Overcoming Black Americans’ Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars

ABSTRACT

This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10410236.2022.2105619

Notes

1. People participating in this study are referred to as “respondents” to avoid confusion with the fictional exemplars who represent clinical trial participants.

2. Within-subjects designs are known as particularly useful to detect subtle effects because they can reduce the error variation caused by individual differences (Grabe & Westley, 2003). Based on the above literature review, the effect size of psychological barriers (e.g., distrust in Meng et al., 2016) and cognitive barriers (e.g., subjective knowledge in Kim et al., 2015) on clinical trial participation intention were small. Therefore, we used a within-subjects design to detect the possible subtle difference between these two types of barriers and the exemplars used to present the barriers.

3. The text of the stimuli can be found in the article’s online supplementary material.

4. Informed written consent was collected at the beginning of the study by providing participants with a consent form and asking them to indicate whether they gave consent. Only those who gave consent were able to proceed. Approval for the study came from a university Institutional Review Board (project number: 2054423).

5. An illustration of the experiment flow can be found in the article’s online supplementary material.

6. For the reliability of a two-item scale, it is best to report the Spearman-Brown reliability estimate (Eisinga et al., 2013). We reported both Cronbach’s alpha and Spearman-Brown coefficient to provide more scale information for future studies.

7. All outcome variables were normally distributed, as assessed by skewness and kurtosis values (Skewness in ±2, Kurtosis in ±7). The assumption of homogeneity of variances was met for all four mixed ANCOVAs, as assessed by Levene’s test (p > .05).

Additional information

Funding

This work was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).