Abstract
Racially and ethnically diverse populations are underrepresented as participants in clinical trials. The disproportionate impact COVID-19 has on communities of color intensifies the imperativeness of equitable access. The purpose of this chapter is to explore how clinical research stakeholders can adapt their traditional approaches to recruitment, research conduct, and design sparked by the current healthcare crisis through technology-oriented strategies designed to increase diverse representation in clinical trials. Strategies utilizing technology will be recommended by examining this issue from a centralized and local perspective across a patient's journey in a clinical trial, with a specific focus on fostering long-term, trusting community relationships. Technology-oriented strategies including health information technology and digital media may provide promising solutions for improving clinical trial diversity amid a transitioning environment that is already adapting to virtual methods for communicating and engaging with patients regarding clinical research.
TopIntroduction
The Healthy People 2030 goals include achieving health equity, eliminating health disparities, and attaining health literacy to improve the health and well-being of all (Healthy People 2030, n.d.). Despite the goals of Healthy People 2030 and other such initiatives, health disparities disproportionately affect members of priority populations including women, children, people of color, individuals with special healthcare needs, the elderly, low-income, and individuals living in inner-city and rural areas (Agency for Healthcare Research and Quality, 2019; Artiga et al., 2020). In particular, the persistence of some health outcomes in racially and ethnically diverse populations has widened over time. For example, the diabetes mortality rate among American Indians has increased at a higher rate over time than among Whites (Institute of Medicine [IOM], 2012; Artiga et al., 2020). Unfortunately, there have been similar trends with the infection rates of COVID-19.
While COVID-19 is affecting the lives of all Americans, the negative impact can be more consequential for specific populations including older adults, persons with underlying medical conditions, and people of color (Gold et al., 2020). In fact, hospitalization rates in the United States due to COVID-19 are approximately three times higher in Hispanic and Black populations compared to White populations (Centers for Disease Control and Prevention [CDC], 2021). Killerby et al. (2020) analyzed COVID-19 patient data from six metropolitan Atlanta hospitals and outpatient clinics finding older age, Black race, diabetes, lack of insurance, male sex, smoking, and obesity were associated with hospitalization. Millett et al. (2020) analyzed publicly available data of predictors of COVID-19 cases and deaths in the US. Findings revealed that nearly 20% of U.S. counties are disproportionately Black, and accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. In a large retrospective cohort study in Louisiana, Price-Haywood et al. (2020) found that 76.9% of the patients who were hospitalized with COVID-19 were Black while only representing 31% of the Ochsner Health population. Furthermore, 70.6% of those who died were Black. Variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate. However, Black race was not independently associated with higher mortality. Based on research findings, it is apparent that socio-economic and demographic factors are playing a role in the impact of COVID-19.
Key Terms in this Chapter
Traditional Media: Media that originated prior to the internet, including newspapers, radio, and broadcast television (IGI Global, n.d.b ).
Minority: An individual having a racial or ethnic background other than non-Hispanic white ( Humes et al., 2011 ).
Clinical Trial: A research study designed to evaluate the safety and efficacy of interventional devices or medications on health outcomes (National Institutes of Health [NIH], n.d.).
Digital Media: Communication medium in which digitized information is broadcast in an electronic format, including audio streaming, video, digital photos, social media, and websites (IGI Global, n.d.b ).
Digital Divide: The circumstance resulting from when populations have limited access to digital media or digital tools, compared to other populations (AMA, n.d.; Anderson & Kumar, 2019 ).
Health Information Technology: Digital tools, such as mobile phone applications, used for the purpose of communicating health information for promoting health knowledge and healthy behaviors ( The Community Guide, n.d. ).
Clinical Research Stakeholders: Individuals involved in designing, conducting, regulating, sponsoring or participating in clinical research.