Preliminary Medicine, Rutgers- New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07103, USA.
Department of Family Medicine and Community Health, Rutgers- Robert Wood Johnson Medical School, 112 Paterson St., New Brunswick, NJ, 08901, USA; The Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Rutgers Institute of Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USA.
J Natl Med Assoc. 2018 Feb;110(1):44-52. doi: 10.1016/j.jnma.2017.06.011. Epub 2017 Jul 13.
To help understand and mitigate health disparities, it is important to conduct research with underserved and underrepresented minority populations under real world settings. There is a gap in the literature detailing real-time research staff experience, particularly in their own words, while conducting in-person patient recruitment in urban community health centers. This paper describes challenges faced at the clinic, staff, and patient levels, our lessons learned, and strategies implemented by research staff while recruiting predominantly low-income African-American women for an interviewer-administered survey study in four urban Federally Qualified Health Centers in New Jersey. Using a series of immersion-crystallization cycles, fieldnotes and research reflections written by recruiters, along with notes from team meetings during the study, were qualitatively analyzed. Clinic level barriers included: physical layout of clinic, very low or high patient census, limited private space, and long wait times for patients. Staff level barriers included: unengaged staff, overburdened staff, and provider and staff turnover. Patient level barriers included: disinterested patients, patient mistrust and concerns over confidentiality, no-shows or lack of patient time, and language barrier. We describe strategies used to overcome these barriers and provide recommendations for in-person recruitment of underserved populations into research studies. To help mitigate health disparities, disseminating recruiters' experiences, challenges, and effective strategies used will allow other researchers to build upon these experience in order to increase recruitment success of underserved and underrepresented minority populations into research studies.
为了帮助理解和减轻健康差距,在真实环境中对服务不足和代表性不足的少数族裔人群进行研究非常重要。文献中缺乏详细描述实时研究人员经验的内容,特别是在他们自己的话语中,而在城市社区卫生中心进行面对面的患者招募时更是如此。本文描述了在诊所、工作人员和患者层面面临的挑战,我们的经验教训,以及研究人员在新泽西州四个城市合格的联邦健康中心为一项以访谈员为基础的调查研究招募主要是低收入非裔美国妇女时所实施的策略。使用一系列的沉浸-结晶循环,招募人员撰写的实地记录和研究反思,以及研究期间团队会议的记录,进行了定性分析。诊所层面的障碍包括:诊所的物理布局、极低或极高的患者人数、有限的私人空间和患者长时间等待。工作人员层面的障碍包括:不投入的工作人员、负担过重的工作人员以及提供者和工作人员的更替。患者层面的障碍包括:不感兴趣的患者、患者对保密性的不信任和担忧、失约或缺乏患者时间以及语言障碍。我们描述了克服这些障碍的策略,并为研究中招募服务不足的人群提供了建议。为了帮助减轻健康差距,传播招募人员的经验、挑战和有效策略,将使其他研究人员能够在这些经验的基础上进行研究,以增加对服务不足和代表性不足的少数族裔人群参与研究的招募成功率。