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

2. Acknowledgements
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

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

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

6. Study 1
RQ1: Are conventional metaphors for randomization appropriate for use with rural, low-income, older adult women?
RQ2: Are there culturally appropriate metaphors that can be used to describe chance for rural, low-income, older adult women?

7. Study 1 Methods Design Participants 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
RQ1: Are conventional metaphors for randomization appropriate for rural, low-income, older adult women?
Conventional metaphors
Trivializing (“you don’t 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
RQ2: 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
RQ1: What predicts rural, low-income, older adult women's intentions to participate in cancer clinical trials?

11. Study 2 Methods Experimental Design Participants (N=106)
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
Yielding
Credibility
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
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 Measurement Non-clinical population
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.