Money talks? Party financial incentives to promote underrepresented groups

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The cost of providing medical care is increasing. The driving forces include inherent health care system conflicts of interest and financial incentives for procedures and technology. Effective lifestyle medicine principles are not easily adopted and rewarded in the present environment. Recent moves toward outcomes-based pay systems offer the potential to demonstrate the effectiveness of lifestyle medicine principles while bypassing many of the biases, application delays, and political machinations of the traditional randomized control trial methodology. The American College of Lifestyle Medicine is uniquely positioned to be a leading organization in improving health, enhancing patient experience, and reducing the cost of care.

Progress in clinical trial research depends on effective recruitment to ensure adequate sample sizes and generalizability of results. Electronic health record (EHR)-based recruitment has been suggested as a potential method to address historical imbalances in trial populations, including underrepresentation of certain racial and ethnic groups. However, disparities in EHR portal uptake and use exist, particularly among these same underrepresented groups. Thus, we hypothesized that EHR-driven recruitment for research may continue to exacerbate these dynamics. In this study, we evaluated whether a financial incentive improved response rates to recruitment messages delivered through an EHR portal in an equitable fashion. A random sample of 1200 patients with diagnoses of breast, colorectal, prostate, or lung cancer and active EHR patient portal accounts received an automated recruitment message for a fictitious cross-sectional survey study, "The Social Aspects of Cancer Care," via their EHR portal. Two strata of patients were sampled, those who identified as non-Hispanic White individuals (n=600, 50%) and those who identified as part of a historically underrepresented racial or ethnic group (n=600, 50%), and randomized to receive an offer of a US $20 monetary incentive (n=400, 33.3%) or no incentive (n=800, 66.7%). Patients were given 14 days to respond. Overall, 39.3% (471/1200) of participants viewed the recruitment message, and 13.3% (159/1200) responded that they were interested. Response rates were higher (P<.001) among non-Hispanic White patients (108/600, 18%) than among African American or Black patients (32/456, 7%) and members of other racial or ethnic groups (18/144, 12.5%). Older patients (≥65 years) were less likely to view the recruitment message (244/720, 33.9% vs 230/480, 47.9%; P=.001) and respond (72/720, 10% vs 82/480, 17.1%; P=.002). Sex was not significantly associated with viewing the message or response outcomes (P=.45 and P=.19, respectively). No differences were observed in response rate for the incentive cohort compared to the cohort with no incentive (60/400, 15% vs 96/800, 12%; P=.21). Patients with cancer who identify as part of a historically underrepresented group were less likely to view and respond to recruitment messages for research studies through their EHR patient portal. Age was also found to significantly impact engagement, with older patients less likely to view and respond. Finally, a modest US $20 financial incentive was not found to significantly impact patient engagement.

Calls to diversify the professoriate have been ongoing for decades. However, despite increasing numbers of scholars from underrepresented racial minority groups earning doctorates, actual progress in transitioning to faculty has been slow, particularly across STEM disciplines. In recent years, new efforts have emerged to recruit faculty members from underrepresented racial minority groups (i.e., African American/Black, Hispanic/Latinx, and/or Native American/Native Hawaiian/Indigenous) through highly competitive postdoctoral programs that allow fellows the opportunity to transition (or “convert”) into tenure-track roles. These programs hybridize some conventional aspects of the faculty search process (e.g., structured interview processes that facilitate unit buy-in) along with novel evidence-based practices and structural supports (e.g., proactive recruitment, cohort communities, search waivers, professional development, enhanced mentorship, financial incentives). In this policy and practice review, we describe and synthesize key attributes of existing conversion programs at institutional, consortium, and system levels. We discuss commonalities and unique features across models (N = 38) and draw specific insights from postdoctoral conversion models developed within and across institutions in the University System of Maryland (USM). In particular, experience garnered from a 10-year-old postdoc conversion program at UMBC will be highlighted, as well as the development of an additional institutional model aimed at the life sciences, and a state-system model of faculty diversification with support from a NSF Alliances for Graduate Education and the Professoriate (AGEP) grant.

To evaluate recruitment strategies that enhance enrollment in nursing education programs, with a focus on global perspectives. Many countries face nursing shortages. Recruitment strategies, such as financial incentives, early exposure programs and mentorship, aim to address these shortages. However, their effectiveness varies across contexts, necessitating a systematic review of evidence. A systematic review following PRISMA guidelines, Institute of Medicine (IOM) standards and Joanna Briggs Institute (JBI) methodology. A comprehensive search was conducted in PubMed, MEDLINE, SCOPUS, CINAHL and ERIC for peer-reviewed studies published in English between 2014 and 2024. Studies reporting on recruitment interventions and outcomes such as enrollment rates, diversity metrics, or career perceptions were included. Quality assessment was performed using JBI tools and findings were synthesized thematically. Fifteen studies from eight countries highlighted that strategies such as simulation, role-playing, mentorship and early exposure programs effectively increased interest in nursing, particularly among underrepresented groups. Motivating factors included job security and the perception of nursing as a caring profession, while barriers such as gender stigma, cultural misconceptions and financial constraints persisted. Public campaigns and culturally sensitive mentorship improved recruitment, particularly among South Asian male nurses. Most studies used questionnaires to assess effectiveness, emphasizing the need for standardized evaluation. A multi-level approach integrating financial support, inclusive messaging, mentorship and long-term career pathways is essential for recruitment. This review provides a global perspective on best practices and underscores the need for standardized evaluation.

ObjectiveEven though the growing prevalence of Parkinson’s disease (PD) is inclusive of ethnic and racial minority groups, these populations remain underrepresented in PD clinical research. This community-based study seeks to add to the limited knowledge on barriers and facilitators to underrepresented group (URG) enrollment in PD trials by assessing minority community members’ PD and research knowledge, trust in medical researchers, and likelihood to participate in research based on various study design factors.ResultsOf the 97 total workshop participants, 80 completed demographic information, with the majority female (71%) and from minority racial groups -- African American/Black (37.5%) and East/Southeast Asian (45%). Levels of trust in medical researchers were generally high and improved post-workshop. Most respondents were likely to participate in trials requiring DNA or cognitive testing, and unlikely if requiring intravenous infusion or lumbar puncture. Facilitators to trial participation included offering transportation and financial incentives, while longer study visits and study duration were barriers.

In the United States, the United Kingdom and other developed countries university outreach initiatives have been developed to promote progression in STEM subjects and increase uptake of STEM among women, poorer students and minority groups who are currently severely underrepresented on many post compulsory and undergraduate STEM courses. Research indicates that young people often dis-identify with STEM subjects and careers at an early age and highlights the importance of adult figures in motivating young people’s engagement. During the past two decades in the United Kingdom and the United States, university students have been widely used by universities to support STEM outreach work with younger students. These student ambassadors are generally assumed to act as positive role models for school students because of their proximity in age and life stage, and are widely seen as able to contribute to valuable STEM learning opportunities and to support progression in these subject areas. This chapter draws on findings from two research studies, in the UK and US, exploring student ambassador STEM outreach activity with school age students, including the settings and content of activities and how ambassadors are matched with younger students. The studies reveal the potential of ambassadors to challenge younger students’ self-identities in relation to STEM, but also identify problems of organising and funding outreach to effectively engage large numbers of young people from underrepresented groups. In the UK, university outreach activity is often located in administration and marketing departments with limited involvement of academic faculties, which can mean that the pedagogical aspect of activities are overlooked. In the US, while recruitment is still a focus, funding incentives and an emphasis on public engagement have led to increased engagement of academics and consideration of learning and teaching in outreach activity at some institutions. This chapter points to the need for a sharper focus on pedagogy, particularly in UK contexts, and an increased focus in both countries on outreach practice that effectively supports identification between student ambassadors and younger students whilst reaching wider audiences of young people. The chapter highlights the need for increased collaboration across universities to identify and support best practice and promote effective and far reaching student ambassador STEM outreach activity.

BackgroundLower socioeconomic status (SES) groups, particularly lower SES males, are at greater risk of alcohol-related harm than higher SES groups, despite drinking at the same level or less. However, they are rarely recruited for research through typical recruitment strategies. Consequently, limited evidence exists on patterns of alcohol use and effectiveness of public health messages for these groups. Using workplaces to recruit male drinkers from lower SES backgrounds may provide a feasible and accessible approach to research participation and enable improved understanding of alcohol use, drinking motives and acceptance of alcohol-related public health messages in this underrepresented and high-risk group. We investigated workplace-based strategies to recruit male drinkers from lower SES backgrounds. We also investigated their experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages.MethodsA feasibility element investigated the effectiveness of workplace-based strategies to recruit male drinkers from lower SES backgrounds in the south west of England. A pilot element investigated this population’s experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages, through a mixed-methods survey.ResultsFeasibility results indicated that workplace-based recruitment strategies, including recruiting participants in person at their workplace and providing a financial incentive, effectively led to the recruitment of 84 male drinkers (70% recruitment rate), predominately from lower SES backgrounds, to a survey. Pilot results indicated that more than half of participants were at increasing risk of alcohol-related harm, and approximately one fifth engaged in weekly heavy episodic drinking. Participation in campaigns aimed at reducing alcohol use, and knowledge of government alcohol consumption guidelines, were low. Participants reported negative beliefs about alcohol including health effects, dependency and excess use, and financial and occupational effects. Positive beliefs about alcohol included relaxation, socialising, and enjoyment.ConclusionsWorkplace-based recruitment, using in-person recruitment and a financial incentive, may be a feasible strategy to recruit male drinkers from lower SES backgrounds. Pilot results may direct larger scale research aiming to understand alcohol use in this population and inform targeted public health messages. Workplace-based recruitment may represent a promising avenue for future research aiming to tackle inequalities in participation in alcohol research.

Achieving Diversity in Academic Internal Medicine: Recommendations for Leaders

Contents: Series preface Introduction. Part I Meaning of Death: Is it time to abandon brain death?, R. Truog The importance of being dead: non-heart-beating organ donation, J. Menikoff. Part II The Body as Property: An alternative to property rights in human tissue, R. Marusyk and M.S. Swain Living tissue and organ donors and property law: more on Moore, B.M. Dickens. Part III Commerce in Organ Procurement: Nephrarious goings on: kidney sales and moral arguments, J. Radcliffe-Richards Why liberals should accept financial incentives for organ procurement, R.M. Veatch Increasing the supply of transplant organs: the virtues of a futures market, L.R. Cohen Money talks, money kills - the economics of transplantation in Japan and China, C. Becker. Part IV Cadaveric Organ and Tissue Donation: Freedom to choose and freedom to lose: the procurement of cadaver organs for transplantation, B. Hoffmaster The moral duty to contribute and its implications for organ procurement policy, P.T. Menzel The case for presumed consent to transplant human organs after death, C. Cohen Presumed consent or contracting out, C.A. Erin and J. Harris The failure to give: reducing barriers to organ donation, J.F. Childress 2 steps to 3 choices: a new approach to mandated choice, S.E. Herz Ethical issues in limb transplants, D. Dickenson and G. Widdershoven On the ethics of facial transplantation, O. Wiggins, J. Barker, S. Martinez, M. Vossen, C. Maldonado, F. Grossi, C. FranA ois, M. Cunningham, G. Perez-Abadia, M. Kon, J. Banis. Part V Living Donor Transplantation: Autonomy's limits: living donation and health-related harm, R. Sauder and L.S. Parker Moral agency and the family the case of living related organ transplantation, R.A. Crouch and C. Elliott Organ donations by incompetents and the substituted judgment doctrine, J.A. Robertson. Part VI Specific Classes of Donors: Taking the camel by the nose: the anencephalic as a source for pediatric organ transplants, J.A. Friedman A

Changing the health care workforce: lessons from foundation-sponsored programs.

Widening participation (WP) in higher education (HE) is an increasingly important policy issue, with interventions to increase participation from minority ethnic, low-income and other under-represented groups undertaken in HE sectors in many countries. In the UK there is a large amount of WP activity but a lack of robust evidence of its effectiveness. This article presents a systematic review in the topic area of WP in HE. We included studies of systematic review, randomised controlled trial (RCT) and quasi-experimental (QE) designs, and assessed evidence of the effectiveness of university access strategies and approaches in relation to the participation of disadvantaged students at university. We searched for, quality appraised and synthesised the international evidence, that is, evidence published in any country, in the English language. The findings from 4 systematic reviews and 12 experimental studies (4 RCTs, 4 RDDs and 4 QEDs) are presented as narrative syntheses in a series of thematic sub-topics. We found some evidence of effectiveness for a number of university access interventions. ‘Black box’ WP programmes (those with multiple elements in a single programme) and financial incentives were found to be effective. However, much of the evidence had design limitations and the majority were conducted in the US. The article concludes with research recommendations in relation to UK interventions, including suggested designs for future quasi-experimental evaluation.

Enhancing Enrollment of Patients to Radiation Oncology Clinical Trials Across a Multi-Institutional Community-Academic Partnership: An Interrupted Time Series Analysis

BackgroundColorectal cancer (CRC) is common and leads to significant morbidity and mortality. Although screening with fecal occult blood testing (FOBT) or endoscopy has been shown to decrease CRC mortality, screening rates remain suboptimal. Screening rates are particularly low for people with low incomes and members of underrepresented minority groups. FOBT should be done annually to detect CRC early and to reduce CRC mortality, but this often does not occur. This paper describes the design of a multifaceted intervention to increase long-term adherence to FOBT among poor, predominantly Latino patients, and the design of a randomized controlled trial (RCT) to test the efficacy of this intervention compared to usual care.MethodsIn this RCT, patients who are due for repeat FOBT are identified in the electronic health record (EHR) and randomized to receive either usual care or a multifaceted intervention. The usual care group includes multiple point-of-care interventions (e.g., standing orders, EHR reminders), performance measurement, and financial incentives to improve CRC screening rates. The intervention augments usual care through mailed CRC screening test kits, low literacy patient education materials, automated phone and text message reminders, in-person follow up calls from a CRC Screening Coordinator, and communication of results to patients along with a reminder card highlighting when the patient is next due for screening. The primary outcome is completion of FOBT within 6 months of becoming due.DiscussionThe main goal of the study is to determine the comparative effectiveness of the intervention compared to usual care. Additionally, we want to assess whether or not it is possible to achieve high rates of adherence to CRC screening with annual FOBT, which is necessary for reducing CRC mortality. The intervention relies on technology that is increasingly widespread and declining in cost, including EHR systems, automated phone and text messaging, and FOBTs for CRC screening. We took this approach to ensure generalizability and allow us to rapidly disseminate the intervention through networks of community health centers (CHCs) if the RCT shows the intervention to be superior to usual care.Trial registrationClinicalTrials.gov NCT01453894

Reducing inequalities through greater diversity in clinical trials - As important for medical devices as for drugs and therapeutics.