Message Factors Affecting the Recruitment of Black Caribbean and African American Participants for Clinical Trials

Susan E Morgan*; Tyler R Harrison; Kallia O Wright; Xiaofeng Jia; Ekaterina Malova; Bonnie Deal

**Susan E Morgan*, Tyler R Harrison, Kallia O Wright, Xiaofeng Jia, Ekaterina Malova and Bonnie Deal**

Volume5-Issue7
Dates: Received: 2024-06-25 | Accepted: 2024-07-04 | Published: 2024-07-06
Pages: 699-709

Abstract

The need for effective and ethical recruitment of Black Caribbean and African American individuals for participation in research studies and clinical trials is urgent; without adequate representation, findings cannot be generalized to these populations. The factors affecting recruitment are complex, including many systems-based issues. However, communication issues have received relatively little attention. To advance knowledge of communication behaviors that impact recruitment of research participants from Black communities, we describe the findings from a study of 48 participants in 9 focus groups. Participants included 31 African American and Black Caribbean individuals who described their experiences being recruited for research studies and clinical trials as well as 17 (primarily Hispanic and African American) clinical research coordinators who described how message factors impacted recruitment and retention of Black Caribbean and African American participants. Using the lens of the Elaboration Likelihood Model (ELM), which describes the communication factors that help motivate the cognitive processing of information, we describe how the amount of information provided, the accessibility of information, and the complexity of information all impact study recruitment. Participants offered insights about the adequacy (and excess) of information provided, tensions related to deviation from consent form language when simplifying complex terminology, preemptively addressing common conspiracy theories during recruitment, the importance of using metaphors and analogies, and communicating complex information using multiple communication modalities.

FullText HTML FullText PDF DOI: 10.37871/jbres1945

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How to cite this article

Morgan SE, Harrison TR, Wright KO, Jia X, Message Factors Affecting the Recruitment of Black Caribbean and African American Participants for Clinical Trials. J Biomed Res Environ Sci. 2024 Jul 06; 5(7): 699-709. doi: 10.37871/jbres1945, Article ID: JBRES1945, Available at: https://www.jelsciences.com/articles/jbres1945.pdf

Subject area(s)

Clinical Trials

Epidemiology

References

Diversity and inclusion in clinical trials. National Institute on Minority Health and Health Disparities. 2022.
Langford AT, Orellana KT, Buderer N. Correlates of knowledge of clinical trials among U.S. adults: Findings from the 2020 Health Information National Trends Survey. Contemp Clin Trials. 2022 Mar;114:106676. doi: 10.1016/j.cct.2022.106676. Epub 2022 Jan 10. PMID: 35026434.
Occa A, Leip A, Merritt AS, Stapleton JL. Prevalence and correlates of invitation to participate in clinical trials among US adults. Prev Med Rep. 2022 Feb 22;26:101742. doi: 10.1016/j.pmedr.2022.101742. PMID: 35251912; PMCID: PMC8889234.
Williams CP, Senft Everson N, Shelburne N, Norton WE. Demographic and Health Behavior Factors Associated With Clinical Trial Invitation and Participation in the United States. JAMA Netw Open. 2021 Sep 1;4(9):e2127792. doi: 10.1001/jamanetworkopen.2021.27792. PMID: 34586365; PMCID: PMC8482053.Cunningham-Erves J, Mayo-Gamble TL, Hull PC, Lu T, Barajas C, McAfee CR, Sanderson M, Canedo JR, Beard K, Wilkins CH. A pilot study of a culturally-appropriate, educational intervention to increase participation in cancer clinical trials among African Americans and Latinos. Cancer Causes Control. 2021 Sep;32(9):953-963. doi: 10.1007/s10552-021-01449-7. Epub 2021 May 27. PMID: 34046808; PMCID: PMC8567194.
Kim SH, Tanner A, Friedman DB, Foster C, Bergeron C. Barriers to Clinical Trial Participation: Comparing Perceptions and Knowledge of African American and White South Carolinians. J Health Commun. 2015;20(7):816-26. doi: 10.1080/10810730.2015.1018599. Epub 2015 Jun 4. PMID: 26042496.
Langford AT, Resnicow K, Dimond EP, Denicoff AM, Germain DS, McCaskill-Stevens W, Enos RA, Carrigan A, Wilkinson K, Go RS. Racial/ethnic differences in clinical trial enrollment, refusal rates, ineligibility, and reasons for decline among patients at sites in the National Cancer Institute's Community Cancer Centers Program. Cancer. 2014 Mar 15;120(6):877-84. doi: 10.1002/cncr.28483. Epub 2013 Dec 10. PMID: 24327389; PMCID: PMC3947654.
Leiter A, Diefenbach MA, Doucette J, Oh WK, Galsky MD. Clinical trial awareness: Changes over time and sociodemographic disparities. Clin Trials. 2015 Jun;12(3):215-23. doi: 10.1177/1740774515571917. Epub 2015 Feb 10. PMID: 25673636; PMCID: PMC4667750.
London L, Hurtado-de-Mendoza A, Song M, Nagirimadugu A, Luta G, Sheppard VB. Motivators and barriers to Latinas' participation in clinical trials: the role of contextual factors. Contemp Clin Trials. 2015 Jan;40:74-80. doi: 10.1016/j.cct.2014.11.013. Epub 2014 Nov 26. PMID: 25433203; PMCID: PMC4357359.
Albrecht TL, Eggly SS, Gleason ME, Harper FW, Foster TS, Peterson AM, Orom H, Penner LA, Ruckdeschel JC. Influence of clinical communication on patients' decision making on participation in clinical trials. J Clin Oncol. 2008 Jun 1;26(16):2666-73. doi: 10.1200/JCO.2007.14.8114. PMID: 18509178; PMCID: PMC3807688.
Barton E, Eggly S, Winckles A, Albrecht TL. Strategies of persuasion in offers to participate in cancer clinical trials I: Topic placement and topic framing. Commun Med. 2014;11(1):1-14. doi: 10.1558/cam.v11i1.16614. PMID: 26402960.
Baur C, Prue C. The CDC Clear Communication Index is a new evidence-based tool to prepare and review health information. Health Promot Pract. 2014 Sep;15(5):629-37. doi: 10.1177/1524839914538969. Epub 2014 Jun 20. PMID: 24951489.
Brown R, Bylund CL, Siminoff LA, Slovin SF. Seeking informed consent to Phase I cancer clinical trials: identifying oncologists' communication strategies. Psychooncology. 2011 Apr;20(4):361-8. doi: 10.1002/pon.1748. Epub 2010 Apr 7. PMID: 20878842.
Jenkins VA, Fallowfield LJ, Souhami A, Sawtell M. How do doctors explain randomised clinical trials to their patients? Eur J Cancer. 1999 Aug;35(8):1187-93. doi: 10.1016/s0959-8049(99)00116-1. PMID: 10615228.
Krieger JL. Last resort or roll of the die? Exploring the role of metaphors in cancer clinical trials education among medically underserved populations. Journal of Health Communication. 204;19(10):1161-1177. doi: 10.1080/10810730.2013.801537.
Krieger JL, Parrott RL, Nussbaum JF. Metaphor use and health literacy: A pilot study of strategies to explain randomization in cancer clinical trials. Journal of Health Communication. 2010;16:3-16. doi: 10.1080/10810730.2010.529494.
Krieger JL, Neil JM, Strekalova YA, Sarge MA. Linguistic strategies for improving informed consent in clinical trials among low health literacy patients. Journal of the National Cancer Institute. 2017;109:djw233. doi: 10.1093/jnci/djw233.
Krieger JL, Palmer-Wackerly A, Dailey PM, Krok-Schoen JL, Schoenberg NE, Paskett ED. Comprehension of Randomization and Uncertainty in Cancer Clinical Trials Decision Making Among Rural, Appalachian Patients. J Cancer Educ. 2015 Dec;30(4):743-8. doi: 10.1007/s13187-015-0789-0. PMID: 25608719; PMCID: PMC4792119.
Locock L, Smith L. Personal experiences of taking part in clinical trials - a qualitative study. Patient Educ Couns. 2011 Sep;84(3):303-9. doi: 10.1016/j.pec.2011.06.002. Epub 2011 Jul 6. PMID: 21737226.
Morgan SE, Mouton A, Occa A, Potter J. Clinical Trial and Research Study Recruiters' Verbal Communication Behaviors. J Health Commun. 2016 Jul;21(7):765-72. doi: 10.1080/10810730.2016.1157654. Epub 2016 Jun 3. PMID: 27259754.
Morgan SE, Finn A, Raley JA, Occa A, McFarlane S, Peng W, Potter J. Assessing communication practice during clinical trial recruitment and consent: A measurement tool. In: Prostran M, editor. Clinical Trials in Vulnerable Populations. InTech; 2018. p.199-213.
Morgan SE, Occa A, Peng W, McFarlane S. Evidence-based communication in clinical, mass media, and social media contexts to enhance informed consent for participation in clinical trials and precision medicine initiatives. O’Hair D, editor.Handbook of Applied Communication; 2020:897-915. doi: 10.1002/9781119399926.ch49.
Morgan SE, Harrison TR, Wright KO, Jia X, Deal B, Malova K. 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. PLoS One. 2023 Jun 21;18(6):e0275770. doi: 10.1371/journal.pone.0275770. PMID: 37342999; PMCID: PMC10284411.
Morgan SE, Harrison TR, Wright KO, Malova E, Deal B, Jia X. Reducing Health Disparities Among African American and Black Caribbean Patients by Improving the Communication Practices of Clinical Research Coordinators. Health Commun. 2024 Jun;39(7):1298-1309. doi: 10.1080/10410236.2023.2211740. Epub 2023 May 10. Erratum in: Health Commun. 2024 Jun;39(7):I. doi: 10.1080/10410236.2023.2215091. PMID: 37165558. 25. Paramasivan S, Huddart R, Hall E, Lewis R, Birtle A, Donovan JL. Key issues in recruitment to randomised controlled trials with very different interventions: a qualitative investigation of recruitment to the SPARE trial (CRUK/07/011). Trials. 2011 Mar 15;12:78. doi: 10.1186/1745-6215-12-78. PMID: 21406089; PMCID: PMC3068963.
Wright KO, Deal B, Harrison TR, Malova K, Jia X, Morgan SE. Examining uncertainty management in the clinical trial experiences of African American and Black Caribbean participants and the coordinators who recruit them. Social Science & Medicine: Qualitative Research in Health. 2023.
Tamir C, Anderson M. The Caribbean is the largest origin source of Black immigrants, but fastest growth is among African immigrants. Pew Research Center. 2022.
Moslimani M, Tamir C, Budiman A, Noe-Bustamante L, Mora L. Facts about the U.S. Black Population. Pew Research Center. 2023.
Petty RE, Cacioppo JT. The elaboration likelihood model of persuasion. In: Berkowitz L, editor. Advances in Experimental Social Psychology. San Diego, CA: Academic Press; 1986. p.123-205.
O’Keefe D. The elaboration likelihood model. In: Dillard JP, Shen L, editors. The Sage Handbook of Persuasion: Developments in Theory and Practice; 2013. p.137-149.
Kruglanski AW, Thompson EP. Persuasion by a single route: A view from the unimodal. Psychological Inquiry. 1999;10(2):83-109.
Hallahan K. Enhancing motivation, ability, and opportunity to process public relations messages. Public Relations Review. 2000;26(4):463-480. doi:10.1016/S0363-8111(00)00059-X.
Petty RE, Cacioppo JT, Schumann D. Central and peripheral routes to advertising effectiveness: The moderating role of involvement. Journal of Consumer Research. 1983;10:135-146. doi: 10.1086/208954
Trivedi N, Lowry M, Gaysynsky A, Chou WS. Factors Associated with Cancer Message Believability: a Mixed Methods Study on Simulated Facebook Posts. J Cancer Educ. 2022 Dec;37(6):1870-1878. doi: 10.1007/s13187-021-02054-7. Epub 2021 Jun 19. PMID: 34145508; PMCID: PMC8213533.
Yang ZJ, McComas K, Gay G, Leonard JP, Dannenberg AJ, Dillon H. Motivation for health information seeking and processing about clinical trial enrollment. Health Commun. 2010 Jul;25(5):423-36. doi: 10.1080/10410236.2010.483338. PMID: 20677046.
Janet Yang Z, McComas K, Gay G, Leonard JP, Dannenberg AJ, Dillon H. From information processing to behavioral intentions: exploring cancer patients' motivations for clinical trial enrollment. Patient Educ Couns. 2010 May;79(2):231-8. doi: 10.1016/j.pec.2009.08.010. Epub 2009 Sep 11. PMID: 19748204.
Yang Z, McComas KA, Gay G, Leonard JP, Dillon H. Information seeking related to clinical trial enrollment. Communication Research. 2011;38(6):856-882. doi: 10.1177/0093650210380411.
Curbow B, Fogarty LA, McDonnell KA, Chill J, Scott LB. The role of physician characteristics in clinical trial acceptance: Testing pathways of influence. Journal of Health Communication. 2006;11(2):199-218. doi: 10.1080/10810730500526703.
Yang ZJ, McComas KA, Gay GK, Leonard JP, Dannenberg AJ, Dillon H. Comparing decision making between cancer patients and the general population: thoughts, emotions, or social influence? J Health Commun. 2012;17(4):477-94. doi: 10.1080/10810730.2011.635774. Epub 2012 Feb 29. PMID: 22376222.
Pinto da Costa M. Conducting cross-cultural, multi-Lingual and multi-country focus groups: Guidance for researchers. International Journal of Qualitative Methods. 2021;20:1-6. doi: 10.1177/16094069211049929.
Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory, 3rd ed. Sage Publications, Inc; 2008. doi: 10.4135/9781452230153.
Massett HA, Dilts DM, Bailey R, Berktold J, Ledsky R, Atkinson NL, Mishkin G, Denicoff A, Padberg RM, Allen MP, Silver K, Carrington K, Johnson LE. Raising Public Awareness of Clinical Trials: Development of Messages for a National Health Communication Campaign. J Health Commun. 2017 May;22(5):373-385. doi: 10.1080/10810730.2017.1290715. Epub 2017 Mar 24. PMID: 28339327.
Morgan SE, Occa A, Potter J, Mouton A, Peter ME. "You Need to Be a Good Listener": Recruiters' Use of Relational Communication Behaviors to Enhance Clinical Trial and Research Study Accrual. J Health Commun. 2017 Feb;22(2):95-101. doi: 10.1080/10810730.2016.1256356. Epub 2017 Jan 13. PMID: 28085636.
Morgan SE, Occa A, Mouton A, Potter J. The Role of Nonverbal Communication Behaviors in Clinical Trial and Research Study Recruitment. Health Commun. 2017 Apr;32(4):461-469. doi: 10.1080/10410236.2016.1140266. Epub 2016 Jun 17. PMID: 27314155.
Occa A, Morgan SE, Potter J. Underrepresentation of Hispanics and other minorities in clinical trials: Recruiters’ perspectives. Journal of Racial and Ethnic Health Disparities. 2018;5:322-332. doi: 10.1007/s40615-017-0373-x.