Engendering Rapport: Recruiting African Americans in Research Studies in an Era of Heightened Mistrust

Chalandra M. Bryant, Ph.D., CFLE, Professor, Department of Family Social Science, University of Minnesota
/ NCFR Report, Fall 2021

Thumbnail
Chalandra M. Bryant, Ph.D., CFLE

See all articles from this issue

In Brief

  • Community-based participatory research emphasizes equitable involvement of community members, academic researchers, and other stakeholders.

  • Factors inhibiting the participation of African Americans in research involve experiences of discrimination, mistrust, misconceptions about the research, and inconvenience of participation.

  • Development and implementation of culturally responsive interventions are a means of engaging, recruiting, and maintaining African American study participants.

 

Perpetuating Misinformation

Reports suggest that recruiting African Americans into research studies is challenging (Denny et al., 2020; Hughes, 2017). The absence of African Americans in research perpetuates misinformation by yielding findings that are not generalizable. This is essentially structural racism, and it is destructive to science. Researchers must learn to engage with Black, Indigenous, and People of Color (BIPOC) families and communities in open discourse in order to facilitate tangible change. How? An initial step is to stop explaining that samples lack diversity because African Americans refused to participate, thereby placing the blame on the unrecruited sample. Doing so certainly does not engender social justice.

What is the role of social justice in research? That is a question many researchers are asking. Importantly, social justice in research is not synonymous with social justice research, which involves exploring the “origins, structures, and consequences of justice in human affairs” (see the aims and scope of the journal Social Justice Research). Instead, social justice in research refers to how researchers approach their work. Clarity is needed regarding the meaning of social justice, a term that has reached mainstream discourse in the United States in the past few years in reference to the fundamental inequities in American society. On the surface, it sounds as though everyone is using the term in the same way, but the usage differs across individuals and organizations.

The United Nations defines social justice as follows: “Social justice may be broadly understood as the fair and compassionate distribution of the fruits of economic growth” (United Nations Department of Economic and Social Affairs, 2006, p. 7). According to the Center for Economic and Social Justice (n.d., para. 3), “Social justice encompasses economic justice.” The National Association of Social Workers (NASW) defines social justice as the view that every individual deserves equal economic opportunities, political opportunities, and social rights (Benner et al., 2021). Five social justice priorities serve as guiding principles for the NASW (2018):

  • Voting rights
  • Criminal justice and juvenile justice
  • Environmental justice
  • Immigration
  • Economic justice

Although each definition differs slightly, equality is reflected in each one. But those definitions do not explicitly capture a core component (or what should be a core component) of social justice: the right to be, to exist. For example, a statistic about newborn babies illustrates that missing component. According to Greenwood et al. (2020), Black newborns in the United States die at three times the rate of White newborns during their initial hospital stays. When Black doctors care for Black babies, that mortality rate is cut in half—a striking and sobering detail. This race-concordance disparity increases even further for medically complicated cases involving Black newborns. This mortality issue is not addressed—explicitly or implicitly—in most definitions of social justice. (Perhaps this is one reason people must explicitly exclaim “Black Lives Matter.”) The motives or pretexts undergirding these pronounced differences in mortality rates are not entirely clear. They are likely a mixture of structural issues and biases.

Although this mortality problem does not neatly fall within any of the aforementioned definitions, it is a social justice issue. It goes beyond the impact of political, economic, or social opportunities. Again, it is about the right to be. It is about valuing the rights of others to be, to exist in a state of good health. African Americans bear a disproportionate burden of negative health outcomes in the United States despite accounting for only 13% of the population (U.S. Census Bureau, 2019). These health outcomes are attributed, in part, to historical injustices and income disparities that were and continue to be nourished and sustained by structured systems of inequality (Forde et al., 2019; Gehlert et al., 2008).

Researchers cannot possibly foster a strong understanding of mortality, health, or social determinants of health without a sample of African Americans. How, then, do we recruit samples of African Americans? One way involves creating partnerships.

 

Partnership Approach

Community-based participatory research (CBPR), a partnership approach to undertaking research, emphasizes the equitable involvement of community members, academic researchers, and other stakeholders (Collins et al., 2018; Wallerstein et al., 2017). It is undergirded by a philosophy that the researcher is not the only one who holds privileged knowledge or power (Wallerstein & Duran, 2006). This collaborative approach has become more common over the years, as it provides a viable means of exploring health inequities within a community and actually promoting health equity (Brush et al., 2020; Collins et al., 2018). Social injustice and racism (a structured system of power and opportunity) have an impact on health equity. There are marked differences between traditional research and CBPR. Table 1 highlights a few differences (see Table 1).  

 

Table 1. Comparing Traditional and CBPR Research

Variable

Traditional Research

CBPR

Research idea

  • Developed by researchers
  • Driven by funding priorities and researchers’ interests
  • Arise from community needs
  • Developed with community

Recruitment

  • Conducted by research staff
  • May be conducted with aid of community members

Research design

  • Unchanged through duration of study
  • Flexible and accommodating, particularly in early stages of study

Dissemination

  • Authorship: researchers and institutions only
  • Academic audience is main focus
  • Promotion of institution or researcher interests is main focus
  • Authorship: community members frequently included as coauthors
  • Includes academic as well as community audience
  • Promotion of community well-being is main focus

Sustainability

  • Programs and interventions cease when project ends
  • Neither data nor findings given to community
  • Sustaining programs and interventions is a goal
  • Data and findings shared with community (can be used for future funding requests, even if researcher not involved)

Source: Adapted from Collins et al. (2018, p. 887).

 

Community-Focused Recruiting Practices

In an effort to be culturally responsive and aware, researchers should consider centering CBPR-focused health interventions around places frequented by community members, such as barbershops and salons. Some researchers use such establishments as recruitment sites (Luque et al., 2016; Rader et al., 2013). In many communities, barbershops are cultural institutions (Owens et al., 2017), and researchers may be able to develop trust and rapport with barbers who have already established trust and rapport with their clients (Owens et al., 2017). Note that the use of barbershops and salons to recruit African American participants has yielded mixed results. For example, older African American women indicated that they could be recruited from salons only if the research topic was of interest to them (James et al, 2017). CBPR could help identify research of interest to them.

Some researchers have successfully recruited through fraternities and sororities. These organizations are typically well networked in the community and can serve as valuable recruitment agents. Some researchers report that the best method of recruiting African American men is the snowball method (Friedman et al., 2012; Naderifar et al., 2017; Owens et al., 2013). Some researchers have successfully recruited from churches, because churches typically provide stable repeat audiences (James et al., 2017).

 

Inhibiting Factors

Factors inhibiting the participation of African Americans in research (particularly health research) involve experiences of discrimination, misconceptions about the research, inconvenience of participation, and mistrust (George et al., 2014; Speights et al., 2017; Webb et al., 2019). For example, a known statistic like the mortality rate of Black infants under the care of White doctors engenders mistrust; it will take much more than CBPR to mitigate such a serious situation. CBPR is only a research method, a philosophy, so to speak. Despite recruitment resources, researchers still need to know how to approach their potential study participants. An older African American male churchgoer felt that researchers take African American churchgoers for granted. This is what he said about the use of churches as recruiting grounds: “They [the researchers] have to approach us right. They need to be respectful. We are good people. If someone is pushy or is a hard salesman . . . they’re not going to get too far” (James et al., 2017, p. 784).

 

Implications: Recommendations for Research

African Americans want to participate in research that will help them improve their health outcomes (James et al., 2017). As researchers we need to decrease and remove factors that inhibit their participation. All factors cannot be easily addressed, but some can. The development of rapport and trust do not manifest overnight; they take time. Partnering with organizations embedded within the community and deemed trustworthy by community members may be a way to start.

Let’s not blame African Americans for not participating in our research studies. The churchgoer was right; we as researchers have to approach them right. This means that we need to show up in person and explain who we are and what we are trying to do. They don’t know us, and during this era, fraught with racial discrimination, hate, and injustice, they owe us absolutely nothing. We need them—their time, their attention, their consideration—to make our work better. Ironically, who holds the power here? I’ll give you a hint: It’s not the researcher.

 

References

Benner, K., Pope, N. D., & Strawn, E. C. (2021). Setting the stage for justice-driven social work practice. In K. Benner, D. N. Loeffler, & N. D. Pope (Eds.), Social, economic, and environmental justice: Building social work practice skills (pp. 1-16). Springer.

Brush, B. L., Mentz, G., Jensen, M., Jacobs, B., Saylor, K. M., Rowe, Z., Israel, B. A., & Lachance, L. (2020). Success in long-standing community-based participatory research (CBPR) partnerships: A scoping literature review. Health Education & Behavior, 47(4), 556–568. https://doi.org/10.1177/1090198119882989

Center for Economic and Social Justice (n.d.). Defining economic justice and social justice. www.cesj.org/learn/definitions/defining-economic-justice-and-social-justice/

Collins, S. E., Clifasefi, S. L., Stanton, J., Straits, K. J., Gil-Kashiwabara, E., Rodriguez Espinosa, P., Nicasio, A .V., Andrasik, M. P., Hawes, S. M., Miller, K. A., Nelson, L. A., Orfaly, V. E., Duran, B. M., & Wallerstein, N. (2018). Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research. American Psychologist, 73(7), 884-898. http://dx.doi.org/10.1037/amp0000167

Denny, A., Streitz, M., Stock, K., Balls‐Berry, J. E., Barnes, L. L., Byrd, G. S., Croff, R., Gao, S., Glover, C. M., Hendrie, H. C., Hu, W. T., Manly, J. J., Moulder, K. L., Stark, S., Thomas, S. B., Whitmer, R., Wong, R., Morris, J. C., & Lingler, J. H. (2020). Perspective on the “African American participation in Alzheimer disease research: Effective strategies” Workshop, 2018. Alzheimer’s & Dementia, 16(12), 1734–1744. https://doi.org/10.1002/alz.12160

Forde, A. T., Crookes, D. M., Suglia, S. F., & Demmer, R. T. (2019). The weathering hypothesis as an explanation for racial disparities in health: A systematic review. Annals of Epidemiology, 33, 1–18. https://doi.org/10.1016/j.annepidem.2019.02.011

Friedman, D. B., Hooker, S. P., Wilcox, S., Burroughs, E. L., & Rheaume, C. E. (2012). African American men’s perspectives on promoting physical activity: “We’re not that difficult to figure out!” Journal of Health Communication, 27(10), 1151–1170. https://doi.org/10.1080/10810730.2012.665424

Gehlert, S., Sohmer, D., Sacks, T., Mininger, C., McClintock, M., & Olopade, O. (2008). Targeting health disparities: A model linking upstream determinants to downstream interventions. Health Affairs, 27(2), 339–349. https://doi.org/10.1377/hlthaff.27.2.339

George, S., Duran, N., & Norris, K. (2014). A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. American Journal of Public Health, 104(2), e16–e31. https://doi.org/10.2105/AJPH.2013.301706

Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences, 117(35), 21194–21200. https://doi.org/10.1073/pnas.1913405117

Hughes, T. B., Varma, V. R., Pettigrew, C., & Albert, M. S. (2017). African Americans and clinical research: Evidence concerning barriers and facilitators to participation and recruitment recommendations. Gerontologist, 57(2), 348–358. https://doi.org/10.1093/geront/gnv118

James, D. C., Harville, C., Efunbumi, O., Babazadeh, I., & Ali, S. (2017). “You have to approach us right”: A qualitative framework analysis for recruiting African Americans into mHealth research. Health Education & Behavior, 44(5), 781–790. https://doi.org/10.1177/1090198117727324

Luque, J. S., Ross, L., & Gwede, C. K. (2016). Prostate cancer education in African American barbershops: Baseline client survey results and differences in decisional conflict and stage of decision making. American Journal of Men’s Health, 10(6) 533–536. https://doi.org/10.1177/1557988316630952

Naderifar, M., Goli, H., & Ghaljaie, F. (2017). Snowball sampling: A purposeful method of sampling in qualitative research. Strides in Development of Medical Education, 14(3). Article e67670. https://doi.org/10.5812/sdme.67670

National Association of Social Workers. (2018). NASW Social Justice Priorities. Equity and Inclusion 2018-2019. www.socialworkers.org/Portals/0/PDF/Advocacy/Public/Social-Justice/Social-Justice-Priorities-2018-2019.pdf

Owens, O. L., Jackson, D. D., Thomas, T. L., Friedman, D. B., & Hebert, J. R. (2013). African-American men’s and women’s perceptions of clinical trials research: Focusing on prostate cancer among a high-risk population in the South. Journal of Health Care for the Poor Underserved, 24(4), 1784–1800. https://doi.org/10.1353/hpu.2013.0187

Owens, O. L., James, C., & Friedman, D. B. (2017). Overcoming the challenges of African-American recruitment in health sciences research: Strategies and recommendations. Urologic Nursing, 37(6), 293–303, 315. https://www.proquest.com/docview/1979764658

Rader, F., Elashoff, R. M., Niknezhad, S., & Victor, R. G. (2013). Differential treatment of hypertension by primary care providers and hypertension specialists in a barber-based intervention trial to control hypertension in black men. American Journal of Cardiology, 332(9), 1421–1426. https://doi.org/10.1016/j.amjcard.2013.07.004

Speights, J. S. B., Nowakowski, A. C., De Leon, J., Mitchell, M. M., & Simpson, I. (2017). Engaging African American women in research: An approach to eliminate health disparities in the African American community. Family Practice, 34(3), 322–329. https://doi.org/10.1093/fampra/cmx026

United Nations Department of Economic and Social Affairs. (2006). Social justice in an open world: The role of the United Nations. United Nations Division for Social Policy and Development. www.un.org/esa/socdev/documents/ifsd/SocialJustice.pdf

U.S. Census Bureau. (2019). Quick facts: 2019 population estimates. www.census.gov/quickfacts/fact/table/US/PST045219

Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312–323. https://doi.org/10.1177/1524839906289376

Wallerstein, N., Duran, B., Oetzel, J., & Minkler, M. (2017). Community-based participatory research for health (3rd ed.). Jossey-Bass.

Webb, F. J., Khubchandani, J., Striley, C. W., & Cottler, L. B. (2019). Black–White differences in willingness to participate and perceptions about health research: Results from the population-based Health Street study. Journal of Immigrant and Minority Health, 21(2), 299–305. https://doi.org/10.1007/s10903-018-0729-2