Using Vignette-Based Methodology to Explore Caring in the Recruitment of Older African Americans Into Health-Related Research

Background: Older minority populations are chronically underrepresented in federally-funded health-related research studies. Recruitment equity is problematic in health-related research studies when the opportunity to participate in the research study is extended to a limited portion of a targeted population. There are two frequently endorsed recruitment challenges in conducting federally-funded epidemiological research studies and clinical trials in the United States, 1) insufficient accrual of targeted populations and 2) inaccurate sample representativeness (Durant, Davis, George, Williams, Blumenthal, & Corbie-Smith, 2007). Insufficient accrual of targeted populations is attributed to perpetuated inequities in the allocation of recruitment resources to special populations such as aging adults, specifically older African-Americans (Barrett, Ingraham, Vann, & Moorman, 2017). Reported barriers to obtaining sample representativeness is the lack of standardized recruitment strategies specific to older African-American adults (Williams & Corbie-Smith, 2006). Consequently, recruitment challenges faced by federally-funded clinical trials result in delayed or failed studies at rates of approximately 80% and 30% respectively (Gul & Ali, 2010). There is a need to examine the recruitment phase of the research study process. Furthermore, an examination of the impact of the research study recruiter’s caring behavior from the perspective of older African-American adults is warranted.

Purpose: The purpose of this study is to describe the development, evaluation and pilot testing of written vignettes (scenarios) used to garner older African-Americans’ perspective of the recruiter’s caring behaviors in the recruitment phase of the research process. The objective was to assess caring recruitment behaviors that correlate with successful recruitment of older African-American adults into health-related research studies.

Research questions:

1) Can written vignettes successfully simulate realistic recruitment scenarios with older African-American adults currently enrolled in a longitudinal health-related research study that includes higher commitment (i.e., brain donation)?

2) Is vignette-based survey methodology a successful method to measure perceptions of caring recruitment behaviors (e.g., Knowing, Being with, Doing for, Enabling, Maintaining belief) based on Kristen Swanson’s Middle Range Theory of Caring?

3) What is the feasibility of using vignette-based survey methodology in an existing longitudinal health-related research study?

Methods: A vignette-based survey methodology was employed with a cross-sectional design. Kristen Swanson’s middle-range Theory of Caring (1991) was used to guide the examination of African-American adults (65 years of age and older) perceptions of caring recruitment behaviors. This 14-month (June, 2017–August, 2018) study utilized a vignette-based survey methodological approach informed by Atzmüller et al., (2010) & Evans et al., (2015) and guided by Hughes & Huby (2012) and Aguinis & Bradley (2014) to develop and evaluate written vignettes with systematic rigor. The following study is delineated into two main phases. Phase One describes the formation, construction and evaluation of two core-vignettes that utilized a Delphi process (Yousuf, 2007). Phase Two was a feasibility pilot study with 45 older African-American adults who were recruited from an existing federally funded Alzheimer’s-related research study. Tools: Eight vignettes were designed to promote a realistic recruitment scenario. The author-developed evaluation survey was a 5-item tool developed to assess the participants’ perception of realism of the vignette, judgement of the vignette character’s caring behavior and decision to make a higher commitment to the study. To capture qualitative participant feedback, open-ended questions were included. Swanson’s Caring Professional Scale was modified to 14-items and used to assess the older African American adults’ perception of caring recruitment behaviors of the hypothetical recruiter in the eight written vignettes.

Main Findings: Phase One – the Delphi panel completed the evaluation of the two-core vignettes online via Survey Monkey™. Seventy percent (n=7) of the invited ten Delphi members provided feedback that resulted in a substantial re-write of the core-vignettes. In Phase Two, 23 of the 45 older African-Americans adults completed the pilot study. While the sample size was too small to determine effect size, the 51% (23/45) response rate revealed that this methodology was able to capture older African-American adults’ perception of research study recruiters’ behavioral characteristics during the recruitment process. Moreover, the older African-Americans who received the hypothetical caring vignette were twice as likely to indicate their willingness to enroll into a research study with a high commitment (i.e. brain donation) as compared to participants who received the hypothetical uncaring recruitment scenario.

Principal Conclusions: Vignette-based survey methodology holds promise as a tool for informing the recruitment of older African-American adults into federally- funded health-related research studies.

Clinical and practical implications: It is important to gain an understanding of the recruitment process at the individual level of a targeted population. Further, examination of the research recruiters’ behavioral characteristics when engaged in direct contact with potential research subjects is warranted. These findings also have the potential to be translated to the recruitment of other minorities and vulnerable populations in health related research.