Minority Recruitment Research Articles

Abstract WP333: Clinical Research Coordinators' Barriers and Best Practices to Minority Recruitment in Stroke Clinical Trials

Background: Poor recruitment and retention of clinical trial participants continues to be a major contributor to the early termination of many clinical trials. Specifically, low racial-ethnic minority and female participation rates can limit scientific, economic, and ethical value of a clinical trial. Previous literature has explored patient-centered enrollment barriers, while research has yet to investigate recruitment challenges facing clinical research coordinators (CRCs). Aim: To gain insight of the barriers facings CRCs with particular attention to minority and female recruitment efforts. Methods: Two semi-structured focus groups were conducted with a purposive sample of stroke CRCs in 2013 (N=17) and 2014 (N=23). Discussion topics included: 1) integrating NIH Inclusion Policy into trial design and recruitment strategies; 2) experiences recruiting minorities and women in stroke/neurological trials; and 3) strategies to enhance minority and female involvement. Two reviewers independently developed an initial set of base codes (n=6). Reviewers met and reconciled their independent coding using the 2013 transcript before applying the same process to the 2014 transcript. Codes and sub-codes were used to identify thematic areas. Results: Both focus groups included majority female participants with nearly half holding nursing degree. Codes informed three thematic areas: administration, enrollment and “other.” Administrative findings highlight organizational barriers. Enrollment findings identified challenges related to the severity of condition and time limitations. The “other” theme cut across administration and enrollment, often informed by coordinators’ personal experiences. Personal barriers include biases and uncertainty approaching patients from diverse backgrounds. Participants identified coordinator conferences, trainings, Internet resources, direct support from PIs and team building between hospital and research staff as key strategies. Conclusion: Our findings identified multi-dimensional organizational, administrative and resource barriers and the need for more focused CRC support to enhance participant recruitment efforts in stroke clinical research.

Barriers to Recruitment and Adherence in a Randomized Controlled Diet and Exercise Weight Loss Intervention Among Minority Breast Cancer Survivors.

Minority recruitment to cancer trials is low and there are limited data on minority adherence to lifestyle modification interventions. We examined factors related to recruitment and adherence to a pilot weight loss intervention among Hispanic and black breast cancer survivors. Participants completed a detailed screening interview to assess barriers to enrollment. An index was created to assess adherence at 6months. 112 potentially eligible women were identified; 66 consented and completed a screening interview. After screening, 9 were ineligible; 15 opted to not enroll; and 42 were randomized. Among eligible women, earlier stage at diagnosis, treatment type, and negative beliefs related to exercise and diet after diagnosis were negatively associated with study enrollment (P<0.05). Self-reported barriers to adherence included fatigue, family responsibilities, illness, work, transportation, and negative perceptions of exercise and diet. Results from this study emphasize the need to adapt recruitment and adherence strategies to address these factors.

Building a "Deep Fund of Good Will": Reframing Research Engagement.

The engagement of underrepresented populations in health research has been an ongoing challenge. Yet, the participation of these groups is recognized as key to health equity. Semi-structured interviews with 31 experienced investigators successful in the recruitment of underrepresented minorities were analyzed with reference to the concept of social capital to determine: 1) if it is actually in use by successful researchers although yet unidentified as such; and 2) if the rubric could shed light on new directions especially for those who find it difficult to implement community-engaged recruitment methods systematically. Findings indicate that some elements of the concept of social capital are being used successfully, but that there are also substantial barriers to its full implementation. A lack of enforceable trust and associated institutional support for researchers is a detriment to research engagement. Efforts to remedy this would benefit large research projects, including clinical trials.

Recruitment of Underrepresented Minorities in Medical School Through a Student-led Initiative

The goal of matriculating a diverse medical cohort remains important for institutions across the country as it results in an increase in the diversity of the physician workforce. By admitting students who are underrepresented in medicine, the pressing health needs of the growing and diverse patient population of our country can be met by physicians who are representative of their communities. Given the challenges of choosing from a small pool of applicants, medical schools should consider seeking the support of current medical students in expanding the applicant pool and recruiting the next generation of physicians. The purpose of this paper is to describe a student-led initiative established at the University of Kentucky College of Medicine for recruiting students underrepresented in medicine. Through this pipeline program, current underrepresented applicants experience a two-day recruitment event that introduces them to life as a medical student. Incorporating current medical students in recruitment programming allows institutions to access a knowledgeable and inspirational resource that is readily available. Current medical students can provide firsthand perspectives into the journey that is medical school while serving as role models for future physicians.

Just Good Developmental Science: Trust, Identity, and Responsibility in Ethnic Minority Recruitment and Retention.

Given the noted difficulty of recruiting and retaining ethnic and racial minority populations into various kinds of research endeavors (e.g., basic, prevention, intervention, health), they remain underrepresented and thus underserved by the research community as compared to other US groups. As developmental scientists, we often ask questions that imply longitudinal research designs, and thus, issues of attentiveness and responsiveness are paramount to the successful engagement (i.e., recruitment) and sustainability (i.e., retention) of our research with ethnic/racial minority samples. The goal of this chapter is to advance an ongoing dialogue about much of the work researchers of ethnic/racial minority child and youth development do in order to effectually recruit and retain youth and families but that is not often obvious to colleagues and readers of the final products. We frame our discussion with three key broadly significant themes: the role of trust, researcher identity and insider/outsider status, and responsibility. Perhaps most importantly, throughout the chapter, we provide concrete examples of the ways in which developmental scientists are transforming potential recruitment and retention challenges into opportunities in their own research programs.

Supplemental Material for Investigation of Social Cognitive Career Theory for Minority Recruitment in School Psychology

Supplemental Material for Investigation of Social Cognitive Career Theory for Minority Recruitment in School Psychology

Managing Multi-Center Recruitment in the PLCO Cancer Screening Trial.

There were significant recruitment challenges specific to the PLCO Cancer Screening Trial. Large numbers of participants were to be randomized from ten catchment areas nationwide within time and budgetary constraints. The eligible population was elderly and had to meet health and behavioral thresholds. Informed consent was required to participate and be randomized to screening for three cancers at periodic clinic visits or to a usual care arm that included no clinical visits. Consenting required special efforts to fully explain the trial and its potential scientific benefit to future patients with potentially no benefits but possible harms to PLCO participants. Participation would include continued follow-up for at least 13 years after randomization. Strong collaborative investments were required by the NCI and screening centers (SCs) to assure timely recruitment and appropriate racial participation. A trial-wide pilot phase tested recruitment and protocol follow through at SCs and produced a vanguard population of 11,406 participants. NCI announced the trial nationally in advance of the pilot and followed with an even more intense collaborative role with SCs for the main phase to facilitate trial-wide efficient and timely recruitment. Special efforts to enhance recruitment in the main phase included centralized and local monitoring of progress, cross-linking SCs to share experiences in problem solving, centralized training, substantial additional funding dedicated to recruitment and retention, including specialized programs for minority recruitment, obtaining national endorsement by the American Cancer Society, launching satellite recruitment and screening centers, including minority focused satellites, and adding a new SC dedicated to minority recruitment.

ASH Minority Recruitment Initiative

ASH Minority Recruitment Initiative

Examining Barriers and Practices to Recruitment and Retention in Stroke Clinical Trials.

The National Institutes of Health policy calls for the inclusion of under-represented groups, such as women and minorities, in clinical research. Poor minority recruitment and retention in stroke clinical trials remain a significant challenge limiting safety and efficacy in a general population. Previous research examines participant barriers to clinical trial involvement, but little is known about the investigator perspective. This study addresses this gap and examines researcher-reported barriers and best practices of minority involvement in stroke clinical trials. Quantitative and qualitative methods, including surveys, focus groups, and key informant interviews were used. In a survey of 93 prominent stroke researchers, 43 (51.2%; 70% response rate) respondents reported proactively setting recruitment goals for minority inclusion, 29 respondents (36.3%) reported requiring cultural competency staff training, and 44 respondents (51.2%) reported using community consultation about trial design. Focus groups and key informant interviews highlighted structural and institutional challenges to recruitment of minorities, including mistrust of the research/medical enterprise, poor communication, and lack of understanding of clinical trials. Researcher-identified best practices included using standardized project management procedures and protocols (eg, realistic budgeting to support challenges in recruitment, such as travel/parking reimbursement for participants), research staff cultural competency and communication training, and developing and fostering community partnerships that guide the research process. This study's formative evaluation contributes a new dimension to the literature as it highlights researcher-reported barriers and best practices for enhancing participation of minority populations into stroke clinical trials.

Ethnic Minority Recruitment and Policing Ethnically Diverse Neighbourhoods in Germany

Ethnic Minority Recruitment and Policing Ethnically Diverse Neighbourhoods in Germany

A conflict of principles: the battle over affirmative action at the University of Michigan

No state ...shall deny to any person within its jurisdiction the equal protection of the laws. So says the Equal Protection Clause of the U.S. Constitution, a document held dear by Carl Cohen, a professor of philosophy and longtime champion of civil liberties who has devoted most of his adult life to the University of Michigan. So when Cohen discovered, after encountering some resistance, how his school, in its admirable wish to increase minority enrollment, was actually practicing a form of racial discrimination--calling it action--he found himself at odds with his longtime allies and colleagues in an effort to defend the equal treatment of the races at his university. In A Conflict of Principles Cohen tells the story of what happened at Michigan, how racial preferences were devised and implemented there, and what was at stake in the heated and divisive controversy that ensued. He gives voice to the judicious and seldom heard liberal argument against affirmative action in college admission policies. In the early 1970s, as a member of the Board of Directors of the American Civil Liberties Union, Cohen vigorously supported programs devised to encourage the recruitment of minorities in colleges, and in private employment. But some of these efforts gave deliberate preference to blacks and Hispanics seeking university admission, and this Cohen recognized as a form of racism, however well-meaning. In his book he recounts the fortunes of contested affirmative action programs as they made their way through the legal system to the Supreme Court, beginning with DeFunis v. Odegaard (1974) at the University of Washington Law School, then Bakke v. Regents of the University of California (1978) at the Medical School on the UC Davis campus, and culminating at the University of Michigan in the landmark cases of Grutter v. Bollinger and Gratz v. Bollinger (2003). He recounts his role in the initiation of the Michigan cases, explaining the many arguments against racial preferences in college admissions. He presents a principled case for the resultant amendment to the Michigan constitution, of which he was a prominent advocate, which prohibited preference by race in public employment and public contracting, as well as in public education. An eminently readable personal, consistently fair-minded account of the principles and politics that come into play in the struggles over affirmative action, A Conflict of Principles is a deeply thoughtful and thought-provoking contribution to our national conversation about race.

Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies.

BackgroundThe ethnic minority population in developed countries is increasing over time. These groups are at higher risk of mental illness and demonstrate lower participation in research. Published evidence suggests that multiple factors like stigma, lack of trust, differences in explanatory models, logistical issues and lack of culturally aware researchers act as barriers to ethnic minority recruitment into mental health research. To reduce inequalities in participation, there is a need to devise innovative and culturally sensitive recruitment strategies. It is important that researchers share their experience of employing these strategies so that ethnic minority participation can be facilitated.MethodsWe previously published a systematic review of barriers to recruiting ethnic minority participants into mental health research. The nine papers included in our prior review formed the basis for developing a typology of barriers to recruiting ethnic minorities into mental health research. This typology identified 33 barriers, described under five themes. We further extracted data on the strategies used to overcome these recruitment barriers, as described in the included studies.ResultsThe strategies employed by the authors could be matched to all but two barriers (psychopathology/substance misuse and limited resource availability). There was evidence that multiple strategies were employed, and that these depended upon the population, clinical set-up and resources available.ConclusionsThis typology of strategies to overcome barriers to recruiting ethnic minorities provides guidance on achieving higher rates of recruitment. It is important that researchers plan to deploy these strategies well in advance of initiating recruitment. Whilst adopting these strategies, the authors have not been able to quantify the positive impact of these strategies on recruitment. The typology should encourage researchers to employ these strategies in future research, refine them further and quantitatively evaluate their impact.

Institutional support for diverse populations: perceptions of Hispanic and african american students and program faculty.

Using the Adapted Model of Institutional Support as a framework, data were collected from 90 minority students, 80 faculty members, and 31 administrators from schools of nursing in Texas to determine perceived barriers and needed supports for program completion. Findings illustrate similar and differing perceptions of Hispanic and African American students, faculty, and program administrators. The data provide a baseline for making improvements and establishing "best practices" for minority recruitment and retention.

A Review of Barriers to Minorities' Participation in Cancer Clinical Trials: Implications for Future Cancer Research.

To enhance nurses' awareness and competencies in practice and research by reporting the common barriers to participation of minorities in cancer clinical trials and discussing facilitators and useful strategies for recruitment. Several databases were searched for articles published in peer reviewed journals. Some of the barriers to minorities' participation in clinical trials were identified within the cultural social-context of cancer patients. The involvement of community networking was suggested as the most effective strategy for the recruitment of minorities in cancer clinical trials. Using culturally sensitive approaches to enhance ethnic minorities' participation is important for advancing cancer care and eliminating health disparities. Awareness of barriers and potential facilitators to the enrollment of ethnic minority cancer patients may contribute to enhancing nurses' competencies of recruiting ethnic minorities in nursing research, playing efficient roles in cancer clinical trials team, and providing culturally competent quality care.

A life‐cycle analysis of minority underrepresentation in natural resource fields

ABSTRACTRacial and ethnic diversity in natural resource careers does not reflect U.S. population trends. To explore potential drivers of underrepresentation in this field, we used a life‐cycle analysis to review 55 scholarly articles to identify barriers and supports influencing career choices (i.e., personal, contextual, self‐efficacy, outcome expectations) across 4 age groups. The number of cited barriers differed significantly among age groups. Personal influences included race or ethnicity, gender, age, and perceptions or predispositions toward nature. The latter was the most cited barrier for youth. Contextual influences included social, familial, structural, and experiential, and varied significantly between age groups. Exposure to nature was the most cited contextual barrier for all groups: 59% for youth, 40% for high school, 43% for college, and 50% for career. Self‐efficacy was emphasized in studies referencing youth, high school, and college age groups, and outcome expectations were only discussed in studies of the career group. After the literature analysis, we reviewed web sites, reports, and conducted personal interviews to explore how 21 federal natural‐resource agency diversity programs address variables influencing minority recruitment. Participating agencies reported challenges recruiting individuals, ensuring funding, and creating welcoming environments for minority participants, many of whom have never experienced remote natural environments or nontraditional careers. Our analysis revealed the need for a modified Framework for Career Influences. The proposed framework combines existing theories on social career choice and minority involvement in natural resource activities, but identifies personal and contextual influences that are important for minority students, as endogenous variables that influence and are influenced by self‐efficacy and outcome expectations. © 2015 The Wildlife Society.

The Symbolic Value and Limitations of Racial Concordance in Minority Research Engagement.

The well-documented underrepresentation of racial and ethnic minorities in research demands action. The field of health disparities research, however, lacks scientific consensus about how best to respectfully recruit underrepresented minority populations in research. We explore the investigators' perspective regarding how their own racial and ethnic background influenced their ability to recruit minorities, including (a) the influence of racial concordance ("race-matching") in research recruitment, (b) attributes and shared values important in the development of trust with minority communities, and (c) the role self-reflection plays in the development of meaningful research relationships. In 2010, we conducted in-depth, semi-structured, telephone interviews with investigators (N= 31) experienced with minority populations. Through the analysis of this coherent narrative, we uncovered both the symbolic and surface-level assumptions regarding minority recruitment to expose a deep structural understanding of race, ethnicity, and social context that is critical for bridging the true social difference between researchers and participants.

Antiegalitarians for affirmative action? When social dominance orientation is positively related to support for egalitarian social policies

AbstractPrevious research has found that people high in social dominance orientation (i.e., antiegalitarians) generally oppose affirmative action policies. We propose that antiegalitarians may be less opposed to strong affirmative action policies because such policies may be perceived to ultimately strengthen racial hierarchies. Studies 1 and 2 demonstrate that antiegalitarian individuals are less opposed to affirmative action policies, as compared to egalitarian individuals, when such policies strongly weigh minority status in selection decisions. Study 3 provides evidence that antiegalitarians lessen their opposition to strong policies only when such policies are believed to enhance racial hierarchies through the recruitment of minorities that remain at the bottom of organizational hierarchies. Theoretical, political, and organizational implications are discussed.

Comparing the Recruitment of Ethnic and Racial Minorities in Police Departments in England and Wales with the USA

‘The police are the public, and the public are the police’ Sir Robert Peel In the late 1820s, when British Home Secretary Sir Robert Peel introduced legislation into the British parliament to create the very first police department, the phrase that the ‘police are the public, and the public are the police’ was developed to allay public fears that the new institution would become an oppressive army of an overmighty central state. Unwittingly perhaps, this set the stage for efforts to create modern day police departments that are inclusive of the general community and reflect the racial and ethnic diversity of the wider population. Further to this founding principle, in many countries, the need to recruit a more ethnically and racially diverse police service has been a pressing concern for several decades. Although this imperative is regarded as a core task for police services in liberal democratic countries with a common law tradition, it is worth noting that this aspect of the ‘diversity agenda’ has not been confined to such contexts. Indeed a more diverse pattern of recruitment has been sought by police services in imperialist and segregated societies too.

Outreach to diversify clinical trial participation: A randomized recruitment study

Racial and ethnic minorities remain underrepresented in clinical research, yet few recruitment strategies have been rigorously evaluated. We experimentally tested whether targeted recruitment letters acknowledging diabetes health disparities and health risks specific to recipients' racial/ethnic group improved two metrics of trial participation: willingness to be screened and enrollment. This experiment was efficiently nested within a randomized clinical trial examining a preventive lifestyle intervention among women at high risk for diabetes. Pregnant women with gestational diabetes or impaired glucose tolerance (N = 445) were randomized to receive a targeted recruitment letter with health risk information specific to their racial/ethnic group (n = 216), or a standard letter with risk information for the general population (n = 229). All letters were bilingual in English and Spanish. The targeted as compared to the standard letter did not improve screening or enrollment rates overall or within separate racial/ethnic groups. Among Latina women who preferred Spanish, the targeted letter showed trends for improved screening (66.7% vs 33.3%, p = .06) and enrollment rates (38.9% vs 13.3%, p = .13). In contrast, among Latina women who preferred English, the targeted letter significantly lowered screening (29.6% vs 57.1%, p = .04) and showed trends for lowered enrollment rates (25.9% vs 50.0%, p = .07). Results from this randomized study appear to suggest that recruitment letters with diabetes health risk information targeted to recipients' race/ethnicity may improve one metric of clinical trial participation among Latina women who prefer Spanish, but not English. Larger experimental studies, incorporating input from diverse participant stakeholders, are needed to develop evidence-based minority recruitment strategies.

Multi-cultural Graduate Library Education

IN THE UNITED STATES, almost everyone knows that a librarian is a middle-aged, white woman. Two times out of ten she will be a man and once every 12 or 13 times she will be other than white, but chances are she is white. Few other occupations are more middle-aged, more female and/or more white. 1 The major purpose of this paper is to discover to what extent, during the past eight to ten years, the student bodies of accredited library school programs have changed from the predominately white demographic characteristics. It's principal focus is upon the activities and problems involved inDuring the summer of 1971 at an American Library Association preconference on the recruitment of minorities into the profession, much of the conversation naturally centered on library education. What was said then is still valid: Library schools should be charged with the responsibility of changing the racial and ethnic mix of their student bodies to be more representative of the population which their graduates serve.4 What this profession needs is commitment to the recruitment of minorities. Until we have this commitment, backed up by money, we only play the game of institutional racism.5The money is shrinking and what commitment there was in the early 1970's is waning. The crisis is still with us, now rather more acute than it was then.Minority Education in the U.S.As context, it is im portant for library educators to become familiar with the history of minority education in general and more specifically with postsecondary undergraduate education because of the requirement for Master of Library Science degree candidates to hold the baccalaureate degree. Further, it is useful to be conversant with the experience of other graduate programs, especially professional ones, with regard to minority participation. To that end, the following information is presented. Since its earliest beginnings, the American public school system has been deeply committed to the maintenance of racial and ethnic barriers. Higher education, both public and private, shared this outlook.6 So states Meyer Weinberg, Director of the Center for Equal Education, Northwestern University and Professor of History, City Colleges of Chicago, in his 1977 book on the history of the educational experience of black, Mexican American, Native American, and Puerto Rican children in the United States.Even the most noted defenders of public education in America, John Dewey and Horace Mann, remained silent on the subject of minority participation in public schools. The pattern of discrimination against minorities was national and is reflected clearly, not just by circumstance and neglect, but by statutory exclusion and/or statutory separateness. …