Background & Aims
Neuromodulation techniques, such as transcutaneous auricular vagus nerve stimulation (taVNS), show promise for improving chronic pain management [1]. However, participation in neuromodulation research is notoriously poor for racial and ethnic minorities in the USA [2], even though members of these groups are at higher risk for chronic pain [3]. The poor recruitment of minority participants may be partially driven by mistrust and uncertainty associated with low quality educational information [4]. The goal of this study was to produce culturally sensitive videos to effectively provide high value education on taVNS and specifically target African American (English speaking), Hispanic (Spanish speaking), and Haitian (Creole speaking) participants with chronic pain. This project is supported by the Miami Clinical and Translational Science Institute (#UL1TR002736) and by the National Center of Neuromodulation for Rehabilitation (#P2CHD086844).
Methods
A generic qualitative design [5] was employed with an iterative process focused on patient centered and community engagement strategies to develop the recruitment videos for taVNS research. First, a panel of researchers who use taVNS in their studies were interviewed to gain insight on what content they felt was necessary to include in the videos. Next, test videos were professionally produced with integration of the identified content using a culturally diverse cast of actors. A panel consisting of stakeholders who had a history of chronic pain, and who also represented the target cultural groups, were interviewed to provide input and feedback on video production. Throughout the data collection process, rapid qualitative analysis [6] was used to analyze interview transcripts and to develop matrices of qualitative findings. Finally, findings were used to inform revisions and further production of recruitment videos.
Results
Participants in the research panel interviews (n=10) emphasized the importance of including information on 1) mechanisms of action, 2) what participants should expect, 3) that there is no guaranteed benefit, and 4) there is regulatory oversight to protect participants. This information was incorporated in production of three video segments in each language (9 videos in total) . Participants from the stakeholder panel representing African American (n=6), Hispanic (n=5), and Haitian (n=4) people with chronic pain provided feedback on the videos. Participants valued the aim, clarity, length, and content of the videos, as well as the purpose of research on taVNS within minority populations. However, a recurring concern across groups was the fact that taVNS is not FDA approved and what risks this might present.
Conclusions
Based on results, the final video products will provide more detailed information on the conditions for which vagus nerve stimulation is FDA approved, risks associated with taNVS, and why additional medical research is needed to gain FDA approval for pain management. The videos provide the taVNS research field with a tool to enhance recruitment of racial and ethnic minority participants in English, Spanish, and Haitian Creole languages. The iterative process and the participatory research strategies used in this project provide a valuable framework for developing and optimizing recruitment tools for pain research, and support efforts toward achieving greater engagement and interest in research activities from the underrepresented community.
References
1.Farmer AD, Strzelczyk A, Finisguerra A, et al. International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Front Hum Neurosci. 2020;14:568051.
2.Peebles IS, Phillips TO, Hamilton RH. Toward more diverse, inclusive, and equitable neuromodulation. Brain Stimul. 2023;16(3):737-741.
3.Morales ME, Yong RJ. Racial and Ethnic Disparities in the Treatment of Chronic Pain. Pain Med. 2021;22(1):75-90.
4.Wright KO DB, Harrisoon TR, Malova E, Jia X, Morgan SE. Examining uncertainty management in the clinical trial experiences of African American and Black Caribbean participants and the coordinators who recruit them. SSM – Qualitative Research in Health. 2023;3(100231).
5.Ellis JL HD. Strengthening the Choice for a Generic Qualitative Research Design. The Qualitative Report. 2023;28(6).
6.AB H. Rapid Qualitative Methods in Health Services Research: Spotlight on Women’s Health VA HSR&D National Cyberseminar series: Spotlight on Women’s Health. In:2013.
Presenting Author
Marlon Wong
Poster Authors
Marlon Wong
PhD
University of Miami
Lead Author
Chelsea Miller
PT
University of Miami
Lead Author
Gabriel Gonzalez
The University of Miami
Lead Author
Lisa McTeague
PhD
Medical University if South Carolina
Lead Author
Melissa Tovin
PhD
Nova Southeastern University
Lead Author
Peter Hosein
MD
University of Miami
Lead Author
Frank Penedo
PhD
University of Miami
Lead Author
Annemay Lelis
PT
University of Miami
Lead Author
Jessica Bolanos
PT
University of Miami
Lead Author
Juan Gonzalez
University of Miami, Department of Physical Therapy, APReCIAT Lab
Lead Author
Eva Widerström-Noga
DDS
University of Miami Miller School of Medicine
Lead Author
Topics
- Access to Care