The study, published in the peer-reviewed Journal of Racial and Ethnic Health Disparities, identified multiple strategies to address low participation rates of non-Hispanic Black and Hispanic patients in a National Institutes of Health-funded trial investigating virtual reality for chronic lower back pain.

“Traditional recruitment strategies have not been effective in reaching these communities,” said Lindsey Ross, MD, assistant professor of Neurosurgery at Cedars-Sinai and first author of the study. “We conducted focus groups with Black and Hispanic patients to understand their concerns and preferences, highlighting barriers to participation such as mistrust, lack of interest, cultural differences and ineffective communication. The insights we gained allowed us to revise our recruitment materials to be more culturally responsive, updating language, imagery and outreach methods. We also used advanced digital tools to scan electronic medical records and micro-target eligible Black and Hispanic patients for the trial.”

After these changes were implemented, recruitment of Hispanic participants into the trial more than quadrupled, and recruitment of Black participants showed a notable upward trend. Ross said these results demonstrate that culturally adapted recruitment strategies and digital targeting tools can play a critical role in improving clinical trial diversity, and offer actionable insights for researchers aiming to bridge the gap in clinical trial representation of diverse communities.

Authors: Samuel Eberlein, Carine Khalil, So Yung Choi, Karma McKelvey, Brennan M. R. Spiegel. 

Funding: Open access funding provided by SCELC, Statewide California Electronic Library Consortium. This work was supported by the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) through the Back Pain Consortium (BACPAC) Research Program as a part of the NIH HEAL Initiative [UH3AR076573-03S1].

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Ross, an assistant professor of Neurosurgery and an investigator with the NIH-led Back Pain Consortium Research Program, is working to find nonaddictive treatments for chronic lower back pain. She told the NIAMS Newsroom that Cedars-Sinai researchers identified and engaged a diverse group of clinical trial patients in new ways.

The investigators used artificial intelligence (AI) technology to broaden the pool of potential participants. They used AI-powered software to scan healthcare professionals’ notes in patients’ electronic health records for references to back pain, instead of manually searching for a back pain diagnosis.

“Back pain is very prevalent, and doctors might not always list it in the problem list or ascribe it a specific diagnosis,” Ross said. “We weren’t capturing all the patients with chronic low back pain by doing searches the old way.”

Ross added that AI also helped locate Black and Latin patients to screen for clinical trial eligibility, addressing the need for more diverse participation.

And because pandemic protocols limited in-person contact, investigators studying whether virtual reality headsets can mitigate back pain mailed the headsets and instructional videos to clinical trial participants. The scientists then monitored online feedback about the effectiveness of the headsets as a treatment tool.

Ross told the NIAMS Newsroom that emails and calls to study participants helped improve the patient experience.

“We had a full and dedicated team that was constantly on the phone to make sure we stayed engaged with patients,” she said. “We wanted to be sure it wasn’t just, ‘Here’s an email. Here are the materials. Go.’”

Click here to read the complete article from the NIAMS Newsroom.