Tactics for recruiting diverse patient populations
Patient Recruitment strategies are not the same for all patient populations. The recruitment strategies that work well in a phase III psoriasis study will not be the same as those that work well for a phase II pediatric type 2 diabetes trial. Recruitment strategies will differ among different genders, ethnicities, incomes and ages. In order to develop a sound strategy, you first must understand your audience and then dive deeper to understand preferred mediums and uncover credibility factors that should be considered in the messaging and the medium of recruitment activities.
Beginning with your audience, you must gain credible information about the type of patient that is eligible for a particular clinical research study. Prevalence data is a great place to start. Understanding if there are pockets of higher prevalence in certain areas of the word can assist in site selection and outreach activities. Some conditions have a higher prevalence in certain ethnicities. For example, the SEARCH for Diabetes in Youth population-based study found that the proportion of physician diagnosed type 2 diabetes among those 10 to 19 years old varies greatly by ethnicity in the U.S.: 76% for Native Americans, 40% for Asians/Pacific Islanders, 33% for Blacks, 22% for Hispanics and only 6% for non-Hispanic Whites. This data is crucial to recruitment planning. Couple this with the fact that most children with type 2 diabetes are in middle to late puberty at the time of diagnosis and you begin to get a clear picture of the patient profile.
Once you know who you are trying to reach, outreach strategies need to be devised to match your patient profile. With a rising number of people going online to research health information, consider social media messaging to augment other outreach activities. When looking for the best social media platform, research the breakdown of users. While Facebook users mirror the U.S. population demographic and can reach all groups, African Americans and Latinos are more likely to use Twitter, according to Pew Research. Online media can be geo-targeted to certain areas. If you know that 57% of all African Americans live in the Southeast U.S. and Atlanta has the second largest metro African American population, you should consider that market for media if you are recruiting for a study with a high African American patient population such as sickle cell or heart disease. To recruit a pediatric population with type 2 diabetes, understanding that it affects Native Americans the greatest, you can seek out diverse patient associations or groups such as the Alaska Native Tribal Health Consortium. Conduct research and dive deeper to seek informal patient groups and enlist diverse community organizers and clergy.
Once you know who your patient is, where they are and their preferred mediums, it’s time to look at the credibility factor. It is true that minority groups have a particularly strong distrust of clinical research trials and with good reason. The effects of the widespread Native American sterilization in the 1970s and the Tuskegee syphilis experiment on rural black men has led to huge credibility issues for these groups. While these instances are few and rare, the damage to the trust of clinical research is far reaching and long lasting. Perception is reality and credibility becomes very important to recruiting populations with issues of distrust. If someone hears about a clinical trial from a source of trusted information such as the National Black Church Initiative, a Sorority/Fraternity group or even a trusted radio personality, it can go a long way.
There are many recruitment tactics, and most of them work well for the majority of clinical trials. Popular recruitment tools such as posters/brochures and a study-specific website with online drivers are a few examples of what have now become standard issue. Dive deeper to ensure your strategy is customized for the patient population and you will have better recruitment success. Design literature that is relatable to the population and translated into different languages, if needed. Choose imagery for your website that is relevant to the population and the health condition. Disseminate your messages where your audience communicates and ensure influences are credible. If you are not actively recruiting a diverse population, it is never too late to begin. It matters that research is conducted with people who could stand to benefit the most from the research.
Ashley Tointon has more than 18 years of patient recruitment and project management experience supporting clinical trials and the pharmaceutical industry. Currently she provides recruitment expertise, strategy and leadership as Principal Consultant of Accelerate Clinical Enrollment LLC. Email comments and suggestions to firstname.lastname@example.org.
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