Recruitment and Participation of Black Home Health Care Patients in Speech-Based Cognitive Research: Mixed Methods...

Older Black adults remain underrepresented in dementia research, particularly in studies using speech-based methods for early cognitive assessment. Understanding how to effectively recruit and engage this population in research involving audio-recorded interactions is critical to ensuring equitable inclusion and developing culturally responsive study designs. However, recruiting older Black adults into dementia research remains a significant challenge.

This study assessed the feasibility of recruiting older Black home health care (HHC) patients into speech-based cognitive research and examined the factors influencing participation and participants' data collection experiences.

We conducted a convergent mixed methods feasibility study using a 4-component recruitment pipeline at a nonprofit HHC agency: (1) patient identification and study introduction, (2) in-home audio-recorded cognitive assessments, (3) follow-up calls, and (4) audio-recorded patient-clinician encounters. Both patients and their corresponding clinicians were included in this study. Eligible participants were Black adults aged 60 years and older receiving HHC services in New York City. Patient demographic and clinical characteristics were compared between those who consented and those who declined using bivariate analysis. Qualitative feedback was gathered through patient questionnaires and clinician semistructured interviews and was analyzed using reflexive thematic analysis.

Of 246 patients contacted, 71 (28.9%) provided verbal consent and 60 (24.4%) completed cognitive assessments. Five patients were excluded due to health conditions or severe cognitive impairment, leaving 55 eligible participants. Among these participants, retention remained high across study components, including follow-up calls (48/55, 87.3%) and audio-recorded clinician visits (54/55, 98.2%). Patients who did not consent were more likely to have greater complex medical profiles, including higher pain interference (P=.01), need for assistance with medication reading (P=.04), and polypharmacy (≥5 medications; P=.01), while no significant differences were observed for age, gender, or functional status. Qualitative findings demonstrated high acceptability and feasibility of audio recording. Patients reported strong motivation to participate, positive and engaging experiences, comfort with recording, and minimal disruption to care. Clinicians reported ease of integration into workflow, initial discomfort that diminished over time, minor technical challenges, and perceived benefits for communication and patient engagement.

Recruiting Black older adults receiving HHC into speech-based dementia research was feasible and well accepted. Culturally tailored recruitment may enhance equitable participation and guide future research using audio-recorded speech for early cognitive detection.