The Symbolic Value and Limitations of Racial Concordance in Minority Research Engagement

Abstract

The well-documented underrepresentation of racial and ethnic minorities in research demands action. The field of health disparities research, however, lacks scientific consensus about how best to respectfully recruit underrepresented minority populations in research. We explore the investigators’ perspective regarding how their own racial and ethnic background influenced their ability to recruit minorities, including 1) the influence of racial concordance (“race-matching”) in research recruitment, 2) attributes and shared values important in the development of trust with minority communities, and 3) the role self-reflection plays in the development of meaningful research relationships. In 2010, we conducted in-depth, semi-structured, telephone interviews with investigators (N=31) experienced with minority populations. Through the analysis of this coherent narrative, we uncovered both the symbolic and surface level assumptions regarding minority recruitment to expose a deep structure understanding of race, ethnicity, and social context that are critical for bridging the true social difference between researchers and participants.

Despite 20 years since the United States approved the National Institutes of Health (NIH) Revitalization Act, investigators are still challenged to ensure equitable and ethical inclusion of racial and ethnic minorities in research. For more than a decade, an important scientific body of literature has been generated in which investigators examine the issue of increasing minority representation in research (Corbie-Smith, Thomas, Williams, & Moody-Ayers, 1999; Ford et al., 2008, Isler & Corbie-Smith, 2012; Yancey, Ortega, & Kumanyika, 2006). The majority of this work is about overcoming specific barriers to recruitment through building trust, community engaged programs, and other strategies designed to increase success in recruiting minorities (Carroll et al., 2011; Yancey, Ortega, & Kumanyika, 2006). One crucial step to building trust is creating open, clear communication between researchers and participants during all steps of the recruitment process. For some time, investigators have indicated that different socioeconomic groups gather health information from different sources, and thus, communication inequalities can contribute to health inequalities (Bell, 2014). It is essential for researchers to ensure the participants they recruit, particularly vulnerable populations, understand the research in which they are participating, potential risks, and the implications of participation (Minkler & Wallerstein, 2008; Thomas et al, 2011). A strategy that is often mentioned is the inclusion of racially-matched research staff as a way to improve recruiting racial and ethnic minority participants. The use of racial and ethnic concordance (hereafter referred to as concordance) for minority recruitment evolved from research on relationships between physicians and patients, which suggests that racially-matched relationships are associated with increased patient satisfaction, greater patient trust in the health care system, and longer visit times and continuance in care (Alegria et al., 2013; Cooper et al., 2003; Laveist & Nuru-Jeter, 2002; Thorton, Powe, Roter, Cooper, 2011). The little empirical evidence that exists on concordance as a recruitment strategy, however, yields equivocal results (Davis et al., 2013; Diaz, Mainous, McCall, & Geesey, 2008; Durant et al., 2007), suggesting that racial concordance is only one factor among many that impacts the decision to participate.

A critical message supported by the public health literature is that race continues to play a central role in research recruitment, an idea promulgated by Public Health Critical Race praxis (PHCR) (Ford & Airhihenbuwa, 2010a; Ford & Airhinenbuwa, 2010b). PHCR investigators tailor critical race theory to the field of public health and promote a race conscious approach where race must be acknowledged and confronted rather than adopting a “color blind” stance (Ford & Airhihenbuwa, 2010a; Ford & Airhihenbuwa, 2010b). Other researchers explore this idea from another angle and propose that although race is an important aspect of the research relationship, it is moderated by a number of other factors. To this end, investigators highlight the intimate relationship between race and other individual or socioeconomic factors such as gender, age, SES, education) that function in concert to define the outcome of both the recruitment and the research process (Davis et al., 2013; Johnson-Bailey, 1999). This idea of multiple factors working in unison to impact participation is expanded upon by Bowleg (2012), who proposed using the framework of intersectionality as a way to better understand how multiple social identities such as race, gender, age interlock and reflect the larger societal patterns of privilege and oppression. Much has been written in this vein, especially during the crisis of representation experienced in anthropology and feminism during the 1990s (Bell, 1998; Bell-Scott & Johnson-Bailey, 1998; Johnson-Bailey, 1999; Bishop, 1998; Marcus & Fisher, 1996; Mohanty, Russo & Torres, 1991). More recent discussions continue to explore the intricacies of power in the research relationship with specific reference to qualitative methodologies (Aluwihare-Samaranayake, 2012; Ben-Ari & Enosh, (2013); Yost & Chmielewski, 2013). Bowleg (2012) suggests that the examination of the intersection of these individual factors can better explain such phenomena as the persistence of health disparities, and, we propose, the continued underrepresentation of racial minority groups in research.

Bowleg’s (2012) framework elevates the discussion from the simple focus on recruitment to the complexity of the investigator/participant research relationship, including the role of hierarchy and power. A small pertinent, yet older body of literature contains data that suggest that more vital than racial concordance is the unity of values or priorities between the investigator and the community (Brown, Fouad, Basen-Engquist, & Tortolero-Luna, 2000; Felsen, Shaw, Ferrante, Lacrois, & Crabtree, 2010; Levkoff & Sanchez, 2003; Minkler & Wallerstein, 2008). In this body of work, researchers introduced the concept of self-reflexivity and problematize basic tenets of empirical science such as the nature of objectivity, yet also create room for the realization that power difference (between genders, races, ethnic groups, colonial relationships, and so forth) has an impact on research procedures, data collection, analysis, interpretation, and dissemination of findings. Investigators with this perspective counter the social science argument that such a discussion is destructive to the pursuit of science.

Given the complex, and sometimes contradictory, role that race plays in the researcher/participant relationship and its impact on recruitment of racial and ethnic minorities into research, we conducted this study in an effort to better understand the intricacies related to race and research. We asked experienced investigators who routinely engage with minority populations in their work to reflect on the issue of race and how their own racial and ethnic background impacts their research experiences. Although not an examination of effectiveness, we explore the dynamics of the research relationship from the perspective of investigators who were successful in engaging racial and ethnic minority populations as a mechanism to better understand the relevance of concordance in the research enterprise.

The Setting

Building Trust between Minorities and Researchers (Building Trust) was a national Bioethics Research Infrastructure initiative funded by the NIH from 2009–2012 in the United States. The parent study was comprised of five specific aims, which included both research and training components.

The research component encompassed three specific aims each designed as research studies to increase knowledge about minority participation in research, including clinical trials. The studies included 1) an online survey conducted with researchers, research staff, Institutional Review Board members, and community members, 2) in-depth interviews with principal investigators to study best practices in the recruitment of racial and ethnic minorities in research (data from which are the primary focus of the article), and 3) a national random digit dial telephone survey with African American and Latino adults to understand knowledge and attitudes about health and medical research. The education component contained the remaining two aims, and resulted in the development of curricula.

This article is about the analysis of in-depth interviews concerning best practices in the respectful engagement of minorities in research by drawing upon the experiences of a multicultural group of established investigators conducting behavioral and social science research in the United States. We posed a series of questions to investigators about their research experiences, including one specific question about how their own ethnic or racial identity influenced their ability to recruit minorities in research. In this article, we report on the responses we received to this single question, and compare how the responses from researchers of color (individuals who self-identify as being African American/black, Latino/Hispanic, or Native American/American Indian) contrasted with those of White researchers. Additionally, we acknowledge the intersection of race and ethnicity with other demographic factors such as gender and age in the research relationship. Primarily, we describe and illuminate their ideas about the nuanced role of race, its complexities, and the importance of self-reflection upon their experiences in the research enterprise.

Methods

Recruitment of Participants

We interviewed experienced researchers across the United States for the development of best practices in the respectful recruitment of minorities into biomedical and public health research. Participants of this purposive, convenience sample were identified using three distinct strategies. The research team reviewed (a) the list of investigators registered in the NIH Research Portfolio Online Reporting Tools (RePORT) electronic repository of funded studies website, specifically looking for researchers who identified as having experience recruiting minorities into research, (b) the published literature on the effective recruitment of minority participants into research, and (c) word of mouth referral from members of the research team based upon experience within the field of health disparities research. The participants were recruited from May to December 2010 using an email letter invitation to be interviewed by phone. Once the potential participant agreed via email to be interviewed, a date and time were then scheduled for the interview. No incentive was provided to the study participants. The study protocol was approved by a large, public, East Coast University’s Institutional Review Board (IRB).

Data Collection

We conducted in-depth, telephone interviews from June 2010 to January 2011 with the use of an extensive, open-ended, semi-structured, protocol developed by the authors. Informed, verbal consent was obtained and a brief sociodemographic survey was completed by each participant before the start of the interview. Demographic variables collected included: race and ethnicity, gender, age, place of employment, professional rank, number of years of consistent research funding, and source, type, and primary setting of research, to name a few. All telephone calls were made to the participants’ office of employment.

The interview protocol was pilot tested with six investigators for clarity and parsimony of question content and structure. The pilot stage lasted three weeks and all research materials were revised based upon findings from this phase of the study. The final version of the interview protocol was comprised of 21 questions (not including probes and subquestions), and addressed six domains: experience conducting research, strategies used to build partnerships, strategies and challenges in both recruiting and retaining minorities in research, and overall perspective of the research enterprise. The recruitment of study participants ended once no new themes began to emerge during the interviews (saturation was reached). These data reported herein highlight responses to one specific interview question: How has your racial and ethnic background influenced your ability to actively engage and recruit underrepresented minority populations into research?

Data Analysis

The analysis plan comprised several processes to identify the most salient themes emerging from the data. The interviews were digitally recorded and transcribed verbatim for an in-depth analysis. We developed a multidimensional qualitative data analysis plan that featured the method Co-analysis (Maietta, 2006), in collaboration with a qualitative research consulting company. The Co-analysis method required shared decision-making between the research team and the consulting company. The research team (topical experts) ensured that the deductive points of inquiry outlined in the project proposal were addressed while the consultants (technical experts) took responsibility for emergent discovery. Regular engagement with data and frequent interactions between both teams ensured the success of this approach. Initially, two members within each team independently reviewed the interview transcripts and then met to share their reflections of the data with one another. The consistent engagement in discussion regarding the meaning of initial threads and potential themes and the movement back and forth between the data topics advanced this dynamic qualitative analysis process.

Our analysis approach proceeded through the six core phases of the Sort and Sift, Think and Shift approach: data inventory, written reflection, reflective diagrams, categorization, bridging, and data presentation (Curry, Shield & Wetle, 2006; Maietta, 2006). To perform a thorough treatment of the data, this approach was comprised of traditional aspects of qualitative analysis combined with the functionality of software to allow for fluid movement between the “diving in” and “stepping back” phases of data analysis. The analysis plan began with data inventory in which each response was renamed with a descriptive moniker that captures the essence and summary of the response and, ideally, used the respondent’s language, for instance “really connected.” Next, consensus was reached between both teams regarding each quotation moniker. Simultaneously with these primary steps, both teams participated in ongoing written reflection of the data. Reflective diagrams were created, by racial and ethnic background, highlighting responses to the question for each participant and by subtopics that emerged within each of these diagrams. Finally, in the categorization process, codes were generated and reviewed for each emergent thread, subsequent themes and related subthemes within the data. We present the data below to highlight the respondents’ reflections regarding the influence of their self-identified racial and ethnic background on their ability to engage minorities in research. ATLAS.ti 6 (2011), a qualitative software package, was used to facilitate data management and organization.

For the purposes of this manuscript, the following codes were used to describe both the racial or ethnic background and gender (in that order) of the study participant: AA=African American/black, BR=Biracial, L=Latino/Hispanic, NA=Native American/American Indian, W=White, W=woman, and M=man.

Results

A total of 31 investigators were interviewed for the study. The interviews ranged from 33 to 82 minutes in duration. Even though the largest proportion of investigators self-identified as White (n=12), the sample was racially and ethnically diverse with ten participants identifying as African American/black, six as being of Latino/Hispanic descent, two as Native American/American Indian, and one as biracial (black and Native American). Fifty-five percent of the sample self-identified as being a woman, 48% as being 50–59 years of age, and a little more than half (58%) achieving the rank of Full Professor. Additional demographic details of the respondents are shown in Table 1.

Table 1.

Study Participant Demographics

Category	Demographics	N = 31
Gender	Woman	17
	Man	14
Race and Ethnicity	African American	10
	Latino	6
	White	12
	Native American	2
	Biracial	1
Title/Rank	Full Professor	18
	Associate Professor	7
	Assistant Professor	1
	Other	5
Age Range	30–39	1
	40–49	8
	50–59	15
	60–69	5
	70–79	2

The unique, multi-step analysis plan revealed three main themes: racial and ethnic concordance, becoming “really connected,” and self-reflection. Each of these main themes also included subthemes, which are discussed below.

Racial and Ethnic Concordance

As expected, the theme of concordance was prominent in each interview and the responses of the researchers differed along the lines of self-identified racial and ethnic background (non-White and White). Within these two groups; however, there was a high degree of commonality in the responses.

Almost all of the researchers of color reported that they had experienced an initial benefit in working with minority populations, whereas others highlighted the nuanced effect of their racial and ethnic background depending upon the situation. For example, an associate professor noted the unique opposite influences her ethnic (Latino/Hispanic) identity has had on her career advancement and as a specific research skill, “It [ethnic identity] has a negative effect on my career, but a very beneficial effect on recruiting minorities” (LW).

Whereas many study participants recognized the potential value of concordance in recruitment, others stated that it was not the “primary factor” and “not much of an influence” in their success as research scientists. For instance, an investigator who studies men’s health stated: I think it helps, to a degree.

I think it certainly can open doors initially, but those doors will quickly close if as people sort of get to know you, if it’s very clear that you don’t have the genuine interest of the community at heart. (AAM)

Another respondent described her experience over time:

I think during my early years it helped a little bit, but it wasn’t as significant as an outsider would think because they’d say oh, well, it’s an American Indian researcher so it’s going to be easy for her. But it isn’t because you have to develop a trust in every setting that you go into, even in my own community. (NAW)

Indeed, researchers of color noted that although race was one positive point of connection and identification to minority community members, there remained differences in social class (education and income) with the potential to undermine trust and increase social distance. A Full Professor who conducted nutrition research highlighted this point:

There was a shared identity because of race, but if I had gone into the community as a black person, … believing I was better than other people, not engaging with them on an equal basis, I don’t think they would have reciprocated [positively] the way they did. (AAW)

Other participants of color reported the potential negative impact of a shared ethnic background. For instance, an investigator from a research organization explained:”…[at times] your biggest criticizers are other people from your own race. And it’s usually for some… the crab gets his claw caught and he starts pulling himself out and the other crabs pull him down. . .” (NAW)

Equally important, White investigators reported that their racial identity was an initial barrier. Some described their realization that identity had an impact on their ability to work with populations of color. For example, an investigator who primarily conducts epidemiological studies with urban communities commented on being an “outsider:” “I think it also has made me realize some things pretty early - that I’m not from that community.” (WW)

Although it may appear simplistic establishing personal relationships across the color line is not easy. A White male investigator who conducts research with youth illustrates the symbolic value of racial identity within the context of being an “outsider:” “I think an outsider is an outsider. So just because you share the same skin color, that doesn’t make someone more culturally relevant or culturally sensitive, and sometimes quite the opposite.”

Racial concordance, matching the race of the researcher with the population being recruited, emerged in the narratives as limited in the conduct of research. Case in point, a Latino interventionist who conducts randomized clinical trials, commented on the importance of diverse research teams as more salient than direct racial or ethnic concordance:

I recruit a fair amount of African Americans in my population, I’m not African American, but I am Hispanic, and I do think that our participants respect that we do have the diverse research group, including investigators…and I think that it is important to convey. (LM)

Echoing this theme, an African American investigator described how the common strategy of ‘race-matching’ did not account for the intersection of other facets of social identification:

I’ve seen White colleagues be equally successful in connecting with people and earning their respect and trust… Sometimes, the bigger barrier is simply age… it sometimes can be difficult for them to follow someone who is so much younger than they are, and for me to lead someone who is so much older than I am. (AAM)

Equally important, like their racial and ethnic minority colleagues, White researchers reported that ultimately they were successful in engaging minority study participants by using interpersonal skills and demonstrating human qualities that demonstrated authenticity and cultivated trust and respect.

Becoming “Really Connected”

Across all groups, investigators spent time explaining the dynamics that were the “primary factors” in their successful recruitment and retention of minority communities in research. Researchers discussed human values and virtues as more important methods to be “really connected” to minorities. These factors centered on relationship building that emphasized reflecting values of the community, trustworthiness, actively “listening,” expressing “empathy,” reciprocity, “transparency,” and humility. For example, a qualitative investigator declared:

So simply being African American is not going to help you work in African American communities if they don’t really think that you are really connected to the community, you are really invested in the community and reflect community needs and values. (AAM)

Additionally, a cancer disparities researcher noted the importance of building trustworthy relationships:

… because you have to develop a trust in every setting that you go into, even in my own community. So if I’m working with the [a Native American community], I’m going to take some time in getting to know them… (NAW)

There was a confluence of comments where study participants described the value of listening and showing empathy as critical components of being “really connected.” The following three quotes from African American, Latino, and White investigators, respectively, exemplify the multifaceted and dynamic nature of these human qualities: “So I think my background makes it easier for me to empathize with their position [oppression] that most minority participants are coming from” and “Well, I think being from the same community and knowing the language and knowing where the community comes from and empathizing, I don’t think only Latinos can empathize with Latinos.”

I think it’s been a challenge at times because I’m a White researcher, and I think the things that I’ve learned over the years is just to listen and sometimes just to shut my trap because I’ll be learning so much if I just listen.

It is noteworthy that study participants also described ways in which they sought to give back to the community as an indication of being “really connected.” The ensuing comments denote the important component of reciprocity in research partnerships demonstrated by data findings dissemination and advocating on behalf of the community in other community-academic partnership affairs. “I have gone back to make sure that I have given the information back to people who have been in the research project to share the findings with them, beyond what is in the published, in the journals.” (AAW)

I could be an objective outsider that was a helpful voice… being the bridge between the communities and the academic institution. And once they trusted me, I could be a really good bridge for them. And I could also be a really safe advocate at the institution. (WW)

“Transparency” was another common factor identified as contributing to being “really connected” and demonstrating trustworthiness as illustrated by the following quote, “ you have to really, really be honest and forthcoming with information, treat everybody with respect,… give them enough information to make their own decision and respect that and then people will accept you.” (WW)

The theme of “humility” frequently emerged during the interviews. Many of the investigators reported demonstrating humility as contributing to being “really connected” to the study population. Moreover, humility facilitated learning from the minority community and understanding external influences on the decision to participate in research. Namely, “…I try to bring an attitude of humility and that I’m going to be learning, and that helps me build that relationship.” (WW)

I think what has worked in my favor has been just more of a humbling of understanding what people, the stress that people are encountering and the struggles and the decisions that they make about being in, engaging in research. (AW)

Finally, the necessity for training investigators, regardless of racial or ethnic background, to respectfully work with minority communities emerged as an important thread of discussion during the interviews. Study participants called for extensive training of research staff, including principal investigators in human relations as part of standard operating procedures. The two illustrative comments below underscore pertinent aspects of training, including awareness of power relations and comfort level: “…and I need to be comfortable with issues related to power and control, the history of the institutional role in the community.” (WM)

…you have to be able to connect on a human basis with people whom you are working with in that close range in the community, in their homes…Yes, they’re in charge so you have to fall-in and be part of them. (AAW)

Above all, during all facets of the interview when discussing effective strategies for relationship building, we found no difference in the mechanisms utilized between non-White and White researchers.

Self-Reflection

The final major theme to emerge in the analysis was the concept of self-reflection. Self-reflection was defined from two perspectives: 1) motivation for doing “good work” and 2) the lived experience. Notwithstanding, self-reflection represented a deeper level of awareness that not only facilitated authentic relationships with minority communities, but ultimately provided evaluation of the research process. The following comments epitomize the perspective of doing “good work” – that is, honestly evaluating their work especially with regard to the community’s goals: “…there needs to be some self-reflection, there needs to be some dialogue with others, there needs to be what I call self-clearance to figure out what I’m doing correctly, what I’m not doing correctly.” (BRW)

I think they might say that he at least tries to do his best to represent us and to do his work with integrity and try to genuinely benefit the community and to address the health issues and the social issues that we have here. (AAM)

Equally important, researchers often shared their lived experience when self-reflecting about their work and the engagement of minority communities. Of particular note, almost all of the study respondents reminisced about poignant episodes in their lives as a way to underscore how genuine connections were made with study participants. As illustrated by the following, “I think that my lived experience is much more similar to the communities I work with than someone, other typical university faculty, and I think that that lived experience is a huge benefit in partnerships.” (NAW)

I grew up in the south in the 1950s and 1960s. …I really care about issues of health equity as these affect the nation’s black people… And I think I’m able to communicate that passion to many of the people I work with and despite the color of my skin, I think that that passion really helps. (WM)

…I do think that my own background, and the sort of struggles with racism and discrimination that my family’s faced, my parents as well as me personally, have provided a certain perspective on all of this, a better understanding, a deeper understanding of what people are thinking and feeling. (AAW)

More specifically, study participants, particularly White researchers, detailed how they consciously drew upon their own personal experiences of vulnerability such as their heightened awareness of otherness regarding their ethnicity, gender, or sexual orientation in an effort to resonate with minority communities. A White genetics researcher explained the detailed account below:

…A good portion of my family was exterminated in Europe in World War II because of their ethnicity, and so I think it’s something that is in my core…to try to understand that there are differences, but these differences may affect a certain view and outlook, but doesn’t change our humanity. (WM)

Moreover, this full professor summarized the essence of this theme: “I think where one’s own race comes in handy is that it sometimes gives you insight, certainly being a gay man I’ve got insight into how people are treated differently, I’ve got insight into how to build community.” (WM)

Discussion

We learned a great deal from the investigators about the influence of their racial and ethnic background on the ability to recruit minorities in research. Although we anticipated comments on the use of “race-matching” in research, we were struck by how much importance respondents ascribed to themes not often discussed in the literature, such as being “really connected” to the community and “self-reflection” in their personal accounts and experiences of vulnerability. Moreover, the nuanced and complex contexts of race and ethnicity were apparent in their detailed accounts of building respectful research relationships sustained over time.

It should be no surprise that racial and ethnic concordance is one of the most common solutions utilized to overcoming barriers to recruitment and retention of minority populations in research (Carroll et al., 2011; Yancey et al., 2006). This response has been shaped by the literature on doctor-patient communications in the clinical encounter (Cooper et al, 2003; Thorton, Powe, Roter, Cooper, 2011). Within the context of population health and community engaged research, however, racial and ethnic concordance is only ‘symbolic’ when operationalized as hiring one minority outreach worker or study coordinator with the task of increasing participation of minorities across the research enterprise. Although little evidence exists to either support or disprove the effectiveness of concordance between the research team member responsible for recruitment and the prioritized minority community (Davis, R.E., Couper, M.P., Janz, N.K., Caldwell, C.H., & Resnicow, K., 2009; Davis et al., 2013), investigators describe race-matching as a main recruitment strategy (Davis et al., 2013; Yancey et al., 2006). Some studies report that minority participants are more likely to participate or prefer to enroll in a study conducted by a racially-matched investigator or research staff (Davis et al., 2013; Ibrahim & Sidani, 2013; Diaz et al., 2008), although others find concordance has no effect at all (Durant et al., 2007; McGinnis et al, 2006).

Often the adoption of such strategies is grounded in convenience and routine. We posit that the racial and ethnic identity of the principal investigator is important, as it impacts a community’s “first impression” of the research team, the representative institution, and the research study. Nonetheless, the danger in utilizing race-matching assumes that the inclusion of a racial and ethnic minority research team member, is “waving a magic wand,” an immediate solution perceived to have cultural effectiveness to respectfully engage, recruit, and retain minority participants in research, including clinical trials. Used solely as a symbolic gesture, race-matching places undue burden on minority staff made to feel responsible engaging all minority study participants. Nevertheless, when racial and ethnic diversity is used to build capacity by making the traditional research team more inclusive of diversity, it necessitates the ability and capacity to engage in critical conversations about race and the research enterprise. This is not as easy as it sounds and every research team is not equipped to handle such demands. Thus, we believe most research teams who embark on building diverse and inclusive study participants may benefit from formal training.

Theme: Racial-Matching

Investigators emphasized that the perceived barrier of racial discordance was not a lasting one, and over time by both expressing and demonstrating humility, honesty, and respect, they were able to overcome it. Notably, both non-White and White respondents used identical language in their portrayal of these experiences. We use this finding to illuminate a more subtle, yet relevant assumption when race-matching is employed as a recruitment tool in research. Specifically, the counterfactual presumption is that racial and ethnic discordance implies the inability to successfully engage certain subgroups of participants in research. Our findings dispute this claim and emphasize other characteristics (interpersonal skills) of the investigator that are more relevant to human relationship building. Conversely, it would be a critical mistake to conclude that racial and ethnic diversity of the research team is non-significant. Indeed, it is a vital component in assisting predominantly White research teams to build trust and become more trustworthy in their engagement with racial and ethnic minority communities. We argue that race-matching should not be used as a superficial strategy of expedience, but is better understood as one component in a complex and nuanced system of human relationship building.

When approached in a comprehensive manner to enhance diversity and inclusion, all members of the research team must strive to possess a high degree of social intelligence, understand and appreciate historical context, and demonstrate an ability to utilize other qualities, such as empathy, trustworthiness, and commitment to genuinely support relationship building. For investigators who fail to evolve beyond symbolic gestures, our study participants emphasized that “doors will quickly close” not only to current, but also future investigators.

Theme: Being “Really Connected”

Study participants characterized being “really connected” as a constellation of ideal interpersonal and social skills and human qualities such as humility and cultural sensitivity, honesty and willingness to give something of themselves in the form of reciprocity. Together, these attributes constitute the profile of a trustworthy researcher. Minority communities recognize the combination of these characteristics as primary evidence that the investigator has the capacity to form genuine relationships.

The scientific literature is replete with investigations focused on building research relationships. Researchers, especially in the social sciences, have a tradition of describing the role of social class differences and inequality in the researcher-participant relationship. This dynamic has been delineated in reference to class relations (Aluwihare-Samaranayake & Paul, 2013), gender (Yost & Chmielewski, 2013), colonial relationships (Bishop, 2011), and social location (Ford and Airhihenbuwa, 2010a; Ford & Airhihenbuwa, 2010b). Additionally, both research teams and participants report more subjective attributes such as friendliness, trustworthiness, and empathy as more relevant determinants of recruitment success than any specific demographic measures such as race or gender (Brown et al., 2000; Felsen et al., 2010; Levkoff & Sanchez, 2003). This body of literature is consistent with our findings. Overwhelmingly, respondents reported that the aforementioned attributes were pertinent in the development of trusting research relationships. Furthermore, Levkoff and Sanchez (2003) found that minority recruitment was most successful when there was concordance between the goals of the researcher and community needs. Our study supports this important finding.

Our results also highlight new issues. For example, researchers might be familiar with the components or important factors of true relationship building, yet might not have the appropriate background or training to feel comfortable in doing so. They can even find it specifically challenging. We believe this is an important skill for investigators to master and add to their professional repertoire. One White investigator summarized it well as he declared, “…I’ve become very comfortable about talking about the reality of uncomfortable things.” In this respect, some researchers identified the need for formal training in methods for engaging minorities in research. Core components of such training must assess the investigator’s ability to recognize and address the role of identity, power, bias, and social hierarchy when developing true relationships with minority communities.

Theme: Self-Reflection

Several scholars (Thomas et al, 2011; Walker, Read, & Priest, 2013) have supported the use of self-reflection and reflexivity in the research process. Ford and Airhihenbuwa (2010a) explicitly call for critical approaches, in which the researcher is engaged both cognitively and affectively in questioning their own biases and how they affect the relationships with communities and the research activities themselves. The benefits of self-reflection in research have been suggested to be manifold, increasing the validity of data, improving interpretation in analysis as well as supporting ethical research (Lessard 2007; Milner, 2007; Mosavel, Ahmad, Daniels, & Simon, 2011). Our findings support another positive effect of self-reflection – the ability to “really connect” to research participants. Thomas and colleagues (2011) define self-reflection not as a means of simply understanding the researcher/participant relationship, but as a means of creating and strengthening it. They encourage the use of self-reflection as a bridge to “cultural confidence,” a “lifelong process based on the individual’s self-reflection about their personal bias and prejudices” (Thomas et al, 2011, p. 411). We corroborate this definition within our data while also suggesting that researchers self-reflect as a means to access shared human experience through vulnerability and difference. The study respondents routinely commented on employing self-reflection as a process to connect as human beings external to their roles in research. Such connectedness allowed investigators to communicate with and engage minority communities in ways that challenge the status quo of investigator/study participant research relationships. Instead of purposefully relying upon distance/“objectivity” in the development of the research relationship, investigators employed self-reflection/“subjectivity” in their recruitment efforts as an active agent to collaborate with minority communities.

The process of self-reflection is neither a simple nor easy one. Even though some researchers are comfortable with the research process as an inherently social endeavor, others might be less so. In spite of the fact that many of the study respondents denoted the importance of self-reflection and utilized it in their work, others were hesitant to do so. We believe part of this hesitancy is an uneasiness felt by researchers about the role of “self” in the pursuit and process of research. Specifically, the notion that self-reflection challenges some scientists perceived value of “objectivity” in science and, as a result, is enough to prevent them from engaging in this process.

Furthermore, even though the benefit to research can be evident, self-reflection creates vulnerability that is often challenging to researchers and causes them to confront the temptation to hide within the “garb of our profession,” as Bell (1998) asserts. In essence, by decreasing the distance in the research relationship, the power scale becomes more balanced and thus, researchers can no longer or easily hide behind the cloak of academia. One respondent who conducts violence prevention research provided an illustrative example of this point. He stated that, “I have a doctorate in something, but it doesn’t mean squat in the neighborhood.”

Finally, self-reflection is an intricate process that often results in the heightened awareness of the interplay of multidimensional characteristics of a person. In our study, investigators provided accounts of the intersection of their racial and ethnic background in combination with other characteristics such as age, gender, and sexual orientation. Future research should empirically examine the intersectional components of identity and its influence on building respectful research relationships.

Limitations of the Findings

Qualitative data are not designed to be generalizable, yet are well-suited for the exploration and uncovering of interpretations of phenomena that are not clearly understood (Denzin, 2009). To this end, we purposely identified and recruited investigators with expertise in the engagement of underrepresented minority populations in research. This decision is not only appropriate, but also necessary when qualitatively examining best practices and uncovering related intricate factors in the recruitment of minorities in research. Fundamentally, we believe that the themes discussed herein can apply to other investigators partly because major themes of our study results are consistent with findings from previous work in this area (Carroll et al., 2011; Davis et al., 2013). For example, researchers have reported on the broad use of “race-matching” as a recruitment strategy for minority groups (Quinn et al, 2012; Yancey et al., 2006), which is in concert with our finding of the importance, but limited usefulness of “race-matching.” Although the data represent the voices and comments of 31 seasoned experts in the engagement of minorities in various types of research, their experiences might not be representative of all investigators conducting research with minority communities. As a result, we cannot generalize outside of this group of scientists. Moreover, we report data regarding the experiences of investigators collected at a single time and place, which might not represent changes in new ideas or recruitment strategies used over time. Even though the sample represents a multicultural group of scientists, our study was not designed to examine the relationship of racial and ethnic concordance and recruitment outcomes or effectiveness, an important issue for future research. Notwithstanding, we believe that many aspects of the investigators’ rich reflection on how their racial and ethnic background influenced their ability to recruit minorities would apply to a broad spectrum of investigators currently working in this area or those who desire to in the future. We make this statement because the main themes reported by our study participants emphasized core values and virtues in the respect of humans and personhood, essentially universal themes in the development of relationships.

Conclusion

It is clear from our work that the examination of race and ethnicity in research relationships with minority communities is both complex and nuanced. The use of race-matching as a “magic pill” approach in the development of authentic research relationships is an overly simplistic, perhaps ill-fitting solution for bridging the real social difference between researchers and participants. Although racial and ethnic concordance is undeniably important, it is not a comprehensive mechanism to respectfully recruit minorities into research. We submit that a racially and ethnically diverse research team can be a more genuine indication of inclusiveness than matching the study recruiter to the priority population by race or ethnicity.

Our study of investigators has raised important questions regarding the use of race-matching as a method in research. Fundamentally, we understand that race-matching as an outward phenotypic strategy might offer preliminary and symbolic benefits. Race-matching does not, however automatically instill the internal virtues such as honesty, humility, and empathy that are critically vital components of a trusting and mutually beneficial relationship. Equally important, building realistic research relationships has led these successful researchers to explore their own personal experiences with racial and ethnic identity. As a result, self-reflection became pertinent for relationship building with minorities (Thomas et al, 2011). Unfortunately, this process is not valued in the research paradigm because it is deemed “non-scientific” and thus, creates an awkward and uncomfortable disposition for some investigators. In effect, the operationalization of the many lessons learned from this research make evident the unavoidable tension between being “really connected” with people of color in research and traditional research approaches. Moreover, we underscore the critical need for comprehensive curricula designed to train investigators in best practices for the respectful and ethical recruitment of minority populations in research.

Addressing racial and ethnic differences in research is rooted in the burdens of race and history. Changing the traditional paradigm will take time and there is no simple recruitment strategy that can overcome the vestiges of racial discrimination embedded within the research enterprise. Nevertheless, research with minority populations necessitates the same things that any good relationship demands – honesty, reciprocity, and trust.