Recruitment and retention of low-income minority women in a behavioral intervention during pregnancy

Statistics and Epidemiology Unit, RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD 20852-3903, USA.
BMC Public Health (Impact Factor: 2.26). 02/2007; 7(1):233. DOI: 10.1186/1471-2458-7-233
Source: PubMed


Researchers have frequently encountered difficulties in the recruitment and retention of minorities resulting in their under-representation in clinical trials. This report describes the successful strategies of recruitment and retention of African Americans and Latinos in a randomized clinical trial to reduce smoking, depression and intimate partner violence during pregnancy. Socio-demographic characteristics and risk profiles of retained vs. non-retained women and lost to follow-up vs. dropped-out women are presented. In addition, subgroups of pregnant women who are less (more) likely to be retained are identified.
Pregnant African American women and Latinas who were Washington, DC residents, aged 18 years or more, and of 28 weeks gestational age or less were recruited at six prenatal care clinics. Potentially eligible women were screened for socio-demographic eligibility and the presence of the selected behavioral and psychological risks using an Audio Computer-Assisted Self-Interview. Eligible women who consented to participate completed a baseline telephone evaluation after which they were enrolled in the study and randomly assigned to either the intervention or the usual care group.
Of the 1,398 eligible women, 1,191 (85%) agreed to participate in the study. Of the 1,191 women agreeing to participate, 1,070 completed the baseline evaluation and were enrolled in the study and randomized, for a recruitment rate of 90%. Of those enrolled, 1,044 were African American women. A total of 849 women completed the study, for a retention rate of 79%. Five percent dropped out and 12% were lost-to-follow up. Women retained in the study and those not retained were not statistically different with regard to socio-demographic characteristics and the targeted risks. Retention strategies included financial and other incentives, regular updates of contact information which was tracked and monitored by a computerized data management system available to all project staff, and attention to cultural competence with implementation of study procedures by appropriately selected, trained, and supervised staff. Single, less educated, alcohol and drug users, non-working, and non-WIC women represent minority women with expected low retention rates.
We conclude that with targeted recruitment and retention strategies, minority women will participate at high rates in behavioral clinical trials. We also found that women who drop out are different from women who are lost to follow-up, and require different strategies to optimize their completion of the study.

Download full-text


Available from: Michele Kiely, Apr 30, 2014
  • Source
    • "In recent years it has become more challenging to recruit pregnant women to volunteer for research and many strategies have been employed to increase participation. Studies have found that women decline to participate for a variety of reasons, including a growing number of requests to participate [1], time commitments [2,3], language barriers [2,4], the intrusiveness of the study (e.g., provision of biological specimens) [5,6], lack of interest and/or feeling that there is no perceived benefit from participation [5,7,8], and/or practical considerations such as holiday plans [9]. Although participants may be wary of committing to a project that requires a substantial amount of time, a review of large epidemiologic prospective pregnancy studies recruiting women prior to conception found that in some circumstances women are willing to be involved in time-consuming and/or invasive projects over an extended period of time [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Pregnant women were recruited into the Alberta Pregnancy Outcomes and Nutrition (APrON) study in two cities in Alberta, Calgary and Edmonton. In Calgary, a larger proportion of women obtain obstetrical care from family physicians than from obstetricians; otherwise the cities have similar characteristics. Despite similarities of the cities, the recruitment success was very different. The purpose of this paper is to describe recruitment strategies, determine which were most successful and discuss reasons for the different success rates between the two cities. Methods Recruitment methods in both cities involved approaching pregnant women (< 27 weeks gestation) through the waiting rooms of physician offices, distributing posters and pamphlets, word of mouth, media, and the Internet. Results Between May 2009 and November 2010, 1,200 participants were recruited, 86% (1,028/1,200) from Calgary and 14% (172/1,200) from Edmonton, two cities with similar demographics. The most effective strategy overall involved face-to-face recruitment through clinics in physician and ultrasound offices with access to a large volume of women in early pregnancy. This method was most economical when clinic staff received an honorarium to discuss the study with patients and forward contact information to the research team. Conclusion Recruiting a pregnancy cohort face-to-face through physician offices was the most effective method in both cities and a new critically important finding is that employing this method is only feasible in large volume maternity clinics. The proportion of family physicians providing antenatal and post-natal care may impact recruitment success and should be studied further.
    BMC Pregnancy and Childbirth 03/2013; 13(1):75. DOI:10.1186/1471-2393-13-75 · 2.19 Impact Factor
  • Source
    • "Yet other factors may lead to exclusion from efficacy trials, such as a lack of trials occurring in racial/ethnic minority serving institutions, limited awareness of ongoing trials, work/family and insurance barriers, trial referral practices of PCPs, and the prevalence of co-morbid conditions [5-7]. Regardless of the challenges, inclusion of these groups in clinical research is important to ensure that results are relevant, and generalizable [8]. Many of the health conditions under study in trials disproportionately affect communities of color, and thus their participation is critical [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and hypertension and their associated health complications disproportionately affect communities of color and people of lower socioeconomic status. Recruitment and retention of these populations in research trials, and retention in weight loss trials has been an ongoing challenge. Be Fit, Be Well was a pragmatic randomized weight loss and hypertension management trial of patients attending one of three community health centers in Boston, Massachusetts. Participants were asked to complete follow-up assessments every 6-months for two years. We describe challenges encountered and strategies implemented to recruit and retain trial participants over the 24-month intervention. We also identify baseline participant characteristics associated with retention status. Retention strategies included financial incentives, contact between assessment visits, building relationships with health center primary care providers (PCPs) and staff, and putting participant convenience first. Active refusal rates were low with 130 of 2,631 patients refusing participation (4.9%). Of 474 eligible persons completing telephone screening, 365 (77.0%) completed their baseline visit and were randomized into the study. The study population was predominantly non-Hispanic Black (71.2%), female (68.5%) and reported annual household income of less than $35,000 (70.1%). Recruitment strategies included use of passive approval of potential participants by PCPs, use of part-time staff, and outsourcing calls to a call center. A total of 314 (86.0%) people completed the 24-month visit. Retention levels varied across study visits and intervention condition. Most participants completed three or more visits (69.6%), with 205 (56.2%) completing all four. At 24-months, lower retention was observed for males and the intervention condition. Retention strategies included building strong relationships with clinic staff, flexibility in overcoming participant barriers through use of taxi vouchers, night and weekend appointments, and keeping participants engaged via newsletters and social gatherings. We were able to retain 86.0% of participants at 24-months. Recruitment and retention of high percentages of racial/ethnic minorities and lower income samples is possible with planning, coordination with a trusted community setting and staff (e.g. community health centers and RAs), adaptability and building strong relationships. Identifier: NCT00661817.
    BMC Public Health 03/2013; 13(1):192. DOI:10.1186/1471-2458-13-192 · 2.26 Impact Factor
  • Source
    • "Recruiting participants for research studies can be challenging; many studies fall short of their targeted sample size or must prolong recruitment to reach it (1). Recruitment and retention of low-income urban residents is particularly challenging and may be complicated by lack of time, transportation, and child care; inflexible work schedules; unstable housing and unsafe neighborhood conditions; chaotic lives; and distrust of medical institutions and research (2). Studies with narrow eligibility criteria (3) or complex protocols face additional obstacles (4). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recruiting participants for research studies can be challenging. Many studies fall short of their target or must prolong recruitment to reach it. We examined recruitment and retention strategies and report lessons learned in a behavioral intervention developmental trial to encourage healthy pregnancy weight gain and stress reduction in low-income overweight pregnant women. In the San Francisco Bay area from February 2010 through March 2011, we used direct and indirect strategies to recruit English-speaking overweight and obese pregnant women who were aged 18 to 45, were in the early stages of pregnancy, and who had an annual household income less than 500% of the federal poverty guidelines. Eligible women who consented participated in focus groups or an 8-week behavioral intervention. We identified successful recruiting strategies and sites and calculated the percentage of women who were enrolled and retained. Of 127 women screened for focus group participation, 69 were eligible and enrolled. A total of 57 women participated in 9 focus groups and 3 women completed individual interviews for a completion rate of 87%. During recruitment for the intervention, we made contact with 204 women; 135 were screened, 33% were eligible, and 69.1% of eligible women enrolled. At 1 month postpartum, 82.6% of eligible women completed an assessment. Recruiting at hospital-based prenatal clinics was the highest-yielding strategy. The narrow window of eligibility for enrolling early stage pregnant women in a group intervention presents obstacles. In-person recruitment was the most successful strategy; establishing close relationships with providers, clinic staff, social service providers, and study participants was essential to successful recruitment and retention.
    Preventing chronic disease 03/2013; 10(3). DOI:10.5888/pcd10.120096 · 2.12 Impact Factor
Show more