Art of recruiting diverse pediatric samples for randomized clinical trials: A recruiter’s perspective

Objective: Randomized Clinical Trials (RCTs) play a critical role in advancing our understanding of early brain development and its connection to behavioral outcomes. However, there is limited generalizability when research samples predominantly consist of individuals from higher-resourced communities who identify as White. This paper addresses the pressing issue of diversity in neuro-imaging, RCTs, and clinical research, focusing on the challenges, implications, and barriers to achieving diverse sample representation. The study aims to explore recruitment strategies and the role of well-trained, diverse research staff in recruiting and retaining underrepresented communities. This research provides valuable insights into the experiences of field recruiters working with diverse and disadvantaged populations, with the goal of informing effective recruitment practices while minimizing associated costs, time, and recruiter stress. 

Method: We conducted interviews with experienced recruitment staff from large longitudinal clinical neuroimaging, schooling intervention, parenting intervention, and survey studies involving samples from highly diverse socio-economic families. Recruiters were invited to participate in semi-structured interviews to identify effective strategies for increasing the recruitment of underrepresented populations. Importantly, this research offered recruitment staff the opportunity to share their experiences with a peer researcher rather than their employer or principal investigators. 

Results: The data yielded significant findings, including the impact of racial and cultural similarities on recruiters' experiences and methodologies for approaching families to increase the chances of enrollment. Families who recognize the benefits of a research study are more likely to consent, regardless of their social-cultural background; however, building trust is crucial for families to perceive a study as safe and credible. Pressure from funding agencies, research investigators, and field recruiters negatively affect recruiters. The initial impressions made by recruiters regarding the study play a key role in study enrollment and completion rates. Socio-cultural similarities, such as the language spoken between recruiters and participants, have a positive impact on enrollment. One recruiter noted, "I feel like it can be very helpful for recruitment if you can find something that you relate to. It always feels like I get a call-in brownie points in studies where I could recruit Hispanic families." However, recruiters who are observant, empathetic, and quick problem solvers tend to be more successful in recruiting participants. 

Conclusions: The study findings build on various themes and offer specific methodological guidelines for improved recruitment and retention strategies. Increasing the diversity of research samples will enhance our understanding of pediatric research and contribute to the development of interventions that can improve outcomes for children and families. The study findings have the potential to enhance ethical recruitment and promote equal opportunities for families to participate in research that reflects the linguistic, ethnic, and racial diversity in the U.S.