Increasing ethnic minority participation in substance abuse clinical trials: Lessons learned in the National Institute on Drug Abuse's Clinical Trials Network.

Abstract

Underrepresentation in clinical trials limits the extent to which ethnic minorities benefit from advances in substance abuse treatment. The objective of this article is to share the knowledge gained within the Clinical Trials Network (CTN) of the National Institute on Drug Abuse and other research on recruiting and retaining ethnic minorities into substance abuse clinical trials. The article includes a discussion of two broad areas for improving inclusion— community involvement and cultural adaptation. CTN case studies are included to illustrate three promising strategies for improving ethnic minority inclusion: respondent-driven sampling, community-based participatory research, and the cultural adaptation of the recruitment and retention procedures. The article concludes with two sections describing a number of methodological concerns in the current research base and our proposed research agenda for improving ethnic minority inclusion that builds on the CTN experience.

Review of Substance Use Disorder Treatment Research in Indian Country: Future Directions to Strive toward Health Equity

“…There appears to be a trend for adapting evidence-based treatments (EBTs) to include elements of AI/AN healing practices and ways of life such as cultural identity, spirituality and religiosity, discrimination, collectivism (33,42,43), and historical trauma (44). Researchers maintain that these inclusions increase the appeal and efficacy of treatment, contribute to better outcomes and engagement among a wider range of AI/ANs (e.g., varying levels of acculturation) and may thereby help to reduce substance-related health disparities (42)(43)(44)(45)(46).…”

“…Retention of ethnic minority participants is difficult for medication trials, and recruitment is difficult in part due to strict eligibility criteria. Future studies should consider protocol adaptations to facilitate participant engagement and retention, including community outreach and SUBSTANCE ABUSE TREATMENT involvement, respondent-driven sampling, and enhanced participant incentives (45).…”

“…Enhanced recruitment and retention would increase confidence in the findings, but needs to be done in culturally acceptable ways. Examples include partnering with tribes and AI/AN organizations to conduct research that is relevant to and driven by the community, employing research staff from the community, consultation with community members regarding the appropriateness of follow-up strategies, and communicating the principles of respect and autonomy to participants (45).…”

Does Cultural Adaptation Have a Role in Substance Abuse Treatment?

“…The Minority Interest Group of the CTN recently published a review of effective strategies for increasing either recruitment or retention within CTN studies and in the broader literature (Burlew et al, 2011). Along with community involvement, our review showed that the cultural adaptation of the recruitment process increased the inclusion of ethnic minorities in clinical research.…”

Conducting Health Disparities Research with Criminal Justice Populations: Examining Research, Ethics, and Participation

“…Participants must be made aware of clinical trials available to them and be informed of the potential benefits and risks to participation. Studies have shown that inclusion of ethnically and diverse populations into clinical trials is a challenge for researchers (Buchanan et al, 2010; Burlew et al, 2012; Dancy et al 2004; Durant, Davis, St. George, Williams, & Blumental, 2007). Because little information is available regarding clinical trial participation among populations under community supervision, strategies to increase their knowledge, effective recruitment, and access to clinical trials are needed.…”