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Recruitment to Clinical Trials in Rural Communities Janice L. Raup-Krieger, PhD The Ohio State University Roxanne L. Parrott, PhD The Pennsylvania State.

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Presentation on theme: "Recruitment to Clinical Trials in Rural Communities Janice L. Raup-Krieger, PhD The Ohio State University Roxanne L. Parrott, PhD The Pennsylvania State."— Presentation transcript:

1 Recruitment to Clinical Trials in Rural Communities Janice L. Raup-Krieger, PhD The Ohio State University Roxanne L. Parrott, PhD The Pennsylvania State University Janice L. Raup-Krieger, PhD The Ohio State University Roxanne L. Parrott, PhD The Pennsylvania State University

2 Acknowledgements Research supported by a pilot project grant from the Appalachia Cancer Network (ACN) Community cancer coalitions: Action Health CPAC Indiana Lawrence Research supported by a pilot project grant from the Appalachia Cancer Network (ACN) Community cancer coalitions: Action Health CPAC Indiana Lawrence

3 Acknowledgements PSU faculty/students : Jon Nussbaum, PhD Michael Hecht, PhD Eugene Lengerich, VMD Shyam Sundar, PhD Collins Airhihenbuwa, PhD Rachel McLaren, MA Julie Volkman, MA Amy Chadwick, MA Christie Ghetian, MA Audrey Deterding, PhD PSU faculty/students : Jon Nussbaum, PhD Michael Hecht, PhD Eugene Lengerich, VMD Shyam Sundar, PhD Collins Airhihenbuwa, PhD Rachel McLaren, MA Julie Volkman, MA Amy Chadwick, MA Christie Ghetian, MA Audrey Deterding, PhD

4 Background & Need Low participation rates in cancer clinical trials Disparities between the general population and medically-underserved groups The significance of aversion to randomization in Phase III clinical trials Low participation rates in cancer clinical trials Disparities between the general population and medically-underserved groups The significance of aversion to randomization in Phase III clinical trials

5 Clinical Communication & Clinical Trials Metaphorical language in the clinical context Common metaphorical explanations for randomization: Toss of a coin Lottery Picking a number from a hat Metaphorical language in the clinical context Common metaphorical explanations for randomization: Toss of a coin Lottery Picking a number from a hat

6 Study 1 RQ 1 : Are conventional metaphors for randomization appropriate for use with rural, low-income, older adult women? RQ 2 : Are there culturally appropriate metaphors that can be used to describe chance for rural, low- income, older adult women? RQ 1 : Are conventional metaphors for randomization appropriate for use with rural, low-income, older adult women? RQ 2 : Are there culturally appropriate metaphors that can be used to describe chance for rural, low- income, older adult women?

7 Study 1 Methods Design Four focus groups (N=30) In-depth interviews (N=11) Participants Women living in rural PA counties <200% of HHS Poverty Guidelines Over age 50 Focus Groups: M=67.2, SD=9.65 Interviews: M=70.3, range: 55-84 Design Four focus groups (N=30) In-depth interviews (N=11) Participants Women living in rural PA counties <200% of HHS Poverty Guidelines Over age 50 Focus Groups: M=67.2, SD=9.65 Interviews: M=70.3, range: 55-84

8 Study 1 Findings RQ 1 : Are conventional metaphors for randomization appropriate for rural, low-income, older adult women? Conventional metaphors Trivializing (you dont flip a coin for something serious) Devaluing (only worth flipping a coin…) Gambling (gambling with my life.) Definitions for randomization The role of chance (is there a chance you will get treatment?) RQ 1 : Are conventional metaphors for randomization appropriate for rural, low-income, older adult women? Conventional metaphors Trivializing (you dont flip a coin for something serious) Devaluing (only worth flipping a coin…) Gambling (gambling with my life.) Definitions for randomization The role of chance (is there a chance you will get treatment?)

9 Study 1 Findings RQ 2 : Are there culturally appropriate metaphors that can be used to describe chance? A culturally-grounded metaphor for randomization: Sex of baby …Like how some people are born women and some are born men. RQ 2 : Are there culturally appropriate metaphors that can be used to describe chance? A culturally-grounded metaphor for randomization: Sex of baby …Like how some people are born women and some are born men.

10 Study Two RQ 1 : What predicts rural, low-income, older adult women's intentions to participate in cancer clinical trials?

11 Study 2 Methods Experimental Design 4 message condition (attention control, definition, conventional metaphor, cultural metaphor) pretest-posttest design with random assignment Participants (N=106) Women living in rural PA counties <200% of HHS Poverty Guidelines 75% annual income between $10,000-$15,000 Over age 50 (M=68.10, SD=12.32) Experimental Design 4 message condition (attention control, definition, conventional metaphor, cultural metaphor) pretest-posttest design with random assignment Participants (N=106) Women living in rural PA counties <200% of HHS Poverty Guidelines 75% annual income between $10,000-$15,000 Over age 50 (M=68.10, SD=12.32)

12 Cultural Metaphor Message

13 Study 2 Findings Relationships among trait variables and intentions to participate in clinical trials: Age Rural identity Intrinsic religiosity Extrinsic religiosity Pre- message behavioral intentions Post- message behavioral intentions -.10.31**.15.22*.80**

14 Study 2 Findings Relationships among message outcomes and intentions to participate in clinical trials: Attention Compre- hension Affective Response YieldingCredibility Post- message behavioral intentions.50**-.07-.03.44**.43**

15 Study 2 Findings Effect of message strategy on intentions to participate in clinical trials: F(3,105)=.48, ns Attention Control Standard Definition Conventional Metaphor Cultural Metaphor Post- message behavioral intentions M = 3.90 sd =.75 M = 3.80 sd =.58 M = 3.93 sd =.91 M = 3.71 sd =.77

16 Study 2 Findings Interaction of attention & message strategy as a predictor of behavioral intentions

17 Study 2 Limitations Design Non-clinical population Measurement The perception of being tested as a threat to internal validity Design Non-clinical population Measurement The perception of being tested as a threat to internal validity

18 Conclusion Using conventional metaphors for randomization with rural women may have unintended effects. Culturally appropriate language appears to be most important when audiences have limited attention (e.g., high cognitive demand resulting from cancer diagnosis). Contextual cues may influence how individuals interpret metaphors used to explain randomization. Using conventional metaphors for randomization with rural women may have unintended effects. Culturally appropriate language appears to be most important when audiences have limited attention (e.g., high cognitive demand resulting from cancer diagnosis). Contextual cues may influence how individuals interpret metaphors used to explain randomization.


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