Abstract: Evaluating the process and ethics of randomizing African American and Latino adults with diabetes to a community health worker intervention (Society for Social Work and Research 14th Annual Conference: Social Work Research: A WORLD OF POSSIBILITIES)
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101P Evaluating the process and ethics of randomizing African American and Latino adults with diabetes to a community health worker intervention

Schedule:
Saturday, January 16, 2010
* noted as presenting author
Michael Spencer, PhD , University of Michigan-Ann Arbor, Associate Professor, Ann Arbor, MI
Karen Tabb Dina, MSW , University of Washington, PhD Student, Seattle, WA
Gloria Palmisano, MA , REACH Detroit Partnership, Project Manager, Detroit, MI
Edith Kieffer, PhD , University of Michigan-Ann Arbor, Associate Research Professor, Ann Arbor, MI
Michael Anderson, BA , REACH Detroit Partnership, Senior Family Health Advocate, Detroit, MI
Michele Heisler, MD , Veterans Affairs Medical Center Ann Arbor, Research Scientist, Ann Arbor, MI
Purpose: The purpose of this presentation is to describe and evaluate the process of a randomized control trial for a community health worker intervention with African American and Latino REACH Detroit participants.

Methods: We recruited 164 clients and randomly assigned them to two arms of our 12-month intervention: an immediate and a six-month, delayed control group. Our overall retention rate is 71.7%, and was higher for Latinos (81%) compared to African Americans (62%). We had a higher drop-out rate in our delayed group (33%) compared to the immediate group (24%). Drop-out rates were similar across groups for African Americans (about 38%), but higher for the delayed group among Latinos (11% vs. 27%).

Results: In-depth interviews with 20 clients across the two arms by race/ethnicity and drop-out status revealed that individuals did not report adverse effects due to randomization, however some clients in the delayed group expressed considerable disappointment in not being selected for the immediate group. Although procedures were presented in the initial orientation and documented in the consent forms, many clients from both groups did not fully understand the process. A few clients questioned the fairness of the process and whether it was truly random. However, the majority expressed satisfaction, regardless of whether they were clear on the process. Drop out was not due to perceptions of fairness, but for other reasons, including work and time commitments.

Conclusion: The study offers lessons learned for designing randomized control trials with under-represented groups in urban settings and policies related to ethical considerations in health disparities research.