Hae-Ra Han, PhD, RN Johns Hopkins University School of Nursing

1. Community-Based Participatory Research as a Tool to Maximize Recruitment of Linguistic Minorities in Health Promotion Research Office of Recruitment and Retention Monthly Seminar Series 12-17-09 Hae-Ra Han, PhD, RN Johns Hopkins University School of Nursing

2. Consequences of invisibility …. • Not acknowledged • Not addressed • Not engaged • Not impacted Source: Underwood S. Annual Conference “Creating Research Careers: The Beginning,” National Coalition of Ethnic Minority Nurse Associations (NCEMNA) Washington D.C., March 10-13, 2005. The Office of Recruitment and Retention Lunch Lecture Series December 17 2009 14th Int'l Conference-Keimyung Univ

3. Population by Race & Hispanic Origin: 2000 & Projected 2050 Source: U.S. Census Bureau The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

4. Language spoken at home • US Census – 11% (23.1 million) of the total population (>= 5 yrs) spoke a language other than English in 1980 to 14% (31.8 million) in 1990 to 18% (47.0 million) in 2000. • American Community Survey – 19.7% (54.9 million) in 2006 Source: U.S. Census Bureau. Available from http://factfinder.census.gov/servlet/STTable?-geo_id=01000US&-qr_name=ACS_2006_EST_G00_S1601&-ds_name=ACS_2006_EST_G00_ The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

5. Source: Han et al. (work in progress). Exposure to smoking-related media campaign: A report on a linguistically isolated population. The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

6. Barriers to Research Participation 1. Individual Level - Schedule conflicts - Distrust of research - Fear of losing services - Confidentiality - Cultural beliefs/attitudes - Language - Transportation 2. Community Level - Gate-keepers - Lack of health insurance - Limited health literacy - Consent procedure - Physician perceptions - Bias against research (perhaps related to type of research) The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

7. Cultural Beliefs “Please forgive me for not helping you out. As much as I want to be out there, asking Korean women to get a mammogram, I need to think about my family. I have a son to be wed soon. Who will give us a daughter if one found out my family has an inferior gene running…” Source: Han HR et al. J Immigr Minor Health. 2007;9(2):137-46. The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

8. Strategies to enhance minority inclusion • Community involvement in all stages of a trial • - Establishing a strong, positive relationship with the community, family, and potential referral sources • - Going out into the community to recruit trial subjects • - Educating about the disease under study and benefits of participating • - Having members of the community as part of the research team • - Giving something back to the community for their involvement The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

9. Strategies to enhance minority inclusion 2. Conduct the study in the target community. - Research site is conveniently located - Less travel time and expenses The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

10. Strategies to enhance minority inclusion 3. Develop a tailored recruitment strategy design. - Mailing vs. face-to-face contact - Ethnic groceries and churches - Available community directories - Incentives - Bilingual-bicultural staff - Flexible times and places for recruitment and interventions The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

11. Self-Help Intervention Program for Hypertension (SHIP-HBP) • A community-based HBP management program specially designed for Korean Americans with HBP (2003-2007) • Employed CBPR principles in all phases of the study, including planning, implementing, and evaluating Funded by AHRQ (R01 HS13160, PI: M Kim) The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

12. Recruitment Methods • Word of mouth • Ads through ethnic TV stations, radios, and newspapers • Mass mailing using available community directories • Weekend BP screening at ethnic groceries and churches The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

13. Source: Han HR et al. J Community Health. 2007;32(5):324-42. The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

16. Script from the Korea Times The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009

17. The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009 Source: Han HR et al. J Immigr Minor Health. 2007;9(2):137-46.

18. Successful strategies so far • Bilingual interviewers • Utilization of available community human resource • Small group approach • Face-to-face contacts • Flexible interview times and places • Advertising with the language of a target population • Ethnic groceries and churches • Flexibility to change • Frequent research team meetings • Additional resources for health care access The Office of Recruitment and Retention Lunch Lecture Series December 17, 2009