BARRIERS TO RESEARCH PARTICIPATION AND UTILIZATION OF HEALTHCARE

Previous work has shown that there may be several factors that influence use of the healthcare system that may also influence participation in CBPR efforts that are related to healthcare. These may include preference for Eastern medicine in these communities, cultural beliefs about not looking for asymptomatic ailments, and the stigma if friends and family were to find out about certain disease diagnoses.^151,152 If the goal of the research or intervention is to deliver a health or educational service, researchers should consider the Asian American subgroup and other characteristics, such as gender, when understanding influences on use and acceptability of the intervention or service. For example, among Vietnamese women the gender of the physician rather than the ethnicity was a major determinant for requesting or approving cancer-screening services.^153,154

Another factor that specifically affects participation in research by undocumented Asian American immigrants is the false belief that a signed research consent form becomes a document that could lead to deportation. This points to a lack of understanding of the consent and confidentiality procedures and how study information is used.¹³⁹ Researchers could help alleviate this issue by using CBPR processes to understand and generate solutions on how to best communicate and respond to concerns among undocumented populations who may have this concern.

There are important considerations to be taken into account and openly discussed with the community throughout the design and development of CBPR. Researchers must be aware that language barriers could be a deterrent to par- ticipation¹⁵⁵ and that linguistic and social isolation may discourage potential participants from becoming involved in or frequenting community events or organizations.^155,156 Other common barriers reported by Asian Americans are time constraints, family commitment, and transportation difficulties.¹⁵⁵ These should be considered during intervention design and data collection procedures to minimize the burden. Potential solutions are to have participation opportunities during lunch breaks, evenings, and weekends and offering childcare during research participation.

Some authors argue that there are cultural considerations that if taken into account could improve participation. For example, because collective decisionmaking is a core value for several Asian cultures, addressing health issues as a family matter rather than as a personal issue can be an effective approach for engaging Asian communities, especially if the target audience are women or elderly.¹⁵¹,^157-159

Planning and implementing CBPR with Asian American communities may include considerations of cultural practices and beliefs. To improve participation in CBPR researchers may want to consider the following strategies:

• 1. working with community-based organizations and groups,
• 2. using community or lay health workers from the communities of interest,
• 3. using culturally appropriate materials and language,
• 4. employing multiple recruitment methods, including social networks to recruit

family members and friends, flyers, and broadcast media,^160,161

• 5. scheduling community partner meetings, focus groups, and research participation events outside business hours, and
• 6. planning for program sustainability.

Researchers may benefit from working with community groups, establishing and then maintaining long-standing partners in the community, gaining insight from community members, and developing a CAB. Having a community partner introduce the researcher and the project to the community may increase acceptance and participation. Partnering with community-based organizations (CBOs) that primarily serve Asian communities can facilitate entry into a community and increase trust. Often, CBOs are trusted by the community members they serve and therefore may help recruit and attract participants to the CBPR process.¹³⁸-¹⁶¹ In return, researchers could offer to help the CBOs with their program evaluations, which they often must provide to their funders. The CBO would then benefit from the expertise of researchers, who could help build capacity within the organization to conduct their own evaluations in the future or even compete for additional sources of funding to conduct independent research that the CBO is interested in.¹⁶² This collaboration may help in recruitment and reach as well as sustainability and future research. Mutual knowledge transfer and training in the planning phase would provide the CBO with basic research concepts,¹⁵⁷ services, or education that CBOs, themselves, may not be able to provide.