Black Caribbean Research Articles

BI08 Defining the burden of mucocutaneous disease in organ transplant recipients living with HIV: the Mucocutaneous disorders in Organ Transplant recipients living with HIV study

Abstract Organ transplant recipients (OTRs) have a high incidence of skin disease. People living with HIV (PLWH) are also at increased risk of skin disease, despite highly active antiretroviral therapy. Dual immunosuppressive states would be expected to increase substantially the risk of mucocutaneous disease, including skin infections and malignancy, but this is not well documented. The aim of the MOTH (Mucocutaneous disorders in Organ Transplant recipients living with HIV) study is to assess the burden of skin disease in PLWH who are also OTRs. The first phase of the MOTH study was a single-centre observational study of PLWH who had received a solid organ transplant at our centre, following their HIV diagnosis. We identified eligible patients through our OTR database. Demographic data and details of previous/current skin disease were collected. Patients with a documented full skin examination (FSE), including anogenital skin assessment within the previous 3–6 months, were not recalled for clinical review. Those not reviewed within the prior 6 months or those without a documented anogenital skin examination (even if they had a FSE within the past 6 months) were invited for clinical review. Thirty OTRs living with HIV were identified. Twenty-five were clinically assessed in person and case notes reviewed for five. Fourteen patients were men and 16 were women; mean age was 55 years (range 31–70). Most (n = 25; 83%) were Black African; the remainder were Black Caribbean (n = 3), White (n = 1) and mixed race (n = 1). Only two patients identified as men who have sex with men (MSM). Human papillomavirus (HPV)-associated disorders were the most common mucocutaneous conditions identified with 31 separate diagnoses in 19 (63%) patients: non-anogenital cutaneous warts (n = 9); low-risk HPV-related anogenital disease (n = 14); premalignant HPV-related anogenital disease (n = 6) and HPV-associated malignant disease (n = 2; vulval squamous cell carcinoma in situ and oral mucosal carcinoma). One patient (White, MSM) had been HPV vaccinated pretransplant. Other diagnoses included cutaneous/nail fungal infections (n = 10), HSV infection (n = 10), pruritus associated with renal replacement therapy (n = 7), bacterial skin infection (n = 4), steroid-induced folliculitis (n = 3), Kaposi sarcoma (n = 3), lichen sclerosus (n = 1), acquired erythro­dysplasia verruciformis (n = 1), erythema multiforme (n = 1), lichen simplex chronicus (n = 1) and cytomegalovirus-associated perioral ulceration (n = 1). These findings confirm a high burden of skin disease in OTRs living with HIV. HPV-related mucocutaneous disease was particularly common, supporting the need for routine HPV-related anogenital surveillance and guidance on pretransplant HPV vaccination. Further prospective research is required to define the mucocutaneous health-related needs of this cohort, and an international multicentre extension of the MOTH study is currently underway.

BH03 Lipoedematous scalp occurring in two female siblings: further evidence of a genetic role?

Abstract Lipoedematous scalp (LS) is a rare disorder characterized by thickening of the adipose subcutaneous scalp layer. We describe an unusual case of two female siblings presenting with the same condition. A 58-year-old black Caribbean woman presented with a 7-year history of an itchy, painful and scaly scalp, without any associated hair loss. Mycology had been negative. There was a history of paranoid schizophrenia and bipolar disorder, for which she was taking olanzapine. Body mass index (BMI) was 39 mg kg–2. Examination revealed a thickened scalp with a spongy consistency, with no associated surface change or hair loss. Scalp ultrasound was performed, demonstrating a scalp thickness of 12 mm at the vertex (normal range 5–6 mm). Scalp biopsy revealed prominent fat in the dermis around the hair follicles, with follicular distortion and some focal perifollicular fibrosis. Based on these findings, a clinicopathological diagnosis of LS was made. The patient’s 63-year-old sister presented with similar scalp symptoms. She had a background of diabetes mellitus type 2, migraine and hypomania and was taking metformin, gliclazide, atorvastatin, sodium valproate and mirabegron; her BMI was 26 mg kg–2. Scalp ultrasound revealed diffuse thickening of the subcutaneous fat measuring 9 mm at the vertex, which was also consistent with a diagnosis of LS. The pathogenesis of LS is poorly understood. It is more common in females, and there appears to be an association between LS and obesity (Yasar S, Gunes P, Serdar ZA, Tosun I. Clinical and pathological features of 31 cases of lipedematous scalp and lipedematous alopecia. Eur J Dermatol 2011; 21:520–8). Studies have implicated leptin, a hormone that regulates distribution of adipose tissue. There is limited evidence for a genetic role in LS. We identified three female cases of LS in the literature with a positive family history in their daughters (Yasar et al.) but no cases of siblings with LS. We identified one reported case of the related disorder, lipoedematous alopecia, occurring in a pair of female siblings (Koç Yıldırım S, İğde B. Lipedematous alopecia: report of two female siblings. J Cosmet Dermatol 2022; 21:1324–5). Our case highlights a possible genetic role in the pathogenesis of LS, and further studies are needed to investigate this link further.

The role of perceived expertise and trustworthiness in research study and clinical trial recruitment: Perspectives of clinical research coordinators and African American and Black Caribbean patients.

This study investigates the role of source credibility on minority participant recruitment, particularly African American and Black Caribbean patients. A total of nine focus groups (N = 48 participants) were conducted with both patient groups and clinical research coordinators (CRCs). Using the elaboration likelihood model as a guiding framework for analysis, this study found that the credibility of research coordinators (or other professionals who recruit for research studies and clinical trials) was instrumental in shaping attitudes of prospective participants. The perspectives of patients and CRCs aligned closely, with few exceptions. For both groups, professionalism and professional displays (clothing, institutional artifacts) enhanced perceived expertise, a core component of credibility. Trustworthiness, another important component of credibility, was fostered through homophily between recruiter and patient, expressions of goodwill and assuaging anxiety about CRCs' financial motivations for recruitment. Additionally, CRCs believed that credibility was supported when CRCs could emphasize transparency and truthfulness in communication. The importance of these findings for the development of empirically-based training programs to improve communication practices in recruitment contexts is discussed.

Facilitating cardiopulmonary resuscitation training in high-risk areas of England: A study protocol

IntroductionBystanders’ interventions improve chances of survival from out-of-hospital cardiac arrest (OHCA) before Emergency Medical Services arrive. Some areas in England are of concern. These high-risk areas have a higher incidence of cardiac arrest combined with lower-than-average bystander CPR rates and are characterised by higher proportions of minority ethnic group residents and deprivation.Collaborating with people from the Black African and Caribbean and South Asian minority communities in deprived areas of England, we aim to develop and evaluate the implementation of theoretically informed intervention(s) to address factors contributing to lower bystander intervention rates. MethodsThe study is a collaborative realist enquiry, informed by the Theoretical Domains Framework and associated Behaviour Change Wheel. It consists of 1) a realist evidence synthesis to produce initial program theories developed from primary workshop data and published evidence. It will include identifying factors contributing to the issue and potential interventions to address them; 2) theoretically informed intervention development, using the initial program theories and behaviour change theory and 3) a realist mixed methods implementation evaluation with embedded feasibility.Public involvement (PPI) as study team and public advisory group members is key to this study.We will conduct realist evidence synthesis, qualitative and statistical analyses appropriate to the various methods used. DisseminationWe will develop a dissemination plan and materials targeted to members of the public in high-risk areas as well as academic outputs. We will hold an event for participating community groups and stakeholders to share findings and seek advice on next steps. Study registrationISRCTN90350842. Registration date 28.03.2023. The study was registered after its start date.

Ethnic-Racial Socialization, Teacher Discrimination, and Black Youth’s School Engagement and Achievement

Ethnic-racial socialization is one strategy Black parents use to support their children’s school engagement and academic achievement given the occurrence and toxic effects of discrimination. Egalitarianism and preparation for bias socialization messages have yielded mixed evidence of promotive and protective effects for Black youth's school outcomes, and effects may vary according to ethnicity. Thus, this research examined associations between ethnic-racial socialization messages and school engagement and achievement, and whether these messages protected against teacher discrimination effects on academic achievement transmitted through school engagement, among a nationally representative sample of Black adolescents who participated in the National Survey of American Life Adolescent supplement study. Ethnic-racial socialization message content and the frequency of communication about race demonstrated different associations with engagement (i.e., school bonding, aspiration-expectation discrepancy, and disciplinary actions) and achievement (i.e., grades) for African American and Caribbean Black youth. However, the benefits were not sufficient to combat the adverse effects of teacher discrimination on school engagement and, in turn, achievement. These findings highlight the utility of integrating ethnic-racial socialization into prevention programs to support Black youth’s school experiences; demonstrate the importance of attention to heterogeneity within Black youth; and underscore the critical need for prevention programs to address teacher discrimination.

Book Review of George Padmore’s: Black Internationalism by Rodney Worrell

The publication of Rodney Worrell’s work on the political ideas and practical politics of George Padmore is a monumental contribution to global Pan-African scholarship. The book is a major contribution to the fields of Africana Studies, Pan-Africanism, Caribbean Political Thought, Black radicalism and Marxist historiography. One strength of the book resides in the author’s training as a historian and political scientist. The book benefits from Worrell’s disciplined use of the methods of historical research combined with the analytical insights of political science relevant to the production of a work devoted chiefly to the study of the ideas and political activism of a major twentieth-century political actor, of Caribbean origin, George Padmore. His serious and detailed treatment of Padmore’s Pan-Africanism, which, perhaps for marketing purposes, he now refers to as “black internationalism”, has now undoubtedly cemented his place as a leading authority on the subject.

DEFINE AND EMPOWER: Black Feminist Discourse in a Caribbean Context

In the global Feminist forum, many women and women-identifying voices are forgotten and subsequently omitted. Women of colour, specifically Black women, are often left out of discourses due to the troubled history of Feminism and its founders. In light of this, black women have frequently been forced to create narratives and discourses through art, music, resistance and scholarship. This discussion aims to highlight the progression of Feminism over the years, beginning with its troubled past and recognizing the potential for its future while incorporating discussions of the reclamation or emergence of Black Caribbean Feminism from the residual shackles of colonialism and the patriarchy.

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.

Stressful life events and relapse of psychosis: analysis of causal association in a 2-year prospective observational cohort of individuals with first-episode psychosis in the UK

Despite accumulating evidence of an association between stressful life events and psychosis relapse, the extent to which this is a causal relationship remains unclear. We aimed to examine the association between exposure to, and number of, stressful life events after initial psychosis onset and psychosis relapse. In this 2-year prospective observational study, we recruited individuals with first-episode psychosis, aged 18-65 years, who presented to psychiatric services in south London, UK. Participants were assessed via interview, with additional data obtained from electronic clinical records. Stressful life events were recorded at psychosis onset and during the 2-year follow-up using a brief questionnaire that assesses 12 major life events. Psychosis relapse was defined as inpatient admission because of symptom exacerbation within 2 years from psychosis onset. We examined the time to first psychosis relapse and the number and length of relapses using survival and binomial regression analyses. We used fixed-effects regression and cross-lagged path analysis to examine the directionality of effects and control for unmeasured confounders. Between April 12, 2002, and July 26, 2013, 256 individuals with first-episode psychosis (100 [39%] female and 156 [61%] male; 16 [6%] Asian, 140 [55%] Black African or Caribbean, 86 [34%] White, and 14 [6%] mixed ethnicity) were recruited, with a mean age of onset of psychosis of 28·06 years (SD 8·03; range 17·21-56·03). 93 (36%) participants experienced at least one relapse during the 2-year follow-up. 253 individuals had all relevant data and were included in analyses. For people exposed to stressful life events after the onset of psychosis, the adjusted hazard (hazard ratio [HR] 2·60, 95% CI 1·63-4·16, p<0·0001), incidence (incidence rate ratio [IRR] 1·87, 1·24-2·80, p=0·0026), and length (IRR 2·53, 1·40-4·67, p=0·0011) of relapse were greater than for those who were unexposed. These relationships were dose dependent (HR 1·36; 1·09-1·69, p=0·0054; incidence IRR 1·26, 1·02-1·53, p=0·023; length IRR 1·52, 1·12-2·12, p=0·0028). Adjusted fixed-effects models showed a higher (odds ratio [OR] 3·82, 1·82-8·00, p=0·0004) and dose-dependent (OR 1·62, 1·18-2·21, p=0·0028) risk of relapse when stressful life events preceded relapse compared with the period when they did not. Cross-lagged path analysis confirmed an effect of stressful life events on the number of subsequent relapses (β=0·66, p=0·0055) that was dose dependent (β=0·29, p=0·029), but it did not show an effect of relapses on subsequent risk or number of stressful life events. These results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events. National Institute for Health Research, UK.

Inequalities in smoking among pregnant women in North West London.

London has the lowest smoking prevalence among pregnant women in England. However, it was unclear whether the low overall prevalence masked inequalities. This study investigated the prevalence of smoking among pregnant women in North West London stratified by ethnicity and deprivation. Data regarding smoking status, ethnicity and deprivation were extracted from electronic health records collected by maternity services at Imperial Healthcare NHS Trust between January 2020 and August 2022. A total of 25231 women were included in this study. At the time of booking of antenatal care (mean of 12weeks), 4% of women were current smokers, 17% were ex-smokers and 78% never smokers. There were marked differences in the smoking prevalence between ethnic groups. Women of Mixed-White and Black Caribbean ethnicity and White Irish women had the highest prevalence of smoking (12 and 9%, respectively). There was an over 4-fold increase in the prevalence of smoking between the most and the least deprived groups (5.6 versus 1.3%). Even in a population with an overall low prevalence of smoking in pregnancy, women experiencing deprivation and from certain ethnic backgrounds have a high smoking prevalence and hence are the most likely to benefit from smoking cessation interventions.

Experiences of initiating rapid antiretroviral therapy among people newly diagnosed with HIV in East London: a qualitative study

ObjectivesWe aimed to explore the experiences of people who initiated rapid antiretroviral therapy (ART) within 7 days of HIV diagnosis, as part of routine care in London.MethodsUsing purposive sampling, 18...

Transformation and representation in the clinical space

So a lot has transpired in the world. These last few years have highlighted the ways in which Black and Brown bodies are historically underrepresented, misunderstood and dismissed. As two Black Caribbean clinicians, we worked with various Black Caribbean people in an acute care setting over five years; this article focuses on how representation impacted their care. Black and Brown people often receive inadequate care, care that does not speak to the wholeness of their humanity. We sought to create a methodology that represented our patients’ cultural identities and allowed them to feel seen. We did this by transforming the clinical space into a culturally relevant play space and explored adaptive social skills in preparation for community reintegration and to build ego strength through creative reflection. This work breathed life into us as we explored what it means to be seen in an oppressive system.

Ethnicity and survival after a dementia diagnosis: a retrospective cohort study using electronic health record data

BackgroundIndividuals from minority ethnic groups in the UK are thought to be at higher risk of developing dementia while facing additional barriers to receiving timely care. However, few studies in the UK have examined if there are ethnic disparities in survival once individuals receive a dementia diagnosis.MethodsWe conducted a retrospective cohort study using electronic health record data of individuals diagnosed with dementia from a large secondary mental healthcare provider in London. Patients from Black African, Black Caribbean, South Asian, White British, and White Irish ethnic backgrounds were followed up for a 10-year period between 01 January 2008 and 31 December 2017. Data were linked to death certificate data from the Office of National Statistics to determine survival from dementia diagnosis. Standardised mortality ratios were calculated to estimate excess deaths in each ethnicity group as compared to the gender- and age-standardised population of England and Wales. We used Cox regression models to compare survival after dementia diagnosis across each ethnicity group.ResultsMortality was elevated at least twofold across all ethnicity groups with dementia compared to the general population in England and Wales. Risk of death was lower in Black Caribbean, Black African, White Irish, and South Asian groups as compared to the White British population, even after adjusting for age, gender, neighbourhood-level deprivation, indicators of mental and physical comorbidities. Risk of death remained lower after additionally accounting for those who emigrated out of the cohort.ConclusionsWhile mortality in dementia is elevated across all ethnic groups as compared to the general population, reasons for longer survival in minority ethnic groups in the UK as compared to the White British group are unclear and merit further exploration. Implications of longer survival, including carer burden and costs, should be considered in policy and planning to ensure adequate support for families and carers of individuals with dementia.

Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England

ObjectivesUptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as...

Discrimination, psychotic experiences, and racial identity among Black Americans: Findings from the National Survey of American Life

An emerging body of evidence suggests racial and ethnic identity may buffer the effects of discrimination on psychotic experiences, though the buffering effects have not been consistent across studies. More research is needed to clarify the conditions under which aspects of racial identity modify the effects of various forms of discrimination on psychotic experiences among Black Americans. We analyzed data from the National Survey of American Life (2001-2003). Using multivariable logistic regression, we examined the relations between various forms of discrimination and lifetime psychotic experiences, testing the interactive effects of two aspects of racial identity (racial group identification and racial private regard), adjusted for sociodemographic covariates. The relation between everyday discrimination and psychotic experiences was stronger for African Americans who reported higher levels of racial group identification. Conversely, the relation between major discriminatory events and psychotic experiences was stronger for Caribbean Black Americans who reported lower levels of racial group identification. Higher racial private regard moderated the associations between everyday discrimination and psychotic experiences, and outgroup colorism and psychotic experiences among Caribbean Black Americans. The role of racial identity is complex and appears to moderate the relation between some (but not all) forms of discrimination and lifetime psychotic experiences, depending on ethnicity.

With Flags Waving

Abstract In contrast to the usual story that ICFTU efforts in Africa were moribund by the mid-1960s, its connections to the Liberian CIO were increasing then, due largely to the efforts of Black American, Caribbean, and African trade unionists who worked with or for the ICFTU. When European ICFTU officials hesitated for fear of upsetting the repressive Tubman government, ICFTU members from among the African diaspora expressed more optimism and consistently advocated for connecting directly with Liberian labor. They also made key visits to Liberia, either on their own or on delegations, and often distributed aid and provided training on the ground. Although the ICFTU did not achieve all its goals there, demonstrating the difficulty in organizing labor in the face of government opposition, small gains did occur due primarily to the bottom-up pressure from Black members among the lower ranks of the ICFTU, revealing consistent Black agency in the ICFTU's African activities in the 1960s. This study also shows how ICFTU actions, largely based on the understanding by its Black members that labor was linked closely to society and politics, threatened to undermine the key goal of domestic stability and control that Tubman sought to achieve through his foreign policy efforts in Africa during the 1960s.

Duration of Residence and Hypertension in Black Foreign-Born Residents: NHIS, 2004-2017.

Black Americans have the highest prevalence of hypertension in the USA. Black immigrants, who, by definition, have time-limited exposure to the USA, may provide insight into the relationship between exposure to the US environment, Black race, and hypertension. This is a cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data of foreign-born White European and Black adults (N = 11,516). Multivariable robust Poisson regressions assessed the relationship between self-reported hypertension and duration of the residency (< 5, 5-9, 10-14, 15years) among Black, Black African, Black Caribbean, and White European foreign-born residents. In multivariable analyses-controlling for age, sex, education, poverty-to-income ratio, insurance status, recent encounter with a clinician, and BMI-Black foreign-born residents (PR = 1.40, 95% CI = 1.03, 1.90) and Black Africans (10-14years.: PR = 1.70, 95% CI = 1.13, 2.56; 15years.: PR = 1.56, 95% CI = 1.04, 2.34) with a duration of residency of at least 15 and 10years, respectively, had a greater prevalence of hypertension than those with duration less than 5years. A nonsignificant positive association between a duration of residency of at least 15years (compared to less than 5years) and self-reported hypertension was observed for White Europeans (PR 1.49, 95% CI = 0.88, 2.51) and Black Caribbeans (PR = 1.09, 95% CI = 0.69, 1.72). Duration of residency is particularly associated with hypertension among Black Africans after migration to the USA. This discrepancy may be explained by differences in primary care utilization and awareness of hypertension diagnoses among recent African immigrants, along with greater stress associated with living in the USA.

The profile study: Prostate cancer screening in men of Black African and African Caribbean ancestry—Early results.

306 Background: Heritable risk factors account for a significant proportion of prostate cancer (PrCa) risk, of which only a minority are high risk Mendelian traits. Men of Black African and African Caribbean ancestry are at higher risk of developing PrCa in their lifetime (1 in 4) compared with the general population in the United Kingdom (1 in 8). PROFILE is a multi-cohort study of targeted screening for groups of men at higher risk of developing PrCa: 1) men of European ancestry with family history of PrCa, 2) men of black African and African Caribbean ancestry regardless of family history and 3) men with known rarer higher risk gene mutations for PrCa. This abstract concentrates on group 2. The aim is to investigate the role of targeted PrCa screening in men at higher genetic risk and its association with specific genetic profiles and biomarkers. Methods: Healthy men aged 40-69 are invited to participate. Inclusion Criteria: Both parents and all four grandparents must be of either black African or African Caribbean ancestry. Arm 1: PSA only – once PSA is below an age-related threshold (aged 40-49 and PSA ≥0ng/ml, aged 50-69 PSA &gt;/= 2ng/ml) they continue on the study with annual PSA, only triggering a prostate MRI and Biopsy if the PSA is above the threshold. Arm 2: Regardless of PSA men opt for prostate mpMRI and biopsy. Polygenic risk score (PRS) calculated based on 230 SNPs including latest AA specific variants. Results: Arm 1: 121 enrolled PSA only (this has triggered 8 biopsies with 3 cancers). Arm 2: 58 enrolled MRI and biopsy, 58 MRIs and 36 biopsies carried out, PrCa detected in 15 men (42%). 22% are Gleason score ≥7. Association between PRS and MRI/Biopsy results will be presented. Conclusions: We will continue to perform MRI and biopsies on men, we will also carry out polygenic risk scores on these men to verify whether a genetic PRS can help guide enhanced screening for certain men in the population. Although data are early, a significant proportion of biopsies are positive for PrCa that needs radical treatment. Clinical trial information: NCT02543905 .

Countering anti-Blackness with migrant solidarity: Black and Caribbean linkages through racial struggle

ABSTRACT Black Caribbean migrants are uniquely positioned between multiple forms of negative racialization – that of their experiences with both anti-Black racism and xenophobia due to their immigrant status. Such positioning means that they may be subject to increased anti-Black and anti-migrant policing. In this paper, I argue that Black Caribbean migrants’ experiences with race in the United States can and should be interwoven with research and advocacy focused on the increasing criminalization of migrants or, Crimmigration research. I use archived newspapers, fliers, and pamphlets produced by Caribbean activists to show how they not only recognized these two-fold processes and but also reframed Black identity and politics to include anti-Black and anti-migrant discrimination as linked causes. I contend that their advocacy and concern for Afro-descent migrants, African Americans, and migrants more broadly reveal the expansiveness of Black politics through the bringing together of both Black and migrant concerns.

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.