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. 2023 Mar 1;20(5):4391.
doi: 10.3390/ijerph20054391.

Community Health Representatives as Trusted Sources for Increasing Representation of American Indian Communities in Clinical Research

Samantha Sabo  1 , Naomi Lee  2 , Grant Sears  1 , Dulce J Jiménez  1 , Marissa Tutt  1 , Jeffersson Santos  1 , Omar Gomez  1 , Nicolette Teufel-Shone  1 , Marianne Bennet  3 , J T Neva Nashio  4 , Fernando Flores  5 , Julie Baldwin  1
Affiliations

Community Health Representatives as Trusted Sources for Increasing Representation of American Indian Communities in Clinical Research

Samantha Sabo et al. Int J Environ Res Public Health. .

Abstract

Indigenous and American Indian Alaskan Native (AI/AN) community members are systematically underrepresented in clinical trial research. This paper focuses on exploratory steps to partner with Native Nations of Arizona to engage Community Health Representatives (CHR) as a trusted source for building COVID-19 clinical trial research, including vaccine trials awareness. CHRs are frontline public health workers who apply a unique understanding of the experience, language, and culture of the population served. This workforce has entered the spotlight as essential to the prevention and control of COVID-19.

Methods: Three Tribal CHR programs were engaged to develop and refine culturally centered educational materials and a pre-post survey using a consensus-based decision-making approach. CHRs used these materials in brief education sessions during regular client home visits and community events.

Results: At 30 days post CHR intervention, participants (N = 165) demonstrated significantly increased awareness about and ability to enroll in COVID-19 treatment and vaccine trials. Participants also described a significant increase in trust in researchers, decreased perceived barriers related to cost for participation in a clinical trial, and improved belief that participation in a COVID-19 clinical trial for treatment was considered a benefit to American Indian and Alaskan Native people.

Conclusion: CHRs as trusted sources of information, coupled with culturally centered education materials designed by CHRs for CHR clients, demonstrated a promising approach to improved awareness of clinical trial research generally and COVID-19 trials specifically among Indigenous and American Indian community members of Arizona.

Keywords: American Indian; clinical trial participation; community health representatives; cultural humility; equity.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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