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2023 HSR&D/QUERI National Conference Abstract

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5006 — How can we establish trustworthiness in remote trials to promote diversity, equity, and inclusion?

Lead/Presenter: Aaron Call
All Authors: Karras, E (Canandaigua VA Medical Center, Center of Excellence for Suicide Prevention) Teo, AR (VA Portland Health Care System, Center to Improve Veteran Involvement in Care)

The aim of this project was to determine the feasibility of recruiting and retaining Veterans and their close supports into a fully remote randomized controlled trial of suicide prevention training. As a Veteran, VA employee, and study coordinator, the factors affecting Veterans’ trust in VA research and the impact of trust on their participation were of particular interest to me.

VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training designed to teach people how to identify and assist Veterans at risk for suicide. We used Facebook advertisements to recruit participants and used REDCap to administer surveys and send survey reminder emails over six months of follow-up. A subgroup of participants completed qualitative interviews.

I drew on my experiences and identity as a Veteran in developing participant-facing recruitment materials, communicating with participants, and conducting qualitative data analysis. Phone calls to participants were a key opportunity to build rapport and trust, while interview data was key to understanding participants’ experience of our Facebook advertisements and the ways trust played into their decisions to participate.

Participants (N = 214) described several concerns about trustworthiness of our study. Some were wary of providing identifying information and completing surveys about their mental health due to social media ads and scams targeting Veterans. An additional barrier to trust resulted from participant incentives. Payments required sharing of social security numbers, came as checks from the Treasury Department with no mention of the study, and often arrived more than two months after survey completion, causing frustration to participants on limited incomes. Incorporating elements of “direct touch” between participants and research staff, particularly through phone calls, provided opportunities for these issues to be aired and trust to be repaired.

Trustworthiness is a crucial consideration for Veterans’ decisions about research participation, particularly in remote trials where direct contact with participants is limited. Social media is a promising avenue to reach and potentially increase diversity, equity, and inclusion (DEI) among Veterans participating in research, but measures to establish trustworthiness are critical. Currently approved methods for providing payment to Veterans for research participation introduce a barrier to establishing trust in remote trials.