African-Caribbean Participants Research Articles

Reducing Health Disparities Among African American and Black Caribbean Patients by Improving the Communication Practices of Clinical Research Coordinators

ABSTRACT This manuscript focuses on the communication factors that affect the willingness of African Americans and Black Caribbean patients to participate in clinical trials and research studies. Low rates of research participation by members of communities of color have long been linked to health disparities. While there are many factors that contribute to low rates of accrual of African American and Black patients to clinical trials, a lack of attention to communication factors that enhance or inhibit the recruitment process is central to the problem. In this study, we describe results from the analysis of six focus groups (N = 31) consisting of African American (k = 3) and Black Caribbean (k = 3) participants. Our analyses focus on verbal and nonverbal communication behaviors and how they affect participants’ willingness to participate in clinical trials. Specifically, when clinical research coordinators (CRCs) had a professional appearance, made the effort to explain a study in detail, made eye contact, took the time to listen and answer questions patiently, and gave the sense that the CRC was being truthful and transparent, patients felt respected and valued. Additionally, participants emphasized the importance of the process of developing and maintaining a trusting relationship between study participants and CRCs. The results of this study will be used to develop a clinical trial communication training program designed to enhance the communication skills of clinical research coordinators who discuss research participation with African American and Caribbean Black patients.

Examining uncertainty management in the clinical trial experiences of African American and Black Caribbean participants and the coordinators who recruit them

Clinical research studies experience low accrual rates for African American and Black Caribbean participants. These low rates could result in treatment regimens that are less effective for these groups. This study applied a communication lens to the decision-making processes that occur when the groups are being recruited for studies. Attention was paid to how participants managed their uncertainty in decision-making. Focus group discussions were conducted with 48 participants, with exclusive groups for African American, Black Caribbean, and clinical research coordinator (CRC) participants. Respondents were asked semi-structured questions. While the CRCs were asked about their practices recruiting within these groups, the patients were asked about their experiences being recruited. Three themes were derived from the data. Participants experienced uncertainty when the quality of information was lacking. Many participants realized they had little knowledge about research and struggled with understanding medical terms; therefore, they sought to manage uncertainty by asking questions. Additionally, participants experienced uncertainty because of sources of uncertainty, including family experiences and historical narratives. Participants also offered strategies for managing uncertainty. For instance, recruiters must incorporate matriarchal figures and use clear information about the purpose, process, and potential outcomes. Altogether, our findings indicate that research on the cause of the low number of African American and Black Caribbean participants in research studies needs to examine how uncertainty is experienced and managed during the research recruitment process.

Welcome to the Motherland. An exploration into how experience is storied through generations of African Caribbean immigrants

AbstractThis study explores the ways in which African Caribbean families communicate with each other and the outside world in the context of post migration. The Big and Small Story in narrative inquiry was used to make sense of the data as it pays attention to the manner and style in which this story is told, and what identities are being claimed post migration. The key findings are set out using three archetypal positions: the trickster, passer/conformer and resister/revolutionary. These were used to capture different ways people responded to power and identities claimed within their daily life. Findings in part of reflect Du Bois’ concept of double consciousness to consider the way black people carry out their negotiations with power. These African Caribbean participants were having to think about what is acceptable to the power base and how can this be negotiated. This paper is intended to be helpful to practitioners interested in indigenous knowledge of self and its clinical implications.

Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study.

Background: People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom reported.Methods: The Southall and Brent Revisited (SABRE) study is the UK's largest tri-ethnic longitudinal cohort. Over 1,400 surviving participants (58–85 years) attended the 2nd study visit (2008–2011); during which, comprehensive cardiovascular phenotyping, including 3D-echocardiography [3D-speckle-tracking (3D-STE)], computed tomography, coronary artery calcium scoring, pulse wave velocity, central blood pressure, carotid artery ultrasound, and retinal imaging, were performed. We describe the methods used with the aim of providing a guide to their feasibility and reproducibility in a large tri-ethnic population-based study of older people.Results: Conventional echocardiography and all vascular measurements showed high feasibility (>90% analyzable of clinic attendees), but 3D-echocardiography (3DE) and 3D-STE were less feasible (71% 3DE acquisition feasibility and 38% 3D-STE feasibility of clinic attendees). 3D-STE feasibility differed by ethnicity, being lowest in South Asian participants and highest in African Caribbean participants (p < 0.0001). Similar trends were observed in men (P < 0.0001) and women (P = 0.005); however, in South Asians, there were more women with unreadable 3D-images compared to men (67 vs. 58%). Intra- and inter-observer variabilities were excellent for most of conventional and advanced echocardiographic measures. The test-retest reproducibility was good-excellent and fair-good for conventional and advanced echocardiographic measures, respectively, but lower than when re-reading the same images. All vascular measures demonstrated excellent or fair-good reproducibility.Conclusions: We describe the feasibility and reproducibility of detailed cardiovascular phenotyping in an ethnically diverse population. The data collected will lead to a better understanding of why people of South Asian and African Caribbean ancestry are at elevated risk of cardiometabolic diseases.

Associations of dietary intake with cardiometabolic risk in a multi-ethnic cohort: a longitudinal analysis of the Determinants of Adolescence, now young Adults, Social well-being and Health (DASH) study.

Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21-23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21-23 years were higher among those who regularly skipped breakfast at 11-13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI -0·01, 0·31), P=0·063) and at 21-23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta-analysis.

To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta-analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). Thirty-two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to ESRD.

Cerebral Blood Flow and Cognitive Functioning in a Community-Based, Multi-Ethnic Cohort: The SABRE Study.

Introduction: Lower cerebral blood flow (CBF) is associated with cardiovascular disease and vascular risk factors, and is increasingly acknowledged as an important contributor to cognitive decline and dementia. In this cross-sectional study, we examined the association between CBF and cognitive functioning in a community-based, multi-ethnic cohort.Methods: From the SABRE (Southall and Brent Revisited) study, we included 214 European, 151 South Asian and 87 African Caribbean participants (71 ± 5 years; 39%F). We used 3T pseudo-continuous arterial spin labeling to estimate whole-brain, hematocrit corrected CBF. We measured global cognition and three cognitive domains (memory, executive functioning/attention and language) with a neuropsychological test battery. Associations were investigated using linear regression analyses, adjusted for demographic variables, vascular risk factors and MRI measures.Results: Across groups, we found an association between higher CBF and better performance on executive functioning/attention (standardized ß [stß] = 0.11, p < 0.05). Stratification for ethnicity showed associations between higher CBF and better performance on memory and executive functioning/attention in the white European group (stß = 0.14; p < 0.05 and stß = 0.18; p < 0.01 respectively), associations were weaker in the South Asian and African Caribbean groups.Conclusions: In a multi-ethnic community-based cohort we showed modest associations between CBF and cognitive functioning. In particular, we found an association between higher CBF and better performance on executive functioning/attention and memory in the white European group. The observations are consistent with the proposed role of cerebral hemodynamics in cognitive decline.

Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK

The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a new Knowledge about Psychosis (KAP) self-report measure and a culturally-adapted version for African-Caribbean people (CaKAP). Content and face validity were achieved through consultations with experts in psychosis and a focus group with service users, carers, and community members. Eighty-seven predominantly White British participants and 79 African-Caribbean participants completed the knowledge questionnaires (KAP and CaKAP) and measures of help-seeking and stigma. Overall, the measures showed good internal consistency and test re-test reliability. Construct validity was evidenced via significant positive associations between knowledge about psychosis and help-seeking and significant negative associations between knowledge and stigma. These measures could improve the delivery of psychosocial interventions and outcome measurement in research trials.

African Caribbean Migration

This article seeks to examine the concept of the better life in the context of African Caribbean migration to Canada with the aim of contributing toward a more complicated and nuanced understanding of the intersection of transnational migration and decolonizing approaches in social work. Within this examination, I contend that migration by African Caribbeans is a form of resistance to the ongoing evisceration of their life chances and choices as a result of colonization. The movement of African Caribbean people is tied to a legacy of centuries of resistance to European exploitation, extortion, and extraction of resources enacted through regimes of slavery, colonization, and globalization. This article briefly explores the history of social work values in what is now known as Canada, as it relates to understanding how social work is positioned in relation to African Caribbean migration to Canada through a decolonizing lens and draws on recent findings from research with African Caribbean participants in the city of Toronto, Ontario, to critically deconstruct the concept of a better life. This deconstruction is necessary to supporting decolonizing understandings of the contemporary social conditions endured by African Caribbean peoples in Canada and to transforming relations between social work and African Caribbean peoples.

Factors influencing participation in colorectal cancer screening-a qualitative study in an ethnic and socio-economically diverse inner city population.

BackgroundEthnic and socio‐economic inequalities have been reported in the uptake of colorectal cancer (CRC) screening. This study aimed to explore the factors affecting CRC screening participation in an ethnically and socio‐economically diverse inner city population.MethodsSemi‐structured interviews were undertaken with 50 people aged 55–74 years, recruited from GP practices in south‐east London. Participants were from Black African (n=13), Black Caribbean (n=15), White British (n=17), Black other (n=2) and White other (n=3) backgrounds. Participants' socio‐economic status (SES) was assessed using a combined measure of educational attainment, housing tenure and car ownership. Participants' SES varied although there were more participants from less deprived backgrounds than those from more deprived backgrounds. The interview topic guide was informed by the Theoretical Domains Framework. Interviews were recorded, transcribed and analysed using framework analysis.FindingsLack of awareness of CRC screening was a barrier for all participants. There were also some notable group differences by ethnicity and SES. Cancer fear was a barrier for White British participants of varying SES. Misunderstanding instructions for completing the guaiac faecal occult blood test (gFOBt) was a barrier for people of low SES regardless of ethnicity. For Black African and Black Caribbean participants, of any SES, religious faith and a perceived civic duty to participate in screening encouraged participation.Discussion and conclusionsThis is the first study to provide detailed information on the separate views of Black African and Black Caribbean participants about screening. Consideration of ethnicity and SES together also allowed us to identify pertinent barriers for particular groups that can be targeted to improve access to screening for those who wish to take part.

“Mirror, mirror...." A preliminary investigation of skin tone dissatisfaction and its impact among British adults.

This study examined skin tone dissatisfaction, measured using a skin tone chart, among a multiethnic sample of British adults. A total of 648 British White individuals, 292 British South Asians, and 260 British African Caribbean participants completed a visual task in which they were asked to indicate their actual and ideal skin tones. They also completed measures of body appreciation, self-esteem, and ethnic identity attachment. Results showed that Asians had a lighter skin tone ideal than White and African Caribbean participants. Conversely, White participants had higher skin tone dissatisfaction (preferring a darker skin tone) than Asian and African Caribbean participants, who preferred a lighter skin tone. Results also showed that skin tone dissatisfaction predicted body appreciation once the effects of participant ethnicity, age, ethnic identity attachment, and self-esteem had been accounted for. Implications of our findings and suggestions for future research are discussed.

Estimation of CT-Derived Abdominal Visceral and Subcutaneous Adipose Tissue Depots from Anthropometry in Europeans, South Asians and African Caribbeans

BackgroundSouth Asians and African Caribbeans experience more cardiometabolic disease than Europeans. Risk factors include visceral (VAT) and subcutaneous abdominal (SAT) adipose tissue, which vary with ethnicity and are difficult to quantify using anthropometry.ObjectiveWe developed and cross-validated ethnicity and gender-specific equations using anthropometrics to predict VAT and SAT.Design669 Europeans, 514 South Asians and 227 African Caribbeans (70±7 years) underwent anthropometric measurement and abdominal CT scanning. South Asian and African Caribbean participants were first-generation migrants living in London. Prediction equations were derived for CT-measured VAT and SAT using stepwise regression, then cross-validated by comparing actual and predicted means.ResultsSouth Asians had more and African Caribbeans less VAT than Europeans. For basic VAT prediction equations (age and waist circumference), model fit was better in men (R2 range 0.59-0.71) than women (range 0.35-0.59). Expanded equations (+ weight, height, hip and thigh circumference) improved fit for South Asian and African Caribbean women (R2 0.35 to 0.55, and 0.43 to 0.56 respectively). For basic SAT equations, R2 was 0.69-0.77, and for expanded equations it was 0.72-0.86. Cross-validation showed differences between actual and estimated VAT of <7%, and SAT of <8% in all groups, apart from VAT in South Asian women which disagreed by 16%.ConclusionWe provide ethnicity- and gender-specific VAT and SAT prediction equations, derived from a large tri-ethnic sample. Model fit was reasonable for SAT and VAT in men, while basic VAT models should be used cautiously in South Asian and African Caribbean women. These equations will aid studies of mechanisms of cardiometabolic disease in later life, where imaging data are not available.

OP31 Ethnic Differences in the Development of Disability Over 20 Years: Results from the Sabre Study

BackgroundAs life expectancy increases, healthy ageing becomes more salient, and therefore it is important to understand how conditions such as disability may affect the later years of our extended lives....

Population health status of South Asian and African-Caribbean communities in the United Kingdom

BackgroundPopulation health status scores are routinely used to inform economic evaluation and evaluate the impact of disease and/or treatment on health. It is unclear whether the health status in black and minority ethnic groups are comparable to these population health status data. The aim of this study was to evaluate health-status in South Asian and African-Caribbean populations.MethodsCross-sectional study recruiting participants aged ≥ 45 years (September 2006 to July 2009) from 20 primary care centres in Birmingham, United Kingdom.10,902 eligible subjects were invited, 5,408 participated (49.6%). 5,354 participants had complete data (49.1%) (3442 South Asian and 1912 African-Caribbean). Health status was assessed by interview using the EuroQoL EQ-5D.ResultsThe mean EQ-5D score in South Asian participants was 0.91 (standard deviation (SD) 0.18), median score 1 (interquartile range (IQR) 0.848 to 1) and in African-Caribbean participants the mean score was 0.92 (SD 0.18), median 1 (IQR 1 to 1). Compared with normative data from the UK general population, substantially fewer African-Caribbean and South Asian participants reported problems with mobility, usual activities, pain and anxiety when stratified by age resulting in higher average health status estimates than those from the UK population. Multivariable modelling showed that decreased health-related quality of life (HRQL) was associated with increased age, female gender and increased body mass index. A medical history of depression, stroke/transient ischemic attack, heart failure and arthritis were associated with substantial reductions in HRQL.ConclusionsThe reported HRQL of these minority ethnic groups was substantially higher than anticipated compared to UK normative data. Participants with chronic disease experienced significant reductions in HRQL and should be a target for health intervention.

Acceptance of Cosmetic Surgery Among British Female University Students

Although patients of cosmetic surgery are increasingly ethnically diverse, previous studies have not examined ethnic differences in attitudinal dispositions toward cosmetic surgery. In the present study, 751 British female university students from three ethnic groups (Caucasians, South Asians, and African Caribbeans) completed measures of acceptance of cosmetic surgery, body appreciation, self-esteem, and demographic variables. Initial between-group analyses showed that Caucasians had lower body appreciation and self-esteem than Asian and African Caribbean participants. Importantly, Caucasians had higher acceptance of cosmetic surgery than their ethnic minority counterparts, even after controlling for body appreciation, self-esteem, age, and body mass index. Further analyses showed that ethnicity accounted for a small proportion of the variance in acceptance of cosmetic surgery, with body appreciation and self-esteem emerging as stronger predictors. Possible reasons for ethnic differences in acceptance of cosmetic surgery are discussed in Conclusion.

Systematic review of the effect of education on survival in Alzheimer's disease

According to the cognitive reserve model, higher levels of education compensate for the neuropathology of Alzheimer's disease (AD), delaying its clinical manifestations. This model suggests that for any level of cognitive impairment, people with more education have worse neuropathology than those with less education and will therefore have shorter survival post-diagnosis. This is the first systematic review of the relationship between more education and decreased survival in people with AD. We reviewed the literature systematically, searching electronic databases and reference lists of included studies. We used Centre for Evidence Based Medicine criteria for inclusion and rating of the validity of cohort studies that reported the relationship of education to survival in people with AD. 22 studies met inclusion criteria. We found Grade A evidence (highest evidence level) that more education was not associated with decreased survival post-diagnosis in AD. Only one of 11 studies rated 1b (highest level of quality) supported our hypothesis that more education predicted reduced survival after adjusting for age, gender and dementia severity; it comprised African-Caribbean participants, who had on average more severe cognitive impairment than other studies' participants. Education delays the onset of the dementia syndrome in AD, but does not lead to earlier death after diagnosis.

A Comparison of African-Caribbean and White European Young Adults' Conceptions of Schizophrenia Symptoms and the Diagnostic Label

Discrepancies in the experiences of different ethnic groups in mental health services exist, such as in the persistently higher rates of schizophrenia diagnosis found among the African-Caribbean population compared to the white European population in the UK. Some hypotheses consider whether this is due to greater stigmatizing attitudes to mental illness in the African-Caribbean community, leading individuals to avoid treatment-seeking and an increased incidence of schizophrenia. This study aimed to investigate recognition and evaluation of schizophrenic symptoms across African-Caribbean and white European individuals. One hundred and twenty eight adult students from London colleges completed a questionnaire assessing stigma beliefs, evaluation of symptoms as mental illness and help-seeking beliefs, in response to symptom vignettes. African-Caribbean participants indicated less stigmatizing beliefs towards both the symptoms and diagnostic label of schizophrenia compared to the white European participants. White European participants were more likely to label vignettes as implying 'mental illness' and also more likely to recommend professional health treatment. These results are inconsistent with a hypothesis that on average African-Caribbean people stigmatize schizophrenia more than white European people. While white European participants' beliefs were more likely to follow a western model of mental illness, African-Caribbean participants were more likely to have alternative beliefs. The influence of racial discrimination, mental illness knowledge and societal structures are discussed.

ReGAE 2: glaucoma awareness and the primary eye-care service: some perceptions among African Caribbeans in Birmingham UK

Investigations into glaucoma awareness have drawn on informed, clinic-based populations. The paper reports a section of findings from a larger study that aimed to elicit the perceptions of those potentially less informed in community settings. A qualitative investigation used face-to-face interviews and focus group discussions with 48 African Caribbean participants outside the hospital eye-service. Interview data were transcribed and coded using manual and computer-aided methods. Inferences and interpretations were corroborated by discussion with expert advisors and community members not directly involved in the study. Positive attitudes to health promotion existed, but 'eye health' did not appear to be integral to individuals' health schemas. The capacity for primary eye care to enhance glaucoma knowledge appeared under utilised and inconsistent across modes of service delivery and was undermined by perceived conflicts of interest. Enhancing reciprocal understanding between service users and ophthalmic practitioners in primary care is central to developing flexible, responsive local eye-care services. The study suggested useful foci for cultural self-reflection and self-awareness on the part of health professionals themselves, in relation to glaucoma detection. Areas for further research are identified.

Meaningful patterns of activity amongst the long‐term inner city unemployed: a qualitative study

AbstractA number of studies have sought to establish the social psychological factors involved in the maintenance of active lifestyles during long‐term unemployment. The aim of this study was to describe and account for the development and maintenance of different patterns of activity, with reference to their perceived meaningfulness. This was undertaken with a sample of Birmingham's inner city, long‐term unemployed population recruited from three inner city Jobcentres, including men and women, and White, Asian and African Caribbean participants (N = 24). Interviews were conducted using a semi‐structured interview guide. Using the qualitative software program, NUD.IST, the data were analysed according to the principles of the grounded theory approach. Activities were characterized as: domestic; educational; work‐like; socializing; and none. A model of meaningful activity in the context of formal unemployment was developed. The main components of the model were: features of formal employment that inhibited participants' engagement in it; the requirements for personal meaningful activity (challenging activity, effort and commitment, and being valued by others); the consequences of meaningful activity (opportunities for self‐determination and self‐development, and achievement, competence, and confidence) and consolidating factors (social comparison, self‐appraisal, religious and political beliefs, and social support). Theories of unemployment of Jahoda, Warr, and Fryer are considered in the light of the present findings. Copyright © 2002 John Wiley &amp; Sons, Ltd.

Cognitive function in UK community-dwelling African Caribbean elders: normative data for a test battery.

Many 'first generation' African Caribbean residents in the UK have now reached ages where risk of cognitive impairment and dementia starts to increase. In addition, conditions which may impair cognitive function, such as hypertension, diabetes and stroke, have high prevalence rates in African Caribbean populations. However, there is a lack of normative data for cognitive tests in this ethnic group. Cognitive assessment was carried out in a south London community population of 285 African Caribbean participants aged 55-75 years. Tests were drawn principally from the consortium to establish a registry for Alzheimer's disease (CERAD) battery (Boston Naming Test, verbal fluency, word list recall, and Trailmaking Tests A and B) and also included orientation items from the Mini-Mental State Examination (MMSE) and the Clock Drawing Test. Independent effects of age, sex, education and occupation were identified on scores for most but not all cognitive tests. Compared with normative data for African American populations, lower scores on verbal fluency and the Boston Naming Test were observed but scores on memory tests were comparable. Normative data for the tests are presented, stratified by level of education.