The role of functional, social, and mobility dynamics in facilitating older African Americans participation in clinical research

Abstract

PurposeOlder African Americans experience disproportionately higher incidence of morbidity and mortality related to chronic and infectious diseases, yet are significantly underrepresented in clinical research compared to other racial and ethnic groups. This study aimed to understand the extent to which social support, transportation access, and physical impediments function as barriers or facilitators to clinical trial recruitment of older African Americans.MethodsParticipants (N=221) were recruited from six African American churches in Atlanta and surveyed on various influences on clinical trial participation.ResultsLogistic regression models demonstrated that greater transportation mobility (odds ratio [OR]=2.10; p=0.007) and social ability (OR=1.77; p=0.02) were associated with increased intentions of joining a clinical trial, as was greater basic daily living ability (OR=3.25; p=0.03), though only among single participants. Among adults age ≥65 years, those with lower levels of support during personal crises were more likely to join clinical trials (OR=0.57; p=0.04).ConclusionTo facilitate clinical trial entry, recruitment efforts need to consider the physical limitations of their potential participants, particularly basic physical abilities and disabilities. Crisis support measures may be acting as a proxy for personal health issues among those aged >65 years, who would then be more likely to seek clinical trials for the personal health benefits. Outreach to assisted living homes, hospitals, and other communities is a promising avenue for improved clinical trial recruitment of older African Americans.

Choosing Channels, Sources, and Content for Communicating Prostate Cancer Information to Black Men: A Systematic Review of the Literature

“…This review suggests that Black men want information about standard-of-care treatment and the outcomes it will produce. This is not surprising given that many Black men are reluctant to participate in clinical trials, while others may view clinical trial participation as simply not practical for them due to barriers such as distance from a research center, lack of access to transportation, physical limitations, concerns about time commitments, conflicts with other family needs, or other barriers ( Ford et al, 2008 ; Shapiro, Schamel, Parker, Randall, & Frew, 2017 ). Culturally tailoring and framing information about clinical trials for Black men is very important to ensure their representation in clinical trials.…”

Low-Income, Older African Americans’ Engagement in and Perceptions of a Smartphone-Based Ecological Momentary Assessment Study of Physical Activity and Sedentary Behavior

“…Underrepresentation of minority older adults in research further contributes to health disparities related to physical activity and excessive sedentary behavior. Minority groups report barriers to participating in health-related research such as skepticism of the research or distrust of the researchers, lack of interest in the study, privacy or surveillance concerns, and lack of transportation to the study site ( James & Harville, 2017 ; Liljas et al, 2017 ; Shapiro et al, 2017 ). When seeking representation from minority older adults from community sites, it is essential to be aware of potential underlying community-based barriers such as perceived exploitation of a vulnerable population, lack of knowledge of the benefit from health-related research, and the apparent reluctance of the researchers to establish relationships with the community members ( George et al, 2014 ; Kammerer et al, 2019 ; Shapiro et al, 2017 ).…”

Caring in the recruitment of older African American adults with chronic health disease: An integrative review

“…9 However, compared to their White counterparts of similar age, chronic underrepresentation of older African-American adults in health-related research studies persists. 10 African-Americans' hesitation to participate in research is repeatedly cited in the literature. [8][9][10] These reasons include historical, societal, educational, and economical origins.…”

“…10 African-Americans' hesitation to participate in research is repeatedly cited in the literature. [8][9][10] These reasons include historical, societal, educational, and economical origins. 9,10 To develop effective health treatment, prevention, and research initiatives, it is essential to garner an understanding of the recruitment process, which may contribute to the underrepresentation of older African-American adults in chronic illness-related research studies.…”

“…[8][9][10] These reasons include historical, societal, educational, and economical origins. 9,10 To develop effective health treatment, prevention, and research initiatives, it is essential to garner an understanding of the recruitment process, which may contribute to the underrepresentation of older African-American adults in chronic illness-related research studies. Epstein 8 recommends that research teams ought to employ active engagement activities to recruit hardto-reach and vulnerable populations such as older African-American adults.…”