Hard to reach or easy to ignore: learning from ROSHNI2 on engaging culturally diverse participants to research

Background
British South Asian women are under-served due to stigma, language, and cultural barriers. This trial tested the clinical effectiveness of a culturally adapted group cognitive behavioural therapy intervention (Positive Health Programme) delivered by non-specialist health workers, for Postnatal Depression (PND) in British South Asian women.

Methods
A multi-centre randomised controlled trial, with an internal pilot comparing the Positive Health Programme (PHP) with treatment as usual (TAU) in British South Asian women with postnatal depression.  Participants were recruited in Northwest England, East Midlands, Yorkshire, Glasgow, and London.  A number of approaches were developed to drive recruitment with a particular focus on building trust in the community and normalising conversations on mental health and research participation. Bilingual research assistants recruited across general practices and children’s centres. They also collaborated with 3rd sector and faith organisations, held community ‘chai with ROSHNI2’ events and family engagement sessions.

Results
A total of 4319 participants were screened to the study and 732 participants across five study centres were randomised between February 2017 – March 2020. The study found a significant increase in the odds of achieving recovery in the treatment group compared to the TAU group (OR = 1.95, 95% CI = 1.21 – 3.17). The way in which the team have recruited participants and maintained retention is a marker of skill and understanding in the complexities of cultural engagement, which has been learned throughout the ROSHNI journey.

Conclusions
This study is a shining example of investment from a community that is ‘seldom heard’.  It is important that researchers share their experience of this model of adaptation and cultural engagement and what works well in this community so that all voices can be heard.