Investigator beliefs and reported success in recruiting minority participants

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Abstract

Purpose

Attaining adequate minority participation in clinical trials has been challenging and limited by the lack of data on the role that investigator perceptions play in minority recruitment. We sought to determine what investigator and study factors were associated with investigators' reported success in recruiting minority populations in research.

Methods

Principal investigators (PIs) who conducted clinical research funded by the National Heart, Lung and Blood Institute in 2001 were surveyed about their success in recruiting minority populations, perceptions about the importance of minority recruitment, use of recruitment strategies, and barriers to minority recruitment. Logistic regression was used to identify factors associated with PIs' reports of success in minority recruitment.

Results

A total of 440 PIs completed the survey about minority recruitment. PIs who agreed more strongly about the importance of minority inclusion in their research reported being more successful in minority recruitment. PIs who reported midstream modifications to their recruitment strategies to increase minority participation and those who reported more barriers reported less success in recruiting minority populations.

Conclusion

PIs' reports of success in recruiting ethnic/racial minority populations for research are associated with the value investigators place on inclusion of minority participants in their research. PIs' perceptions should be considered in minority recruitment efforts as they may influence minority participation rates.

Introduction

The NIH 1993 Revitalization Act challenged investigators to include minority subjects as participants in clinical research. This directly mandated that researchers recruit minority groups in a manner that is sufficient to provide valid analyses appropriate to the goals of the research project [1]. Recent health disparities research has brought additional attention to the need to include minority populations in clinical trials. Yet while most investigators would agree that including minority populations is important in generalizing findings, they seldom discuss the challenges of doing so [2].

Some literature suggests that investigators face barriers in minority recruitment when research studies are designed (e.g., [3], [4], [5]). These barriers include potential participants' lack of awareness of trials, financial/economic factors, communication and cultural barriers, and participant mistrust. These obstacles can be reduced with proper pretrial planning, patient education, and genuine communication and concern by study staff [4]. Stone and colleagues suggest that failure to implement remedies or address these barriers is influenced by the attitudes and perceptions of providers or clinical investigators, who may believe that minority populations have little interest in participating in clinical research and thus, investigators may decide not to put much effort into recruiting from that population [6]. This finding introduces a more complex set of questions into the issue of how to improve minority participation in research illustrates that no researcher can be “value-free,” and investigator values may have an impact on the way research and recruitment strategies are designed and conducted [7].

There is a limited empirical study of the perceptions and beliefs that investigators bring to their studies, and thus a limited understanding of investigator characteristics or practices that may be associated with successful recruitment or the lack of it. For example, whether investigators report themselves to be successful in recruiting minority populations may be influenced by their beliefs about the importance of minority recruitment, the recruitment strategies they use, and how many barriers they encounter. In the current study, we examined investigators' perspectives on recruiting minority populations into clinical studies and how those perspectives related to whether they report success in doing so. The specific aims of the project were to: (1) describe the investigators' beliefs about the importance of minority recruitment; (2) describe relevant recruitment strategies; (3) describe perceived barriers to recruitment; and (4) identify factors associated with reported success in recruiting minority populations in clinical studies.

Section snippets

Study population

We obtained a hard copy list from the National Heart, Lung and Blood Institute (NHLBI) of 894 potential investigators who had active grants in FY 2001 in which clinical research on human subjects was conducted. We cleaned this list and double-checked it against our requested filtering criteria. As a result, we eliminated 177 names because they were duplicates, because the investigators had only fellowship and training awards (e.g., R13 awards for conferences), or because their study did not in

Results

The final sample size consisted of 440 investigators, a 70% response rate. Ninety percent of PIs identified themselves as white, and 74% were male (Table 1). Most PIs (66%) reported that inclusion of racial/ethnic minority groups was very important to their research. Seventy-three percent of all investigators somewhat or strongly agreed that they had been successful in minority recruitment. PIs reported including minority personnel on the research team in order to increase minority recruitment:

Discussion

In this study, there were a variety of factors associated with investigators' reported success in recruiting minority populations in research. First, investigators who reported that they valued minority recruitment also more often reported success in such recruitment. It is possible that investigators who valued inclusion were also more committed to finding ways to address some of the cited potential recruitment barriers. The value that researchers placed on minority recruitment may have

Acknowledgements

The authors would like to gratefully acknowledge the contributions of the following individuals who reviewed earlier drafts of this paper: Diane Marie St. George, Raegan Durant, and Connie Blumenthal. We would also like to thank Brenda Denzler for her editorial assistance.

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This work was supported by a training grant from the National Institute on Aging, (Grant #T32 AG00272) and grants from the National Heart, Lung Blood Institute (HL 04039), the National Center for Minority Health and Health Disparities (P60 MD000244) and the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (#038407).

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