Browsing by Subject "Underrepresentation"

Now showing 1 - 3 of 3
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    Promoting a more diverse and inclusive research workforce through the research scholars program
    (Springer Nature, 2024-01-30) Schoenberg, Nancy E.; Robinson, Jimmy; McGladrey, Margaret; Cassis, Lisa A.; Conwell, Darwin; Pearson, Kevin J.; Tannock, Lisa R.; Wilcock, Donna; White, Stephanie; Neurology, School of Medicine
    Background: Novel and comprehensive approaches are needed to address shortcomings in the diversity and inclusiveness of the scientific workforce. In response to this need and informed by multiple programs and data sources, we created the Research Scholars Program (RSP). The RSP is a yearlong program for early-career faculty with an overall objective to overcome barriers to the academic success, retention, progression, and promotion of groups underrepresented in biomedical and behavioral research. The goal of the RSP is to increase research confidence and productivity, build a supportive research community, and reduce isolation by providing personal and group research enrichment to junior faculty through professional development, mentorship, and networking. Methods: We adapted evidence-based approaches for our institutional context and vetted the RSP across our campus. The resulting RSP consists of three main elements: (1) five levels of Mosaic Mentorship; (2) group and tailored professional development programming; and (3) scientific and social networking. To determine the potential of the RSP to improve research confidence critical to success, we used a modified shortened version of the Clinical Research Appraisal Inventory (CRAI-12) to assess participants' confidence in performing a variety of research tasks before and after program participation. We collected information about retention, promotion, and grants submitted and awarded. Additionally, we conducted semi-structured exit interviews with each scholar after program participation to identify programmatic strengths and areas for improvement. Data for Cohorts 1 and 2 (N = 12) were analyzed. Results: Our assessment finds, with one exception, increasing confidence in participants' research skills across all items, ranging from 0.4 (4.7%) to 2.6 (40.6%). In their exit interviews, the Research Scholars (RS) described their improved productivity and increased sense of belonging and support from others. Research Scholars noted numerous components of the RSP as strengths, including the Mosaic Mentorship model, professional development programming, and opportunities for both informal and formal interactions. Respondents identified time pressure, a lack of feedback, and unclear expectations of the various mentorship roles as areas in which the program can improve. Conclusion: Preliminary findings indicate that the RSP is successful in building the research confidence of underrepresented and disadvantaged early-career faculty. While this report focuses on the development and protocol of the RSP, additional cohorts and data will provide the evidence base to support dissemination as a national model of research professional development. Such programming is critical to ensure sustainable support structures, institutional networks, infrastructure, and resources that will improve discovery and equity through inclusive excellence.
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    Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review
    (JMIR, 2024-02-01) De Jesús-Romero, Robinson; Holder-Dixon, Amani R.; Buss, John F.; Lorenzo-Luaces, Lorenzo; Psychiatry, School of Medicine
    Background: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. Objective: Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. Methods: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. Results: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. Conclusions: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.
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    Underrepresentation in Cardiovascular Disease Clinical Trials
    (2023-07-28) Khan, Uzair; Raman, Subha
    Background: When it comes to inequalities in medicine, there are countless avenues through which barriers are placed that lead to worse health outcomes for marginalized groups. One inequality that isn't mentioned nearly as often is how difficult it is for marginalized groups to participate in clinical trials. As such, the results from these studies are most broadly applicable only to white men, the most common demographic to participate, as opposed to people from all races and backgrounds. The project for this summer is the first step in a longitudinal project meant to identify and address the barriers that preclude marginalized groups from participating. Methods: There are three steps to researching this underrepresentation. The first is a literature review. In this step, we searched for any existing literature about the presence of underrepresentation in cardiovascular disease (CVD) clinical trials as well as in other fields. From this literature, the results were analyzed, to ensure the validity of conducting our study, as well as the methodology of the studies, to ensure our own research will follow the established methods of other successful studies. The second is to interview experts in the field, such as others who research this topic as well as cardiologists and community leaders, to determine what barriers and solutions they believe decrease participation of POC patients. The final step is to conduct our own clinical trial that addresses those barriers by applying solutions discerned from the previous steps and creates a successful methodology to properly include underrepresented patients in the future. For this summer, we made it to the second step. Results: The literature review found that there indeed exists a discrepancy in participation of POC patients in clinical trials. Specifically, while the percent of overall nonwhite participation has increased, the number of black participants has remained the same since January of 2001, indicating that while there has been improvement in this inequality, there is still a need to improve recruitment for black participants specifically (Tahhan et al., 2020). Findings from the literature review also indicated potential barriers for underrepresented groups, including mistrust of clinical trials as a whole, time/resources constraints, and just a general lack of awareness of the existence of clinical trials (Clark et al., 2019). While determining solutions is part of the future directions of this study, Clark, et al. seems to suggest that the best solutions will address the interface between patients, physicians, and clinical trial teams on all 3 levels. One final conclusion from the literature review is the fact that there was “no price to pay for achieving diversity” (Batchelor et al., 2021). In looking at studies all over the country from 2 US National Coronary Stent Registries, a higher focus on increasing racial minority groups and women did not negatively influence research site performance, and possibly could lead to lower protocol deviation rates. While the interview portion of the study has yet to be completed, we have interviewed Francine Epperson, a researcher who has investigated barriers to black patient participation in Alzheimer’s clinical trials. Her study concluded that one facilitator to increase black participation is a “return of results to make informed decisions about their health” (Eliacin et al., 2023). Too often, clinical trials take results from participants and apply them elsewhere, with their participants being none the wiser as to what they helped accomplish. By applying and sharing the results of the studies to the communities that are recruited, we establish trust and a continued partnership, something that is desperately needed to help address the underrepresentation in cardiovascular disease clinical trials. Future Directions: The next steps in this project include conducting expert interviews, including cardiologists but also public health and community leaders, to determine barriers to participation and potential solutions. The final step involves consolidating the first two steps into solutions that can be used to conduct a clinical trial that minimizes barriers and increases rates of nonwhite participation. Citations: Batchelor, W. B., Damluji, A. A., Yong, C., Fiuzat, M., Barnett, S. D., Kandzari, D. E., Sherwood, M. W., Epps, K. C., Tehrani, B. N., Allocco, D. J., Meredith, I. T., Lindenfeld, J., O'Connor, C. M., & Mehran, R. (2021). Does study subject diversity influence cardiology research site performance?: Insights from 2 U.S. National Coronary Stent Registries. Am Heart J, 236, 37-48. https://doi.org/10.1016/j.ahj.2021.02.003 Clark, L. T., Watkins, L., Pina, I. L., Elmer, M., Akinboboye, O., Gorham, M., Jamerson, B., McCullough, C., Pierre, C., Polis, A. B., Puckrein, G., & Regnante, J. M. (2019). Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Curr Probl Cardiol, 44(5), 148-172. https://doi.org/10.1016/j.cpcardiol.2018.11.002 Eliacin, J., Polsinelli, A. J., Epperson, F., Gao, S., Van Heiden, S., Westmoreland, G., Richards, R., Richards, M., Campbell, C., Hendrie, H., Risacher, S. L., Saykin, A. J., & Wang, S. (2023). Barriers and facilitators to participating in Alzheimer's disease biomarker research in black and white older adults. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 9(2). https://doi.org/10.1002/trc2.12399 Tahhan, A. S., Vaduganathan, M., Greene, S. J., Alrohaibani, A., Raad, M., Gafeer, M., Mehran, R., Fonarow, G. C., Douglas, P. S., Bhatt, D. L., & Butler, J. (2020). Enrollment of Older Patients, Women, and Racial/Ethnic Minority Groups in Contemporary Acute Coronary Syndrome Clinical Trials. JAMA Cardiology, 5(6), 714. https://doi.org/10.1001/jamacardio.2020.0359