African Americans will enroll in CTs: just ask

Socio-economics can be barrier

A recent study involving recruitment for a nicotine dependence trial has found that African American populations are open to involvement in clinical research when asked.1

Investigators made attempts to contact more than 78,000 people and conducted telephone interviews with 28,658. They compared zip codes with less than 5% African Americans to zip codes with at least 60% African Americans, and found the latter group was significantly more likely to answer the telephone and less likely to refuse the telephone interview than was the group in the zip code with very few African Americans.1

The participation rate among European Americans was significantly lower than the participation rate of African Americans.1

"Many people told the study's principal investigator that it would be very difficult to conduct this study because of the participation of African Americans," says Sarah McConnell Hartz, MD, PhD, an instructor at the Washington University School of Medicine, department of psychiatry in St. Louis, MO.

This turned out to be an unfounded concern.

"Once we got ahold of [African Americans], they were very likely to participate," Hartz says. "They were even more likely to participate than European Americans in the region."

The only obstacle to enrollment of African Americans was that it was more difficult to find members of this population, an issue confounded with socioeconomic status, she adds.

"The communities with a high proportion of African Americans were also communities with high rates of poverty and frequent household moves, so the registered addresses and phone numbers were incorrect," Hartz says. "But that's not to say they won't participate in research; they were very willing to participate."

The study traced subjects from random selection in the community through participation in a telephone interview and recruitment in a genetic study. Investigators evaluated each step of recruitment to see which posed barriers for recruiting African Americans, and their first finding was having considerable difficulty in locating subjects in zip codes with higher proportions of African Americans.1

Once investigators obtained the correct phone number, they found that African Americans were more likely to answer the phone and more likely to participate in the telephone interview. When they were identified as eligible for the study, they were more likely to participate in the genetic study, as well.1

"We had to keep trying to find people," Hartz recalls. "But once we could contact them, it seemed like a major barrier had been overcome."

This particular barrier might be different now, some six years after the telephone interviews were conducted, because in 2005, cell phones were less ubiquitous, she notes.

"I've heard that finding people now is somewhat different than finding people before cell phones became a primary means of communication," Hartz says.

"We wanted a random sample from the community, so we went to the drivers' license registry in Missouri," she says. "We were recruiting people who had smoked 100 cigarettes in their life, and then we distinguished between dependent smokers and nondependent smokers and those who no longer smoked."

The driver's license database no longer is available, and technology has altered the way investigators might go about this type of study, so it could be more challenging to recruit now, she adds.

"We have to use the technology we have now and the culture we have now to physically get ahold of people," Hartz says.

While socioeconomics might have played a role in locating African Americans to recruit for this study, it should not be seen by researchers as a common barrier, an expert suggests.

"Economics may play a role, but in a number of minority communities, most people now have cell phones," says Mary A. Garza, PhD, MPh, an assistant professor in the department of behavioral and community health and associate director for the Maryland Center for Health Equity, University of Maryland School of Public Health.

"Just because they're poor doesn't mean they're hard to recruit," Garza says. "Yes, poverty has its issues and it may contribute to that, but I don't think just for the sake of being poor that people will not want to participate in research."

Also, the technological shift means people can keep their cell phone number as they move, which might make it easier to keep in touch with subjects even as they move from one city to the next.

Some of the strategies investigators used to reach potential participants included first mailing out letters that introduced people to the study. Then a research professional would call people and read from a telephone recruitment script, Hartz says.

"We asked them questions to determine if they were eligible, and if they were eligible they were invited to participate," Hartz says.

The take home message for researchers is that while European American researchers might be more comfortable reaching out to communities with similar ethnic backgrounds, they can include more minorities in their studies by finding ways to engage these communities, as well, Hartz says.

"It's definitely easier to do what we always do, which is reaching out to white men," she adds. "I don't think researchers have been actively discriminating, but it's just the easiest thing to do, so it's important that we acknowledge this has been happening."

Reference:

  1. Hartz SM, Johnson EO, Saccone NL, et al. Inclusion of African Americans in genetic studies: what is the barrier? Am J Epidemiol. 2011;174(3):336-344.