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Recruitment of American Indians and Alaska Natives Into Clinical Trials

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Abstract

Challenges in recruiting American Indians and Alaska Natives into cancer clinical trials are addressed in this article. Researchers, health care providers, and American Indian and Alaska Native patients face significant communication barriers when prevention or treatment trials are designed or implemented. For researchers, the challenges lie in understanding the cultural distinctiveness of individual tribes, coping with the family orientation of Indian subjects, dealing with the lack of standardized research measures, and defining the subject's pathway in seeking and obtaining healing and health care services. For providers, the challenges center on patient–provider communication, illness beliefs, transportation, and sociocultural barriers. This article explores these complex issues and offers recommendations for researchers and health care providers on conducting research in American Indian and Alaska Native populations.

Introduction

Few American Indians and Alaska Natives participate in clinical trials. Although the U.S. Congress passed legislation in 1993 mandating that women and minorities be included in federally funded research studies, there has been little improvement in recruiting American Indians and Alaska Natives. Critical to increasing the number of such individuals participating in clinical trials is an understanding of the sociodemographic characteristics of these populations, their health status, and their levels of access to health services as well as barriers to care and illness beliefs. This paper explores these complex issues and offers recommendations for researchers and health care providers on conducting research in American Indian and Alaska Native populations.

Section snippets

Sociodemographic characteristics of the american indian and alaska native populations

The 1996 U.S. census estimate enumerates 2.3 million American Indians and Alaska Natives in the United States (1), which is less than 1% (.09%) of the total U.S. population. Within this relatively small demographic subgroup, the American Indian/Alaska Native population is incredibly diverse, consisting of more than 500 federally recognized tribes residing on or near approximately 310 reservations clustered in 35 states, primarily in the western part of the United States. Most of these

Health status of the american indian and alaska native populations

The health status of American Indians is improving but is still well below that of the general population. Statistics available from the Indian Health Service (IHS) and other targeted studies include the following:

  • Health problems, such as upper respiratory infection, diarrhea, acute otitis media, and influenza, that were controlled effectively in the general population by modern medicine are still major causes of illness in the Indian population and contribute to increased outpatient visits,

Delivery of health care services to american indian and alaska native populations

Historically, American Indians and Alaska Natives have been recognized as underserved populations in terms of delivery of and access to health care services. Federally sponsored health care for Indians began in the 1800s as an attempt to control the spread of epidemics to military post personnel and their families. After the creation of the IHS in 1955, the Federal Government developed a primary health care delivery system for American Indians and Alaska Natives, with more than 300 hospitals

Barriers to clinical trial recruitment

Barriers to the recruitment of American Indians and Alaska Natives into clinical trials include a complex mixture of cultural, physical, and societal factors. The following paragraphs first discuss barriers faced by those conducting research studies in Indian communities and then discuss the barriers that individual physicians might face in recruiting Indian patients into large multi-ethnic clinical trials.

Recommendations

In light of the above-mentioned barriers to the recruitment of American Indians and Alaska Natives into clinical trials, the following recommendations are directed to researchers and health care providers.

Conclusions

The recruitment of American Indians and Alaska Natives into clinical trials presents a significant challenge to both researchers and providers. There are cultural differences and nuances that must be addressed, and systemic and structural barriers present obstacles.

The American Indian population is unique in its health care status, its access to and receipt of health services, its sociocultural status, and its illness beliefs. More efforts are needed to improve the health of Indian communities,

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