Abstract A43: Barriers, strategies, and recommendations to engaging African American women in clinical research: The recruiter's perspective
Authors: Barrett Nadine J. , Moorman Patricia , Hawkins Tracey Vann , Wickramasekara Chamali 
Published: October 2015

The Purpose: The purpose of this study was to systematically gather information on the barriers interviewers encounter when recruiting African American women (AAW) study participants, identify approaches that increase the likelihood that an individual will agree to participate, and describe the resources and support that interviewers believe is important for them to be successful.

Background: The challenge of recruiting African Americans for clinical and epidemiologic research have been presented in numerous papers, with some focusing on patient/community perceptions (Herring, 2004; Corbie-Smith, 1999; Scharff, 2010) and others focusing on the perspective of the investigator. One viewpoint that has received relatively little attention is the role of the recruiter or interviewer. These individuals are often the first point of contact between the research study and the potential participant, and they may be a prime determinant of overall participation rates. Although some papers have examined the association between participation rates and interviewer characteristics such as race, age and years of experience, (Hansen, 2006; Davis 2010; Moorman, 1999) these papers have not solicited the input and opinions of the interviewers. There is little in the scientific literature about barriers to participation and strategies for improving response rates from the perspective of the interviewer.

Methods: To address this gap in knowledge, we conducted a series of focus groups with interviewers experienced in recruiting African American women for observational epidemiologic studies, including case-control and prospective cohort studies. Focus groups were conducted reaching 18 recruiters from three research intensive academic/medical institutions along the east coast and the Midwest. Sessions were conducted via 90 minute recorded conference calls and a $10 incentive was provided to each participant. Study approval was obtained through the University's IRB.

The following questions guided the focus groups: (1) What barriers do you hear and face when recruiting AAW into research? (2) What strategies have you used to overcome challenges associated with recruiting AAW in research studies? (3) What resources, tools, and skills would you find helpful so as to more effectively recruit AAW in research? Recordings were transcribed and a thematic analysis of the data was implemented using a systematic, multistep, rigorous process outlined by Braun and Clarke (2006).

Summary of Data: Commonly cited barriers to research participation among AAW include “the gatekeeper,” maintaining confidentiality, lack of community engagement among researchers, requesting bio specimens, and lack of buy-in among clinic staff. As with other studies, research participation among AAW included fear of being a guinea pig, historical medical atrocities, fear and distrust of the medical system, and competing priorities. Key strategies often used to address barriers and increase enrollment include being open about the historical relationship between research and minorities, emphasize the voluntary role, treat potential and current enrollees as a “whole” person, address competing needs with resources, be flexible with protocol, specimen requests, and schedules. Unique recommendations include highlighting the importance of system and research team engagement by understanding clinic culture and increasing researcher's engagement within local minority communities. Consistent with the literature, other cited recommendations to improve enrollment include training around building rapport, understanding bias, cultural competence, and role play with significant feedback on the nuances to consider when engaging minorities in clinical research.

Conclusion: The strategies and recommendations gleaned from front line recruiting personnel have significant policy and practice implications. These findings will inform training and interventions designed to more effectively support research teams as they aim to reach, enroll, and retain African American women and other minorities in clinical research.

Citation Format: Nadine J. Barrett, Patricia Moorman, Tracey Vann Hawkins, Chamali Wickramasekara. Barriers, strategies, and recommendations to engaging African American women in clinical research: The recruiter's perspective. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A43.