Attaining gender and ethnic diversity in health intervention research: cultural responsiveness versus resource provision

Current status of inclusion of black subjects in neuropsychological studies: A scoping review and call to action

In recognition that insufficient diversity in research impedes the generalizability of findings and negatively impacts clinical outcomes, the 1993 National Institutes of Health (NIH) Revitalization Act required NIH-funded clinical trials to include and assess outcomes for women and minority participants. Since that time, the American Psychological Association (APA) and the American Academy of Clinical Neuropsychology (AACN) have also acknowledged the reporting of this information as an essential element of research, and they have established similar aspirational goals. Nevertheless, Black communities remain disproportionately underrepresented in neuropsychology research. The objective of this study was to investigate current levels of inclusion and reporting of Black research participation in neuropsychological studies.

Publications from high impact neuropsychology journals between 2019-2020 were selected via established methodologies. Studies were analyzed to determine the rates of demographic inclusion and reporting of minority, particularly Black, participants.

A total of 1,764 articles were reviewed across seven neuropsychology journals. Of the 653 studies not excluded for other reasons, 43% neglected to include sufficient information about participants' race/ethnicity. Of the subset of eligible studies that did include racial/ethnic demographic information (n = 349), only 61% included any Black participants at all. Only 34.1% of them included enough Black participants equal to or greater than the proportion of Black individuals within the United States.

Setting a standard of routinely reporting and analytically reflecting on demographic information is necessary to make valid inferences regarding disease sequelae, treatment, and public health strategies. The authors offer specific recommendations to improve the inclusion and reporting of Black research participation, ensure compliance with established policies, and improve the quality of neuropsychological research.

Health Equity Among Black Women in the United States

Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved.

HIV/AIDS in Asian and Pacific Islander Communities in the United States: A Follow-up Review and Analysis with Recommendations for Researchers and Practitioners

A steady increase in the spread of HIV in Asian and Pacific Islander (API) communities in the United States has been reported in the new millennium. This article provides an update on Yep's earlier synthesis of research on HIV/AIDS in API communities in the United States [1], and offers recommendations for further theoretical work and community interventions. First, the AIDS Risk Reduction Model (ARRM) is introduced and described. Second, using ARRM as an organizing framework, behavioral research on API HIV/AIDS published since 1992–93 is reviewed and synthesized. Third, the ARRM is examined for its appropriateness for API communities. Finally, recommendations are offered for researchers and practitioners doing HIV education and prevention work in U.S. API communities in the coming decade.

AIDS in any community of color involves a thorough discourse on AIDSphobia, racism, homophobia, sex(uality), sexism, classism, and other social diseases that compose the total realities of the pandemic…. The AIDS crisis in Asian America is riddled with complexities [2, pp. 201–202].

The development of Asian American responses to the HIV/AIDS epidemic has been a struggle for visibility and particularity within an epidemic in which Asians and Pacific Islanders were first invisible and then seen as monocultural by dominant institutions [3, p. 63].

Considerations of Methodological Approaches in the Recruitment and Retention of Immigrant Participants

OBJECTIVE

This study aims to identify effective strategies related to recruitment and retention of immigrant survey participants.

METHODOLOGY

The study used a multi-mode approach in, first, conducting a literature review of recent articles on surveys that either targeted immigrants or included large numbers of immigrants in their samples. Next, six surveys were reviewed that either targeted or included large numbers of immigrants. Finally, expert opinions on immigration were gathered regarding recruitment and retention of immigrant survey participants.

RESULTS

Although immigrants may be difficult to recruit due to limited English proficiency, mistrust of strangers, and/or high mobility, many of these challenges can be overcome by adopting the same strategies used when surveying ethnically diverse populations (e.g., snowballing versus advertisement, establishing a personal connection with data collectors). Nonetheless, a few practices were identified as most relevant for recruitment and retention of immigrant populations, including involving local community organizations relevant to immigrants, translation of materials tailored to the vernacular language of the various ethnicities, and customizing non-monetary incentives to the specific ethnicity.

CONCLUSIONS

Based on the reviews and expert interviews, multiple strategies have been shown to be effective in recruiting and retaining immigrant participants.

Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers

BACKGROUND

Although the challenges of working with culturally and linguistically diverse groups can lead to the exclusion of some communities from research studies, cost effective strategies to encourage access and promote cross-cultural linkages between researchers and ethnic minority participants are essential to ensure their views are heard and their health needs identified. Using bilingual research assistants is one means to achieve this. In a study exploring alcohol and other drug service use by migrant women in Western Australia, bilingual workers were used to assist with participant recruitment and administration of a survey to 268 women who spoke more than 40 different languages.

DISCUSSION

Professional interpreters, bilingual students, bilingual overseas-trained health professionals and community sector bilingual workers were used throughout the research project. For the initial qualitative phase, professional interpreters were used to conduct interviews and focus group sessions, however scheduling conflicts, inflexibility, their inability to help with recruitment and the expense prompted exploration of alternative options for interview interpreting in the quantitative component of the study. Bilingual mature-age students on work placement and overseas-trained health professionals provided good entry into their different community networks and successfully recruited and interviewed participants, often in languages with limited interpreter access. Although both groups required training and supervision, overseas-trained health professionals often had existing research skills, as well as understanding of key issues such as confidentiality and referral processes. Strategies to minimise social desirability bias and the need to set boundaries were discussed during regular debriefing sessions. Having a number of workers recruiting participants also helped minimise the potential for selection bias. The practical and educational experience gained by the bilingual workers was regarded as capacity building and a potentially valuable community resource for future health research projects.

SUMMARY

The use of bilingual workers was key to the feasibility and success of the project. The most successful outcomes occurred with students and overseas-trained health professionals who had good community networks for recruitment and the required linguistic skills. By describing the advantages and disadvantages encountered when working with bilingual workers, we offer practical insights to assist other researchers working with linguistically diverse groups.

The alliance in relationship education programs

Couple relationship education (CRE) programs are associated with positive romantic relationship outcomes; however, the mechanisms by which these gains occur are less understood. The current study (122 couples) utilized actor-partner modeling to examine the association between the therapeutic alliance and dedication and negative and positive communication for racial/ethnic minority couples. Additionally, we examined whether gender and delivery format moderated these relationships. Results demonstrated that both men's and women's alliance scores were significantly related to their own outcomes. Higher ratings of alliance were related to partner outcomes for men only. The association between partners' alliance and dedication outcomes was stronger within the group format as compared to the couple format. Implications for leaders of CRE programs are offered.

The generalizability of a participant registry for minority health research

PURPOSE

Effective strategies to recruit minority elders into health research (e.g., through churches, partnering with community gatekeepers) often involve nonrandom sampling methods. The current study has two aims: (a) to examine some new practices in recruitment of African American elders and (b) to determine the similarities and differences of the volunteers in the Healthier Black Elders (HBE) Participant Resource Pool (PRP), with a population-based community sample from the Detroit Health Needs Assessment (Chapleski, E. E. (2002). Facing the future: City of Detroit needs assessment). Detroit, MI: Wayne State University.

DESIGN AND METHODS

A community-based participatory research approach was used to establish the HBE as an educational and support program in Detroit and to use HBE to launch a research participant registry of older Black adults. Data were drawn from a community-based telephone survey of 723 older African American elders aged 60 years and older recruited into the PRP registry.

RESULTS

PRP participants had some differences from those in the Detroit Health Needs Assessment. These included that older women had a significantly higher participatory rate compared with their male counterparts. African American women in the PRP reported a modestly healthier life with less disability compared with their Detroit Health Needs Assessment counterparts, whereas for men, it was the reverse for chronic diseases. The PRP was able to attract a significantly higher percentage of older old compared with the population = based survey.

IMPLICATIONS

Study findings suggest that the HBE approach of recruiting African American elders in health research appears effective and to have some unique strengths.

Recruitment and retention strategies in longitudinal clinical studies with low-income populations

BACKGROUND

Conducting longitudinal research studies with low-income and/or minority participants present a unique set of challenges and opportunities.

PURPOSE

To outline the specific strategies employed to successfully recruit and retain participants in a longitudinal study of nutritional anticipatory guidance during early childhood, conducted with a low-income, ethnically diverse, urban population of mothers.

METHODS

We describe recruitment and retention efforts made by the research team for the 'MOMS' Study (Making Our Mealtimes Special). The 'multilayered' approach for recruitment and retention included commitment of research leadership, piloting procedures, frequent team reporting, emphasis on participant convenience, incentives, frequent contact with participants, expanded budget, clinical staff buy-in, a dedicated phone line, and the use of research project branding and logos.

RESULTS

Barriers to enrollment were not encountered in this project, despite recruiting from a low-income population with a large proportion of African-American families. Process evaluation with clinic staff demonstrated the perception of the MOMS staff was very positive. Participant retention rate was 75% and 64% at 6 months and 12 months post-recruitment, respectively. We attribute retention success largely to a coordinated effort between the research team and the infrastructure support at the clinical sites, as well as project branding and a dedicated phone line.

CONCLUSIONS

Successful participant recruitment and retention approaches need to be specific and consistent with clinical staff buy in throughout the project.

Psychometric testing of the Immigrant Barriers to Health Care Scale: Hispanic Version

Barriers to care contribute to health inequities for immigrant populations. Although inadequate health insurance is a known barrier, other factors impact the issue. Few instruments exist to specifically measure these other barriers. The purpose of this study was to test the Immigrant Barriers to Health Care Scale - Hispanic Version. It was first pilot-tested in southern California with a Mexican population. After refinement, the instrument was tested in a north-eastern sample of diverse Hispanic adults. The data were analyzed using exploratory factor analysis. Factor loadings and communalities were used to assess the adequacy of the scale's items. Six items were deleted due to ambiguous factor loadings. The final 11 items loaded onto four factors and explained 54.58% of the variance. The coefficient alpha was 0.81 for the instrument. The Immigrant Barriers to Health Care Scale is a reliable and valid tool. Its further use and reporting with other socially and economically disadvantaged groups is advised.

Early life experiences and their impact on our understanding of depression

This paper presents part of a larger Grounded Theory study, which was designed to capture a sample of people's perceptions of living with or, caring for, individuals with depression. Data were collected from a focus group consisting of people with depression (n = 7). In-depth one-to-one interviews were undertaken with eight further respondents (n = 8). Purposeful sampling was used initially. Thereafter, in keeping with one of the key tenets of grounded theory, theoretical sampling was used. The emergent concepts were pursued until saturation occurred. The constant comparative approach was used to analyse the data together with the NVivo qualitative analysis software package. This paper focuses on the respondents' perceptions of the pre-diagnosis, depression encounter. The key category that emerged was 'the pre-diagnosis phase of depression and the now experience'. Five key themes surfaced within this category: (1) negative impact significant life events; (2) self-blame; (3) personal characteristics; (4) pre-diagnosis, depression unknowingness; and (5) pre-help seeking. The findings suggest that those in the field of human services need to better understand the lived experience of people with depression, in order to provide holistic treatment and care.

Naming of depression: nursing, social and personal descriptors

This paper explores descriptors of depression and begins by exploring nursing descriptors including the nature of assessment and nursing diagnosis and progresses to underpin these major processes by considering social descriptors such as cultural and spiritual constructs. The role and influence of stigma is discussed and an examination of gender influences and experiences is undertaken. The paper concludes by examining personal descriptors in the literature. The overall aim of the paper is (1) to add to nursing knowledge by depicting the grounded realities of the experience of depression and (2) stimulate discussion on the need to provide holistic care pathways that are responsive to the uniqueness of this lived experience and finally to (3) encourage further research on key psycho-social factors associated with depression and the concurring advancement of nursing care. This paper has been completed in the context of an ongoing study into the grounded experience of 'Depression' and the development of a psychiatric nursing theory of connectivity.

Mutual moral caring actions: a framework for community nursing practice

A community practice framework is presented as the synthesis of research findings from the analysis of a critical ethnonursing study of women in recovery from chemical dependence. Critical Social Theory is used to examine the paradoxical experiences of women from their lifeworld and system within the community. The framework focuses on the mutual moral caring actions of the community nurse and the women in the recovery. It is supported by the concepts of transcultural nursing ethics. The utility of the framework is to promote clarity of speech and parity of community membership for women in recovery from chemical dependence and their return to the community.

Recruiting Blacks to the Adventist Health Study: Do Follow-up Phone Calls Increase Response Rates?

PURPOSE

To determine whether follow-up phone calls improve response rates to a long questionnaire among black and white subjects.

METHODS

Forty black and 39 white Seventh-day Adventist churches were randomized to experimental or control status in a 2:1 ratio favoring the intervention, which is a follow-up phone call to certain church members. Subjects selected from each church were those who had signed up for the Adventist Health Study-2 but not returned a questionnaire 3 months after promotion began. Further returns from a church over the next 3 months, and this increment as a proportion of baseline response, were assessed using t-tests and Poisson regression, respectively.

RESULTS

Comparing black experimental and control churches, the mean difference was 5.5 returned questionnaires per church (p < 0.01). Among white churches the mean difference was 3.0 (ns). The baseline-adjusted increment, however, was greater by a factor of 3.37 (95% confidence interval, 1.92, 5.93) in the black experimental relative to control churches, but among white experimental churches was 13% (ns) lower than controls. This difference in response by ethnic group was statistically significant (p < 0.01).

CONCLUSION

Follow-up phone calls improved response rates among black subjects only.

Normative health research experiences among African American elders

OBJECTIVE

Data are meager regarding the prevalence of participation and the overall experience of African American elders in research across a variety of health-related studies. This study sought to increase our knowledge about older African Americans' participation in health research by capturing some of their normative experiences and attitudes.

METHODS

A telephone-based survey was conducted on 1,290 urban African Americans greater than or equal to 60 years old. The assessment focused on issues of housing, neighborhoods, health, and experiences with health research.

RESULTS

The overall prevalence of respondents who took part in a health research project was 14%. Significant predictors included income, attitudes about fairness, perceptions of protection from harm, understanding of research as a key to improving health care, and participation in survey research.

DISCUSSION

Findings underscore the importance of addressing economic, educational, and trust barriers to research participation as well as the importance of conveying a sense of caring for the health of individuals and the community as a whole.

Demographic differences between consenters and non-consenters in an obstetric anesthesiology clinical study

Willingness to participate in obstetric anesthesiology clinical studies may be influenced by age, parity or ethnicity. This study was designed to determine whether there were demographic differences between consenters and non-consenters in a minimum local analgesic concentration clinical study. Four hundred and fifty-two women were approached for the study and the age, ethnicity and parity of patients who consented or declined to participate were collected. Ethnicity was categorized as Asian or Pacific Islander, black, Hispanic, white, or other. Parametric data were analyzed using t-tests and non-parametric data using chi(2) tests. There were no significant differences in the consent rate based on age or parity. Black Americans were more likely to consent than Asian Americans (P<0.001) and as likely to consent as white Americans. There were no statistically significant differences in the consent rate between Caucasian and Asian Americans. More studies are needed to determine the socioeconomic and demographic factors that affect consent rates of labor patients.

Othering and being othered in the context of health care services

Othering is a process that identifies those that are thought to be different from oneself or the mainstream, and it can reinforce and reproduce positions of domination and subordination. Although there are theoretical and conceptual treatments of othering in the literature, researchers lack sufficient examples of othering practices that influence the interactions between patients and health care providers. The purpose of this study was to explore the interactions between health care providers and South Asian immigrant women to describe othering practices and their effects. Ethnographic methods were used involving in-depth interviews and focus group discussions. The analysis entailed identifying uses of othering and exploring the dynamics through which this process took place. Women shared stories of how discriminatory treatment was experienced. The interviews with health care professionals provided examples of how views of South Asian women shaped the way health care services were provided. Three forms of othering were found in informants' descriptions of their problematic health care encounters: essentializing explanations, culturalist explanations, and racializing explanations. Women's stories illustrated ways of coping and managing othering experiences. The analysis also revealed how individual interactions are influenced by the social and institutional contexts that create conditions for othering practices. To foster safe and effective health care interactions, those in power must continue to unmask othering practices and transform health care environments to support truly equitable health care.

Acculturation and perinatal outcomes in Mexican immigrant childbearing women: an integrative review

Despite several sociocultural factors associated with increased risk for low birth weight and infant mortality, the rate for infants born to first-generation and less acculturated Mexican immigrant women is the same as that of non-Hispanic whites, and half that of African Americans with similar risks. It appears that sociocultural rather than genetic variables are the primary factors associated with this phenomenon. Higher levels of acculturation to North American values and lifestyle in Mexican American childbearing women have been correlated with poor perinatal outcomes, including low birth weight. Acculturation is emerging as an important variable that should be considered when providing health care to Mexican immigrant childbearing women and their families.

Incorporating multiculturalism into oncology nursing research: the last decade

PURPOSE/OBJECTIVES

To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000.

DATA SOURCES

Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded.

DATA SYNTHESIS

Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education.

CONCLUSIONS

Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations.

IMPLICATIONS FOR NURSING

Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.

A model for the delivery of culturally competent community care

AIM

To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model.

BACKGROUND

Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community-based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities.

METHODS

Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes.

CONCLUSIONS

The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.

Obtaining family consent for participation in Alzheimer's research in a Cuban-American population: strategies to overcome the barriers

Cultural values and beliefs affect family attitudes toward participation in research. Significant resistance to allowing their elders with dementia to participate in clinical research was encountered in Cuban-American families. These families expressed concern about disturbing the elder's comfort (tranquilidad) and solitude (soledad). Furthermore, most believed that intervention would be futile. Feelings of guilt associated with nursing home placement may have been exacerbated by the suggestion that active intervention could be effective. Strategies to overcome these barriers included reduced emphasis on the potential superiority of the intervention to be tested, reassurance that contact with research staff was usually appreciated by participants, arrangements to talk with the family as a group about the study, and increased use of Spanish-language consent forms.