The CAHR-model: A culturally adaptive hybrid recruitment strategy for Asian American breast cancer survivors

Background: Asian American breast cancer survivors remain underrepresented in survivorship and behavioral health research due to cultural stigma, linguistic diversity, and privacy concerns. To address these barriers, culturally aligned outreach strategies leveraging trusted relationships and ethnic-preferred communication channels are needed. This study describes the Culturally Adaptive Hybrid Recruitment Model ( CAHR-Model), which integrates community consultants with ethnic-specific digital outreach to recruit Asian American breast cancer survivors in the United States. Methods: The CAHR-Model was developed through an integrative approach combining evidence synthesis, community collaboration, pilot implementation, and iterative refinement. A review of prior research identified barriers such as language discordance, stigma, and privacy concerns as well as facilitators such as collectivist values, community trust, and increasing technology-based communication. Recognizing growing digital connectivity within Asian communities, the research team incorporated technology-enabled outreach as a core strategy. Guided by these insights, consultations with community leaders, survivor advocates, healthcare professionals, and faith-based connectors mapped culturally congruent communication pathways across Korean, Chinese, and Japanese subgroups. Community consultants played a key role in reaching potential participants through trusted networks and providing feedback to refine recruitment messages and delivery. This iterative process led to a dual-channel framework integrating community trust with targeted digital outreach to enhance recruitment. Results: This hybrid approach enhanced trust, expanded geographic reach, and fostered culturally meaningful engagement. Community consultants, especially healthcare-affiliated connectors such as community health workers and survivor peers, achieved the highest enrollment conversion rates through personal referrals. Korean participants most often engaged digital platforms through KakaoTalk and MissyUSA , Chinese through WeChat and RED , and Japanese survivors through Vivinavi. Digital outreach also effectively reached younger survivors and those less connected to formal networks. Conclusion: Anchored in community trust and ethnic-specific digital ecosystems, the CAHR-Model demonstrated effectiveness in recruiting Asian American breast cancer survivors. This culturally adaptive and scalable framework offers a practical model to strengthen participation and representation in future breast survivorship and behavioral health research.