Trust and Culture in Rural Research Design

Abstract

Background: Community isolation, poor economic conditions, intimate group structures and the natural terrain creates unique challenges in both the treatment and study of opioid use disorder (OUD). The maternal and neonatal consequences for OUD can be profoundly altered by co-occurring psychiatric conditions in the mother, a phenomenon that may be more profound in rural communities. Because of these unique issues, the level of direct interaction in a patient-centric rural research design is critical to the effectiveness of the study. Objective: We set out to test the hypothesis that maternal stress and psychological state has a prolonged developmental impact on prenatally exposed children in rural areas by reducing needed stimulation in the caretaking environment. The study quickly changed as we discovered the geographic isolation and health disparate nature of the community had an important implication for research design and data collection. Methods: We used a typical patient-centered study design method for an observational study in rural West Virginia. Results: Original concise designs created complications for participants leading to recruitment difficulties and poor retention. Patients were resistant to study participation related to culture and severe community health disparities that were not identified until the patient population became comfortable with the research team. Conclusion: Despite the cultural and genetic background similarities between patients in less isolated areas and the test site, the geographic isolation and health disparate nature of the community had a profound effect on the research design. The findings in this study suggest a reevaluation of approaches to conducting research in rural isolated areas.