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In this episode, our host, Jerry Tribout, Research Participant Recruitment Manager for the CTSC, sits down with Erika Trapl, MD, Director of the Prevention Research Center for Healthy Neighborhoods and Associate Director of Community Outreach and Engagement at the Case Comprehensive Cancer Center. Jerry and Erika discuss a critical aspect of clinical research: relationship based recruitment. They will focus on strategies for building trust and ensuring that recruitment efforts are effective and inclusive. Plus, learn more about the resources the CTSC offers for research recruitment.
Links:
- Become a CTSC Member
- Interested in getting connected or participating in research studies in Northeast Ohio? Sign up for the CTSC research participant & volunteer registry
- To gain access to these systems or to request an Informatics consult, submit a SPARC Request
- Learn more about the UH Mobile Research Unit
- Learn more about the Case Comprehensive Cancer Center
Transcript
"...we're limiting people's ability to participate. And I think people really do want to be part of research and want to know that they are represented in the work." - Erika Trapl, PhD
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[Intro]
From Research to Real Life, A podcast by the Clinical and Translational Science Collaborative of Northern Ohio.
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Jerry Tribout:
Hello, everyone. Welcome to episode six of From Research to Real Life. I'm your host, Jerry Tribout, manager of research participant recruitment here at the CTSC at Case Western Reserve University. Today, we're excited to discuss a critical aspect of clinical research recruitment. We're focusing on strategies for building trust and ensuring that recruitment efforts are effective. Before we dive in today and let me introduce our guest Dr. Erika Trapl.
Jerry Tribout:
Erika is a behavioral epidemiologist with extensive experience in chronic disease prevention, and she currently serves as the director of the Prevention Research Center for Healthy Neighborhoods. And she is the Associate Director of Community Outreach Engagement at the Case Comprehensive Cancer Center. Erika, thank you for being a guest today. It's a pleasure to be here. You've worked on some incredible projects focused on tobacco use studies, cancer screening, food related research, and community engagement initiatives.
Can you briefly highlight your experience in some of the key roles we've played in these areas?
Erica Trapl:
Yeah. I'd love to do that. So thanks. You know, as an epidemiologist, one of the things that we learn early on is about how to minimize bias. And when we think about designing studies, we have to think a lot about who those studies are for the populations that we're trying to learn about.
So my work and embracing that epidemiologic concept of minimizing bias, I thought a lot in all of my work about how to engage people where they are. And, and most of my work has been community based, non-clinical. So I'm thinking a lot about where people are and how people are living their lives in the places where we might conduct our research so we can apply that lens to all of those different content areas that you just mentioned.
Erika Trapl:
But through the lens of where are people moving through their day? Where might this research, impact them? When we learn what we need to do so that we make sure it also translates into action once we've, you know, really made those discoveries.
Jerry Tribout:
Let's dive into the heart of today's discussion. Recruitment. Erika, what are some of the key challenges and strategies you've encountered when it comes to recruiting participants, especially those that are kind of hard to reach?
Erika Trapl:
Yeah, you know, I think when we think about recruitment and participation, what's really been great for me is, working in non-clinical, community based environments and with with other community organizations, I'm really challenged to think about how do we frame our work in a way that makes it easy for people to participate, right. And so it's not necessarily that populations are hard to reach, but that we might just not be using the right strategies to reach them where they are.
Yeah. And so sometimes, you know, not to certainly not to minimize the complexity of recruitment in clinical settings. But sometimes we might have different relationships where we might have to think about those a little bit differently in community settings. So where are people showing up? Where are we engaging them? How are we making it easy for them to participate?
When we're sitting here in our institution, right, as an academic institution at a university or in our hospitals, we're used to how this environment works. And we might plan or design our studies to work in our environments. And so we really have to take the lens of how do we take what we do and maybe adapt it so that it works better in other settings.
Erika Trapl:
And that's where I have found a lot of strength in partnering with community members, community organizations, and sort of having some humility and saying, how might this work if we did this here? We might do data collection this way, but what we need to do in a different way, we might talk about consent in this way, but could we do it a different way?
And by opening up to perspectives outside of just our research team, we got a really great set of insights that help us design our work to be easier to engage in. Right. And I think about this a lot in behavior change, which also translates into, participation trials. How do we make it easy for people to do the thing we're asking them to do?
Jerry Tribout:
And when we make it easy for people, wherever they are, with whatever barriers they might have, we're more likely to get folks to participate. You know, I've worked on studies where we have only focused on email recruitment, and 75% of the participants were white women. So the results and weren't very generalizable. So I think meeting participants where they are is definitely a big aspect of.
Erika Trapl:
Exactly. You know, bringing back that that bias rate. That's a great example of thinking about bias. If we don't create opportunities, or if we don't even know to think about those things that might impact our ability to get folks to participate. We're inherently creating an error, right, where we're limiting people's ability to participate. And I think people really do want to be part of research and want to know that they are represented in the work.
Jerry Tribout:
Let's look at a specific example. One of your notable projects is the barbershop, a prostate cancer screening program which targeted black men in barbershops. Can you tell us more about how this program worked and what made it so successful?
Erika Trapl:
Absolutely. So as as you can probably tell, I'm a huge advocate and proponent of community engagement because I think it brings new perspectives into the work. I had an opportunity through the Case Comprehensive Cancer Center to think about how to create a program that might begin to address the, disparities that we observe in both, onset and mortality for African American men and prostate cancer. And so, in looking to think about that first strategy, I went to, a colleague on our community advisory board, Waverly Willis, who's known locally for, for his health advocacy.
And he's a barber. And I said, Waverly, what's our opportunity to to have some impact? This is sort of what I'm thinking, but, as a black man and thinking about your community, what might be impactful. And so I was able to build upon an existing, trusting relationship where we could really have a conversation about what that looked like, that perspective of Waverly contributing not just to the conception of the idea, but really into the entire process of the the data collection research methods, as well as the execution of the development of program.
And so we were able to sort of build something that centered our participants, right, and made the project about that experience. And said, well, it might be different than what we would typically do, if we were at the office, but this is a different context. So what makes it easier for a man at the barbershop to be interested, to have this conversation, to be willing to participate?
And we use that approach to really design all of our methods, which are still rigorous and still, you know, past scientific rigor and are still scientific. But we've made it easier. Again, thought about ways based on feedback from our partners that make it easier for men to participate in this study. That's great. We see a lot of studies trying to utilize community partners to help, specifically with recruitment, but I think involving them in the design is crucial to the success of a study and program like that.
Erika Trapl:
One of the things that we found is that when we can articulate what the benefit of participation is, that helps everyone get on the same page about why it might be of value for an individual to participate, right? Because then the barbers can say, hey, man, this is why this might be a good thing for you to try out right there.
We're all on the same page for being very transparent. We all have different benefits, right? We all are. Have, some different things we might be trying to get out of it. But we all have the same overarching goal of trying to solve these really complex problems that we all face in research in a real life, every day.
Jerry Tribout:
Did you experience any challenges when developing this program, and how did you overcome them?
Erika Trapl:
Yeah. You know, any time you try to do something that's a little different, you're going to bump up against challenges. So the key solution to most of our challenges was really just communication. So communication with our partners, communication within our team, communication with the IRB.
Right. Because we might be doing things a little bit differently, making sure that we're still meeting all of the regulations, that we're clear on why we're doing certain processes that we're clear on the language that we're using. But what allows for that success is taking a little bit of time to have that extra communication, making sure that everyone knows why we might be doing something.
Not saying, well, this is how we've always done it. Not letting that be the easy answer and saying, can we do something that makes this a little bit better for everyone? Sounds like trust and relationship building were crucial to your success. What are some other key themes you focus on when developing recruitment strategies? So the relationship building and the trust, which as you said, it's it's really important.
And getting on the same page, moving away from transaction and moving into relationships. So I like to reiterate that. Right. We're moving away from the transaction of your community partner. Can you help me get people in my trial to really, this is our shared goal beyond that again, but I think the importance is how do we make our procedures easy, right?
Erika Trapl:
So what does the consent process look like? We all know that there's a lot of language that's required in our consent forms. I think it's worth saying, you know what? How is this received by the people that we're trying to recruit into our study? How do we make it easier for them to understand this information? And I think there are a number of examples from researchers across campus who have figured out how to, make that experience a little easier.
How are we doing data collection? You mentioned earlier, right. Having multiple modes of engagement. We think about that as well. What are the implications? Again, as an epidemiologist, I'm thinking about, okay, if we do one method versus this method, what are the implications. But we have trade offs, right. And we can sort of acknowledge I'm willing to maybe trade off on a methods issue if I can reduce bias and participation.
Learning about new technologies. There are some really great tools that, we don't necessarily learn about as researchers or in our classrooms or that our, our teams might not know about. So we've really maximized the use of Redcap, which is an available tool through the CTC, and how it talks with Qualtrics and how we can actually use text messages, right, to prompt responses or to prompt data collection.
Erika Trapl:
We've talked about how data collection looks on a phone versus on a screen. Right. Because people might be in different formats. How do we need to make phones available? Right. And some other studies I've been a part of, we thought about how do we accommodate Spanish language translation, right. If that's a group that we are including and that excludes, you know, explicitly excluding, how do we accommodate that?
So again, thinking about our methods and our measures and our data collection procedures, I think that creates also a lot of flexibility. That makes it either more appealing or easier for participants not just to enroll, but to actually complete right and avoid that dreaded loss to follow up. Yeah, it definitely seems like it makes it easier for them throughout the whole entire lifespan of the study.
Absolutely. And, you know, these are things that we can try to anticipate. But until we talk with community partners, until we talk with the folks that we hope benefit from the research, we're just sort of guessing. And again, that comes back to really establishing some, some relationships where we can talk these things through, where we make the time and we build back into our protocols and processes to say, hey, can you tell me what you think about this?
Erika Trapl:
Right. I remember I started doing this early on in one of my first projects. We were working with adolescents. We were a whole bunch of adult researchers. Right? Not in the adolescent mind. And so, we wanted to sort of know how kids would respond. And so some of our colleagues and I'll, I'll take this home to my teenager and see what right, what that that looks like, because none of us could really fully grasp what it meant to be a teenager or an adolescent today.
Yeah, those are the most insightful little tidbits that really go a long way to making our research successful. So I talked about, you know, not wanting our community partnerships to be transaction null. And and really building relationship and trust. And one avenue that, you know, can really be important for recruitment is when those organization partners really become your advocate, and become a trusted source to speak on your behalf.
So there have been times where we have identified organizations who are sort of, trusted and reputable who can legitimize our research, right, and send out messages on our behalf or promote our project to their constituency because they, are trusted, right? In the same way that the barbers are trusted. Right. And they're speaking on our behalf. But this is really true for for any sort of group.
So in the past, I had a student who reached out to the pharmacy board for the state of Ohio and work to do recruitment for her project to the pharmacy board. Right. Because it's a it's a legitimate organization who brings some legitimacy to our research and again, sort of sells the importance of the research in the context of the work of that organization.
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[BREAK]
Jerry Tribout:
The University Hospitals Mobile Research Unit is a 39ft Winnebago dedicated to supporting clinical research in the CTSC. The unit features two private exam rooms, a fully functional lab processing center, a half bathroom, and multiple convenience and accessibility features such as a wheelchair lift, a private Wi-Fi network, and multiple fridges and freezers for storing food and drinks, investigational products, and lab specimens.
To book the Mobile Research Unit for your study or for a consultation, go to SPARC and find the Mobile Research Unit under Clinical Research Units in the CTSC service catalog.
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Jerry Tribout:
As we look ahead, Erika, how do you see recruitment strategies evolving in the future, particularly with the rise of new technologies and community engagement models in the we know.
Erika Trapl:
I think as we continue to build relationships and trust with community and sort of move into a new day of, away from some of the, the bad behaviors of the past in a to sort of perhaps a more democratic, perspective of research that it is for people and engages people and benefits people, which is what it really always has been and should be. Then what I'm seeing is people actually participating in studies and saying, hey, you have anything else going on? Are there other opportunities to participate? I'm really excited about research, or I have friends who'd like to know more about this. So I think technology is going to help us create more of an avenue to both promote opportunities, to communicate about opportunities, and to share recruitment, opportunities.
Of course, everything has to be built into sort of the disseminating and all of those sorts of things. But I what I'm really excited about is to see a broader conversation. I think many of us, as academics, always assume that everyone's as excited about our research as we are, and that tends not to be the case. But I think when we bring people into it and the way that I've described in some of these other things, there's a lot of excitement, and there's a sense of shared, enthusiasm about the work because really, we do this work to have impact.
And the communities are who participate. They participate because they, like, they believe that this will be a benefit to their community. And I think and hope that this leads us to, just further participation and representation, so that we have as many people as possible who can really benefit for the work I do. Yeah, that's exactly what we've been experiencing at the CTSC.
We've tried traditional recruitment methods in the past and often struggle. You know, we've had studies that only try to recruit in clinic, and they're trying to recruit harder to reach populations and simply just getting them in touch with a collaborator can boost our enrollment numbers greatly. Absolutely. Really relying on our networks, right. Open up whole different pockets of potential participants that we might not have even, been able to get.
But working through those networks can be really powerful. Yeah. That's why tools like spark, where researchers can submit consultation requests for recruitment strategies, can be so valuable to researchers. Through that platform, we can help get them in connection with community partners to help them with their research. Absolutely. There's nothing more challenging than feeling like you're on an island as a researcher and trying to figure this out by yourself.
But there are a number of us who have established a number of really great strategies. And none of us like to recreate the wheel, so we're always happy to share those through consultation. And just sharing like you've suggested. What's worked for us, what might be some other opportunities so that that's one less thing to slow us all down in our pursuit of research.
Jerry Tribout:
Erika, this has been a great conversation and we covered a lot of insights into recruitment strategies. What are some key takeaways you would want our listeners to remember from this conversation?
Erika Trapl:
Yeah that's great. So I think first, Jerry, you know, the, the idea of hard to reach just means really that we don't know how to reach them. Right? And we can do more. I think that's that's number one. There really is no hard to reach population. We just need to challenge ourselves to figure out the right way to reach everyone. We want to have it participate in our in our studies. The second is, building relationships with collaborators, even if those are our nontraditional collaborators who might have networks that bring our research into communities that we might not be in ourselves.
And, and, you know, really building those relationships and building trust. And then I think just allowing ourselves to really, think outside of the box, we pride ourselves on innovation as researchers. This is another space where we can innovate and maybe innovate in a slightly different way, but can also humble ourselves to ask others, what would make this easy for you, right. And think about that as our innovation challenge.
Jerry Tribout:
Thank you very much for sharing your expertise, Erika. It's been an absolute pleasure having you on the podcast today.
Erika Trapl:
Thanks Jerry, [it] has been great to be here to talk about this important work.
Jerry Tribout:
We encourage you to consider how you can implement relationship based recruitment strategies in your own work. And to our listeners, don't forget to check out SPARC to request your recruitment consultation today.
You can find a link to the spark website in the description below. As always, we encourage you to become a member of the CTSC. There's no cost to join. This is the best way to stay informed about our events, funding opportunities and research support. Please visit our website or follow the links in the podcast description. Thank you for tuning in and we'll see you next time on from Research Real Life.