is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW for 45 min, 3×/week for 16 weeks; (3) pleasant events (e.g., going to brunch with friends) scheduling. Eighteen community dwelling Latinos living with HIV aged 50+ will be recruited for this feasibility study adapting the HOLA intervention. Participants will be assessed at three time points (baseline, post-intervention, and 3 months post-intervention) on measures of cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning, and health-related quality of life. CONCLUSIONS If HOLA can be delivered successfully by CHWs, then the scalability, accessibility, and potential for dissemination is increased. Additionally, this study will inform feasibility and identify modifications needed in the design of a larger hypothesis testing study. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03839212. Date of Registration: 8 February, 2019.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA.
| | | | - John Batsis
- Division of Geriatric Medicine, Department of Medicine and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Kraft SA, Rohrig A, Williams A, Shah SK. Better recognition for research participants: what society should learn from covid-19. BMJ 2023; 380:e071178. [PMID: 36649969 DOI: 10.1136/bmj-2022-071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Abie Rohrig
- Department of Philosophy, Swarthmore College, Swarthmore, Pennsylvania, USA
- Research Ethics Team, 1Day Sooner, Delaware, USA
| | - Anthony Williams
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA States
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Moore JX, Anderson LN, Li C, Benson RD, Rychtarikova AG, Williamson LD, Wolf LE, Whisenant EB, Roark E, Jones SR, Ledford CJ. Toward equitable payment for inclusive participation. J Clin Transl Sci 2023; 7:e58. [PMID: 37008619 PMCID: PMC10052444 DOI: 10.1017/cts.2023.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 03/03/2023] Open
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Schneider FH, Campos-Mercade P, Meier S, Pope D, Wengström E, Meier AN. Financial incentives for vaccination do not have negative unintended consequences. Nature 2023; 613:526-533. [PMID: 36631607 PMCID: PMC9833033 DOI: 10.1038/s41586-022-05512-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/02/2022] [Indexed: 01/13/2023]
Abstract
Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1-11, but a large academic literature warns against using them12-16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17-24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.
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Affiliation(s)
| | - Pol Campos-Mercade
- Lund University, Lund, Sweden.
- University of Copenhagen, Copenhagen, Denmark.
| | | | - Devin Pope
- University of Chicago Booth School of Business, Chicago, IL, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Erik Wengström
- Lund University, Lund, Sweden
- Hanken School of Economics, Helsinki, Finland
| | - Armando N Meier
- Unisanté and Lausanne Center for Health Economics, Behavior, and Policy (LCHE), University of Lausanne, Lausanne, Switzerland.
- Faculty of Business and Economics, University of Basel, Basel, Switzerland.
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15
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Fox AW. The Pharmaceutical Year That Was, 2022. Pharmaceut Med 2022. [DOI: 10.1007/s40290-022-00448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Largent EA, Eriksen W, Barg FK, Greysen SR, Halpern SD. Participants' Perspectives on Payment for Research Participation: A Qualitative Study. Ethics Hum Res 2022; 44:14-22. [PMID: 36316972 PMCID: PMC9631331 DOI: 10.1002/eahr.500147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Investigators commonly offer payments to research participants to promote recruitment and retention. Yet the ethics of offering monetary incentives to research participants continues to be debated. Prior conceptual work has addressed some of these concerns; there is, however, also a need for empirical evidence to understand the effects of payment on participants. Here, we report the results of a qualitative study comprising (1) discourse analysis of recruitment conversations between study coordinators and potential participants for an actual clinical trial and (2) semistructured interviews with participants addressing the effects of an incentive on their decision-making. Many participants reported that money had been a motivation for enrolling in the clinical trial but did not use reasoning that suggested undue influence or unjust inducement. These findings add to a growing body of literature suggesting that payment is an ethically acceptable tool for promoting recruitment and retention in clinical trials.
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Affiliation(s)
- Emily A Largent
- Bioethicist in the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine
| | - Whitney Eriksen
- Qualitative researcher in the Department of Family Medicine and Community Health at the University of Pennsylvania Perelman School of Medicine
| | - Frances K Barg
- Medical anthropologist in the Department of Family Medicine and Community Health at the University of Pennsylvania Perelman School of Medicine
| | - S Ryan Greysen
- Hospitalist and health services researcher in the Section of Hospital Medicine at the Center for Evidence-Based Practice at the University of Pennsylvania Perelman School of Medicine
| | - Scott D Halpern
- Intensivist and health services researcher in the Department of Medicine and the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine
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Griffith Fillipo IR, Pullmann MD, Hull TD, Zech J, Wu J, Litvin B, Chen S, Arean PA. Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types. Front Digit Health 2022; 4:963741. [PMID: 36148211 PMCID: PMC9485564 DOI: 10.3389/fdgth.2022.963741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Numerous studies have found that long term retention is very low in remote clinical studies (>4 weeks) and to date there is limited information on the best methods to ensure retention. The ability to retain participants in the completion of key assessments periods is critical to all clinical research, and to date little is known as to what methods are best to encourage participant retention. To study incentive-based retention methods we randomized 215 US adults (18+ years) who agreed to participate in a sequential, multiple assignment randomized trial to either high monetary incentive (HMI, $125 USD) and combined low monetary incentive ($75 USD) plus alternative incentive (LMAI). Participants were asked to complete daily and weekly surveys for a total of 12 weeks, which included a tailoring assessment around week 5 to determine who should be stepped up and rerandomized to one of two augmentation conditions. Key assessment points were weeks 5 and 12. There was no difference in participant retention at week 5 (tailoring event), with approximately 75% of the sample completing the week-5 survey. By week 10, the HMI condition retained approximately 70% of the sample, compared to 60% of the LMAI group. By week 12, all differences were attenuated. Differences in completed measures were not significant between groups. At the end of the study, participants were asked the impressions of the incentive condition they were assigned and asked for suggestions for improving engagement. There were no significant differences between conditions on ratings of the fairness of compensation, study satisfaction, or study burden, but study burden, intrinsic motivation and incentive fairness did influence participation. Men were also more likely to drop out of the study than women. Qualitative analysis from both groups found the following engagement suggestions: desire for feedback on survey responses and an interest in automated sharing of individual survey responses with study therapists to assist in treatment. Participants in the LMAI arm indicated that the alternative incentives were engaging and motivating. In sum, while we were able to increase engagement above what is typical for such study, more research is needed to truly improve long term retention in remote trials.
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Affiliation(s)
- Isabell R. Griffith Fillipo
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- University of Washington SMART Center, Seattle, WA, United States
| | - Thomas D. Hull
- Research and Development, Talkspace, New York, NY, United States
| | - James Zech
- Research and Development, Talkspace, New York, NY, United States
| | - Jerilyn Wu
- Research and Development, Talkspace, New York, NY, United States
| | - Boris Litvin
- Research and Development, Talkspace, New York, NY, United States
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Patricia A. Arean
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- Correspondence: Patricia A. Areán
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Abdelazeem B, Abbas KS, Amin MA, El-Shahat NA, Malik B, Kalantary A, Eltobgy M. The effectiveness of incentives for research participation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0267534. [PMID: 35452488 DOI: 10.1371/journal.pone.0267534] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/10/2022] [Indexed: 01/21/2023] Open
Abstract
Background Recruitment plays a vital role in conducting randomized control trials (RCTs). Challenges and failure of proper recruitment lead to early termination of trials. Monetary incentives have been suggested as a potential solution to these challenges. Therefore, we aimed to do a systematic review and analysis to evaluate the effect of incentives on the number of participants willing to consent to and participate in RCTs. Methods Electronic databases were systematically searched from inception to September 23rd, 2021, using the following keywords: payments, incentive, response, participation, enrollment, randomized, randomization, and RCT. The Cochrane Risk of Bias tool was used to assess the quality of the included trials. Risk ratios (RRs) were calculated with their corresponding 95% confidence interval (CI). All analyses were done with the random-effects model. We used Revman software to perform the analysis. Results Six RCTs with 6,253 Participants met the inclusion criteria. Our analysis showed significant improvement in response rate (RR: 1.27; 95% CI: 1.04, 1.55; P = 0.02) and consent rates (RR: 1.44; 95% CI: 1.11, 1.85; P = 0.006) when an incentive payment was offered to participants. Even a small amount of incentive showed significant improvement in both consent (RR: 1.33; 95% CI: 1.03, 1.73; P = 0.03) and response rates (RR: 1.26; 95% CI: 1.08, 1.47; P = 0.004). Conclusion In conclusion, our meta-analysis demonstrated statistically significant increases in the rate of consent and responses from participants when offered even small monetary value incentives. These findings suggest that incentives may be used to reduce the rate of recruitment failure and subsequent study termination. However, further RCTs are needed to establish a critical threshold beyond which incentive amount does not alter response rates further and the types of RCTs in which financial incentives are likely to be effective.
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Polonijo AN, Dubé K, Galea JT, Greene KY, Taylor J, Christensen C, Brown B. Attitudes Toward Payment for Research Participation: Results from a U.S. Survey of People Living with HIV. AIDS Behav 2022; 26:3267-3278. [PMID: 35386050 PMCID: PMC9474466 DOI: 10.1007/s10461-022-03660-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
Abstract
Little is known about how payment affects individuals' decisions to participate in HIV research. Using data from a U.S. survey of people living with HIV (N = 292), we examined potential research participants' attitudes toward payment, perceived study risk based on payment amount, and preferred payment forms, and how these factors vary by sociodemographic characteristics. Most respondents agreed people should be paid for HIV research participation (96%) and said payment would shape their research participation decisions (80%). Men, less formally educated individuals, and members of some minoritized racial-ethnic groups were less likely to be willing to participate in research without payment. Higher payment was associated with higher perceived study risks, while preferences for form of payment varied by age, gender, education, race-ethnicity, and census region of residence. Findings suggest payment may influence prospective research participants' risk-benefit calculus and participation, and that a one-size-fits-all approach to payment could differentially influence participation among distinct sociodemographic groups.
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Affiliation(s)
- Andrea N. Polonijo
- grid.266096.d0000 0001 0049 1282Department of Sociology and the Health Sciences Research Institute, University of California, Merced, 5200 North Lake Road, Merced, CA 95343 USA
| | - Karine Dubé
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jerome T. Galea
- grid.170693.a0000 0001 2353 285XSchool of Social Work, University of South Florida, Tampa, FL USA ,grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, Tampa, FL USA ,grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard University, Boston, MA USA
| | - Karah Yeona Greene
- grid.170693.a0000 0001 2353 285XSchool of Social Work, University of South Florida, Tampa, FL USA
| | - Jeff Taylor
- HIV+Aging Research Project–Palm Springs, Palm Springs, CA USA
| | | | - Brandon Brown
- grid.266097.c0000 0001 2222 1582Department of Social Medicine, Population and Public Health, University of California, Riverside, Riverside, CA USA
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20
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OUP accepted manuscript. International Journal of Pharmacy Practice. [DOI: 10.1093/ijpp/riac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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