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<p>Black/African American (BAA) women with advanced breast and gynecological cancers remain underrepresented in research, limiting equitable evidence generation. Recruitment challenges are often framed at the individual level, with insufficient attention to structural, relational, and trust-related factors. This study examined recruitment strategies and documented real-world challenges encountered when engaging BAA women with advanced-stage cancer in qualitative research. This study used an autoethnographic design informed by narrative inquiry, drawing on recruitment logs, reflexive field notes (n ≈ 40), and analytic memos (n ≈ 30) collected across clinical, community, and digital settings. Recruitment outcomes were tracked systematically. A total of 17 participants were enrolled (8 patients, 3 family caregivers, 6 healthcare providers) between July and December 2025. Data were analyzed using RTA and Iterative Thematic Inquiry (ITI) identify patterns across recruitment approaches. Recruitment logs and reflexive field notes can function as primary data, not merely process documentation. Recruitment logs, reflexive field notes, and analytic memos documented over multiple site visits and outreach efforts revealed consistently low response rates from clinic-based referrals and digital recruitment despite repeated follow-ups. Field notes recorded instances of institutional gatekeeping, including delayed approvals, unanswered emails, and restricted access to eligible patients at several clinical sites. Reflective entries also captured participants expressed medical mistrust and hesitancy to engage in research, often linked to prior negative healthcare experiences. Analytic memos identified structural barriers such as transportation challenges, illness severity, and fragmented care coordination that limited participation. Meaningful enrollment occurred primarily through trusted community spaces and personal referrals facilitated by community insiders. The researcher’s reflexive documentation further noted accent-related questioning of credibility in clinical environments, shaping access and recruitment interactions. Standard recruitment approaches inadequately address structural and trust-related barriers for BAA women with advanced cancer. Recruitment improved when efforts shifted toward sustained community engagement and partnerships with trusted insiders who could facilitate access and credibility. These findings highlight the need to embed culturally responsive, relationship-centered strategies into recruitment design, ensuring that trust-building and community collaboration are treated as core components of equitable cancer research rather than optional additions.</p>

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Recruitment of blacks (African American/African immigrant) women with advanced breast and gynecological cancers: an autoethnographic exploration

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Evans Appiah Osei,
  • Nasreen Lalani,
  • Steven Burdick,
  • Abidemi Mary Ajuwon

摘要

Black/African American (BAA) women with advanced breast and gynecological cancers remain underrepresented in research, limiting equitable evidence generation. Recruitment challenges are often framed at the individual level, with insufficient attention to structural, relational, and trust-related factors. This study examined recruitment strategies and documented real-world challenges encountered when engaging BAA women with advanced-stage cancer in qualitative research. This study used an autoethnographic design informed by narrative inquiry, drawing on recruitment logs, reflexive field notes (n ≈ 40), and analytic memos (n ≈ 30) collected across clinical, community, and digital settings. Recruitment outcomes were tracked systematically. A total of 17 participants were enrolled (8 patients, 3 family caregivers, 6 healthcare providers) between July and December 2025. Data were analyzed using RTA and Iterative Thematic Inquiry (ITI) identify patterns across recruitment approaches. Recruitment logs and reflexive field notes can function as primary data, not merely process documentation. Recruitment logs, reflexive field notes, and analytic memos documented over multiple site visits and outreach efforts revealed consistently low response rates from clinic-based referrals and digital recruitment despite repeated follow-ups. Field notes recorded instances of institutional gatekeeping, including delayed approvals, unanswered emails, and restricted access to eligible patients at several clinical sites. Reflective entries also captured participants expressed medical mistrust and hesitancy to engage in research, often linked to prior negative healthcare experiences. Analytic memos identified structural barriers such as transportation challenges, illness severity, and fragmented care coordination that limited participation. Meaningful enrollment occurred primarily through trusted community spaces and personal referrals facilitated by community insiders. The researcher’s reflexive documentation further noted accent-related questioning of credibility in clinical environments, shaping access and recruitment interactions. Standard recruitment approaches inadequately address structural and trust-related barriers for BAA women with advanced cancer. Recruitment improved when efforts shifted toward sustained community engagement and partnerships with trusted insiders who could facilitate access and credibility. These findings highlight the need to embed culturally responsive, relationship-centered strategies into recruitment design, ensuring that trust-building and community collaboration are treated as core components of equitable cancer research rather than optional additions.