For years, many Hispanics in the United States have been excluded from treatment studies because they don’t speak English.
So, a handful of Southern California researchers got creative when recruiting patients for a recent project.
Would having Spanish-speaking staff and Spanish-language materials result in significantly more Hispanic participants than they’d seen in previous studies, they wondered.
And it was unexpectedly easy to sign up Spanish-speaking participants once researchers started speaking their language, said Dr. Nerses Sanossian, the study’s lead author and associate professor of neurology at the Keck School of Medicine at the University of Southern California (USC).
Researching in two languages
The study, published recently in the journal Stroke, looked at the protective benefits of magnesium on nerve cells in people having a stroke.
The 1,700 patients in the study were from hospitals in Los Angeles County and Orange County, where the proportion of Hispanics is larger than the national average. In Los Angeles County, 38 percent of residents speak Spanish.
“Patients should be able to give consent and have a discussion with investigators in the language they’re comfortable with,” said Sanossian, who is fluent in Spanish. “It’s not their responsibility for that, it’s the researchers’ responsibility.”
To help them recruit participants, the investigators enlisted paramedics, who carried two cellphones — one that would dial an English-speaking researcher and another that would dial a Spanish-speaking researcher.
When paramedics encountered someone having stroke symptoms, they’d use the phone that matched the patient’s preferred language. Researchers would then go over the study objectives and the consent documents.
In the end, 402 study participants — about a quarter — identified as Hispanic of any race. Among them, nearly half chose to talk to a Spanish-speaking researcher.
The importance to the Hispanic community
Race and ethnicity may affect how well medications and other treatments work, Sanossian said, making it critical for stroke studies to reflect the population at large.
Researchers, he said, must invest the time and money needed to hire Spanish-speaking staff and design Spanish materials for research projects.
Stroke is a top killer among Hispanics, ranking at number four. By comparison, stroke is the number five cause of death for Americans overall and costs the nation about $34 billion a year.
As the nearly 57 million Hispanics and Latinos in the United States age and the population grows, stroke “may have a greater public health impact on them,” said Dr. Ralph L. Sacco, the chief of neurology at Jackson Memorial Hospital in Miami and professor of neurology at the Miller School of Medicine at the University of Miami.
Sacco has worked with Hispanic patients of Caribbean heritage in New York City and Miami over his three-decade career.
The research community, he said, must step up its efforts to enlist study personnel who patients can identify with culturally.
In the Northern Manhattan Study, for example, many Dominican-Americans readily signed up to participate in the stroke research because numerous staff members shared their heritage, Sacco said.
Sanossian plans to include Spanish-speaking researchers in future studies that include Hispanics.
And he has a message for Hispanics: “We would never be able to advance science without your participation. We want the therapies to be applied to people like you, like your family.”