Recruitment into integrative behavioral studies in underrepresented populations: A case for sickle cell and hypnosis

Sickle cell disease (SCD) patients experience acute crisis pain and chronic co-morbidities. This complexity lends itself to integrative medical and behavioral interventions such as clinical and self-hypnosis. Despite the need for well-designed intervention studies, there remains a gap in hypnosis research in typically underserved and underrepresented populations with chronic disease. Although several studies have outlined the barriers and facilitators for minority recruitment, few studies focus specifically on SCD patients. This abstract describes the patient recruitment process and implementation in an ongoing, randomized, controlled, single-crossover, single-blinded pilot study exploring hypnosis as a strategy for managing pain and improving coping within an SCD population. Three main recruitment strategies were used: 1) community visibility, 2) active recruitment, and 3) collaboration with the interdisciplinary clinical research team. Vascular Medicine patients were screened (n= 220) with 50.5% eligible (n=111). During recruitment, patients expressed misunderstandings and myths related to hypnosis, which became an enrollment deterrent. To counter this, a trial video about hypnosis and common myths was developed. During implementation, the already existing burden of the 12 to 24 week commitment became more difficult for the participants (n=30), of which 26.7% were either students or full-time employees. Frequent follow-up calls, providing transportation, expanding the intervention to after clinic hours and providing several appointment time options facilitated participation. Despite customized strategies, optimal recruitment into integrative intervention studies such as clinical hypnosis continues to be a challenge in SCD patients with acute and chronic pain thus potentially compromising intervention fidelity. Reducing respondent burden remains an area of focus.