Introduction
With the emergence of personalized medicine, an approach for disease prevention and treatment that takes into account individual variability in genes, environment, and lifestyle, it is essential for diverse groups to participate in clinical trials and to donate biological samples [1, 2]. However, minority populations have historically low participation rates in clinical research and are under-represented in biobanks [3–6]. This is particularly true for Hispanics who represent only 2% for participation in biobanking and 5% in clinical trials [3, 7, 8]. Additionally, while cancer is the leading cause of death among Hispanics [9], only 1.3% of eligible Hispanic cancer patients participate in cancer-related clinical trials [10].
Researchers have identified a host of barriers and facilitators to low Hispanic participation in biobanking and clinical trials. Some of the barriers include language, distrust of the medical system, concerns about privacy, lack of knowledge or awareness, fear of side effects, and fear of being experimented on [11–14]. Factors that positively influence participation include altruism, desire to contribute to advancing science, having a family member with disease, the opportunity to access healthcare, and monetary incentives [11, 12, 15, 16]. Improving a participant’s knowledge of and attitudes towards clinical research can influence self-efficacy and intentions to participate [17–19]. However, this education should be delivered in a culturally appropriate manner, and researchers have identified a need for more a culturally-appropriate approaches for Hispanics to reduce barriers and facilitate participation in clinical trials [12, 20]. Thus, there is an urgent need to develop and test interventions designed to improve knowledge and attitudes related to participation in clinical trials and biobanking.
To address the low participation among minorities, a few existing educational interventions have specifically targeted certain racial/ethnic groups, including Asians and Pacific Islanders [21–23] and African-Americans [24–26]. However, only a few interventions have targeted Hispanics [27, 28], whose participation barriers and facilitators may be different from other racial/ethnic groups [14]. Furthermore, many existing clinical trial or biobanking interventions target cancer patients in clinical settings but not the general population. Some biobank [29] and cancer prevention studies [30–32] require healthy participants. Educating the general population about clinical trials and biobanking can help with recruitment of healthy Hispanic participants in these types of studies. It would also improve communication between providers and newly diagnosed Hispanic patients because patients would already know about clinical research and more easily understand the options.
Because of the clear need for culturally-appropriate educational materials for Hispanics, we adapted existing educational materials on biobanking and clinical trials for Hispanics and trained promotoras de salud to deliver the adapted intervention to 101 Hispanic adults in community settings in Houston, Texas. We evaluated the impact of the curriculum on perceived barriers, benefits, norms, self-efficacy and intentions to participate in clinical trials and biobanking.
Methods
Understanding Knowledge and Attitudes
To inform eventual educational materials, we conducted 15 focus groups with Hispanics in Texas designed to better understand knowledge and perceptions of clinical trials and biobanking among [11, 12]. We found that there was a lack of knowledge about biobanking and clinical trials, a distrust of health research, and a fear of harm from participating in biobanking or a clinical trial. However, with enough information and assurance that the researchers have good intentions, participants said they would be willing to participate for altruistic reasons. Based on these findings, we determined that more education for the Hispanic community was needed.
Identification and Adaptation of Existing Materials
To identify materials, we conducted a literature review of existing interventions for either biobanking or clinical trials or both, including those specific to Hispanics. We also reached out to the National Cancer Institute funded program: the Community Networks Program Center (CNPC) community. As one of these CNPCs [U54CA153505], our team at the University of Texas Health Science Center at Houston School of Public Healthwas aware of the emphasis on reducing the unequal burden of cancer experienced by racial/ethnic minority populations by applying CBPR approaches to community education and intervention testing, among other aims [33]. We identified two sets of existing Spanish language materials on biobanking and clinical trials. These included one PowerPoint presentation on both clinical trials and biobanking and two accompanying brochures from the University of Texas Health Science Center at San Antonio [U54CA153511] [34, 35] and a video on biobanking from Moffitt Cancer Center [U54CA153509] [36].
In reviewing these existing materials, we noted that while many of the barriers and facilitators to clinical trials and biobanking participation identified in the 15 focus groups were addressed, other were not. To assess the appropriateness of the existing materials and the need for adaptation to the Hispanic population in Houston, we conducted six focus groups during which we shared the material with participants. Results indicated that participants preferred in-person education that provided the opportunity. They also noted that they wanted a video that clearly and succinctly explained the topic, and that written materials were only appropriate if accompanying an oral, -in person session. They also made suggestions about shortening the printed material and made additional recommendations about changes to the wording and formatting. Thus, based on both set of focus groups, we made decisions on what adaptions we would make to the existing materials.
We adapted the materials using IM Adapt, a systematic approach to adapt health promotion interventions for a new population or setting ([37]. We created two distinct educational curriculums, addressing the topics of biobanking and clinical trials separately, as we envisioned that those educating on one topic may not necessarily be educating on the other. Therefore, we first divided the content of the original Trevino-Whitaker et al. (2013) PowerPoint presentation accordingly, separating the content into two presentations. To the presentations, we made the following adaptations: revised the definitions of biobanking and clinical trials; added two interactive activities and added true/false questions that encouraged participation and discussion; emphasized the need to discuss biobanking or clinical trials with a doctor and added a list of questions to ask before deciding whether to donate a biospecimen or participate in a clinical trial. For the clinical trials presentation only, we added information explaining the randomization process and include current clinical trials recruiting in the Houston area.
The original Trevino-Whitaker et al. (2013) materials also included two brochures, one about clinical trials and one about donating biospecimens. We kept these two brochures separate, to accompany their respective presentation. Given the recommendations on length of the written materials from our focus groups, we edited the clinical trials brochure from 12 pages to four pages. The length of the biobanking brochure stayed the same, as a single page brochure, with content on the front and back. Based on feedback from our focus groups, we included additional written information on the informed consent process and a patient’s rights and used text formatting to emphasize key points in the brochure.
Lastly, we made no adaptations to the biobanking video developed by Moffitt Cancer Center. This video was shown following the biobanking presentation only. The video provided testimonials about donating biospecimens and focus group participants found the video useful and appropriate.
The final adapted educational curriculum included a set of materials for educating on clinical trials (a PowerPoint presentation and a take-home brochure) and another set for educating on biobanking (a PowerPoint presentation, take-home brochure, and a video). All educational sessions include a group discussion during which study participants could ask questions and explore topics in greater detail if desired.
Training Promotoras de Salud
Study staff trained four promotoras de salud (community health workers) to deliver both sets of educational curricula (clinical trials and biobanking) in both Spanish and English. The in-person training for each curriculum lasted about 2 hours each. Promotoras then completed practice sessions to ensure they were knowledgeable of the content and comfortable with the group format delivery.
Participants
Participants were recruited in-person or through flyers distributed at community centers, community clinic waiting rooms, and health fairs. Study staff and promotoras invited interested participants to attend an educational session held at a community center. We recruited and educated a convenience sample of 101 adult participants, 51 assigned to the biobanking group and 50 to the clinical trials group.
Data Collection and Measures
The University of Texas Health Science Center’s Institutional Review Board approved the study. Study staff first obtained written informed consent and then administered a pre-test questionnaire to each participant. The promotoras then delivered the educational sessions. After each session, study staff administered a post-test questionnaire, and participants received $10 gift cards.
Pre- and post-test questionnaires included questions assessing psychosocial factors that could be related to participation in clinical trials/biobanking. These included: perceived barriers, perceived benefits, descriptive and subjective norms, self-efficacy, and intentions to participate in clinical trials and/or biobanking (see Table 1). These items were developed by the study team. For the constructs with two items (barriers, benefits, and subjective norms), we averaged the two to create a composite score.
Table 1.
Pre- and post-test psychosocial measures
| Construct | # of items | Item | Response Options |
|---|---|---|---|
| Barriers | 2 | I have concerns about how [donating biospecimens to a biobank/participation in clinical trials] will affect my personal health and safety. I am worried that if I [donate biospecimens to a biobank/participate in clinical trials] my health information may not be kept confidential. | strongly disagree (1) to strongly agree (5) |
| Benefits | 2 | [Donating biospecimens to a biobank is /Clinical trials are] important for improving health research. If I [donate biospecimens to a biobank/participate in clinical trials], it will be useful to others in the future. | strongly disagree (1) to strongly agree (5) |
| Descriptive Norms | 1 | I think that others like me [donate biospecimens to a biobank/participate in clinical trials]. | strongly disagree (1) to strongly agree (5) |
| Subjective Norms | 2 | My doctor would want me to [donate biospecimens to a biobank/participate in clinical trials]. My friends and family would want me to [donate biospecimens to a biobank/participate in clinical trials]. | strongly disagree (1) to strongly agree (5) |
| Self-efficacy | 1 | How sure are you that you could [donate biospecimens to a biobank/participate in a clinical trial]? | very unsure (1) to very sure (5) |
| Intentions | 1 | If invited, how likely is it that you would [donate biospecimens to a biobank/participate in a clinical trial]? | not at all likely (1) to extremely likely (5) |
We also collected basic demographic information at pre-test, including participant’s race, ethnicity, gender, education, employment status, income, health care coverage, and whether he/she had a primary health provider. The post-test included additional questions to determine the best delivery channels and venues for clinical trial and biobanking education, and questions related to how well the participant understood the information, and whether they would share the information with others. Some of these items were adapted from questionnaires accompanying the original materials [34].
Statistical Analyses
We used descriptive statistics to assess the distribution of the psychosocial variables of interest. Because the variables were not normally distributed, we used the Wilcoxon signed rank test to test the null hypothesis of no difference between pre- and post-test scores. We conducted separate analyses for clinical trials and biobanking data. We used Proc Multtest, SAS version 9.4 to adjust for multiple comparisons of the outcomes and the Holm method, which controls the family-wise error rate without assuming independence.
Results
Participant Characteristics
Table 2 shows the demographic characteristics of each group. Both groups were mostly female, spoke mostly Spanish, had an income of less than $25,000 a year, and a high school education or less. The biobanking group was on average 42 years old; clinical trials group was 39 years old on average. Only a few participants had heard about biobanking or clinical trials; even fewer had ever participated.
Table 2.
Demographic characteristics of educational session participants.
| Demographic Characteristic | Received Biobanking Education N = 51 (%) | Received Clinical Trials Education N = 50 (%) |
|---|---|---|
| Mean age in years, (age range) | 42.3 (18–75) | 39.4(18–75) |
| Male | 9(17.6) | 8 (16.0) |
| English | 16(31.4) | 15 (30.0) |
| No | 26(51.0) | 37 (74.0) |
| 12 + | 6(11.8) | 7 (14.0) |
| Don’t Know | 1 (2.0) | 0 |
| Don’t Know | 2 (3.9) | 0 |
| No | 27 (52.9) | 25 (50.0) |
| Heard about biobanking/clinical trials | 9 (17.6) | 23(46.0) |
| Participated in biobanking/clinical trials | 5 (9.8) | 3 (6.0) |
Effect of Educational Curriculum
Biobanking:
Between pre- and post-test, there were statistically significant increases on perceived benefits, descriptive norms, and self-efficacy for donating biospecimens (Table 3). We also observed statistically significant increases in intentions to participate if invited. There were also statistically significant decreases in perceived barriers of biobanking participation. Unexpectedly, there was a decrease in perceived subjective norms (the belief that others want then to participate).
Table 3.
Differences in psychosocial variables between pre-test and post-test
| Variable | Pre-test Mean | Post-test Mean | p-value |
|---|---|---|---|
| Biobanking | |||
| Barriers | 2.92 | 2.35 | 0.034 |
| Benefits | 4.46 | 4.76 | 0.015 |
| Descriptive Norm | 3.78 | 4.33 | 0.034 |
| Subjective Norms | 4.10 | 3.75 | 0.005 |
| Self-efficacy | 3.59 | 4.39 | 0.001 |
| Intentions to participate | 3.22 | 3.69 | 0.005 |
| Clinical Trials | |||
| Barriers | 2.74 | 2.02 | 0.012 |
| Benefits | 4.58 | 4.94 | 0.012 |
| Descriptive Norm | 3.98 | 4.64 | 0.005 |
| Subjective Norms | 3.20 | 4.74 | 0.001 |
| Self-efficacy | 3.68 | 4.14 | 0.084 |
| Intentions to participate | 3.40 | 3.70 | 0.084 |
Note: Wilcoxon signed-rank test using the Holm method to control the family wise error rate
Clinical trials:
Between pre- and post-test, there were statistically significant increases in perceived benefits of clinical trials, descriptive and subjective norms for clinical trial participation (Table 3). There were also statistically significant decreases in perceived barriers to clinical trial participation. While there were increases in self-efficacy and intentions to participate in clinical trials, these changes were not significant.
Delivery of Educational Materials
All 101 participants indicated that the discussion helped them better understand biobanking or clinical trials and that they would share the information with their family and friends. All but one individual (clinical trials group) thought the information presented was easy to understand. Participants in the biobanking group indicated preferred formats for receiving the education included oral presentation (76.5%), oral with video (76.5%), printed materials (58.8%) and internet (51%). Those same participants were asked where they think people would like to receive the information delivered during the educational sessions. Most said community events (82.4%), doctor’s office (52.9%), schools (29.4%) and home visits (15.7%).
Participants in the clinical trials group indicated preferred formats were oral presentation (78%), oral with video (64%), printed materials (52%) and internet (56%) (data not shown). Like the biobanking group, the clinical trials group said they preferred to attend sessions at community events (72%), doctor’s office (64%), schools (46%) and home visits (32%).
Discussion
We successfully implemented an educational curriculum targeting clinical trial and biobanking participation for Hispanics in Houston, TX. This was the first time many that participants reported they had heard the terms biobanking or clinical trial, which indicated the need for education in this community. In the biobanking group, only 17.6% had heard about biobanking and 9.8% reported that they had participated in biobanking, though this was prior to delivering the education. In the clinical trial group, 46% of the participants had heard about clinical trials, which was a much higher proportion than those who heard of biobanking. However, only 6% of those participants reported ever participating in clinical trial.
We saw that the adapted education intervention increased perceived benefits and reduced perceived barriers to participation in both the biobanking and clinical trials groups. This was consistent with previous studies that reported increased positive attitudes related to clinical trials in clinical and community populations. For example, Jacobsen and colleagues’ (2012) brief, multimedia, psycho-educational intervention effectively improved attitudes toward clinical trials among primarily non-Hispanic white patients with cancer and an increased willingness to participate in clinical trials. Similarly, Du and colleagues (2009) used an educational video that improved attitudes toward clinical trials and increased trial enrollment among non-Hispanic White and African-American patients with newly diagnosed breast cancer.
Self-efficacy and intentions to participate in biobanking significantly increased in our study, the former finding being consistent with at least one previous study[27]. However, we did not find statistically significant differences in self-efficacy and intentions to participate in clinical trials, the former which has been seen in another clinical trials educational intervention[28]. Given the contrast between these findings, it appears that this brief educational intervention was more effective for biobanking education than for clinical trial education at least for changing self-efficacy and intention. This may be because the thought of participating in a clinical trial may seem more complicated and time consuming than participation in biobanking. Thus an intervention to increase participation may require more time for providing examples of trials and what participation might entail to increase both the belief in their ability to participate as well as their intention to do so. Another reason may be that the participants did not think they would be provided the opportunity to participate in a clinical trial given their current use of health care and the fact that almost no one had ever been offered participation. Manne and coworkers (2014) found that self-efficacy is a mediator between barriers and clinical trials preparedness, where fewer perceived barriers are associated with higher levels of self-efficacy and, in turn, greater levels of preparedness. Although we saw significantly decreased perceived barriers related to clinical trial participation, this may not have been sufficient to change self-efficacy for or intention to participate. A longer intervention, perhaps even with multiple sessions, that allows additional time to answer questions and more fully address barriers and self-efficacy, may be more effective for clinical trials education.
We also found significant changes for subjective norms, indicating that others who are important to the participant may have influence on his/her decision to participate in biobanking or clinical trials. Our results for subjective norms were inconsistent, showing significant change for both types of research but in the unexpected direction for biobanking. The results may indicate that the influence of others was important for biobanking and clinical trial participation, pointing to the potential value of including other stakeholders in the process of addressing the multi-level barriers to participation 38][38]. Therefore, the close family and community ties seen among Hispanics may point to the importance of holding educational sessions in the community and for including participants’ friends and family[39, 40].
Given that more than half of participants indicated that they would like to receive information on clinical trials and biobanking at the doctor’s office, healthcare providers should be trained to provide recommendations or referrals to clinical research. We must use caution however, in recommending this approach only, as about half of our sample did not have health insurance and did not have a primary healthcare provider. Additionally, participants also indicated that they would like to receive this information in community spaces.
This study demonstrated the feasibility of using promotoras trained in biobanking and clinical trials content to deliver an educational intervention about these topics to Hispanic participants in a community setting. The promotoras were familiar with the Hispanic community in Houston and had successfully delivered cancer education to improve screening, prevention, and access to healthcare service. Promotoras are effective because they are part of the community they serve, speak the language of the people, and know the cultural traditions [41]. These qualities help build trusting relationships and enhance the exchange of health and resource information. Future interventions should consider the promotora model when delivering education about biobanking and clinical trials to minority communities in order to ensure a more culturally appropriate intervention [27].
Given participants’ preference for receiving the information in video format, future interventions could incorporate mobile technology to enhance learning as well as tailoring. This could also accelerate the dissemination of biobanking and clinical trials educational materials. Additionally, more research is needed to better understand both intentions and actual participation. For example, McIntyre and colleagues (2017) evaluated the use of such health communication modalities as mailed materials, mailed materials plus follow-up calls, and charla (face-to-face group discussion) to change knowledge, attitudes, self-efficacy and intention to participate in biobanking. Their pilot trial found the charla approach increased knowledge the most but had the lowest participation rate. Researching differences in effectiveness among various communication channels is needed to optimize intervention delivery and increase participate rates.
Although we did not specifically measure knowledge changes before and after the educational intervention, all participants reported that the discussion helped them better understand biobanking and clinical trials. The lack of a control condition in this study limited our ability to attribute changes to the intervention, however, since the post-test immediately followed the intervention, it is unlikely that the participants were exposed to other sources of information on these topics. The findings should be confirmed with larger randomized, controlled trials and particularly those that can measure behavioral (participation) outcomes in addition to intention. Because we recruited our sample in community areas where people were seeking other social services and assistance, the sample may have included participants who were more likely to participate in clinical research or who were inclined to seek out information. Participants also indicated that they preferred oral presentations and receiving information about biobanking and clinical trials at community events. Given that these questions were asked after receiving education in an oral-format at a community health center, often the location of many community health events, there is a chance that individuals answered in a socially-desirable way. Finally, the educational sessions were presented during the day, which may have excluded working individuals. These two limitations (location and time of educational sessions) may explain the reason that the majority of the participants (82.4%) were female and unemployed (51%). Future studies should expand the sample to include more male and employed participants. Additionally, we did not collect data to document the participant’s country of origin. There is a possibility that there are differences in biobanking and clinical trial participation among Hispanics from different countries of origin or that the sample population was primarily from one particular country [42]. However, based on the demographics of the neighborhood center that we recruited and delivered the intervention, the majority of the members are of Mexican and Central American origin. Thus, future interventions might require adapting the Spanish educational materials for appropriate to Hispanics from different countries of origin [42]. Despite these limitations, our study represents an important step in developing and evaluating educational intervention to increase clinical trial and biobanking participation among Hispanics.
Acknowledgements
The authors thank the promotoras from Prosalud for their valuable assistance in recruiting participants and delivering the intervention. The authors also acknowledge using materials on biobanking and clinical trials, specifically for Hispanics, from the University of Texas Health Science Center at San Antonio and Moffitt Cancer Center. The project received funding from the Center of Clinical and Translational Sciences, which is funded mainly by the National Center for Advancing Translational Sciences, Centers for Translational Science Award (UL1 TR000371), the UTHealth School of Public Health Cancer Education, Career Development Program through a National Cancer Institute/NIH Grant (R25CA57712), and partial funding from the Center for Health Promotion and Prevention Research. This work was also supported by the Duncan Family Institute for Cancer Prevention and Risk Assessment.
Footnotes
Publisher's Disclaimer: Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
References
- 1.Gehlert SJ, Abstract IA40: Maximizing the benefits of precision medicine for cancer disparities. 2016, AACR. [Google Scholar]
- 2.Popejoy AB and Fullerton SM, Genomics is failing on diversity. Nature, 2016. 538(7624): p. 161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Simon MA, et al. , Improving diversity in cancer research trials: the story of the Cancer Disparities Research Network. Journal of Cancer Education, 2014. 29(2): p. 366–374. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Chen MS, et al. , Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual. Cancer, 2014. 120(S7): p. 1091–1096. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Fisher JA and Kalbaugh CA, Challenging assumptions about minority participation in US clinical research. American Journal of Public Health, 2011. 101(12): p. 2217–2222. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Haga SB, Impact of limited population diversity of genome-wide association studies. Genetics in Medicine, 2010. 12(2): p. 81–84. [DOI] [PubMed] [Google Scholar]
- 7.Scott EA, et al. , Biospecimen repositories: are blood donors willing to participate? Transfusion, 2010. 50(9): p. 1943–1950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Parra A, Karnad AB, and Thompson IM, Hispanic accrual on randomized cancer clinical trials: a call to arms. Journal of Clinical Oncology, 2014. 32(18): p. 1871–1873. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Siegel RL, Miller KD, and Jemal A, Cancer statistics, 2016. CA: a cancer journal for clinicians, 2016. 66(1): p. 7–30. [DOI] [PubMed] [Google Scholar]
- 10.Murthy VH, Krumholz HM, and Gross CP, Participation in cancer clinical trials: race-, sex-, and age-based disparities. Jama, 2004. 291(22): p. 2720–2726. [DOI] [PubMed] [Google Scholar]
- 11.Arevalo M, et al. , Mexican-American perspectives on participation in clinical trials: A qualitative study. Contemporary clinical trials communications, 2016. 4: p. 52–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Heredia NI, et al. , Community Perceptions of Biobanking Participation: A Qualitative Study among Mexican-Americans in Three Texas Cities. Public Health Genomics, 2017. 20(1): p. 46–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Dang JH, et al. , Engaging diverse populations about biospecimen donation for cancer research. Journal of community genetics, 2014. 5(4): p. 313–327. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ford JG, et al. , Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer, 2008. 112(2): p. 228–242. [DOI] [PubMed] [Google Scholar]
- 15.Calderón JL, et al. , An ethno-medical perspective on research participation: a qualitative pilot study. Medscape General Medicine, 2006. 8(2): p. 23. [PMC free article] [PubMed] [Google Scholar]
- 16.George S, Duran N, and Norris K, A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. American journal of public health, 2014. 104(2): p. e16–e31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Curbow B, et al. , Can a brief video intervention improve breast cancer clinical trial knowledge and beliefs? Social science & medicine, 2004. 58(1): p. 193–205. [DOI] [PubMed] [Google Scholar]
- 18.Jacobsen PB, et al. , Effects of a brief multimedia psychoeducational intervention on the attitudes and interest of patients with cancer regarding clinical trial participation: a multicenter randomized controlled trial. Journal of Clinical Oncology, 2012. 30(20): p. 2516–2521. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Manne S, et al. , Knowledge, attitudes, and self-efficacy as predictors of preparedness for oncology clinical trials: A mediational model. Medical Decision Making, 2014. 34(4): p. 454–463. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Ellington L, et al. , Factors that influence Spanish‐and English‐speaking participants’ decision to enroll in cancer randomized clinical trials. Psycho‐Oncology, 2006. 15(4): p. 273–284. [DOI] [PubMed] [Google Scholar]
- 21.Gao W, et al. , Culturally appropriate education intervention on biospecimen research participation among Chinese Americans. Cancer Epidemiology and Prevention Biomarkers, 2014. 23(3): p. 383–391. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Ma GX, et al. , The impact of a community-based clinical trial educational intervention among underrepresented Chinese Americans. Cancer Epidemiology and Prevention Biomarkers, 2013: p. cebp. 0773.2013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Thompson B and Hébert JR, Involving disparate populations in clinical trials and biobanking protocols: experiences from the Community Network Program Centers. Cancer Epidemiology and Prevention Biomarkers, 2014. 23(3): p. 370–373. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Ford M, et al. , Assessing an intervention to improve clinical trial perceptions among predominately African-American communities in South Carolina. Progress in community health partnerships: research, education, and action, 2012. 6(3): p. 249. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Frew PM, et al. , Results of a Community Randomized Study of a Faith-Based Education Program to Improve Clinical Trial Participation among African Americans. International journal of environmental research and public health, 2015. 13(1): p. 41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Banda DR, et al. , A pilot study of a culturally targeted video intervention to increase participation of African American patients in cancer clinical trials. The oncologist, 2012. 17(5): p. 708–714. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.McIntyre J, et al. , Comparison of Health Communication Channels for Reaching Hispanics About Biobanking: a Pilot Trial. Journal of Cancer Education, 2017: p. 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Wells KJ, et al. , Feasibility trial of a Spanish-language multimedia educational intervention. Clinical Trials, 2013. 10(5): p. 767–774. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Riegman PH, et al. , Biobanking for better healthcare. Molecular Oncology, 2008. 2(3): p. 213–222. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.The Women’s Health Initiative Study Group, Design of the women’s health initiative clinical trial and observational study. Controlled clinical trials, 1998. 19(1): p. 61–109. [DOI] [PubMed] [Google Scholar]
- 31.Zhu W, et al. , Circulating microRNAs in breast cancer and healthy subjects. BMC research notes, 2009. 2(1): p. 89. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Hylla S, et al. , Effects of resistant starch on the colon in healthy volunteers: possible implications for cancer prevention. The American journal of clinical nutrition, 1998. 67(1): p. 136–142. [DOI] [PubMed] [Google Scholar]
- 33.Hébert JR, et al. , Community-Based Participatory Research Adds Value to the National Cancer Institute’s Research Portfolio. Progress in community health partnerships: research, education, and action, 2015. 9: p. 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Trevino-Whitaker R, et al. , Clinical Trials Outreach for Latinos: Program Replication Manual. 2013, Institute for Health Promotion Research. University of Texas Health Science Center at San Antonio. [Google Scholar]
- 35.Treviño-Whitaker RA, et al. , Abstract A39: GMaP Region 4 clinical trials outreach for Latinos. 2015, AACR. [Google Scholar]
- 36.Meade CD, et al. , Introducing biospecimen science to communities: Tools from two cities. Progress in community health partnerships: research, education, and action, 2015. 9(Suppl): p. 51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Bartholomew-Eldredge LK, et al. , Planning health promotion programs: an intervention mapping approach. 2016, San Francisco, CA: Jossey-Bass. [Google Scholar]
- 38.Durant RW, et al. , Perspectives on barriers and facilitators to minority recruitment for clinical trials among cancer center leaders, investigators, research staff, and referring clinicians: enhancing minority participation in clinical trials (EMPaCT). Cancer, 2014. 120(S7): p. 1097–1105. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Davila YR, Reifsnider E, and Pecina I, Familismo: influence on Hispanic health behaviors. Applied Nursing Research, 2011. 24(4): p. e67–e72. [DOI] [PubMed] [Google Scholar]
- 40.Young J, Clinical pediatrics in the Mexican immigrant community. Contemp Pediatr, 2009. 26(4): p. 58–64. [Google Scholar]
- 41.Rhodes SD, et al. , Lay health advisor interventions among Hispanics/Latinos: a qualitative systematic review. American journal of preventive medicine, 2007. 33(5): p. 418–427. [DOI] [PubMed] [Google Scholar]
- 42.Rivera Y, et al. , When a Common Language Is Not Enough: Transcreating Cancer 101 for Communities in Puerto Rico. Journal of Cancer Education, 2016. 31(4): p. 776–783. [DOI] [PMC free article] [PubMed] [Google Scholar]