The role of perceived expertise and trustworthiness in research study and clinical trial recruitment: Perspectives of clinical research coordinators and African American and Black Caribbean patients.

This study investigates the role of source credibility on minority participant recruitment, particularly African American and Black Caribbean patients. A total of nine focus groups (N = 48 participants) were conducted with both patient groups and clinical research coordinators (CRCs). Using the elaboration likelihood model as a guiding framework for analysis, this study found that the credibility of research coordinators (or other professionals who recruit for research studies and clinical trials) was instrumental in shaping attitudes of prospective participants. The perspectives of patients and CRCs aligned closely, with few exceptions. For both groups, professionalism and professional displays (clothing, institutional artifacts) enhanced perceived expertise, a core component of credibility. Trustworthiness, another important component of credibility, was fostered through homophily between recruiter and patient, expressions of goodwill and assuaging anxiety about CRCs' financial motivations for recruitment. Additionally, CRCs believed that credibility was supported when CRCs could emphasize transparency and truthfulness in communication. The importance of these findings for the development of empirically-based training programs to improve communication practices in recruitment contexts is discussed.

Reducing Health Disparities Among African American and Black Caribbean Patients by Improving the Communication Practices of Clinical Research Coordinators.

This manuscript focuses on the communication factors that affect the willingness of African Americans and Black Caribbean patients to participate in clinical trials and research studies. Low rates of research participation by members of communities of color have long been linked to health disparities. While there are many factors that contribute to low rates of accrual of African American and Black patients to clinical trials, a lack of attention to communication factors that enhance or inhibit the recruitment process is central to the problem. In this study, we describe results from the analysis of six focus groups (N = 31) consisting of African American (k = 3) and Black Caribbean (k = 3) participants. Our analyses focus on verbal and nonverbal communication behaviors and how they affect participants' willingness to participate in clinical trials. Specifically, when clinical research coordinators (CRCs) had a professional appearance, made the effort to explain a study in detail, made eye contact, took the time to listen and answer questions patiently, and gave the sense that the CRC was being truthful and transparent, patients felt respected and valued. Additionally, participants emphasized the importance of the process of developing and maintaining a trusting relationship between study participants and CRCs. The results of this study will be used to develop a clinical trial communication training program designed to enhance the communication skills of clinical research coordinators who discuss research participation with African American and Caribbean Black patients.

Developing and evaluating a team development intervention to support interdisciplinary teams.

INTRODUCTION: Incentivizing the development of interdisciplinary scientific teams to address significant societal challenges usually takes the form of pilot funding. However, while pilot funding is likely necessary, it is not sufficient for successful collaborations. Interdisciplinary collaborations are enhanced when team members acquire competencies that support team success. METHODS: We evaluated the impact of a multifaceted team development intervention that included an eight-session workshop spanning two half-days. The workshop employed multiple methods for team development, including lectures on empirically supported best practices, skills-based modules, role plays, hands-on planning sessions, and social interaction within and across teams. We evaluated the impact of the intervention by (1) asking participants to assess each of the workshop sessions and (2) by completing a pre/postquestionnaire that included variables such as readiness to collaborate, goal clarity, process clarity, role ambiguity, and behavioral trust. RESULTS: The content of the team development intervention was very well received, particularly the workshop session focused on psychological safety. Comparison of survey scores before and after the team development intervention indicated that scores on readiness to collaborate and behavioral trust were significantly higher among participants who attended the workshop. Goal clarity, process clarity, and role ambiguity did not differ among those who attended versus those who did not. CONCLUSIONS: Multicomponent team development interventions that focus on key competencies required for interdisciplinary teams can support attitudes and cognitions that the literature on the science of team science indicate are predictive of success. We offer recommendations for the design of future interventions.

The Invisible Danger of Transferring Toxins with Bunker Gear: A Theory-Based Intervention to Increase Postfire Decontamination to Reduce Cancer Risk in Firefighters.

Studies show significant association between cancer risk and being a firefighter. After exposure to even routine firefighting, firefighters' bunker gear often contains carcinogens that may be absorbed through contact or inhaled through off-gassing, thereby increasing cancer risk. Awareness of increased cancer risk has given rise to policies and practices focused on gear cleaning and decontamination processes to decrease risk; yet, these efforts are in their infancy and tend to be somewhat piecemeal in nature. This study presents a theory-based communication intervention tailored to the unique context of high-reliability organizations (HROs). The intervention focused on increasing postfire decontamination behaviors to reduce exposure to carcinogens among firefighters. Results of the intervention across 14 fire stations from 2 fire departments in South Florida show significant increases in attitudes, norms, and self-efficacy, decreases in perceived barriers, and increased intention to engage in decontamination processes. While the intervention was highly successful in both fire departments, there were significant differences in between organizations; attitudes perceived norms, and barriers to gear cleaning remained significantly different. This highlights the need to examine the specific context of the organization in designing interventions. In line with previous research on HROs, regression models showed that norms and self-efficacy are the strongest predictors of current behavior. However, postintervention, attitudes emerge as the strongest predictor of future behavior. The results of this study provide valuable evidence for utilizing theoretical elements in message design for interventions in HROs, and of the importance of designing communication for specific sites of intervention.

Safety Gear Decontamination Practices Among Florida Firefighters: Analysis of a Text-Based Survey Methodology.

Despite the National Fire Protection Association (NFPA) 1851 Personal Protective Equipment Care and Maintenance guidelines, little is known about the routine cleaning of firefighter bunker gear. In collaboration with a large Florida firefighter union, a mobile phone text survey was administered, which included eight questions in an item logic format. In total, 250 firefighters participated in the survey of which 65% reported cleaning their bunker gear in the past 12 months. Approximately 32% ( n = 52) indicated that they had above average confidence in gear cleaning procedures. Arriving at a fire incident response was a significant predictor of gear cleaning in the 12 months preceding survey administration. Using mobile phone-based texting for periodic queries on adherence to NFPA cleaning guidelines and safety message distribution may assist firefighters to increase decontamination procedure frequency.

Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk.

Firefighters are exposed to carcinogens such as volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) during fires and from their personal protective equipment (PPE). Recent research has shown that decontamination processes can reduce contamination on both gear and skin. While firefighter cultures that honor dirty gear are changing, little is known about current attitudes and behaviors toward decontamination in the fire service. Four hundred eighty-five firefighters from four departments completed surveys about their attitudes, beliefs, perceived norms, barriers, and behaviors toward post-fire decontamination processes. Overall, firefighters reported positive attitudes, beliefs, and perceived norms about decontamination, but showering after a fire was the only decontamination process that occurred regularly, with field decontamination, use of cleansing wipes, routine gear cleaning, and other behaviors all occurring less frequently. Firefighters reported time and concerns over wet gear as barriers to decontamination.

Firefighter perceptions of cancer risk: Results of a qualitative study.

BACKGROUND: Recent epidemiological research on firefighters indicates an increased incidence of specific types of cancer. Intervention is needed in the fire service yet little is known about how firefighters perceive their cancer risk. METHODS: Participant observation (150 h, n = 100) and focus group (n = 17) data were collected from 15 fire stations in South Florida. Firefighters had at least 3 years of experience, ranks included drivers, captains, lieutenants, and specialty captains, with a median age of 51 years. RESULTS: From the qualitative analysis, two major categories (direct and indirect factors) for cancer risks emerged based on participant notions of cancer risk and cancer prevention behaviors as they relate to firefighting. CONCLUSIONS: Firefighters perceive cancer risks as the result of performing essential job tasks and from indirect job factors related to being a firefighter. The two categories of cancer risks suggest different points of entry for intervention.

Reframing, Refocusing, Referring, Reconciling, and Reflecting: Exploring Conflict Resolution Strategies in End-of-Life Situations.

Many problems can occur between family members at the end of a patient's life, resulting in conflict that others-the nurses, patient advocates, clergy, and social workers involved in the case-must resolve. This article explores the strategies used by those individuals to resolve conflict. Using grounded practical theory as a theoretical and methodological framework, qualitative interviews (n = 71) revealed how they manage family conflict at the end of life. The management styles include reframing, refocusing, referring, reconciling, and reflecting (the "5 Rs"). These strategies provide a conflict management typology for those who work with families during end-of-life situations.

Benefits of Transplant Procurement Management (TPM) specialized training on professional competence development and career evolutions of health care workers in organ donation and transplantation.

OBJECTIVES: Training on organ donation and transplantation is relevant for transplantation improvement. This study aimed at investigating the perceived benefits of Transplant Procurement Management training programs on professional competence development and career evolutions of health care workers in organ donation and transplantation. MATERIALS AND METHODS: An online survey was developed in 5 languages (Spanish, English, Italian, French, and Portuguese) and its link was emailed to 6839 individuals. They were asked to forward it to other professionals in organ donation and transplantation. The link was also shared on Facebook and at relevant congresses. Two research questions on the perceived influence of specialized training programs were identified. RESULTS: A total of 1102 participants (16.1%) took the survey; 87% reported participating in Transplant Procurement Management training programs, of which 95% selected Transplant Procurement Management courses as the most influential training they had participated in. For research question one, 98% reported influence on knowledge (score 4.5 [out of 5]), 93% on technical (4.2) and communication skills (4.1), 89% on attitude toward organ donation and transplantation (4.1), 92% on motivation to work (4.2), 91% on desire to innovate (4.0), 87% and 79% on ability to change organ donation and trans plantation practices (3.9) and policies (3.5). For research question 2, main and interaction effects for position at the time of training and type of training were reported. CONCLUSIONS: Transplant Procurement Management training programs had positive perceived effects.

It's up to you: a multi-message, phased driver facility campaign to increase organ donation registration rates in Illinois.

BACKGROUND: The present project applied successful strategies employed in previous driver facility campaigns occurring during the inception of a registry to examine whether these approaches are effective in growing a mature registry, a registry where the majority of individuals have had the opportunity to register as an organ donor. METHODS: Driver facilities (N = 40) in Illinois with high (n = 20) and low (n = 20) organ donation registration percentages were selected and served as either intervention or control sites for the campaign. RESULTS: Among facilities with historically high and low registration percentages, support for the campaign was found with the intervention facilities experiencing higher organ donation registration rates compared with control facilities. In addition, the results provide partial support for the effectiveness of employing a multi-message, phased driver facility intervention in states with a mature registry. CONCLUSION: The practical implications of utilizing driver facility campaigns in states with an established first-person consent registry also are discussed.

Saving lives branch by branch: the effectiveness of driver licensing bureau campaigns to promote organ donor registry sign-ups to African Americans in Michigan.

African Americans are disproportionately represented on the national waiting list for organ transplantation. Promoting organ donor registries is one way to improve the possibility that those on the waiting list can receive a life saving transplant. Driver licensing bureaus have been suggested as an efficient site for campaigns aimed at increasing state-based registry sign-ups. Previous research has suggested these campaigns work well for Caucasian populations, but there is less evidence supporting this approach in more diverse populations. To determine whether more diverse populations demonstrate similar sign-up rates when receiving a driver licensing bureau campaign, the present study used a previously successful strategy as the basis for designing and disseminating materials that would appeal to African Americans and Caucasians in two diverse counties in the state of Michigan (Wayne and Oakland Counties). Communication design and media priming served as the theoretical foundations of a three-prong campaign that used mass media, point-of-decision, and interpersonal components. Results from countywide and zip code data indicate that the campaign greatly increased sign-ups among African American residents (700% increase above baseline). Although more Caucasians still signed up than did African Americans, the inclusion of an interpersonal component resulted in similar numbers of registry sign-ups during 2 intervention months. The study provides evidence supporting the use of driver licensing bureau campaigns to promote organ donation registries to diverse audiences.

The University Worksite Organ Donation Project: a comparison of two types of worksite campaigns on the willingness to donate.

To test the impact of different campaign strategies, a year-long campaign was conducted to promote organ donation among university faculty, staff, and students. Two universities were assigned to each of three conditions: a media-only campaign, a mass media-plus-interpersonal outreach condition, and a control condition. Universities were counter-balanced by geographic region and diversity of population. Changes from pretest to post-test on the key-dependent measures, including signing a donor card and discussing donation with family members, were significantly greater in the media-plus-interpersonal condition than either the mass media only or control conditions. Implications for the creation of campaigns to promote other health behaviors are examined.

Promoting the Michigan organ donor registry: evaluating the impact of a multifaceted intervention utilizing media priming and communication design.

There are currently more than 100,000 individuals waiting for an organ transplant. Organ donor registries represent the easiest and most concrete way for people to declare their intent to donate, but organ donor registries are vastly underutilized. This study reports a campaign intervention designed to increase the rate of joining the Michigan Organ Donor Registry. Grounding intervention development in the theoretical principles of media priming and communication design, the intervention took place in two waves in three counties in Michigan. Each intervention consisted of a media component, point-of-decision materials, and an interpersonal component. Increases in registration rates of 200 to 300% in each intervention county, compared to stable statewide trends in registry rates, provide evidence of highly successful intervention efforts. The rate of registry increase in intervention counties was approximately 1,900% higher than statewide on a per capita basis.

Religiosity, anxiety, and discussions about organ donation: understanding a complex system of associations.

An increasingly large research base on religiosity has shown it to have a buffering effect on anxiety. In a separate vein, scholars interested in organ donation have suggested that both religiosity and anxiety play roles in individuals' willingness to seek information concerning their decisions about organ donations with their family-an event that greatly increases donation rates. This investigation presents 2 studies that examine the associations between religiosity and anxiety (variously measured), on the one hand, and anxiety and individual's information seeking behaviors with family members about organ donation on the other. The first study offers national samples and relies on self-reports, whereas the second study is one of the few organ donation studies to provide observer ratings of interaction between family members on the issue. Results suggest a more complicated role of religiosity with regard to anxiety than previously believed and show a consistent and robust association between anxiety and communication behaviors regarding organ donation. Implications for campaigns are discussed.

The challenges of social marketing of organ donation: news and entertainment coverage of donation and transplantation.

While great strides have been made in persuading the public to become potential organ donors, actual behavior has not yet caught up with the nearly universally favorable attitudes the public expresses toward donation. This paper explores the issue by situating the social marketing of organ donation against a broader backdrop of entertainment and news media coverage of organ donation. Organ donation storylines are featured on broadcast television in medical and legal dramas, soap operas, and other television serials approximately four times per month (not including most cable networks), and feature storylines that promote myths and fears of the organ donation process. National news and other non-fictionalized coverage of organ donation are even more common, with stories appearing over twenty times a month on average. These stories tend to be one-dimensional and highly sensationalized in their coverage. The marketing of organ donation for entertainment essentially creates a counter-campaign to organ donation, with greater resources and reach than social marketers have access to. Understanding the broader environmental context of organ donation messages highlights the issues faced by social marketing campaigns in persuading the public to become potential donors.

Facts versus 'Feelings': how rational is the decision to become an organ donor?

Researchers are already aware that decision making about health issues is not necessarily driven by rational or cognitive-based decision-making processes. This appears to be especially true for the decision to donate organs. Although hints about what is actually driving the decision-making process are scattered throughout the literature, noncognitive factors have not been tested systematically. Structural equation modeling of data gathered from 4426 participants at six different geographic locations in the United States demonstrates that cognitive-based factors (such as knowledge about donation) are less influential on the decision to donate than noncognitive variables such as the desire to maintain bodily integrity, worries that signing a donor card might 'jinx' a person, and medical mistrust.

In their own words: the reasons why people will (not) sign an organ donor card.

This multisite, qualitative study of 78 family-pair dyads provides rich data on the reasons people cite for (not) wanting to sign an organ donor card in the context of family conversations. In this study, dyads were videotaped as they discussed 8 questions pertaining to their views on organ donation, beginning with the most general opinions and progressing to more detailed questions. Analysis of the transcribed data revealed that the most common reasons for wanting to donate organs were based on religion or a desire to help other people in need. The most common reasons cited for not wanting to donate organs were mistrust (of doctors, hospitals, and the organ allocation system), a belief in a black market for organs in the United States, and deservingness issues (that one's organs would go to someone who brought on his or her own illness, or who could be a "bad person"). One of the most surprising findings is that religion is offered far more often as a rationale for wanting to help sick people through organ donation than it was for not wanting to donate organs. These findings both support and contradict past studies based on quantitative survey data. Implications for the construction of more effective future organ donor campaigns are discussed.

Effects of information, education, and communication training about organ donation for gatekeepers: clerks at the Department of Motor Vehicles and organ donor registries.

CONTEXT: Clerks at the Department of Motor Vehicles (DMV) serve as gatekeepers in the quest to fill organ donor registries. Most people who join organ donor registries do so through their local driver's license bureau. OBJECTIVE: To improve knowledge, attitudes, and behavior toward organ donation among DMV clerks, and to improve strategies for communicating with the public about organ donation, resulting in more people joining DMV-based organ donor registries. SETTING: DMV offices in 8 counties in a southern state. PARTICIPANTS: A general survey of 1504 participants in 8 counties was conducted to assess knowledge, attitudes, beliefs, and behaviors toward organ donation. All 76 DMV clerks in those counties participated in surveys before and after a training intervention. INTERVENTIONS: DMV clerks received a 1-hour training intervention focused on the nature of the new organ donor registry, information about organ donation, and communication strategies for interacting with the public. MAIN OUTCOME MEASURES: Knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation were measured for the general public survey and for DMV clerks. RESULTS: Clerks were more knowledgeable about brain death and religious stances on organ donation than the general public, but otherwise both groups shared similar knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation. Overall the general public and clerks had favorable attitudes toward organ donation but low to moderate knowledge, beliefs, and behaviors and behavioral intentions. Training significantly increased DMV clerks' knowledge, attitude, beliefs, and behavioral intention toward donation. Organ donor registration rates were a mean of 14% higher in counties where clerks were trained than in control counties and were 9% higher than statewide. CONCLUSIONS: Training DMV clerks is an effective way to increase knowledge, attitudes, and beliefs for gatekeepers of organ donor registries and may increase donor registration rates among the public.