Table 1.

Facilitators/barriers and strategies used to enhance biospecimen donation among rural Spanish-speaking breast cancer survivors (some strategies address more than one barrier).

Facilitator (F) or barrier (B)Strategies to address facilitator or barrier
Beliefs/attitudes/knowledge
Altruism (F): Latino culture emphasizes collectivism, which instills a desire to give back to improve the health of their communities and future generations (52)
  • General: explained lack of Latina representation in research

  • Biospecimen-specific: explained benefits of biospecimens for advancing scientific discovery

Mistrust (B): Mistrust of researchers due to historical ethical violations and experimentation; general mistrust of health care institutions (53)
  • General: collaborated with trusted community organizations, CHWs served as recruiters

  • Biospecimen-specific: CHWs served as biospecimen collection assistants

Lack of information about biomarkers (B): Purpose of biospecimens and contributions to advancing science (25, 53)
  • Biospecimen-specific: explained rationale for and purpose of biospecimens

Cultural/linguistic factors
Fear of loss of privacy (B): Providing personal information can result in loss of privacy, fear of deportation (54, 55)
  • General: eliminated use of social security numbers for tracking cash incentives

  • Biospecimen-specific: informed participants that samples would be de-identified

Cultural sensitivity (F): Staff members of the same ethnicity and community share cultural values and practices (56)
  • Biospecimen-specific: CHWs shared similar values and lived in the community, multimedia instructional materials used peer models

Limited English proficiency and literacy (B): English-only materials not understood, use of jargon impedes comprehension; complex instructions difficult to understand (57)
  • General: all materials and communication in Spanish

  • Biospecimen-specific: developed easily accessible instructional videos, pretested illustrated bilingual instructions with community members

Intrusiveness (time, routine, family) of biospecimen collection
Invasive biospecimens (B): Collecting tumor biopsies and blood/serum is invasive and requires medical personnel (25)
  • Biospecimen-specific: selected hair and saliva, which are relatively non-invasive and do not require medical personnel

Inconvenience of providing samples (B): Need to visit a laboratory to donate sample; need transportation (58)
  • Biospecimen-specific: selected biospecimens that can be easily self-collected and stored at home, samples picked up by CHWs

Intrusiveness on daily routine (B): Collecting biospecimens may require planning, time, and effort over multiple days (59, 60)
  • Biospecimen-specific: explained significance of biospecimen donation, cash incentives ($20 at baseline and $20 at 6 months)

Complexity of biospecimen collection
Lack of confidence in meeting biospecimen collection requirements (B): Believe they are not capable of following protocol (44)
  • Biospecimen-specific: CHWs provided assistance and placed reminder calls for collecting saliva samples

Complexity of collection protocol (B): Multiple steps, special storage conditions, need to provide/record written details (61, 62)
  • Biospecimen-specific: used step-by-step instructions, color-coded collections materials, collection kit contained all necessary materials