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