Table 4.

Barriers and Challenges to conducting effective third-generation health disparities research among studies of CVD health disparities in African Americans published from 1996 to 2006

Barrier/Challenge	Issues
Financial resources	Limited funders with limited funding, financial incentives are valuable, provisions of health services (medicine, transportation)
Buy-in from community	Community-based participatory research of great benefit, cultural competence a must, some members of investigational team should share cultural background of study sample, use faith-based institutions
Challenges in rural areas	Limited access, no dense populations, poverty
Data often not applicable to other populations/sites	What works in one place may not be applicable to another site
Recruitment and retention	Participant fatigue, other day-to-day pressures on participants, effect of criminal justice system, investigators not part of community, mistrust of scientific community
Difficulty in evaluation of interventions	Long-term follow-up difficult, numbers of participants small, morbidity and mortality data lacking
Varied return on investment	Poor correlation between intensity of intervention and impact