Culturally Competent Strategies for Recruitment and Retention of African American Populations into Clinical Trials

Abstract

Purpose To identify successful recruitment strategies, challenges and best practices for researchers to engage African American communities in clinical studies taken into consideration target participants’ culture and context. Methods We reviewed 50 studies conducted from 2001-2012 at an inner-city research center to determine the type, duration, anticipated enrollments and actual enrollments. Survey was sent to study coordinators to obtain data on recruitment and retention strategies, challenges and dropout rates. We also interviewed 25 study coordinators on challenges and strategies. Results Of the 50 studies, 24 had completed recruitment at the time of this report. The completed studies achieved a median recruitment rate of 88% [range: 50-110]. Successful recruitment and retention strategies included: field-based strategy and snowballing. Major barriers were: distrust, compensation, education disadvantage, lack of interest and inability to have study partner. Strategies to reduce barriers included providing informational sessions, disseminating newsletters about study outcomes. Best practices include being culturally sensitive including demonstrating a caring attitude and being responsive to participants needs. Conclusions Cultural competence is critical in order to design and implement successful recruitment strategies in this population. Research teams should comprised of multi-ethnic staff, involve the community, demonstrate trust and deliver concise education of the research endeavor.

Predictors of Retention Among African Americans in a Randomized Controlled Trial to Test the Healthy Eating and Active Living in the Spirit (HEALS) Intervention

“…9,[16][17][18][19] A review of 50 studies of AAs in clinical trials identified barriers to retention including lack of a study partner, lower educational level, and lack of compensation. 20 An earlier study conducted by our team found that a decentralized CBPR approach led to intervention…”

Factors Related to Differences in Retention among African Americans and White Participants in the Atherosclerosis Risk in Communities Study (ARIC) Prospective Cohort: 1987-2013

“…However, there is very little research on how to effectively reduce these disparities in study recruitment and design, and once reduced, how to prevent attrition among historically underrepresented groups over long follow-up periods. 7 Further, there is no evidence race alone is a determining factor in compliance and attrition rates. 8 Other elements such as socioeconomic status, cultural background, age, study design, and the study investigators may all play a role in initial participation and retention across races.…”

“…A meta-analysis of 24 clinical trials that included African American participants, with follow-up times ranging from 3 months to 5 years (median of 34 months), had an average drop-out rate of 23.3%. 7 Reasons for drop-out included personal obligations, loss to follow-up, non-compliance with study requirements, and monetary or other incentives for participation that participants considered too low. 7 Retention strategies reported were similar to those used in ARIC and focused on building rapport with participants and maintaining frequent, thoughtful communication while trying to keep the burden of participation low.…”

“…7 Reasons for drop-out included personal obligations, loss to follow-up, non-compliance with study requirements, and monetary or other incentives for participation that participants considered too low. 7 Retention strategies reported were similar to those used in ARIC and focused on building rapport with participants and maintaining frequent, thoughtful communication while trying to keep the burden of participation low. 7 While the clinical trials examined were much shorter than ARIC, many of the issues surrounding retention were the same.…”

“…7 Retention strategies reported were similar to those used in ARIC and focused on building rapport with participants and maintaining frequent, thoughtful communication while trying to keep the burden of participation low. 7 While the clinical trials examined were much shorter than ARIC, many of the issues surrounding retention were the same.…”