Assessing Equitable Recruitment in a Digital Health Trial for Asthma.
Assessing Equitable Recruitment in a Digital Health Trial for Asthma.
复制标题
评估哮喘数字健康试验中的公平招募。
DOI：
10.1055/a-2090-5745
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发表时间：
2023
影响因子：
2.9
通讯作者：
KDalal,Anuj
中科院分区：
文献类型：
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作者：
Plombon,Savanna;SRudin,Robert;SulcaFlores,Jorge;Goolkasian,Gillian;Sousa,Jessica;Rodriguez,Jorge;Lipsitz,Stuart;Foer,Dinah;KDalal,Anuj
本研究旨在评估一种以数字方法为主的多管齐下的策略，以公平地招募哮喘患者进入数字健康干预的临床试验。方法我们使用8种招募策略中的至少一种来接近符合条件的患者。我们记录了接近日期和导致完成基于网络的资格问卷的策略，该问卷在口头同意电话中报告。研究小组成员使用结构化指南每月举行会议，以确定招聘障碍和促进者。报告被门户或非门户战略招募的参与者的比例被作为我们的结果来衡量。我们使用Fisher‘s精确检验来比较公平变量的结果，并使用多变量Logistic回归来控制每个协变量并调整效应大小估计。使用扎根理论，我们编码和提取关于招募障碍和促进者的主题。结果符合研究纳入标准的大多数患者(84.4%)是患者门户参与者。在6366名符合条件的患者中，627人完成了资格问卷调查，他们中西班牙裔的比例较低，讲西班牙语的比例较低，而患者门户网站的注册频率较高。在445名同意参与的患者中，241名(54.2%)报告在通过患者门户消息联系后完成了资格问卷。在调整后的分析中，只有种族(优势比[OR]：0.46，95%可信区间[CI]：0.28~0.77，p= 0.003)和大学文化程度(OR：0.6，95%CI：0.39~0.91，p= 0.016)仍然显著。关键的招募障碍包括技术问题(例如，缺乏电子邮件访问)和促进者包括双语研究人员、西班牙语招聘材料、定向电话和临床医生发起的“一键”转诊。结论以数字为主的招募患者参与数字健康试验的战略不太可能实现公平参与，即使在患者门户注册人数过多的人群中也是如此。解决种族和教育差异以及门户网站参与者不那么活跃的非数字化招募方法对于确保临床试验登记的公平性是必要的。
ObjectiveThis study aimed to assess a multipronged strategy using primarily digital methods to equitably recruit asthma patients into a clinical trial of a digital health intervention.MethodsWe approached eligible patients using at least one of eight recruitment strategies. We recorded approach dates and the strategy that led to completion of a web-based eligibility questionnaire that was reported during the verbal consent phone call. Study team members conducted monthly sessions using a structured guide to identify recruitment barriers and facilitators. The proportion of participants who reported being recruited by a portal or nonportal strategy was measured as our outcomes. We used Fisher's exact test to compare outcomes by equity variable, and multivariable logistic regression to control for each covariate and adjust effect size estimates. Using grounded theory, we coded and extracted themes regarding recruitment barriers and facilitators.ResultsThe majority (84.4%) of patients who met study inclusion criteria were patient portal enrollees. Of 6,366 eligible patients who were approached, 627 completed the eligibility questionnaire and were less frequently Hispanic, less frequently Spanish-speaking, and more frequently patient portal enrollees. Of 445 patients who consented to participate, 241 (54.2%) reported completing the eligibility questionnaire after being contacted by a patient portal message. In adjusted analysis, only race (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.28–0.77,p= 0.003) and college education (OR: 0.60, 95% CI: 0.39–0.91,p= 0.016) remained significant. Key recruitment barriers included technology issues (e.g., lack of email access) and facilitators included bilingual study staff, Spanish-language recruitment materials, targeted phone calls, and clinician-initiated “1-click” referrals.ConclusionA primarily digital strategy to recruit patients into a digital health trial is unlikely to achieve equitable participation, even in a population overrepresented by patient portal enrollees. Nondigital recruitment methods that address racial and educational disparities and less active portal enrollees are necessary to ensure equity in clinical trial enrollment.