No votes yet
Online Exclusive Article

Evaluation of Conceptual Framework for Recruitment of African American Patients With Breast Cancer

Sue P. Heiney
Swann Arp Adams
Linda M. Wells
Hiluv Johnson
ONF 2010, 37(3), E160-E167 DOI: 10.1188/10.ONF.E160-E167

Purpose/Objectives: To describe the Heiney-Adams Recruitment Framework (H-ARF); to delineate a recruitment plan for a randomized, behavioral trial (RBT) based on H-ARF; and to provide evaluation data on its implementation.

Data Sources: All data for this investigation originated from a recruitment database created for an RBT designed to test the effectiveness of a therapeutic group convened via teleconference for African American women with breast cancer.

Data Synthesis: Major H-ARF concepts include social marketing and relationship building. The majority of social marketing strategies yielded 100% participant recruitment. Greater absolute numbers were recruited via Health Insurance Portability and Accountability Act waivers. Using H-ARF yielded a high recruitment rate (66%).

Conclusions: Application of H-ARF led to successful recruitment in an RBT. The findings highlight three areas that researchers should consider when devising recruitment plans: absolute numbers versus recruitment rate, cost, and efficiency with institutional review board-approved access to protected health information.

Implications for Nursing: H-ARF may be applied to any clinical or population-based research setting because it provides direction for researchers to develop a recruitment plan based on the target audience and cultural attributes that may hinder or help recruitment.


Advani, A. S., Atkeson, B., Brown, C. L., Peterson, B. L., Fish, L., Johnson, J. L., … Gautier, M. (2003). Barriers to the participation of African-American patients with cancer in clinical trials: A pilot study. <i>Cancer, 97</i>, 1499-1506. doi: 10.1002/cncr.11213

Airhihenbuwa, C. O., Kuymanyika, S. K., TenHave, T. R., & Morssink, C. B. (2000). Cultural identify and health lifestyles among African Americans: A new direction for health intervention research? <i>Ethnic Disparities, 10</i>, 148-164.

Areán, P. A., Alvidrez, J., Nery, R., Estes, C., & Linkins, K. (2003). Recruitment and retention of older minorities in mental health services research. <i>Gerontologist, 43</i>, 36-44.

Ashing-Giwa, K. (1999). The recruitment of breast cancer survivors into cancer control studies: A focus on African-American women. <i>Journal of the National Medical Association, 91</i>, 255-260. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608496/ <a target="_blank" href='http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2608496/'>http://www.ncbi.nl...

Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., … Ahles, T. A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. <i>JAMA, 302</i>, 741-749. doi: 10.10001/jama2009.1198

BeLue, R., Taylor-Richardson, K. D., Lin, J., Rivera, A. T., & Grandison, D. (2006). African Americans and participation in clinical trials: Differences in beliefs and attitudes by gender. <i>Contemporary Clinical Trials, 27</i>, 498-505. doi: 10.1016/j.cct.2006.08.001

Blacklock, R., Rhodes, R., Blanchard, C., & Gaul, C. (2010). Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. <i>Oncology Nursing Forum, 37</i>, 206-212. doi: 10.1188/10.ONF.206-212

Bowen, D. J., Fann, J. R., Andersen, M. R., Rhew, I. C., Gralow, J. R., Lewis, F. M., … Ankerst, D. P. (2007). Recruiting patients with breast cancer and their families to behavioral research in the post-HIPAA period. <i>Oncology Nursing Forum, 34</i>, 1049-1054. doi: 10.1188/07.ONF.1049-1054

Brandon, D., Isaac, L., & LaVeist, T. (2005). The legacy of Tuskegee and trust in medical care: Is Tuskegee responsible for race differences in mistrust of medical care? <i>Journal of the National Medical Association 97</i>, 951-956. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569322/?tool=pubmed <a target="_blank" href='http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569322/?tool=pubmed'>http:/...

Brown, B., Long, H., Gould, H., Weitz, T., & Milliken, N. (2000). A conceptual model for the recruitment of diverse women into research studies. <i>Journal of Women's Health and Gender-Based Medicine, 9</i>, 625-632. doi: 10.1089/15246090050118152

Brown, D. R., Fouad, M. N., Basen-Engquist, K., & Tortolero-Luna, G. (2000). Recruitment and retention of minority women in cancer screening, prevention, and treatment trials. <i>Annals of Epidemiology, 10</i>(8, Suppl.), S13-S21. doi: 10.1016/S1047-2797(00)00197-6

Campbell, M. K., Snowdon, C., Francis, D., Elbourne, D., McDonald, A. M., Knight, R., … STEPS Group. (2007). Recruitment to randomised trials: Strategies for trial enrollment and participation study. The STEPS study. <i>Health Technology Assessment, 11</i>(48), iii, ix-105. Retrieved from http://www.hta.ac.uk/execsumm/summ1148.htm <a target="_blank" href='http://www.hta.ac.uk/execsumm/summ1148.htm'>http://www.hta.ac.uk/execsum...

Carlson, L., Speca, M., Patel, K., & Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. <i>Psychoneuroendocrinology, 29</i>, 448-474. doi: 10.1016/S0306-4530(03)00054-4

Coleman, E. A., Tyll, L., LaCroix, A. Z., Allen, C., Leveille, S. G., Wallace, J. I., … Wagner, E. H. (1997). Recruiting African-American older adults for a community-based health promotion intervention: Which strategies are effective? <i>American Journal of Preventive Medicine, 13</i>(Suppl. 2), 51-56.

Corbie-Smith, G., Thomas, S. B., Williams, M. V., & Moody-Ayers, S. (1999). Attitudes and beliefs of African Americans towards participation in medical research. <i>Journal of General Internal Medicine, 14</i>, 537-546. doi: 10.1046/j.1525-1497.1999.07048.x

Corey, G. (2001). <i>Theory and practice of counseling and psychotherapy</i> (6th ed.). Belmont, CA: Brooks-Cole/Wadsworth.

Cross, J., & Cross, P. (1998). <i>Knowing yourself inside out</i>. Berkeley, CA: Crystal Publications.

Cudney, S., Craig, C., Nichols, E., & Weinert, C. (2004). Barriers to recruiting an adequate sample in rural nursing research. <i>Online Journal of Rural Nursing and Health Care, 4</i>(2), 78-88. Retrieved from http://www.rno.org/journal/index.php/online-journal/article/viewFile/140... <a target="_blank" href='http://www.rno.org/journal/index.php/online-journal/article/viewFile/140...

Dancy, B. L., Wilbur, J., Talashek, M., Bonner, G., & Barnes-Boyd, C. (2004). Community-based research: Barriers to recruitment of African Americans. <i>Nursing Outlook, 52</i>, 234-240. doi: 10.1016/j.outlook.2004.04.012

Dirksen, S. R., & Epstein, D. R. (2008). Efficacy of insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. <i>Advances in Nursing, 61</i>, 664-675. doi: 10.1111/j.1365-2648.2007.04560.x

Escobar-Chaves, S., Tortolero, S., Mâsse, L., Watson, K., & Fulton, J. (2002). Recruiting and retaining minority women: Findings from the Women on the Move study. <i>Ethnicity and Disease, 12</i>, 242-251.

Freimuth, V., Quinn, S., Thomas, S., Cole, G., Zook, E., & Duncan, T. (2001). African Americans' views on research and the Tuskegee syphilis study. <i>Social Science and Medicine, 52</i>, 797-808. doi: 10.1016/S0277-9536(00)00178-7

Gil, K., Mishel, M., Belyea, M., Germino, B., Porter, L., & Clayton, M. (2006). Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-month outcomes. <i>International Journal of Behavioral Medicine, 13</i>, 286-294. doi: 10.1207/s15327558ijbm1304_3

Gordon, R., McDermott, L., Stead, M., & Angus, K. (2006). The effectiveness of social marketing interventions for health improvement: What's the evidence? <i>Public Health Nursing, 120</i>, 1133-1139.

Hastings, G., & McDermott, L. (2006). Putting social marketing into practice. <i>BMJ, 332</i>, 1210-1212. doi: 10.1136/bmj.332.7551.1210

Heiney, S., Parrish, R. S., Hazlett, L. J., Wells, L. M., & Johnson, H. (2008, February). <i>Tuskegee revisited: Relationship of trust, knowledge, demographics and stress in African American women with breast cancer</i>. Poster presented at Nursing: Innovations in Leadership, Research and Practice in Columbia, SC.

Heiney, S. P., Adams, S., Hebert, J., & Cunningham, J. (2005). Subject recruitment for cancer control studies in an unfavorable environment [Abstract]. <i>Oncology Nursing Forum, 32</i>, 162.

Heiney, S. P., Adams, S. A., Cunningham, J. E., McKenzie, W., Harmon, B., Hebert, J., & Modayil, M. (2006). Subject recruitment for cancer control studies in an adverse environment. <i>Cancer Nursing, 29</i>, 291-301. doi: 10.1097/00002820-200607000-00007

Heiney, S. P., Adams, S. A., Fisher-Drake, B., Bryant, L. H., Bridges, L. G., & Hebert, J. R. (2010). Subject recruitment for a prostate cancer behavioral trial. <i>Clinical Trials Journal</i>. Manuscript submitted for publication.

Heiney, S. P., Wells, L. M., & Johnson, H. (2008). Successful recruitment of African American breast cancer patients for telephone group intervention [Abstract 2669]. <i>Oncology Nursing Forum, 35</i>, 494.

Heinrichs, N. (2006). The effects of two different incentives on recruitment rates of families into a prevention program. <i>Journal of Primary Prevention, 27</i>, 345-365. doi: 10.1007/s10935-006-0038-8

Hutchinson, R., Gaynon, P., Sather, H., Bertolone, S., Cooper, H., Tannous, R., … Trigg, M. E. (2003). Intensification of therapy for children with lower-risk acute lymphoblastic leukemia: Longterm follow-up of patients treated on Children's Cancer Group Trial 1981. <i>Journal of Clinical Oncology, 21</i>, 1790-1797. doi: 10.1200/JCO.2003.03.009

Katz, R., Green, B., Kressin, N., Claudio, C., Wang, M., & Russell, S. (2007). Willingness of minorities to participate in biomedical studies: Confirmatory findings from a follow-up study using the Tuskegee Legacy Project Questionnaire. <i>Journal of the National Medical Association, 99</i>, 1052-1060.

Katz, R., Kegeles, S., Kressin, N., Green, B., Wang, M., James, S., … Claudio, C. (2006). The Tuskegee Legacy Project: Willingness of minorities to participate in biomedical research. <i>Journal of Health Care for the Poor and Underserved, 17</i>, 698-715. doi: 10.1353/hpu.2006.0126

Keyzer, J., Melinkow, J., Kuppermann, M., Birch, S., Kuenneth, C., Nuovo, J., … Rooney, M. (2005). Recruitment strategies for minority participation: Challenges and cost lessons from the POWER interview. <i>Ethnicity and Disease, 15</i>, 395-406.

Lee, R. E., McGinnis, K. A., Sallis, J. F., Castro, C. M., & Chen, A. H. (1997). Active vs. passive methods of recruiting ethnic minority women to a health promotion program. <i>Annals of Behavioral Medicine, 19</i>, 378-384. doi: 10.1007/BF02895157

Levkoff, S., & Sanchez, H. (2003). Lessons learned about minority recruitment and retention from the Centers on Minority Aging and Health Promotion. <i>Gerontologist, 43</i>, 18-26.

Lewis, C. E., George, V., Fouad, M., Porter, V., Bowen, D., & Urban, N. (1998). Recruitment strategies in the women's health trial: Feasibility study in minority populations. <i>Controlled Clinical Trials, 19</i>, 461-476. doi: 10.1016/S0197-2456(98)00031-2

Lichtenberg, P. A., Brown, D. R., Jackson, J. S., & Washington, O. (2004). Normative health research experiences among African American elders. <i>Journal of Aging and Health, 16</i>(5, Suppl.), 78S-92S. doi: 10.1177/0898264304268150

Linden, H. M., Reisch, L. M., Hart, A. J., Harrington, M. A., Nakano, C., Jackson, J. C., & Elmore, J. G. (2007). Attitudes toward participation in breast cancer randomized clinical trials in the African American community: A focus group study. <i>Cancer Nursing, 30</i>, 261-269. doi: 10.1097/01.NCC.0000281732.02738.31

Manoff, R. K. (1985). <i>Social marketing</i>. New York, NY: Praeger.

Margiti, S., Sevick, M. A., Miller, M., Albright, C., Banton, J., Callahan, K., … Ettinger, W. (1999). Challenges faced in recruiting patients from primary care practices into a physical activity intervention trial. Activity Counseling Trial Research Group. <i>Preventive Medicine, 29</i>, 277-286. doi: 10.1006/pmed.1999.0543

McCallum, J. M., Arekere, D. M., Green, B. L., Katz, R. V., & Rivers, B. M. (2006). Awareness and knowledge of the U. S. Public Health Service syphilis study at Tuskegee: Implications for biomedical research. <i>Journal of Health Care for the Poor and Underserved, 17</i>, 716-733. doi: 10.1353/hpu.2006.0130

Mills, E. J., Seely, D., Rachlis, B., Griffith, L., Wu, P., Wilson, K., & Wright, J. R. (2006). Barriers to participation in clinical trials of cancer: A meta-analysis and systematic review of patient-reported factors. <i>Lancet Oncology, 7</i>, 141-148. doi: 10.1016/S1470-2045(06)70576-9

Motzer, S. A., Moseley, J. R., & Lewis, F. M. (1997). Recruitment and retention of families in clinical trials with longitudinal designs. <i>Western Journal of Nursing Research, 19</i>, 314-333. doi: 10.1177/019394599701900304

Ott, C. D., Twiss, J. J., Waltman, N. L., Gross, G. J., & Lindsey, A. M. (2006). Challenges of recruitment of breast cancer survivors to a randomized clinical trial for osteoporosis prevention. <i>Cancer Nursing, 29</i>, 21-33. doi: 10.1097/00002820-200601000-00004

Outlaw, F. H., Bourjolly, J. N., & Barg, F. K. (2000). A study of recruitment of black Americans into clinical trials through a cultural lens. <i>Cancer Nursing, 23</i>, 444-452. doi: 10.1097/00002820-200012000-00006

Overholser, J. (2007). The central role of the therapeutic alliance: A simulated interview with Carl Rogers. <i>Journal of Contemporary Psychotherapy, 37</i>, 71-78. doi: 10.1007/s10879-006-9038-5

Peppercorn, J. M., Weeks, J. C., Cook, E. F., & Joffe, S. (2004). Comparison of outcomes in cancer patients treated within and outside clinical trials: Conceptual framework and structured review. <i>Lancet, 363</i>, 263-270. doi: 10.1016/S0140-6736(03)15383-4

Powell, C. B., Kneier, A., Chen, L., Rubin, M., Kronewetter, C., & Levine, E. (2008). A randomized study of the effectiveness of a brief psychosocial intervention for women attending a gynecologic cancer clinic. <i>Gynecologic Oncology, 111</i>, 137-143. doi:10.1016/j.ygyno.2008.06.024

Qualls, C. D. (2002). Recruitment of African American adults as research participants for a language in aging study: Example of a principled, creative, and culture-based approach. <i>Journal of Allied Health, 31</i>, 241-246.

Richardson, M. A., Post-White, J., Singletary, S. E., & Justice, B. (1998). Recruitment for complementary/alternative medicine trials: Who participates after breast cancer. <i>Annals of Behavioral Medicine, 20</i>, 190-198. doi: 10.1007/BF02884960

Rusnak, E. (2003). The privacy rule's effect on recruitment activities in clinical research. <i>Research Practitioner, 4</i>, 169-179.

Sears, S. R., Stanton, A. L., Kwan, L., Krupnick, J. L., Rowland, J. H., Meyerowitz, B. E., & Ganz, P. A. (2003). Recruitment and retention challenges in breast cancer survivorship research: Results from a multisite, randomized intervention trial in women with early stage breast cancer. <i>Cancer Epidemiology, Biomarkers and Prevention, 12</i>, 1087-1090.

Shavers, V., Lynch, C., & Burmeister, L. (2002). Racial differences in factors that influence the willingness to participate in medical research studies. <i>Annals of Epidemiology, 12</i>, 248-256. doi: 10.1016/S1047-2797(01)00265-4

Shavers, V. L., Lynch, C. F., & Burmeister, L. F. (2000). Knowledge of the Tuskegee study and its impact on the willingness to participate in medical research studies. <i>Journal of the National Medical Association, 92</i>, 563-572.

Shavers, V. L., Lynch, C. F., & Burmeister, L. F. (2001). Factors that influence African-Americans' willingness to participate in medical research studies. <i>Cancer, 91</i>(1, Suppl.), 233-236. doi: 10.1002/1097-0142(20010101)91:1+<233::AID-CNCR10>3.0.CO;2-8

Shaya, F. T., Gbarayor, C. M., Yang, H. K., Agyeman-Duah, M., & Saunders, E. (2007). Perspective on African American participation in clinical trials. <i>Contemporary Clinical Trials, 28</i>, 213-217. doi: 10.1016/j.cct.2006.10.001

Tworoger, S. S., Yasui, Y., Ulrich, C. M., Nakamura, H., LaCroix, K., Johnston, R., & McTiernan, A. (2002). Mailing strategies and recruitment into an intervention trial of the exercise effect on breast cancer biomarkers. <i>Cancer Epidemiology, Biomarkers and Prevention, 11</i>, 73-77.

U. S. Department of Health and Human Services. (2000). <i>Recruiting human subjects: Pressures in industry-sponsored clinical research</i>. Retrieved from <a target="_blank" href='http://oig.hhs.gov/oei/reports/oei-01-97-00195.pdf'>http://oig.hhs.gov/o...

U. S. Department of Health and Human Services. (2002). <i>Federal register: Standards for privacy of individually identifiable health information: Final rule</i>. Washington, DC: Author.

Wasserman, J., Flannery, M. A., & Clair, J. M. (2007). Raising the ivory tower: The production of knowledge and distrust of medicine among African Americans. <i>Journal of Medical Ethics, 33</i>, 177-180. doi: 10.1136/jme.2006.016329

Watkins-Bruner, D., Konski, A., Feigenberg, S., Dewberry-Moore, N., & Goplerud, J. (2005). Benchmarking African American recruitment to cancer control trials with social marketing and direct response radio [Abstract]. <i>Oncology Nursing Forum, 32</i>, 180.

Watkins-Bruner, D., Linton, S., Konski, A., Uzzo, R., Greenberg, R., & Pollack, A. (2004). Successful strategies for African American recruitment to prostate cancer research. <i>International Journal of Cancer Prevention, 1</i>, 295-306.

White, R. M. (2005). Misinformation and misbeliefs in the Tuskegee study of untreated syphilis fuel mistrust in the healthcare system. <i>Journal of the National Medical Association, 97</i>, 1566-1573.