Recruitment to Clinical Trials
in Rural Communities
Janice L. Raup-Krieger, PhD
The Ohio State University
Roxanne L. Parrott, PhD
The Pennsylvania State University
Acknowledgements
Research supported by a pilot project grant from
the Appalachia Cancer Network (ACN)
Community cancer coalitions:
Action Health
CPAC
Indiana
Lawrence
Acknowledgements
PSU faculty/students:
Jon Nussbaum, PhD
Michael Hecht, PhD
Eugene Lengerich, VMD
Shyam Sundar, PhD
Collins Airhihenbuwa, PhD
Rachel McLaren, MA
Julie Volkman, MA
Amy Chadwick, MA
Christie Ghetian, MA
Audrey Deterding, PhD
Background & Need
Low participation rates in cancer clinical trials
Disparities between the general population
and medically-underserved groups
The significance of aversion to randomization
in Phase III clinical trials
Clinical Communication &
Clinical Trials
Metaphorical language in the clinical context
Common metaphorical explanations for
randomization:
Toss of a coin
Lottery
Picking a number from a hat
Study 1
RQ1: Are conventional metaphors for randomization
appropriate for use with rural, low-income, older
adult women?
RQ2: Are there culturally appropriate metaphors that
can be used to describe chance for rural, lowincome, older adult women?
Study 1 Methods
Design
Four focus groups (N=30)
In-depth interviews (N=11)
Participants
Women living in rural PA counties
<200% of HHS Poverty Guidelines
Over age 50
Focus Groups: M=67.2, SD=9.65
Interviews: M=70.3, range: 55-84
Study 1 Findings
RQ1: Are conventional metaphors for
randomization appropriate for rural, low-income,
older adult women?
Conventional metaphors
Trivializing (“you don’t flip a coin for something serious”)
Devaluing (“only worth flipping a coin…”)
Gambling (“gambling with my life.”)
Definitions for randomization
The
role of chance (“is there a chance you will get
treatment?”)
Study 1 Findings
RQ2: Are there culturally appropriate metaphors that
can be used to describe chance?
A culturally-grounded metaphor for
randomization:
Sex of baby “…Like how some people are born
women and some are born men.”
Study Two
RQ1: What predicts rural, low-income, older
adult women's intentions to participate in cancer
clinical trials?
Study 2 Methods
Experimental Design
4 message condition (attention control, definition, conventional
metaphor, cultural metaphor) pretest-posttest design with
random assignment
Participants (N=106)
Women living in rural PA counties
<200% of HHS Poverty Guidelines
75% annual income between $10,000-$15,000
Over age 50 (M=68.10, SD=12.32)
Cultural Metaphor Message
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Study 2 Findings
Relationships among trait variables and
intentions to participate in clinical trials:
Postmessage
behavioral
intentions
Age
Rural
identity
Intrinsic
religiosity
Extrinsic
religiosity
Premessage
behavioral
intentions
-.10
.31**
.15
.22*
.80**
Study 2 Findings
Relationships among message outcomes
and intentions to participate in clinical
trials:
Postmessage
behavioral
intentions
Attention
Comprehension
Affective
Response
Yielding
Credibility
.50**
-.07
-.03
.44**
.43**
Study 2 Findings
Effect of message strategy on intentions to
participate in clinical trials: F(3,105)=.48, ns
Postmessage
behavioral
intentions
Attention
Control
Standard
Definition
Conventional
Metaphor
Cultural
Metaphor
M = 3.90
sd = .75
M = 3.80
sd = .58
M = 3.93
sd = .91
M = 3.71
sd = .77
Study 2 Findings
Interaction of attention & message strategy
as a predictor of behavioral intentions
5
4
BEHAVIORAL INTENTIONS
3
2
Stra t eg y
1 .0 0
1
2 .0
.0 0
2 .5
ATTENTION
3 .0
3 .5
4 .0
4 .5
5 .0
Study 2 Limitations
Design
Non-clinical population
Measurement
The perception of being “tested” as a threat to
internal validity
Conclusion
Using conventional metaphors for randomization
with rural women may have unintended effects.
Culturally appropriate language appears to be most
important when audiences have limited attention
(e.g., high cognitive demand resulting from cancer
diagnosis).
Contextual cues may influence how individuals
interpret metaphors used to explain randomization.
