Representative participation in health research is important to ensure results are generalizable so disparities can be reduced or eliminated. Understanding selection bias and reasons for declining study participation can increase external validity of trials, aid in process improvement, and inform recruitment procedures. This study assessed for selection bias and described reasons for refusal in a trial focused on assessing nutrition interventions for patients with diabetes. This was a cross-sectional analysis of candidates who were approached for consent for a randomized control trial. Eligibility screening documents and electronic charts were used to gather age, gender, race, ethnicity, HbA1c, and BMI. Logistic regression was used to assess differences between those who accepted and refused trial participation. Reasons for declining participation were summarized.650 people were included; 394 declined and 256 enrolled. Participants who refused were older (mean age 63.1 v. 55.3 years, p < 0.001) and had a lower HbA1c (9.97 v. 10.81, p = 0.007). Refusal reasons were evenly distributed across age, gender, race and ethnicity. Most common reasons for refusal were general disinterest, feeling their diabetes was well-managed, and a disinterest in dietary changes. Older adults have higher prevalence of diabetes, polypharmacy, and comorbidities, and thus have potential to benefit from nutrition-focused diabetes interventions. Yet among our sample, older people were more likely to refuse participation regardless of race, sex, or health status. Disinterest and food-related preferences were the most common refusal reasons. Future work is needed to explore peoples’ perspectives regarding characteristics that impact acceptability of nutrition interventions.
Petrosky, Daniel, "Lost Voices: Eligible People with Diabetes and the Reasons They Decline to Participate in Nutrition Focused Research" (2022). Master of Public Health Capstone Presentations. Presentation 440.