The COVID-19 pandemic has further exposed and exacerbated a number of racial inequalities in America, one of the most prominent being health disparities. According to the Centers for Disease Control and Prevention, Black people are twice as likely to die from COVID-19 than white or non-Hispanic persons. The reasons for these devastating losses extend far beyond an increased exposure to the virus from occupational risks, including a lack of access to quality health care and lower socioeconomic status that have long had adverse health impacts on Black communities.
One of the pervasive health problems facing Black adults is the prevalence of high blood pressure (hypertension), a leading contributor to cardiovascular disease. It is estimated that fifty-five percent of Black adults suffer from hypertension, more than any other racial or ethnic group. Assistant Professor Loneke Blackman Carr of the Department of Nutritional Sciences in the College of Agriculture, Health and Natural Resources (CAHNR) is looking for ways to improve the health of Black adults with hypertension by increasing participation in a dietary program shown to lower blood pressure. Her work is part of a new grant-funded collaboration with the Duke Global Digital Health Science Center at Duke University.
Blackman Carr is working with Associate Professor Dori Steinberg at the Duke School of Nursing to recruit Black adults to a Dietary Approaches to Stop Hypertension (DASH) study. DASH is an evidence-based strategy that promotes a sodium-reduced diet emphasizing fruits and vegetables, whole grains, lean protein and low-fat dairy while limiting overall total fat intake. DASH has proven positive health outcomes, greatly reducing blood pressure among Black adults, particularly compared to whites. Their research is focusing on improving the representation of Black adults in health research by studying the factors that influence Black subjects’ participation and success in dietary programs.
“We know the dietary changes that are tried and true, regardless of race and ethnicity, to improve blood pressure and overall health,” says Blackman Carr. “The work we’re doing will help us uncover what Black individuals specifically need to know or need to have to engage in research to improve their diet.”
“But there is a long intergenerational mistrust of research and medical organizations. This has made recruiting Black individuals for research studies a challenge.”
Studies have shown that Black individuals often decline to participate in clinical research, based on historical patterns of abuse at the hands of academic and medical professionals and researchers. While the infamous Tuskegee Syphilis Study, in which sharecroppers in Alabama were offered free medical treatment and instead infected with syphilis by researchers, who never informed nor treated the men for the disease, is one of the more prominent reasons for this historical mistrust, there are other recent incidents. In the 1990s, an American university conducted a study seeking to connect aggressive behavior to genetics. Researchers recruited only young Black men and medically mistreated them.
In addition to this troubled history, which extends further back in time, there are current issues of racial disparities and systemic racism. Black adults often report negative interactions with physicians and voice concerns that research will be used to disparage their ethnic group. This has created many obstacles to participation in health research that Blackman Carr hopes to understand how to overcome.
This research goal led to the creation of Diversity in Participation (DIP) into DASH, a study that will examine the hesitations that keep people of color from participating in this type of behavioral research in order to remove barriers and find ways to improve success in a dietary program as a way to increase health. The study is recruiting individuals in the Duke University community of Durham, Chapel Hill and Raleigh, North Carolina. Blackman Carr has recently begun recruiting for her research in the Hartford area with the assistance of graduate and undergraduate students in the Department of Nutritional Sciences and the Department of Allied Health Sciences.
“We’re using different recruitment strategies and interview methods to find what’s the most effective, or ineffective, recruitment strategy across race groups,” says Blackman Carr. “We’ll be looking at Black adults in these areas, but we’re looking at everyone who joined the study to help inform what we do next in order to be diverse and inclusive.”
The research is examining passive and active methods of recruitment. Passive methods involve posting flyers at locations or on social media seeking participants for research. This allows individuals to make the choice to engage with researchers. The active method of recruitment has researchers going out into the community to find participants.
“I call it ‘pounding the pavement,’” says Blackman Carr. “You’re going out into the community, you’re at church meetings, you’re at fraternity and sorority meetings, you’re where people are at and you let them know you want to do research. I think a lot of researchers find a challenge with these active methods. It translates to an investment in the community and trusting relationships that takes time to build.”
Prior to arriving at UConn, Blackman Carr spent many years researching ways to use behavioral interventions to improve health outcomes as a doctoral student at the University of North Carolina at Chapel Hill and as a post-doctoral researcher at Duke University. In her experience, she believes a key to success in this type of research is to keep in mind its bidirectional nature. Researchers want to gain knowledge, but they also have to remember they are serving the community. She says it is important for communities to know researchers are building lasting relationships and their intentions, not to get the data they need for their study and leave.
“You need to approach folks, as you would with any relationship, with a genuine spirit and intention in what you hope it can bring to them and have conversations with those individuals. They need to know you and your research team, so they know your intention and that it is not malicious and that when you’re done with this particular study that you don’t disappear,” says Blackman Carr.
“Being at UConn, the state’s land-grant research institution, our mission is to serve Connecticut. I think where this grant and the mission of the University, and CAHNR, intersect is service. To understand what people need and ask them about that. We have even more geographical reach because we’re partnered with the Duke University community as well. I’m hoping these results inform how we think about recruiting and helping Black individuals improve their health.”
The study described in this article is supported by Grant #3R01HL146768-01S1 from the National Heart, Lung and Blood Institute in the National Institutes of Health.