Psychosocial Influences on Acceptability and Feasibility of Salivary Cortisol Collection From Community Samples of Children.

Salivary cortisol is considered to be a safe and noninvasive measure of hypothalamic-pituitary-adrenal axis functioning, and is a commonly measured biomarker of the human stress response in pediatric research. However, cortisol is highly variable and sensitive to a wide range of factors, creating a challenge for reliable salivary cortisol collection in the community setting. Furthermore, the acceptability of salivary cortisol collection in community samples of children is largely unknown. The purpose of this integrative review was to investigate current evidence on the acceptability and feasibility of salivary cortisol collection in community samples of children. In an analysis framed by the Theory of Planned Behavior, data extracted from 31 studies revealed six categories of psychosocial influences on acceptability and feasibility: uncertainty and misconceptions, cultural and ethnic values, family rules and values, difficulty following protocols and procedures, burden of multiple samples, and child refusal or resistance. Further research is required to fully understand the factors that influence acceptability and feasibility of salivary cortisol collection in community samples of children. Understanding individual, family, and community perceptions of biobehavioral research will lead to more culturally sensitive and feasible community-based research methods.