Publications

Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) mobilizing African churches; (2) utilizing word of mouth through family and friends; (3) maximizing research team's cultural competence and gender concordance; (4) promoting altruism through health education; (5) ensuring confidentiality through the consenting and data collection processes; and (6) providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a "hard-to-reach" immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.

Global migration from Africa to more economically developed regions such as the United States, Europe, the Middle East, and Australia has reached unprecedented rates in the past five decades. The size of the African immigrant population in the United States has roughly doubled every decade since 1970. However, research has not kept up with the growing size of this vulnerable population. Data from African immigrants have not traditionally been reported separately from Blacks/African Americans. There is growing interest in increasing the participation of African immigrants in research to understand their unique health needs and the full spectrum of factors impacting their health, ranging from racial, social, environmental, and behavioral factors, to individual biological and genetic factors which may also inform health challenges. This line of inquiry may also inform our understanding of health disparities among their African American counterparts. However, little is known about effective community engagement and recruitment strategies that may increase the participation of this population in research studies. The purpose of this commentary is to: 1) describe lessons learned from our experiences engaging African immigrants in research in the Baltimore, Washington, DC, and Atlanta metropolitan areas; 2) discuss strategies for successful recruitment; and 3) consider future directions of research and opportunities to translate research findings into health policy for this population.

BACKGROUND: Ethnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations. The prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes was examined and contrasted among a socioeconomically diverse sample of immigrants. It was hypothesized that considerable variability would exist in the prevalence of hypertension, overweight and diabetes.

METHODS: A cross-sectional analysis of the 2010-2016 National Health Interview Survey (NHIS) was conducted among 41,717 immigrants born in Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia and Southeast Asia. The outcomes were the prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes.

RESULTS: The highest multivariable adjusted prevalence of diagnosed hypertension was observed in Russian (24.2%) and Southeast Asian immigrants (23.5%). Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent had the highest prevalence of overweight/obesity (71.5 and 73.4%, respectively) and diagnosed diabetes (9.6 and 10.1%, respectively). Compared to European immigrants, immigrants from Mexico/Central America/Caribbean and the Indian subcontinent respectively had higher prevalence of overweight/obesity (Prevalence Ratio (PR): 1.19[95% CI, 1.13-1.24]) and (PR: 1.22[95% CI, 1.14-1.29]), and diabetes (PR: 1.70[95% CI, 1.42-2.03]) and (PR: 1.78[95% CI, 1.36-2.32]). African immigrants and Middle Eastern immigrants had a higher prevalence of diabetes (PR: 1.41[95% CI, 1.01-1.96]) and PR: 1.57(95% CI: 1.09-2.25), respectively, than European immigrants -without a corresponding higher prevalence of overweight/obesity.

CONCLUSIONS: Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent bore the highest burden of overweight/obesity and diabetes while those from Southeast Asia and Russia bore the highest burden of hypertension.

The purpose of this systematic review was to determine whether nurse-delivered weight management interventions improve weight outcomes across the life span. We conducted a comprehensive search of the PubMed, CINAHL, and PsycINFO electronic databases. We graded the trials using an adapted Jadad approach for methodological quality. The search identified a total of 1,159 citations; 23 articles from 20 studies were eligible for this review. Sixty-five percent of the studies reported significant findings related to body mass index (BMI) or weight reduction. Studies that were particularly successful at helping participants reduce weight and/or BMI involved nurses engaged in health promotion activities, operating within multidisciplinary teams and/or providing consultations, physical activity education, and coaching over the phone. Of the studies that involved long-term follow-up assessments, three out of nine studies showed a significant loss in weight or BMI between the intervention and control groups at follow-up times ranging from 12 months to 2 years.