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Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use
E Jennifer Edelman1, Tami Frankforter, Oscar F Rojas-Perez
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT (EJE, KA, DP, MBW); Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT (EJE, MBW, BDK); Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT (EJE); Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT (EJE, CC, IG); Department of Psychiatry, Yale School of Medicine, New Haven, CT (TF, OFR-P, JC, DMG, YJ, CN, MP, BDK); The Consultation Center, New Haven, CT (DMG); Grayken Center for Addiction at Boston Medical Center (NLJ), Boston, MA; Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA (NLJ); Department of Psychiatry, NYU Langone Health, New York, NY (AJ); Hispanic Clinic, Connecticut Mental Health Center, New Haven, CT (MP); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (MBW); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (ECW); and Health Services Research and Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, Seattle, WA (ECW).
Objective:
This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD).
Methods:
The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment.
Results:
Recipients : (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention : (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting : (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study : (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences.
Conclusions:
Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.
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