This report describes implementation of a clinical trial testing a behavioral approach to reduce stroke risk factors in Black men with stroke or transient ischemic attack (TIA). A survey of research team members identified macro-, mediator-, and micro-level barriers and facilitators to research engagement and participation and identified approaches to address these barriers. Not being aware of the study was the key macro-level barrier. The team used multiple methods of outreach to inform participant candidates including in-person and virtual community events. Key mediator-level barriers were lack of phone and transportation access, and clinicians not referring patients. A multi-pronged strategy was employed, including in-person meetings (for those who lived in the region) often at locations that were accessible to men in their neighborhoods. To help with transportation challenges the team provided ride-share services, bus fare or parking vouchers. At the micro-level, the team also used multiple approaches to help participants manage barriers related to stress or family life circumstances and acute or chronic health conditions. Being able to conduct assessments remotely was critical to being able to reach this community of men who often had significant functional impairments, such as difficulty walking or in speech fluency because of the effects of stroke. When possible, staff encouraged the involvement of care partners. Successful research outreach and engagement addresses barriers at the macro-, mediator-, and micro-levels, and use mixed-method (in-person + virtual) approaches targeted to the specific challenges individuals may be facing.
Sajatovic et al. (Thu,) studied this question.