Recruiting Rural Participants for a Telehealth Intervention on Diabetes Self-Management

Betty Irene Moore School of Nursing at University of California Davis, Sacramento, California  Clinical and Translational Science Center at University of California Davis, Sacramento, California.
The Journal of Rural Health (Impact Factor: 1.45). 12/2013; 29(1):69-77. DOI: 10.1111/j.1748-0361.2012.00443.x
Source: PubMed


Purpose: Recruiting rural and underserved participants in behavioral health interventions is challenging. Community-based recruitment approaches are effective, but they are not always feasible in multisite, diverse community interventions. This study evaluates the feasibility of a rapid, multisite approach that uses rural clinic site coordinators to recruit study participants. The approach allows for rural recruitment in areas where researchers may not have developed long-term collaborative relationships.
Methods: Adults with diabetes were recruited from rural Federally Qualified Health Center (FQHC) clinics. Recruitment feasibility was assessed by analyzing field notes by the project manager and health coaches, and 8 in-depth, semistructured interviews with clinic site coordinators and champions, followed by thematic analysis of field notes and interviews.
Findings: Forty-seven rural sites were contacted to obtain the 6 sites that participated in the study. On average, sites took 14 days to commit to study participation. One hundred and twenty-one participants were acquired from letters mailed to eligible participants and, in some sites, by follow-up phone calls from site coordinators. Facilitators and deterrents affecting study recruitment fell into 4 broad categories—study design, site, site coordinator, and participant factors.
Conclusion: The rapid multisite approach led to quick and efficient recruitment of clinic sites and participants. Recruitment success was achieved in some, but not all, rural sites. The study highlights the opportunities and challenges of recruiting rural clinics and rural, underserved participants in multisite research. Suggestions are provided for improving recruitment for future interventions.

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    • "The second approach involved nonspecific recruitment methods, such as study posters and brochures (Befort et al., 2014; Dibartolo & McCrone, 2003; P. Reddy et al., 2011), media and newspaper advertisements (Befort et al., 2014; Miyamoto et al., 2013; P. Reddy et al., 2011) public service announcements on radio and television stations (Dibartolo & McCrone, 2003; P. Reddy et al., 2011), word of mouth (Dibartolo & McCrone, 2003), and mass mailings (Befort et al., 2014; Miyamoto et al., 2013). Studies by Befort et al. (2014) and Miyamoto et al. (2013) reported that mass mailing with a personalized cover letter from providers reached the largest proportion of potential participants, followed by direct provider referrals, phone contact, and media advertisements. However, the most successful recruitment method is direct referral by healthcare providers (Befort et al., 2014; Miyamoto et al., 2013; P. Reddy et al., 2011), followed by participant referral/word of mouth, media advertisements, study brochures, presentations (P. "
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    ABSTRACT: Self-management plays a vital role in improving health outcomes and reducing costs in patients with cardiovascular disease (CVD) and associated risk factors. Based on existing studies, rural residents with CVD and/or risk factors show low engagement in self-management behaviors. Due to low participation in behavioral intervention trials, the most promising mechanism to promote self-management among rural populations is unknown. In turn, the purpose of this article is to review the evidence that supports strategies to recruit and retain rural patients to participate in behavioral intervention trials aimed to promote self-management of CVD and its risk factors. This review is expected to assist researchers in identifying effective solutions to overcome barriers in the recruitment and retention processes when conducting intervention research studies on the self-management of CVD in rural communities.
    Preview · Article · Oct 2015 · Online Journal of Rural Research & Policy
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    • "Insufficient infrastructure and research resources are major barriers to conducting clinical trials in rural communities [18] [19] [29]. The cultural and social characteristics of diverse rural communities create further challenges in recruiting and retaining study participants [19]. Furthermore, when the intervention program is perceived as a duplicate service competing with a local existing service, the community is reluctant to accept the research program [19] [29]. "
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    ABSTRACT: Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials. Objective: The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials. Methods: We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks. Results: We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients’ intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. Conclusion and Implication of result: the findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.
    Full-text · Article · Aug 2015
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    ABSTRACT: Background: Diabetes educators and self-management programs are scarce in rural communities, where diabetes is the third highest-ranking health concern. The goal of this study was to evaluate the benefits of nurse telehealth coaching for persons with diabetes living in rural communities through a person-centered approach using motivational interviewing (MI) techniques. Materials and methods: A randomized experimental study design was used to assign participants to receive either nurse telehealth coaching for five sessions (intervention group) or usual care (control group). Outcomes were measured in both groups using the Diabetes Empowerment Scale (DES), SF-12, and satisfaction surveys. Mean scores for each outcome were compared at baseline and at the 9-month follow-up for both groups using a Student's t test. We also evaluated the change from baseline by estimating the difference in differences (pre- and postintervention) using regression methods. Results: Among the 101 participants included in the analysis, 51 received nurse telehealth coaching, and 50 received usual care. We found significantly higher self-efficacy scores in the intervention group compared with the control group based on the DES at 9 months (4.03 versus 3.64, respectively; p<0.05) and the difference in difference estimation (0.42; p<0.05). Conclusions: The nurse MI/telehealth coaching model used in this study shows promise as an effective intervention for diabetes self-management in rural communities. The sustained effect on outcomes observed in the intervention group suggests that this model could be a feasible intervention for long-term behavioral change among persons living with chronic disease in rural communities.
    No preview · Article · Jul 2014 · Telemedicine and e-Health