Available online 30 July 2023, 151718

Author links open overlay panel, , , , AbstractPurpose

The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity.

Methods

Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device.

Results

Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5–5, range 1–9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related.

Conclusions

The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.

Section snippetsData

This descriptive analysis used baseline data from a pilot, two-group stroke CP-integrated telerehabilitation therapy trial.10 Ethical approval was obtained by Emory University Institutional Review Board before study implementation and the study protocol is registered on clinicaltrials.gov (NCT02703532). Study evaluators were trained and standardized rehabilitation therapists who were blinded to the study hypothesis. Participants were CP and SS dyads who were enrolled between March 2016 and

Results

Enrolled dyads (n = 32) were CP (62.5 % female; mean age 57.8 + 13.0) and SS (15.8 + 13.3 months post-stroke; mean age 60.6 + 14.2). Most CPs were spouses/significant others (69.9 %), self-identified as Non-Hispanic White (61.3 %), 43.8 % were partially or fully employed, all had some college experience, and 67.7 % had an annual income greater than $50,000 (Table 1). Most SS were self-identified as Non-Hispanic White (56.3 %), 28.1 % were partially or fully employed, and 81.3 % had some college

Discussion

To gain a greater understanding of social determinants of health of CPs caring for SS recruited in our pilot study, we examined participants' physical environment through neighborhood rankings (ADI) and explored relationships between the ADI and CP psychosocial factors. Despite caring for higher functioning SS in the chronic stage after stroke, CP reported worsening life changes, moderate strain levels, and relatively healthy family functioning. In our cohort, physical environment (ADI ranking)

Conclusions

Measures of neighborhood disadvantage, like ADI, have the potential to inform clinical trial recruitment methods to target marginalized patient populations and broaden the generalizability of results. Akin to addressing the hardships of access to healthcare, facilitating diversity in research participation will require more creative ways to include support for individuals from diverse backgrounds and communities. Inclusive measures such as the ADI are critical to identifying gaps in recruitment

Funding acknowledgements

American Heart Association Mentored Clinical and Population Research Award 14CRP18730037; National Institute of Child Health and Human Development Mentored Patient-Oriented Research Career Development Award (K23) and NINDS CTMC grant R25 NS088248. Clinical Trial Registration Number: NCT02703532. A portion of this work was originally presented at the American Congress of Rehabilitation Medicine Annual Conference, Atlanta, Georgia-Virtual, October 2020 (Poster Presentation) [Stroke

Declaration of competing interest

The authors have no conflict of interests to declare.

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