Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use...

Area of Science:

• Clinical Trials
• Health Equity
• Substance Use Disorders

Background:

• Recruiting racially and ethnically diverse patient populations for clinical trials, particularly those with untreated alcohol use disorder (AUD), presents significant challenges.
• Addressing structural racism and social determinants of health is crucial for equitable trial participation.

Purpose of the Study:

• To describe initial experiences and lessons learned from conducting a hospital-based clinical trial focused on recruiting a diverse patient sample with AUD.
• To evaluate the effectiveness of multilevel adaptations in promoting diverse participant recruitment and retention.

Main Methods:

• The study catalogued protocol changes using the Framework for Reporting Adaptations and Modifications-Enhanced.
• Evaluated outcomes using study and electronic medical record data over 18 months.
• Employed multipronged recruitment strategies, including bilingual staff and culturally adapted interventions like Brief Negotiation Interview (BNI) and computer-based cognitive behavioral therapy (CBT4CBT).

Main Results:

• The trial intentionally included individuals impacted by structural racism, utilizing diverse recruitment approaches and staff.
• Intervention adaptations included culturally sensitive BNI scripts, alternative compensation (tablets), and troubleshooting for internet access.
• Setting adaptations involved identifying community AUD treatment options with Spanish-speaking services and resources for social determinants of health.
• Audited data confirmed diverse enrollment: 25% Black, 24% Latine, 58% White, 1% Indigenous, with no observed differences in recruitment or retention by race/ethnicity.

Conclusions:

• Multilevel practices integrated within hospital-based AUD trials can effectively promote the recruitment and retention of racially and ethnically diverse patient samples.
• These findings highlight the importance of tailored, culturally informed strategies to achieve health equity in clinical research.