Table 3.

Suggested Approaches for Investigators to Improve the Quality and Impact of Health and Prevention Research Among AsA and NHPI, 2021 NIH Workshop^*

Approaches and Specific Steps
I. Engage and build sustainable partnership with AsA and NHPI communities.  Partner with AsA and NHPI community-based organizations and community leaders to build sustainable partnership to enhance participation, engagement, recruitment, retention, study implementation, capacity building, and outcome dissemination.
Community-engaged partnership:  Develop a community-engaged approach focusing on patient-centered outcomes within a community context, partnering with community organizations and community leaders to build capacity for research.  Forge strong and sustainable relationships and build research coalitions with community-based organizations before initiating the study and hire culturally and linguistically competent staff and community health workers to improve recruitment materials, engagement methods, results interpretation, and dissemination.
Capacity building:  Recognize that not all communities have the ability or expertise to conduct research; help build their capacity through communication and training in study design, operation, and implementation to enhance sustainability and long-term relationships.  Facilitate study participation by incorporating flexible clinic hours, use community-based settings for in-person exams, provide transportation assistance and adequate remuneration.  Focus on patient-centered outcomes, within a community context aimed at practical benefits (e.g., technical and material assistance, education of youth), and commit to data equity and data ownership for the community.
Probability samples:  Develop a system or methods for probability sampling (covering all socioeconomic strata and other relevant demographic strata) for more valid population-specific representation with community outreach efforts for recruitment.
II. Build infrastructure for studies in AsA and NHPI population groups.  Develop a state-of-the-art research infrastructure to serve as the platform to collaborate, coordinate, and implement innovative research in AsA and NHPI populations.
AsA and NHPI prospective cohorts:  Develop multiple prospective cohort studies with novel approaches, deep phenotyping, serial measurements, and follow-up. Include sufficient sample size in distinct AsA and NHPI subgroups for valid comparison of exposures, genotype, phenotype, and outcomes for common chronic conditions in these groups.  Include multigenerational cohorts, hybrid cohorts (traditional epidemiologic cohorts supplemented by data from electronic health records), and immigrant cohorts.  Use a populomics approach (72) with multilevel, multicentered, multidisciplinary methods to investigate the risk factors, progression, and outcomes of multiple conditions and aging and their underlying biological mechanisms with a socioecological model framework. Develop multilevel conceptual frameworks to study the intersection of ethnicity, culture, socioeconomic position, gender roles, and socioecological determinants on health.  Use an exposome approach to study environmental influences and biological response across the life span. Incorporate early-life and cumulative measures of occupational and neighborhood exposures, including those in the country of origin for more recent immigrants.
Develop a survey repository:  Establish centralized repositories of standard or novel surveys and instruments (in multiple languages). These include tools for measuring acculturation, immigration factors, and social/interpersonal measures (discrimination, social support, neighborhood cohesion). (Examples of existing repositories include the NIH PhenX toolkit or the Common Data Elements repository.)  Develop, test, and validate dietary assessment tools, mental health instruments, and cognitive function measures in specific AsA and NHPI ethnic groups.
Biobank:  Create biobanks that are linked to phenotypic and clinical data (EHR) to enable genomic and other omics to advance biological discoveries unique to AsA and NHPI populations.
Methods studies in AsA and NHPI:  Build statistical methods for estimating annual AsA and NHPI population sizes to generate annual rates for monitoring of trends and patterns to inform prevention, resource allocation, and patient care.
III. Leverage and enhance existing data sources.  Expand AsA and NHPI inclusion and ethnic group identification in ongoing cohorts, EHRs, national and state surveys, and other data sources, with appropriate data disaggregation.
Coding standardization:  Standardize coding methods for AsA and NHPI subgroups (expanding ethnic categorization and nativity) in federal and state data sets, EHR data, disease registries, and claims data sets.  Leverage electronic data resources for screening and recruitment of study participants, and link data with various data sets for exposure and outcome measures.
Secondary data analysis:  Conduct secondary analyses of existing data sets (e.g., national cancer registry systems, California Health Interview Survey, NHANES, NHPI National  Health Interview Survey); carry out pooled analyses from existing cohorts and ongoing cohorts; add ancillary studies to ongoing cohorts.
IV. Incorporate novel technologies for exposure assessment and clinical evaluation.  Leverage modern imaging techniques and digital technology for exposure and outcome assessment to advance health research in AsA and NHPI populations.  Imaging: Use the most appropriate imaging technologies: DXA, MRI, or CT, to accurately quantify body composition; ultrasonography and FibroScan for NAFLD; advanced low-dose CT for lung disease and cardiac plaque; echo and MRI for cardiac function.  Sensor technology: Deploy wearable biosensing and mobile health technology to capture objective, real-time and continuous data for more accurate and reliable measurement of exposures.  Omics: Use modern omics approaches to combine genomic, transcriptomic, proteomic, and metabolomic data with rich phenotypic, environmental, and behavioral data.

AsA = Asian American; CT = computed tomography; DXA = dual-energy X-ray absorptiometry; echo = echocardiography; EHR = electronic health record; MRI = magnetic resonance imaging; NAFLD = nonalcoholic fatty liver disease; NHANES = National Health and Nutrition Examination Survey; NHPI = Native Hawaiian and Pacific Islander.

^*The proposed methods and specific steps are not mutually exclusive and may be complementary and synergistic with other ongoing studies.