American Indian and Alaska Native Recruitment Strategies for Health-Related Randomized Controlled Trials: A Scoping Review

Introduction

Significant health disparities exist among many minority populations in the United States (US), including American Indians and Alaska Natives (AI/ANs). Despite this, AI/ANs are substantially less represented within health-related research. Randomized controlled trials (RCTs) are often considered the gold standard for medical-related research, despite some noted limitations. Appropriate participant representation within RCTs, however, impacts the generalizability of study findings, and therefore health outcomes of communities and populations included in the research. Unfortunately, representation of AI/ANs in RCTs, as well as other types of research, is lacking. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US.

Methods

A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area.

Results

Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research.

Conclusion

Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.