the Native American Cancer Research Program in Denber, Colorado. Relevant considerations include insurance, poverty, racial identification, and distrust of science and research, especially by underserved and underrepresented population. IRB processes are very different for Native Americans, especially with respect to considerations of the protection of individuals and sovereignty. Although the Native American health care system provides excellent access to care, the rate of survival from cancer for this group is the poorest among all ethnic groups. Informed-consent forms and procedures may serve as a barrier to recruitment, as the language commonly used in such forms and procedures may be considered offensive by some Native Americans. In many cases, the informed-consent process is poorly understood by Native Americans. In addition, body language and styles of interaction between researchers and potential research subjects may affect recruitment. Other factors including intonation are important. Among this population, fear of research is real and telephone recruitment is generally unhelpful.
Involvement of the community elders is important in studies among Native Americans. Face-to-face recruitment is likely to be the most successful strategy. Incentives, such as food for research subjects' children or grandchildren, and other rewards are being tested, but they have yet to show results. Although programs such as the Native Sisters (a social and emotional support system) have been implemented, their success is limited. Tribal beliefs are difficult to change, and protocols are often inflexible. The result is that it may take three times as long to recruit Native Americans into clinical trials.
As described by Carolyn Harvey, cultural variations in communication styles also affect the recruitment of African Americans to clinical trials. Linear models of information are preferred among whites, with an emphasis on written messages. In contrast, among African Americans, a cyclical model of consent and information is important, with information being disseminated through real-life situations rather than statistics or written messages. African Americans are more likely to communicate via a church or an interactive educational session and often need the freedom to respond and interrupt during a teaching session. African Americans may also require flexibility and are responsive to nonverbal aspects of communication, accounting for the importance of tone, inflection, and body language. A model for this approach has been developed in East Texas (the Visible Messenger Model), where people who are known, trusted, and accountable in the community are recruited to provide cancer awareness messages.