The difficulty in recruitment and retention of Latinos in clinical health research is an ongoing challenge. The list of barriers to recruitment is substantial, but with careful study design and practice, can be minimized or largely eliminated.15
The goal of sharing this experience is to offer suggestions for improving recruitment of Latino, as well as other minority and hard-to-reach populations.
More collaboration between researchers, providers, and the surrounding community is key. An initial step could be gaining better support from community gatekeepers, ie, church leaders, civic leaders, and community health care professionals to help garner trust within a community.6,13–15
Researchers and community leaders can then help to refine a greater awareness of the health priorities of a given community,14,27
and when possible, frame study goals within these priorities. Although most studies, like this one, set forth a broad goal to include minorities as a critical subset of the participants, the study name and materials could be modified to be more appropriate for all subgroups. For example, in our case, some Latinos were more familiar with the term “low hemoglobin” than “iron deficiency,” so the study name could ideally accommodate this cultural preference.
Some of the steps toward a balanced representation in clinical research likely will be costly, and funding agencies will need to recognize the added cost. The availability of some financial support from the university or hospital to cover required professional translation expenses would be helpful. Institutions should focus on training more bilingual clinical and research personnel or increasing training of clinical hospital interpreter teams in research methodology.16
Ideally, bilingual research team members could make recruitment and follow-up phone calls to help build more empathetic relationships between the subject and the researcher,15
and generally, to serve as health care advocates for the participant.23,26
Sensitive approaches to recruitment begin with recognizing cultural values.6,14,15
Because of the importance of family in the Latino community,6,15,21
research methods should encourage family involvement. The study budget could also include the cost of taxicabs to transport participants without vehicles to and from follow-up appointments, as well as to provide a child-friendly research site for the other children.11,15,21,26
Flexibility with the times of phone calls and appointments and Spanish signage in clinics where follow-up appointments take place would increase ease of participation. Incentives should be culturally appropriate, including cash rewards if possible. To give more back to participants, researchers should provide study updates and employ results in a way that would benefit the community,14,27
including the distribution of educational materials to promote health and well-being.6,26
Despite lower than anticipated initial enrollment in our study, Latina representation was improved after awareness of several of the discussed barriers to participation. By increasing the availability of the recruiters, employing a native Spanish speaker to make study-related phone calls, recognizing some of the culturally sensitive issues for the participants, and accommodating family involvement in the consent process, a more balanced study population was achieved.
As maternal minority is a risk factor for iron deficiency and other health disparities, it is imperative that the mothers and infants of diverse populations be adequately represented. Although it may require an extra investment of time and resources, communities, health care professionals, and researchers must continue to prioritize the attainment of greater diversity in studies to achieve the goal of improving health among all populations.