Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
Appl Nurs Res. 2023 Oct;73:151718. doi: 10.1016/j.apnr.2023.151718. Epub 2023 Jul 30.
The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity.
Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device.
Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related.
The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
区域剥夺指数（ADI）使用美国人口普查指标衡量个人或社交网络的相对劣势。尽管 ADI 是强有力的再住院预测指标，但尚未常规纳入康复研究。本文旨在探讨 ADI 在研究招募中的应用、与照护者心理社会因素的关联以及增加参与者多样性的招募策略。
对一项试点性脑卒中照护者综合治疗试验的基线数据进行描述性分析。参与者为 32 名照护者（N=32；62.5%为女性；平均年龄 57.8±13.0 岁）和脑卒中幸存者（平均年龄（60.6±14.2），居住在城市环境中。测量指标包括 ADI、Bakas 照护者结局量表、照护者压力指数和家庭评估工具。
大多数照护者为非西班牙裔白人参与者（61.3%），部分或全职工作（43%），收入超过$50000（67.7%），且均具有一定的大学学历。大多数脑卒中幸存者为非西班牙裔白人参与者（56.3%），具有一定的大学学历（81.3%）。ADI 州分位数中位数为 3.0（四分位距 1.5-5，范围 1-9），全国百分位数平均值为 41.7±23.5，仅有 6.3%的参与者来自最弱势的社区。在州分位数的较不利一半中，大多数参与者为黑人或亚洲人。ADI 和照护者因素之间没有统计学关联。
ADI 数据的使用突出了这项脑卒中研究在招募方面的差距，缺乏来自弱势社区和教育程度较低的参与者的包容性。使用健康的社会决定因素指标来确定代表性不足的社区，可能有助于确定招募方法，以针对边缘化人群，并拓宽临床试验的普遍性。
