Barriers to Research Participation Among Older Rural Veterans: Early Insights to Strengthen Frameworks for...

Older, rural adults face compounded barriers to participating in research, and existing frameworks that guide study design to improve the recruitment and retention of older adults, such as the 5Ts Framework, require adaptation to address them. Older, rural Veterans are one such underrepresented population. Drawing on the expertise of multiple research stakeholders within the VA Health Care System, this effort aimed to develop preliminary insights for refining the framework to better address the intersectional barriers this population faces.

A series of facilitated listening sessions with three groups: VA health services and clinical research investigators who oversee study design, research staff responsible for recruitment and data collection, and Veterans and caregivers engaged with a local research center. Sessions were structured around participants' experiences, challenges, and strategies encountered in their own work related to conducting research with older, rural Veterans. Following all sessions, we used an iterative approach to synthesize findings, identify key recruitment and retention challenges, and map observations onto the relevant elements of the 5Ts Framework.

Participants identified numerous barriers to the recruitment and retention of older, rural Veterans. Five themes emerged in which age-related and rurality-related challenges intersected: transportation, the digital divide, institutional barriers, communication and accessibility, and context-specific caregiver engagement shaped by both aging and rurality. While some challenges are addressed within existing 5T recommendations, this work identifies several gaps, such as the need to budget for adaptive equipment in rural settings and for live technical support when studies use virtual platforms.

Research investigators, staff, Veterans, and caregivers identified several cross-cutting challenges that are important in the recruitment and retention of older rural Veterans in research. The adaptations proposed here demonstrate that the 5Ts Framework can extend to intersectional aging populations, providing a model for broader representation in research.