Glover Marewa, Kira Anette, Johnston Vanessa, Walker Natalie, Thomas David, Chang Anne B, Bullen Chris, Segan C J, Brown Ngiare
Centre for Tobacco Control Research, University of Auckland, New Zealand
Centre for Tobacco Control Research, University of Auckland, New Zealand.
Glob Health Promot. 2015 Mar;22(1):21-31. doi: 10.1177/1757975914528961. Epub 2014 May 19.
Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation.
The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people's participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data.
Facilitators enabling Indigenous people's participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems.
The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.
每年都会开展许多随机对照试验（RCT），但专门为原住民设计的试验仅占一小部分。在本综述中，我们探讨了新西兰、澳大利亚、加拿大和美国的原住民参与随机对照试验所面临的挑战以及增加参与度的机会。
系统检索文献，查找已发表的文章，这些文章包含有关原住民参与健康相关随机对照试验的障碍和促进因素的信息。通过对电子数据库（Scopus、Medline和EMBASE）进行关键词搜索来识别文章。要纳入综述，论文必须在其发表的作品中至少包含随机对照试验的一个方面，该方面是从例如干预设计或文章讨论部分中确定的参与障碍和/或促进因素。排除综述、讨论、观点文章或理论依据/方法学文章。对结果进行归纳分析，使主题从数据中浮现出来。
促进原住民参与随机对照试验的因素包括建立关系和伙伴关系、雇佣原住民工作人员、借鉴原住民知识模型、有针对性的招募技巧以及调整研究材料。参与面临的挑战包括参与者层面的因素（如对研究的不信任）和随机对照试验层面的因素（包括未充分解决可能的参与者障碍（电话可用性、差旅费），以及缺乏对原住民知识体系的认可或纳入）。
我们综述的结果通过确定开展随机对照试验并让原住民参与其中的有效且实用的策略，丰富了消除健康差距方面的知识体系。未来旨在使原住民受益的试验应积极让原住民研究伙伴参与，并尊重和借鉴相关的原住民知识和价值观。本综述有可能协助此类研究的设计。
