aDepartment of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
Clin Trials. 2014 Apr;11(2):167-77. doi: 10.1177/1740774513518849. Epub 2014 Feb 24.
Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines.
This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research.
Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented.
Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies.
Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources.
Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
癌症是亚裔美国人的主要死因。虽然亚裔美国人是美国增长最快的少数族裔群体，但他们在癌症研究中代表性不足，并且报告称他们对癌症筛查指南的依从性较差。
本研究利用两项大型随机干预试验的数据，评估从社区环境和亚裔美国医生诊所招募第一代华裔美国移民的策略。研究结果将为促进亚裔美国人参与癌症控制研究提供有效的策略。
从大华盛顿特区、纽约市（NYC）和费城（PA）地区招募不符合年度乳房 X 光筛查指南（研究 1 共纳入 664 名 40 岁以上的移民女性）和结直肠癌筛查指南（研究 2 共纳入 455 名 50 岁以上的移民）的华裔美国人。这两项研究都培训了双语工作人员，通过语言上合适的传单和小册子来获得同意书，以便招募会说中文的参与者。研究 1 采用社区方法，并与社区组织合作招募参与者。研究 2 通过 24 家亚裔美国初级保健医生办公室随机选择潜在参与者，并从医生那里寄信招募患者，然后由研究人员打电话。根据招募的参与者人数、不合格人数和同意人数来评估招募方法的成功率。
研究 1 的大多数参与者（70%）是通过面对面的社区方法（如中文学校、商店、健康博览会和个人网络）招募的。由于各种不合格参与者（2%-64%）和拒绝者（0%-92%）的比例不同，最终特定场所的招募结果差异很大（6%-100%）。研究 2 的招募方法（医生信函后电话跟进）在两个地理区域的结果不同，部分原因是 DC 和 NYC/PA 地区的人口统计学特征不同。社区方法招募的最近移民和没有保险的华裔美国人比医生和电话方法多（p<0.001）。本研究还提供了招募成本，以便为未来的研究提供信息。
我们的招募结果可能不适用于所有华裔美国人或其他亚裔美国人，因为它们可能因研究方案（例如试验的长度）、目标人群（即资格标准）和可用资源而有所不同。
使用多种文化相关策略（例如，通过面对面的登记建立信任关系、使用双语和双文化工作人员、使用医生信函以及使用语言上合适的材料）对于成功招募大量华裔美国人在社区和临床环境中至关重要。我们的数据表明，招募需要大量的努力；研究需要为此做出预算，以确保包括亚裔美国人在内的健康研究。
