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      The Symbolic Value and Limitations of Racial Concordance in Minority Research Engagement

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          Abstract

          <p class="first" id="P1">The well-documented underrepresentation of racial and ethnic minorities in research demands action. The field of health disparities research, however, lacks scientific consensus about how best to respectfully recruit underrepresented minority populations in research. We explore the investigators’ perspective regarding how their own racial and ethnic background influenced their ability to recruit minorities, including 1) the influence of racial concordance (“race-matching”) in research recruitment, 2) attributes and shared values important in the development of trust with minority communities, and 3) the role self-reflection plays in the development of meaningful research relationships. In 2010, we conducted in-depth, semi-structured, telephone interviews with investigators (N=31) experienced with minority populations. Through the analysis of this coherent narrative, we uncovered both the symbolic and surface level assumptions regarding minority recruitment to expose a deep structure understanding of race, ethnicity, and social context that are critical for bridging the true social difference between researchers and participants. </p>

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          Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review.

          Jean Ford, Mollie W Howerton, Gabriel Lai … (2008)
          Racial and ethnic minorities, older adults, rural residents, and individuals of low socioeconomic status are underrepresented among participants in cancer-related trials. The authors conducted a systematic review to determine the barriers to participation of underrepresented populations in cancer-related trials. Their search included English-language publications that reported original data on the recruitment of underrepresented groups to cancer treatment or prevention trials between 1966 and December 2005 in multiple electronic databases. They also hand-searched titles in 34 journals from January 2003 to December 2005 and they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicated that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials.
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            Critical Race Theory, race equity, and public health: toward antiracism praxis.

            Chandra L Ford, Collins O. Airhihenbuwa (2010)
            Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism's contemporary influence on health, health inequities, and research. Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded in social justice. Critical Race Theory's tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies. We introduce Critical Race Theory to the public health community, highlight key Critical Race Theory characteristics (race consciousness, emphases on contemporary societal dynamics and socially marginalized groups, and praxis between research and practice) and describe Critical Race Theory's contribution to a study on racism and HIV testing among African Americans.
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              Patient-centered communication, ratings of care, and concordance of patient and physician race.

              Lisa Cooper, Debra Roter, Rachel Johnson … (2003)
              African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits. To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making. Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis. 16 urban primary care practices. 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white). Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction. Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits. Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.
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                Author and article information

                Journal
                Title: Qualitative Health Research
                Abbreviated Title: Qual Health Res
                Publisher: SAGE Publications
                ISSN (Print): 1049-7323
                ISSN (Electronic): 1552-7557
                Publication date Created: March 14 2016
                Publication date Created: May 2016
                Publication date (Electronic): March 13 2015
                Publication date (Print): May 2016
                Volume: 26
                Issue: 6
                Pages: 830-841
                Affiliations
                [1 ]University of Maryland, College Park, Maryland, USA
                [2 ]ResearchTalk, Inc., Bohemia, New York, USA
                [3 ]University of North Carolina at Greensboro, Greensboro, North Carolina, USA
                Article
                DOI: 10.1177/1049732315575708
                PMC ID: 4658313
                PubMed ID: 25769299
                SO-VID: 0a9344e9-4729-457c-a41e-86c61aa0ccb1
                Copyright © © 2016
                License:

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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