What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings

Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark

OBJECTIVES

The World Health Organization (WHO) highlights parous women as a key population for monitoring trends of physical activity (PA). We aimed to estimate the proportion of Danish women non-adhering to WHO PA guidelines in parous women compared with nulliparous women and to describe leisure-time PA intensity in each of these groups.

STUDY DESIGN

Cross-sectional study.

METHODS

This population-based study builds on a sample of 27,668 women aged 16-40 years from the Danish National Health Survey 2021. These data were linked with childbirth data from the Danish National Birth Registry. The primary outcome was self-reported weekly hours of moderate to vigorous leisure-time PA (MVPA) dichotomized into: (i) adhering to WHO guidelines for MVPA or (ii) not adhering to WHO guidelines for MVPA. Binomial regression analysis was used to calculate prevalence proportions (PP) and prevalence proportion ratios (PPR).

RESULTS

Of the 27,668 women, a total of 20,022 were included; 9338 (46.6%) parous women and 10,684 (53.4%) nulliparous women. The PP of women non-adhering to WHO PA guidelines was 63.8% (95% CI 62.9-64.8) for parous and 51.3% (95% CI 50.4-52.3) for nulliparous women, corresponding to a PPR of 1.24 (95% CI 1.21; 1.27).

CONCLUSIONS

The proportion of parous women who did not adhere to WHO PA guidelines for MVPA was 24% higher than that of nulliparous women. This highlights parous women as a subgroup of the adult population at increased risk of non-adherence to WHO PA guidelines. These findings call for future research to inform new strategies aiming to promote PA in parous women.

Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study

BACKGROUND

In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue.

OBJECTIVE

The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning.

METHODS

An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews.

RESULTS

This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education.

CONCLUSIONS

To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663.

"We are not invited": Australian focus group results on how to improve ethnic diversity in trials

OBJECTIVES

Lack of ethnic diversity in trials may contribute to health disparities and to inequity in health outcomes. The primary objective was to investigate the experiences and perspectives of ethnically diverse populations about how to improve ethnic diversity in trials.

STUDY DESIGN AND SETTING

Qualitative data were collected via 16 focus groups with participants from 21 ethnically diverse communities in Australia. Data collection took place between August and September 2022 in community-based settings in six capital cities: Sydney, Melbourne, Perth, Adelaide, Brisbane, and Darwin, and one rural town: Bordertown (South Australia).

RESULTS

One hundred and fifty-eight purposively sampled adults (aged 18-85, 49% women) participated in groups speaking Tamil, Greek, Punjabi, Italian, Mandarin, Cantonese, Karin, Vietnamese, Nepalese, and Arabic; or English-language groups (comprising Fijian, Filipino, African, and two multicultural groups). Only 10 participants had previously taken part in medical research including three in trials. There was support for medical research, including trials; however, most participants had never been invited to participate. To increase ethnic diversity in trial populations, participants recommended recruitment via partnering with communities, translating trial materials and making them culturally accessible using audiovisual ways, promoting retention by minimizing participant burden, establishing trust and rapport between participants and researchers, and sharing individual results. Participants were reluctant to join studies on taboo topics in their communities (eg, sexual health) or in which physical specimens (eg, blood) were needed. Participants said these barriers could be mitigated by communicating about the topic in more culturally cognizant and safe ways, explaining how data would be securely stored, and reinforcing the benefit of medical research to humanity.

CONCLUSION

Participants recognized the principal benefits of trials and other medical research, were prepared to take part, and offered suggestions on recruitment, consent, data collection mechanisms, and retention to enable this to occur. Researchers should consider these community insights when designing and conducting trials; and government, regulators, funders, and publishers should allow for greater innovation and flexibility in their processes to enable ethnic diversity in trials to improve.

Low-intensity resistance exercise with blood flow restriction for patients with claudication: A randomized controlled feasibility trial

BACKGROUND

Claudication is a common and debilitating symptom of peripheral artery disease, resulting in poor exercise performance and quality of life (QoL). Supervised exercise programs are an effective rehabilitation for patients with claudication, but they are poorly adhered to, in part due to the high pain and effort associated with walking, aerobic, and resistance exercise. Low-intensity resistance exercise with blood flow restriction (BFR) represents an alternative exercise method for individuals who are intolerant to high-intensity protocols. The aim of this study was to evaluate the feasibility of a supervised BFR program in patients with claudication.

METHODS

Thirty patients with stable claudication completed an 8-week supervised exercise program and were randomized to either BFR (n = 15) or a control of matched exercise without BFR (control; n = 15). Feasibility, safety, and efficacy were assessed.

RESULTS

All success criteria of the feasibility trial were met. Exercise adherence was high (BFR = 78.3%, control = 83.8%), loss to follow up was 10%, and there were no adverse events. Clinical improvement in walking was achieved in 86% of patients in the BFR group but in only 46% of patients in the control group. Time to claudication pain during walking increased by 35% for BFR but was unchanged for the control. QoL for the BFR group showed improved mobility, ability to do usual activities, pain, depression, and overall health at follow up.

CONCLUSION

A supervised blood flow restriction program is feasible in patients with claudication and has the potential to increase exercise performance, reduce pain, and improve QoL. (Clinicaltrials.gov Identifier: NCT04890275).

Health promotion intervention among women with recent gestational diabetes mellitus: penetration, participation, and baseline findings from the Face-it randomized controlled trial

INTRODUCTION

Face-it is a randomized controlled trial for women with recent gestational diabetes mellitus (GDM) and their families designed to evaluate the effect of a health promotion intervention on type 2 diabetes mellitus (T2DM) risk and quality of life. This study examined (1) the penetration and participation rates for the Face-it trial, (2) the characteristics of the participating women and the potential differences in characteristics according to partner participation status, and (3) representativity of the women at baseline.

RESEARCH DESIGN AND METHODS

We identified women with GDM during pregnancy and invited them and their partners to a baseline examination 10-14 weeks after delivery. Representativity was assessed by comparing the baseline participants with non-participating women, the general population of women with GDM delivering in Denmark, and populations from other intervention trials.

RESULTS

The penetration rate was 38.0% (867/2279) and the participation rate was 32.9% (285/867). The 285 women who attended baseline had a mean age of 32.7 (±4.8) years and body mass index (BMI) of 28.1 (±5.4) kg/m2, and 69.8% had a partner who participated. The women participating with a partner were more often primiparous, born in Denmark (82.8% vs 68.2%), were younger, and more often had a BMI ≤24.9 kg/m2 (35.7% vs 21.2%) compared with women without a partner. Compared with the general population of women with GDM in Denmark, these women broadly had similar degree of heterogeneity, but had higher rates of primiparity and singleton deliveries, and lower rates of preterm delivery and prepregnancy obesity.

CONCLUSIONS

The penetration and participation rates were acceptable. We found a high rate of partner participation. Overall, women participating with a partner were comparable with those participating without a partner. Participating women were broadly similar to the general national GDM population, however with prepregnancy obesity, multiparity, preterm delivery, and multiple pregnancy being less represented.

TRIAL REGISTRATION NUMBER

NCT03997773.

Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review

OBJECTIVE

To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management.

METHODS

Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles.

RESULTS

Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies.

CONCLUSION

This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.

NEW Soul in the neighborhood-reach and effectiveness of a dissemination and implementation feasibility study

Dissemination and implementation (D&I) studies of dietary interventions for African Americans are limited. Restaurants may be an innovative setting to deliver dietary interventions. Purpose: Assess weight loss, self-efficacy for healthy eating, diet quality, and quality of life in African Americans in two groups: virtual synchronous and virtual asynchronous. Guided by RE-AIM, the Nutritious Eating with Soul @ Rare Variety Café Feasibility study included nutrition education, accountability partners for support, and cooking demonstrations led by a community health worker and was delivered across two cohorts in a non-randomized design. The intervention was conducted over 12 consecutive weekly classes. Due to the COVID-19 pandemic, intervention delivery was online. African Americans between 18-65 years old with overweight/obesity, not currently following a plant-based diet or taking medications to control diabetes, and living in a southeastern city were recruited. Participants completed in-person weight assessments and online surveys at baseline and post-intervention. Linear mixed models analyzed changes in outcomes and differences in 3-month outcomes between groups. All models controlled for age and sex. Regarding Reach, 199 participants expressed interest, and 60 enrolled. Among the full sample, participants decreased body weight -2.6 ± 0.5 kg (p < .0001) and increased self-efficacy 1.6 ± 0.7 points (p = .03). No differences in 3-month outcomes between groups were observed. This D&I feasibility study successfully recruited participants during the COVID-19 pandemic and produced significant results. The successful online intervention delivery compared to in-person suggests the potential for greater D&I in vegan soul food restaurants. As restrictions are loosened, future studies will test in-person delivery.

How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research

Most actions targeting children's health behaviors have limited involvement of children in the development, potentially contributing to disappointing effectiveness. Therefore, in the 3-year "Kids in Action" study, 9- to 12-year-old children from a lower-socioeconomic neighborhood were involved as coresearchers in the development, implementation, and evaluation of actions targeting health behaviors. The current study describes the controlled trial that evaluated the effects on children's energy balance-related behaviors, physical fitness, and self-rated health, as well as experienced challenges and recommendations for future evaluations. Primary school children from the three highest grades of four intervention and four control schools were eligible for participation. Outcome measures assessed at baseline, and at 1- and 2-year follow-up were as follows: motor fitness by the MOPER test (N = 656, N = 485, N = 608, respectively), physical activity and sedentary behavior by accelerometry (N = 223, N = 149, N = 164, respectively), and consumption of sugar sweetened beverages and snacks and self-rated health by a questionnaire (N = 322, N = 281, N = 275, respectively). Mixed-model analyses were performed adjusted for clustering within schools and relevant confounders. Significant beneficial intervention effects were found on self-reported consumption of energy/sports drinks at T2 versus T0, and on total time and ≥5-minute bouts of moderate-to-vigorous physical activity at T1 versus T0. Significant adverse effects were found on "speed and agility" and "coordination and upper-limb speed." No other significant effects were found. The inconsistent intervention effects may be explained by the dynamic cohort and suboptimal outcome measures. We advise future studies with a similar approach to apply alternative evaluation designs, such as the delayed baseline design.

Inclusive Recruitment Strategies to Maximize Sociodemographic Diversity among Participants: A St. Louis Case Study

Background. Sociodemographically diverse study samples are critical for research related to health decision making. However, not all researchers have the training, capacity, and funding to engage research methods that recruit the most diverse populations. Objective and Methods. We used participant-generated data, staff salary data, and participant observation to examine the effectiveness and cost of strategies that we used for screening, enrolling, and retaining a sociodemographically diverse sample for a risk communication and behavior change randomized controlled trial. Results. It took approximately 646 hours to contact 1,626 individuals and enroll 554 participants (505 of whom completed the baseline survey; 45.2% were members of a underrepresented racial/ethnic group, 19.4% had no college education, 49.5% were age 30-49 y). Retention at 90-d follow-up was 93%. The total cost was USD$19,898.50. The average cost was $35.92 per participant enrolled. In-person recruitment was most successful in identifying the largest proportion of screened and eligible participants who were members of underrepresented racial/ethnic populations (32.8% and 27.8%, respectively) and with no college experience (39.7% and 33.5%, respectively); it also had the highest total cost ($8,079.17). Existing research pools identified the largest proportion of younger participants (ages 30-49 y; 39.3% and 43.4% for screened and eligible, respectively). Existing listservs yielded the smallest proportion of individuals with no college experience and the fewest members of underrepresented racial/ethnic populations but had the lowest total cost ($290.33). Newspaper ads identified the fewest younger individuals and also had the highest cost per participant enrolled ($166.21). Word of mouth had the lowest cost per participant enrolled ($10.47). Conclusion. Results help medical decision-making researchers formulate recruitment plans that increase sociodemographic diversity in study samples. We also ask funders to accommodate increased costs required to maximize sociodemographic diversity in medical decision-making research.

Highlights

We provide concrete strategies for recruiting, enrolling, and retaining a sociodemographically diverse study sample.We offer cost estimates for all stages of study recruitment and found that in-person recruitment was the most effective, but also the most expensive, way to identify Black participants and participants with no college experience.It is critical for investigators to have access to institutional infrastructure and resources to support conducting research that is inclusive of diverse sociodemographic groups.An intentionally diverse recruitment staff supports a diverse study sample.

Starting the SToP trial: Lessons from a collaborative recruitment approach

OBJECTIVE

Recruitment in research can be challenging in Australian Aboriginal contexts. We aimed to evaluate the SToP (See, Treat, Prevent skin infections) trial recruitment approach for Aboriginal families to identify barriers and facilitators and understand the utility of the visual resource used.

METHODS

This qualitative participatory action research used purposive sampling to conduct six semi-structured interviews with staff and five yarning sessions with Aboriginal community members from the nine communities involved in the SToP trial that were audio recorded and transcribed verbatim before thematic analysis.

FINDINGS

Community members valued the employment of local Aboriginal facilitators who used the flipchart to clearly explain the importance of healthy skin and the rationale for the SToP trial while conducting recruitment. A prolonged process, under-developed administrative systems and stigma of the research topic emerged as barriers.

CONCLUSION

Partnering with a local Aboriginal organisation, employing Aboriginal researchers, and utilising flip charts for recruitment was seen by some as successful. Strengthening governance with more planning and support for recordkeeping emerged as future success factors.

IMPLICATIONS FOR PUBLIC HEALTH

Our findings validate the importance of partnership for this critical phase of a research project. Recruitment strategies should be co-designed with Aboriginal research partners. Further, recruitment rates for the SToP trial provide a firm foundation for building partnerships between organisations and ensuring Aboriginal perspectives determine recruitment methods.

Effects of the COVID‐19 pandemic on recruitment for the working women walking program

The global pandemic of coronavirus disease 2019 (COVID‐19) affected many aspects of randomized controlled trials, including recruiting and screening participants. The purpose of this paper is to (a) describe adjustments to recruitment and screening due to COVID‐19, (b) compare the proportional recruitment outcomes (not completed, ineligible, and eligible) at three screening stages (telephone, health assessment, and physical activity assessment) pre‐ and post‐COVID‐19 onset, and (c) compare baseline demographic characteristics pre‐ and post‐COVID‐19 onset in the Working Women Walking program. The design is a cross‐sectional descriptive analysis of recruitment and screening data from a 52‐week sequential multiple assignment randomized trial (SMART). Participants were women 18–70 years employed at a large urban medical center. Recruitment strategies shifted from in‐person and electronic to electronic only post‐COVID‐19 onset. In‐person eligibility screening for health and physical activity assessments continued post‐COVID‐19 onset with Centers for Disease Control and Prevention precautions. Of those who expressed interest in the study pre‐ and post‐COVID‐19 onset (n = 485 & n = 269 respectively), 40% (n = 194) met all eligibility criteria pre‐COVID‐19 onset, and 45.7% (n = 123) post‐COVID‐19 onset. Although there were differences in the proportions of participants who completed or were eligible for some of the screening stages, the final eligibility rates did not differ significantly pre‐COVID‐19 versus post‐COVID‐19 onset. Examination of differences in participant demographics between pre‐ and post‐COVID‐19 onset revealed a significant decrease in the percentage of Black women recruited into the study from pre‐ to post‐COVID‐19 onset. Studies recruiting participants into physical activity studies should explore the impact of historical factors on recruitment.

Socially Distanced Data Collection: Lessons Learned Using Electronic Bluetooth Scales to Assess Weight

Introduction. Electronic Bluetooth scales (e-scales) may be useful for remote weight assessment. This study analyzed predictors of engagement with e-scales and feasibility for remote weight assessment. Method. Due to COVID-19 restrictions, participants (n = 150, 100% African American, 79% female, average age 48.2 ± 10.6 years) in an ongoing trial were invited to receive an e-scale. Participants had 1 month to complete a weigh-in. Email, text, and phone call reminders were sent. Data were analyzed using descriptive approaches and logistic regression. Results. Seventy-five participants (50% of sample) elected to receive an e-scale. Older participants (t = -2.01, p = .05) and a greater proportion of females (χ2 = 7.8, p < .01) signed up to receive an e-scale. An average of 2.6 ± 1.3 reminders was required. Most participants who received an e-scale completed a weigh-in (n = 70). Discussion. Half the sample elected to receive an e-scale. Strategies to increase willingness among men and younger adults to sign up to receive an e-scale are needed.

Recruiting African American parents of school-aged children in a physical activity study: Lessons learned

OBJECTIVES

To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6-12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans' physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge.

METHODS

Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment.

RESULTS

We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers (n = 87, 69%) and males/fathers (n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust.

DISCUSSION

Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.

A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial

Background

Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment.

Objective

A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response.

Methods

The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk.

Results

Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022.

Conclusions

This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders.

Trial Registration

ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462

International Registered Report Identifier (IRRID)

DERR1-10.2196/30710

Recruitment methods and yield rates in a clinical trial of physical exercise for older adults with hypertension-HAEL Study: a study within a trial

Background

Although the prevalence of hypertension is high in older adults, clinical trial recruitment is a challenge. Our main aim was to describe the HAEL Study recruitment methods and yield rates. The secondary objectives were to explore the reasons for exclusion and to describe the characteristics of the enrolled participants.

Methods

This is a descriptive study within a trial. The HAEL Study was a Brazilian randomized two-center, parallel trial with an estimated sample of 184 participants. The recruitment strategy was based on four methods: electronic health records, word of mouth, print and electronic flyer, and press media. The yield rate was the ratio of the number of participants who underwent randomization to the total number of volunteers screened, calculated for overall, per recruitment method, by study center and by age group and sex. Additionally, we described the reasons for exclusion in the screening phase, as well as the demographic characteristics of those enrolled. The data are presented in absolute/relative frequencies and mean ± standard deviation.

Results

A total of 717 individuals were screened, and 168 were randomized over 32 months. The yield rate was higher for word of mouth (30.1%) in the overall sample. However, press media contributed the most (39.9%) to the absolute number of participants randomized in the trial. The coordinating center and participating center differed in methods with the highest yield ratios and absolute numbers of randomized participants. The main reason for exclusion in the screening phase was due to the physically active status in those intending to participate in the study (61.5%). Out of 220 participants included, 52 were excluded mainly because they did not meet the eligibility criteria (26.9%). Most of the screened volunteers were women (60.2%) age 60–69 years (59.5%), and most of the randomized participants were Caucasian/white (78.0%).

Conclusions

Multiple recruitment methods constituted effective strategies. We observed that approximately one of every four individuals screened was allocated to an intervention group. Even so, there were limitations in obtaining a representative sample of older Brazilian adults with hypertension. Data show an underrepresentation of race and age groups.

Trial registration

This SWAT was not registered.

Physical activity interventions among culturally and linguistically diverse populations: a systematic review

OBJECTIVES

To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions.

DESIGN

Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18).

RESULTS

A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material.

CONCLUSIONS

Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention.

Implementation Science Strategies Promote Fidelity in the Food, Feeding, and Your Family Study

OBJECTIVE

Use of implementation science strategies to promote fidelity in the Food, Feeding, and Your Family study.

DESIGN

Cluster randomized controlled trial with 3 conditions: control, in-class, or online, delivered in English or Spanish. Observations of 20% of classes.

SETTING

Expanded Food and Nutrition Education Program (EFNEP) in 2 states.

PARTICIPANTS

EFNEP peer educators (n = 11).

INTERVENTION

Parental feeding content incorporated into EFNEP lessons (in-class) or through text with links to videos/activities (online). Extensive educator training, scripted curriculum, frequent feedback.

ANALYSIS

Assessment of fidelity compliance. Qualitative analysis of verbatim educator interviews and classroom observer comments.

RESULTS

During 128 class observations (40-45 per condition), peer educators followed scripted lesson plan 78% to 89% of the time. There was no evidence of cross-contamination of parental feeding content in control and only minor sharing in online conditions. Variations with fidelity were primarily tied to the EFNEP curriculum, not the parent feeding content. Educators (n = 7) expressed favorable opinions about the Food, Feeding, and Your Family study, thought it provided valuable information, and appreciated support from EFNEP leadership.

CONCLUSIONS AND IMPLICATIONS

Incorporating implementation science strategies can help ensure successful adherence to research protocols. With proper training and support, EFNEP peer educators can deliver an evidence-based curriculum as part of a complex research study.

Recruitment and Retention for the Evaluation of a Healthy Food Initiative in Economically Disadvantaged, Majority African American Communities

Effective recruitment and retention supports equitable participation in research. The aim of this article is to describe recruitment and retention methods among residents of highly disadvantaged, predominantly African American communities in the southeastern United States during the evaluation of a healthy food access initiative. We proposed that active and passive recruitment methods, intensive retention strategies, community outreach and involvement, over-enrollment to anticipate attrition, and applied principles of community participation would achieve the study's recruitment and retention goals. The enrollment goal of 560 was met at 94% (n = 527), and the retention goal of 400 was achieved (n = 408).

How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies

Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.

Primary Care and Physical Literacy: A Non-Randomized Controlled Pilot Study to Combat the High Prevalence of Physically Inactive Adults in Austria

The multidimensional concept of physical literacy is fundamental for lifelong physical activity engagement. However, physical literacy-based interventions are in their infancy, especially among adults. Therefore, the purpose of this pilot study was to assess the association of a physical literacy-based intervention with changes in self-reported physical literacy among inactive adults. A non-randomized controlled study (2 × 2 design) was conducted, comparing pre- vs. postintervention. Twenty-eight inactive healthy participants in the intervention group (89% female, 53 ± 10 years) entered a physical literacy-based intervention once weekly for 14 weeks. The non-treated control group consisted of 22 inactive adults (96% female, 50 ± 11 years). Physical literacy was evaluated with a questionnaire encompassing five domains: physical activity behavior, attitude/understanding, motivation, knowledge, and self-efficacy/confidence. ANOVA models were applied to evaluate changes by time and condition. Following the intervention, significant improvements were seen for overall physical literacy and in four out of five physical literacy domains, including physical activity behavior, attitude/understanding, knowledge, and self-efficacy/confidence (all p < 0.01, Cohen's d = 0.38-0.83). No changes by time x condition were found for motivation. The physical literacy-based intervention applied in this study may be a promising approach to help inactive adults to adopt an active lifestyle.

A decision-making model to optimize the impact of community-based health programs

Hospitals and clinics are increasingly interested in building partnerships with community-based organizations to address the social determinants of health. Choosing among community-based health programs can be complex given that programs may have different effectiveness levels and implementation costs. This study develops a decision-making model that can be used to evaluate multiple key factors that would be relevant in resource allocation decisions related to a set of community-based health programs. The decision-making model compares community-based health programs by considering funding limitations, program duration, and participant retention until program completion. Specifically, the model allows decision makers to select the optimal mix of community-based health programs based on the profiles of the population given the above constraints. The model can be used to improve resource allocation in communities, ultimately contributing to the long-term goal of strengthening cross-sector partnerships and the integration of services to improve health outcomes.

Recruitment and retention of underrepresented and vulnerable populations to research

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Fostering spirituality and psychosocial health through mind-body practices in underserved populations

Background

This study examined changes in spirituality and psychosocial outcomes among African American and rural adults participating in a culturally-adapted mind-body intervention.

Methods

African American (n = 22) and rural (n = 38) adults in Harmony & Health attended mind-body sessions twice a week for eight weeks and completed questionnaires on spirituality and psychosocial distress at baseline and post-intervention. Linear regression and repeated measures analyses were used to examine associations between intervention attendance and spirituality.

Results

Attendance was significantly associated with increased spirituality (β=0.168, p = 013). Repeated measures analyses revealed a significant three-way interaction between attendance, spirituality, and study site (F(9,31)=2.891, p = 013). Urban African American participants who attended ≥75% of sessions reported greater increases in spirituality.

Conclusion

Findings suggest that mind-body practices may foster spirituality in urban African American adults. Additional adaptations are needed to strengthen spirituality in rural residents and to improve psychosocial health and wellbeing in this underserved population.

Staff and participant perceptions of optimal recruitment and retention strategies for biomedical cohort studies in the Caribbean

Purpose

To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations.

Methods

Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts.

Results

Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups.

Conclusion

Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.

Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature

OBJECTIVE

To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies.

DESIGN

A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up.

RESULTS

From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention.

CONCLUSIONS

This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.

Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature

Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Formative Evaluation of Open Goals: A UK Community-Based Multi-Sport Family Programme

Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of ‘Open Goals’ (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club’s charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May–July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children’s behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.

Recruitment and enrollment of African Americans into health promoting programs: the effects of health promoting programs on cardiovascular disease risk study

Objectives: Randomized controlled trials (RCT) often employ multiple recruitment methods to attract participants, however, special care must be taken to be inclusive of under-represented populations. We examine how recruiting from an existing observational study affected the recruitment of African Americans into a RCT that included yoga-based interventions. In particular, we report the recruitment success of The Effects of Health Promoting Programs (HPP) on Cardiovascular Disease Risk (NCT02019953), the first yoga-based clinical trial to focus only on African Americans. Design: To recruit participants, a multifaceted recruitment strategy was implemented exclusively in the Jackson Heart Study (JHS) cohort. The HPP recruited from the JHS cohort using direct mailings, signs and flyers placed around JHS study facilities, and through JHS annual follow-up interviews. Results: Enrollment into HPP was open to all active JHS participants that were eligible to return for the third clinic exam (n = 4644). The target sample size was 375 JHS participants over a 24 month recruitment and enrollment period. From the active members of the JHS cohort, 503 were pre-screened for eligibility in HPP. More than 90% of those pre-screened were provisionally eligible for the study. The enrollment goal of 375 was completed after a 16-month enrollment period with over 25% (n = 97) of the required sample size enrolling during the second month of recruitment. Conclusions: The findings show that participants in observational studies can be successfully recruited into RCT. Observational studies provide researchers with a well-defined population that may be of interest when designing clinical trials. This is particularly useful in the recruitment of a high-risk, traditionally underrepresented populations for non-pharmacological clinical trials where traditional recruitment methods may prolong enrollment periods and extend study budgets.

Successfully Recruiting Adults with a Low Socioeconomic Position into Community-Based Lifestyle Programs: A Qualitative Study on Expert Opinions

We explored experts’ perceived challenges and success factors in the recruitment of adults with a low socioeconomic position (SEP) for participation in community-based lifestyle modification programs. We conducted semi-structured interviews with 11 experienced project coordinators, based on a topic list that included experiences with recruitment, perceived barriers and success factors, and general views on recruitment strategies. Results revealed challenges related to the context of the program (e.g., limited program resources), psychosocial barriers of the participants (e.g., mistrust or skepticism), practical barriers (e.g., low literacy or having other priorities), and reasons to decline participation (e.g., lack of interest or motivation). Success factors were related to securing beneficial contextual and program-related factors (e.g., multi-layered recruitment strategy), establishing contact with the target group (e.g., via existing networks, community key-members), methods to increase engagement (e.g., personal approach and involvement of the target group in the program process) and making participation easier (e.g., providing transport), and providing various types of incentives. Concluding, the group of participants with low SEP covers a wide spectrum of individuals. Therefore, multiple recruitment strategies at multiple layers should be employed, and tailored. The lessons learned of those with hands-on experiences will help to enhance recruitment in future programs.

Trekstock Meet & Move: The Impact of One-Day Health and Well-Being Events for Young Adults with Cancer

Purpose: To evaluate the impact of a series of one-day events delivered by Trekstock, a charity supporting young adults with cancer in the United Kingdom. Methods: Data on physical activity, mood, perceived support, self-efficacy, and confidence to be active were collected at three time points: before, after, and 2 weeks following the Meet & Move events. Results: Ninety-seven young adults with cancer (mean age: 29 years, 35% still receiving active treatment) attended a Trekstock Meet & Move event and participated within the evaluation. Baseline data demonstrated that before attending a Meet & Move event, 27% (n = 23) of young adults reported feeling their cancer excluded them from engaging in exercise, 44% (n = 37) reported concern that exercise will cause pain or injury, and only 38% (n = 32) knew what exercise they could do. Data collected post-event and at follow-up indicated that Meet & Move had a positive impact upon attendees' self-efficacy and confidence to be active with more than half reporting they felt inspired after attending. There was also a significant reduction in reported worry that exercise may cause pain or injury and reported perception of feeling left out of exercise because of cancer (p < 0.05). Following engagement in the Meet & Move events, 45% of attendees had either signed up for an additional Trekstock physical activity program or initiated engagement in a new type of physical activity on their own. Conclusion: Trekstock Meet & Move events inspire and motivate young adults with cancer in their 20s and 30s to be active.

Key recruitment and retention strategies for a pilot web-based intervention to decrease obesity risk among minority youth

Background

Interactive Nutrition Comics for Urban Minority Youth (Intervention INC) is an innovative, web-based interactive comic tool for dietary self-management, which aims to decrease obesity risk among urban minority preadolescents. The feasibility and acceptability of Intervention INC was assessed by implementing a two-group randomized pilot study. To date, intervention studies have typically faced various barriers in recruiting and retaining study participants. The purpose of this paper is to describe recruitment and retention activities from this study and in particular, discuss challenges faced, strategies implemented, and lessons learned.

Methods

Black/AA and Latino children (ages 9–12 years) and their parent/guardian were recruited from East Harlem/Harlem, New York. Recruitment strategies included flyering in the community, having a convenient study location, providing participation incentives, and partnering with community/school-based organizations. Potential participants were screened for eligibility; enrollees completed online surveys and interviews at baseline (T1), intervention midpoint (T2), intervention end (T3), and 3-months post-intervention (T4). Retention strategies included flexible scheduling, reminder calls/texts, incremental compensation, and consistent study staff.

Results

Eighty-nine enrolled dyads completed a T1 visit (August to November 2017) and were randomized to the experimental (E, n = 45) or comparison (C, n = 44) group. Enrolled dyads learned about the study through community events (39%), community flyering (34%), friend/referral (15%), or a community clinic partner (12%). T1 child demographics were mean age = 10.4 ± 1.0 years, 61% female, 62% Black and 42% Latino, and 51% overweight/obese; parent demographics were mean age = 30.8 ± 8.9 years, 94% female, and 55% Black and 45% Latino. Survey completion rates by dyad were high throughout the study: T2, 87%; T3, 89%; and T4, 84%. Average data collection per session was 65 min. Parents at T4 (n = 76) felt they received enough study information (97%) and that their questions were answered properly (80%). Eighty-one percent of children at T4 (n = 75) were very satisfied/extremely satisfied with how study staff communicated and interacted with them.

Conclusion

Effective recruitment strategies consisted of community events and flyering, while a variety of retention strategies were also used to successfully engage urban Black/AA and Latino families in this study. Though our findings are limited to only Latino and Black families in low-income neighborhoods, we have identified successful strategies for this specific high-risk population and potentially similar others.

Trial registration

ClinicalTrials.gov, NCT03165474, registered 15 May 2017

Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research: A Traumatic Brain Injury Model Systems National Database Study

OBJECTIVE

To investigate the contribution of race/ethnicity to retention in traumatic brain injury (TBI) research at 1 to 2 years postinjury.

SETTING

Community.

PARTICIPANTS

With dates of injury between October 1, 2002, and March 31, 2013, 5548 whites, 1347 blacks, and 790 Hispanics enrolled in the Traumatic Brain Injury Model Systems National Database.

DESIGN

Retrospective database analysis.

MAIN MEASURE

Retention, defined as completion of at least 1 question on the follow-up interview by the person with TBI or a proxy.

RESULTS

Retention rates 1 to 2 years post-TBI were significantly lower for Hispanic (85.2%) than for white (91.8%) or black participants (90.5%) and depended significantly on history of problem drug or alcohol use. Other variables associated with low retention included older age, lower education, violent cause of injury, and discharge to an institution versus private residence.

CONCLUSIONS

The findings emphasize the importance of investigating retention rates separately for blacks and Hispanics rather than combining them or grouping either with other races or ethnicities. The results also suggest the need for implementing procedures to increase retention of Hispanics in longitudinal TBI research.

Engaging Latina breast cancer survivors in research: building a social network research registry

Disparities persist in breast cancer outcomes between Latina survivors and non-Hispanic Whites. Identifying methods to ensure that Latinas participate in and benefit from translational behavioral medicine research is important to reduce disparities. We developed a "Social Network Research Registry" to enhance Latina survivors' engagement in research and explored the social networks and research/cancer organization participation in this population. We initially recruited 30 Latina breast cancer survivors ("seeds") from community organizations and identified other survivors through snowball sampling. Guided by Social Network Analysis, we assessed the structural (e.g., size) and functional (e.g., social support) characteristics of the network, willingness to join the registry, prior research participation, involvement in cancer organizations, and interest in different types of research and roles in research. The resulting network size was 98, including 53 women who enrolled in the study and 45 who were listed in the network but did not enroll. All enrolled participants (N = 53) agreed to be part of the registry. We identified 15 participants who occupied strategic positions as hubs and/or bridges. Women who were currently involved in cancer organizations were more likely to have participated in research (70.3% vs. 18.8%); χ2 (1, 53) = 11.97, p = .001. Most were interested in surveys/interviews (98%), behavioral interventions (96%), and becoming health promoters (79%). The Social Network Research Registry is an acceptable and feasible strategy to engage underrepresented Latina survivors in research. Social network analysis can be useful to identify members who occupy key positions to enhance recruitment and translational efforts.

Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review

Background

People from socioeconomically disadvantaged population groups are less likely to be physically active and more likely to experience adverse health outcomes than those who are less disadvantaged. In this umbrella review we examined across all age groups, (1) the effectiveness of interventions to improve physical activity among socioeconomically disadvantaged groups, (2) the characteristics of effective interventions, and (3) directions for future research.

Methods

PubMed/MEDLINE and Scopus were searched up to May 2017 to identify systematic reviews reporting physical activity interventions in socioeconomically disadvantaged populations or sub-groups. Two authors independently conducted study screening and selection, data extraction (one author, with data checked by two others) and assessment of methodological quality using the ‘Assessment of Multiple Systematic Reviews’ scale. Results were synthesized narratively.

Results

Seventeen reviews met our inclusion criteria, with only 5 (30%) reviews being assessed as high quality. Seven (41%) reviews focused on obesity prevention and an additional four focused on multiple behavioural outcomes. For pre school children, parent-focused, group-based interventions were effective in improving physical activity. For children, school-based interventions and policies were effective; few studies focused on adolescents and those that did were generally not effective; for adults, there was mixed evidence of effectiveness but characteristics such as group-based interventions and those that focused on physical activity only were associated with effectiveness. Few studies focused on older adults. Across all ages, interventions that were more intensive tended to be more effective. Most studies reported short-term, rather than longer-term, outcomes and common methodological limitations included high probability of selection bias, low response rates, and high attrition.

Conclusions

Interventions can be successful at improving physical activity among children from socioeconomically disadvantaged groups, with evidence for other age groups weak or inconclusive. More high-quality studies in this population group are needed, which adopt strategies to increase recruitment rates and reduce attrition, report longer term outcomes, and provide adequate intervention details, to allow determination of the characteristics of effective interventions. We recommend that the benefits of physical activity be recognised more broadly than obesity prevention in future studies, as this may have implications for the design and appeal of interventions.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0676-2) contains supplementary material, which is available to authorized users.

Racial disparities in healthcare provider advice to quit smoking

African-American/Black smokers are less likely than White smokers to be told to quit smoking by healthcare providers. This preliminary study examined the predictors of being told to quit separately by race for the first time to potentially highlight the source of this racial disparity. A random, household sample of 1670 Black and White adults from a southeastern county of the United States completed a brief survey on their demographics, smoking, access to healthcare, health status, and receipt of healthcare provider advice to quit smoking. Analyses are based on the 512 Black and White smokers in that sample. The logistic regression for all smokers revealed that after controlling for demographic, healthcare, and health status variables, White smokers were 2.39 times more likely than Black smokers to have ever been told to quit smoking. The regression for Black smokers revealed that women and older people were more likely to be told to quit, and that healthcare and health status did not contribute. In the regression for White smokers, no predictor was statistically significant. These findings suggest that one possible reason that African-Americans receive cessation advice less often than Whites is that such advice varies with their age and gender, whereas for Whites this is not the case.

Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study

Integrating physical activity (PA) counseling in routine clinical practice remains a challenge. The purpose of this study was to evaluate the implementation and effectiveness of a pragmatic strategy aimed to improve physician PA counseling and patient PA. An effectiveness-implementation type-2 hybrid design was used to evaluate a 3-h training (i.e., implementation strategy-IS) to increase physician use of the 5-As (assess, advise, agree, assist, arrange) for PA counseling (i.e., clinical intervention-CI) and to determine if the CI improved patient PA. Patients of trained and untrained physicians reported on PA and quality of life pre-post intervention. Medical charts (N = 1700) were examined to assess the proportion of trained physicians that used the 5-As. The RE-AIM framework informed our evaluation. 305/322 of eligible physicians participated in the IS (M age = 40 years, 52% women) and 683/730 of eligible patients in the CI (M age = 49 years, 77% women). The IS was adopted by all state regions and cost ~ $20 Mexican pesos (US$1) per provider trained. Physician adoption of any of the 5-As improved from pre- to post-training (43 vs. 52%, p < .01), with significant increases in the use of assessment (43 vs. 52%), advising (25 vs. 39%), and assisting with barrier resolution (7 vs. 15%), but not in collaborative goal setting (13 vs. 17%) or arranging for follow-up (1 vs. 1%). Patient PA and quality of life did not improve. The IS intervention was delivered with high fidelity at a low cost, but appears to be insufficient to lead to broad adoption of the CI.

Testing Tele-Savvy: Protocol for a randomized controlled trial

Many informal caregivers of persons with dementia suffer adverse health consequences. Although established psychoeducation programs are known to benefit caregivers, attending in-person programs is challenging for them. To address this challenge, the Savvy Caregiver Program, an evidence-based psychoeducation program with demonstrated effectiveness for caregiving and disease-related outcomes, was transformed into an on-line program, Tele-Savvy. This article describes the rationale for and design of a prospective longitudinal randomized controlled trial (targeted N = 215), currently underway. The trial aims to establish Tele-Savvy's efficacy in (i) reducing the negative effects of caregiving on caregivers; (ii) promoting care recipients' quality of life; (iii) improving caregiver mastery; and to explore (iv) Tele-Savvy's efficacy among caregivers of different races/ethnicities. The mediating role of mastery will be assessed. Participants are randomized to the active condition (immediate Tele-Savvy participation), attention control, or usual care. Participants in the two latter conditions will complete Tele-Savvy 6 months post-baseline. Multilevel mixed effects models will be used to examine changes in outcomes and to model group by time (months since baseline) interactions. The exploratory aim will be addressed using analysis of covariance and qualitative analysis. This trial's results may be used by healthcare and community organizations to implement Tele-Savvy in dementia care, increasing caregivers' access to this evidence-based intervention.

Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009–2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as “Other”. Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted.

•

Describes racial/ethnic minority inclusion in behavioral weight loss studies

•

Majority of studies continue to include a majority white sample.

•

Modest increases in the representation of some racial/ethnic minority groups.

•

Lack of adequate representation of minority groups limits generalizability.

•

Greater racial/ethnic inclusion in weight loss intervention studies is warranted.

Evaluation of a Person-Centered, Theory-Based Intervention to Promote Health Behaviors

BACKGROUND

Effective promotion of health behaviors requires strong interventions. Applying person-centered approaches and concepts synthesized from two motivational theories could strengthen the effects of such interventions.

OBJECTIVES

The aim of the study was to report the effect sizes, fidelity, and acceptability of a person-centered, health behavior intervention based on self-regulation and self-determination theories.

METHODS

Using a pre- and postintervention design, with a 4-week follow-up, advanced practice registered nurses made six weekly contacts with 52 volunteer participants. Most participants were educated White women. Advanced practice registered nurses elicited participant motives and particular goals for either healthy diet or physical activity behaviors. Minutes and type of activity and servings of fat and fruit/vegetables were assessed.

RESULTS

Effect sizes for engaging in moderate aerobic activity and in fruit/vegetable and fat intake were 0.53, 0.82, and -0.57, respectively. The fidelity of delivery was 80-97% across contacts, and fidelity of participants' receipt of intervention components was supported. Participant acceptance of the intervention was supported by positive ratings on aspects of relevance and usefulness.

DISCUSSION

To advance the science of health behavior change and improve client health status, person-centered approaches and concepts synthesized from motivational theories can be applied and tested with a randomized, controlled design and diverse samples to replicate and extend this promising behavioral intervention.

The Influence of Race and Ethnicity on Becoming a Human Subject: Factors Associated with Participation in Research

Inroduction

The purpose of this study was to explore factors associated with willingness of African Americans and Latinos to participate in biomedical and public health research and to delineate factors that influence the decision to become a human subject.

Methods

We present results from a 2010 random digit-dial telephone survey of 2,455 African American (N = 1191) and Latino (N = 1264) adults. We used standard measures to assess knowledge of research, terminology, informed consent procedures, previous participation in research, health care experiences, social support, risk perception, religiousness, and trust.

Results

Over 60% of both African Americans and Latinos reported they believed people in medical research are pressured into participating. Over 50% said that it was not at all important to have someone of the same race/ethnicity ask them to participate. In a sub-sample of 322 African Americans and 190 Latinos who had previously been asked to participate in a research study, 63% of African Americans and 65% of Latinos consented to participate in a study. Finally, both African Americans (57%) and Latinos (68%) reported willingness to participate in future research. Overall, the multivariate analysis explained 29% of the variability in willingness to participate in future research.

Conclusions

Results suggest that African Americans and Latinos have no automatic predisposition to decline participation in research studies. These results can inform culturally tailored interventions for ethical recruitment of minorities into research and clinical trials.

Dancing in time: feasibility and acceptability of a contemporary dance programme to modify risk factors for falling in community dwelling older adults

BACKGROUND

Falls are a common cause of injury in older adults, with the prevention of falls being a priority for public health departments around the world. This study investigated the feasibility, and impact of an 8 week contemporary dance programme on modifiable physical (physical activity status, mobility, sedentary behaviour patterns) and psychosocial (depressive state, fear of falling) risk factors for falls.

METHODS

An uncontrolled 'pre-post' intervention design was used. Three groups of older (60 yrs.+) adults were recruited from local community groups to participate in a 3 separate, 8 week dance programmes. Each programme comprised two, 90 min dance classes per week. Quantitative measures of physical activity, sedentary behaviour, depression, mobility and fear of falling were measured at baseline (T1) and after 8 weeks of dance (T2). Weekly attendance was noted, and post-study qualitative work was conducted with participants in 3 separate focus groups. A combined thematic analysis of these data was conducted.

RESULTS

Of the 38 (Mean Age = 77.3 ± 8.4 yrs., 37 females) who attended the dance sessions, 22 (21 females; 1 male; mean age = 74.8, ±8.44) consented to be part of the study. Mean attendance was 14.6 (±2.6) sessions, and mean adherence was 84.3% (±17). Significant increases in moderate and vigorous physical activity were noted, with a significant decrease in sitting time over the weekdays (p < 0.05). Statistically significant decreases in the mean Geriatric Depression Scale (p < 0.05) and fear of falling (p < 0.005) score were noted, and the time taken to complete the TUG test decreased significantly from 10.1 s to 7.7 s over the 8 weeks (p < 0.005). Themes from the focus groups included the dance programme as a means of being active, health Benefits, and dance-related barriers and facilitators.

CONCLUSIONS

The recruitment of older adults, good adherence and favourability across all three sites indicate that a dance programme is feasible as an intervention, but this may be limited to females only. Contemporary dance has the potential to positively affect the physical activity, sitting behaviour, falls related efficacy, mobility and incidence of depression in older females which could reduce their incidence of falls. An adequately powered study with control groups are required to test this intervention further.

Re-recruiting young adult women into a second follow-up study

Background

Recruitment among young adults presents a unique set of challenges as they are difficult to reach through conventional methods.

Purpose

To describe our experience using both traditional and nontraditional methods in the re-recruitment of young adult women into the second follow-up study of the Trial of Activity for Adolescent Girls (TAAG).

Methods

589 adolescent girls were re-recruited as 11th graders into TAAG 2. Re-recruitment efforts were conducted when they were between 22 and 23 years of age (TAAG 3). Facebook, email, postal mail, and telephone (call and text) were used. Descriptive statistics were used to summarize cohort characteristics. Discrete categorical variables were compared using Pearson chi-square or Fisher's exact test, while Wilcoxon rank sum or t-tests were calculated for continuous variables. Pearson's chi square test, analysis of variance, and the Kruskal-Wallis test were also used. Logistic regression was used to calculate adjusted models.

Results

All 589 cohort members were located and 479 (81.3%) were re-recruited. Participants who reported living in a two parent household or with their mothers only, and who did not perceive a lot of crime in their neighborhood were more likely to consent to participate in TAAG 3 (p = 0.047 and p = 0.008, respectively). Perceived neighborhood crime remained significant in the adjusted model (OR 0.48, 95% CI 0.25-0.90, p = 0.02). Early and late consenters differed by race/ethnicity (p = 0.015), household type (p = 0.001), and socioeconomic status (p = 0.005). In the adjusted model, Black participants were more likely to consent later than White participants (OR 1.83, 95% CI 1.07-3.13, p = 0.03).

Conclusions

A number of recruitment strategies and outreach attempts were needed to recruit young adult women into a follow-up study. Persistent efforts may be needed to recruit participants with race/ethnic diversity and lower socioeconomic status.

A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: The Talking Health Trial

Background

A primary challenge for behavior change strategies is ensuring that interventions can be effective while also attracting a broad and representative sample of the target population. The purpose of this case-study was to report on (1) the reach of a randomized controlled trial targeting reduced sugary beverages, (2) potential participant characteristic differences based on active versus passive recruitment strategies, and (3) recruitment strategy cost.

Methods

Demographic and recruitment information was obtained for 8 counties and for individuals screened for participation. Personnel activities and time were tracked. Costs were calculated and compared by active versus passive recruitment.

Results

Six-hundred and twenty, of 1,056 screened, individuals were eligible and 301enrolled (77% women; 90% white; mean income $21,981 ± 16,443). Eighty-two and 44% of those responding to passive and active methods, respectively, enrolled in the trial. However, active recruitment strategies yielded considerably more enrolled (active = 199; passive = 102) individuals. Passive recruitment strategies yielded a less representative sample in terms of gender (more women), education (higher), and income (higher; p’s <0.05). The average cost of an actively recruited and enrolled participant was $278 compared to $117 for a passively recruited and enrolled participant.

Conclusions

Though passive recruitment is more cost efficient it may reduce the reach of sugary drink reduction strategies in lower educated and economic residents in rural communities.

Trial registration

Clinicaltrials.gov; ID: NCT02193009, July 2014, retrospectively registered.

Patient Navigators and Parent Use of Quality Data: A Randomized Trial

BACKGROUND

Consumers rarely use publicly reported health care quality data. Despite known barriers to use, few studies have explored the effectiveness of strategies to overcome barriers in vulnerable populations.

METHODS

This randomized controlled trial tested the impact of a patient navigator intervention to increase consumer use of publicly reported quality data. Patients attending an urban prenatal clinic serving a vulnerable population enrolled between May 2013 and January 2015. The intervention consisted of 2 in-person sessions in which women learned about quality performance and viewed scores for local practices on the Massachusetts Health Quality Partners Web site. Women in both the intervention and control arms received a pamphlet about health care quality. Primary study outcomes were mean clinical quality and patient experience scores of the practices women selected (range 1-4 stars).

RESULTS

Nearly all (726/746; 97.3%) women completed the study, 59.7% were Hispanic, and 65.1% had a high school education or less. In both unadjusted and adjusted models, women in the intervention group chose practices with modestly higher mean clinical quality (3.2 vs 3.0 stars; P = .001) and patient experience (3.0 vs 2.9 stars; P = .05) scores. When asked to rate what factors mattered the most in their decision, few cited quality scores.

CONCLUSIONS

An intervention to reduce barriers to using publicly reported health care quality data had a modest effect on patient choice. These findings suggest that factors other than performance on common publicly reported quality metrics have a stronger influence on which pediatric practices women choose.

Promoting Physical Activity among Underserved Populations

Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations.

The Symbolic Value and Limitations of Racial Concordance in Minority Research Engagement

The well-documented underrepresentation of racial and ethnic minorities in research demands action. The field of health disparities research, however, lacks scientific consensus about how best to respectfully recruit underrepresented minority populations in research. We explore the investigators' perspective regarding how their own racial and ethnic background influenced their ability to recruit minorities, including (a) the influence of racial concordance ("race-matching") in research recruitment, (b) attributes and shared values important in the development of trust with minority communities, and (c) the role self-reflection plays in the development of meaningful research relationships. In 2010, we conducted in-depth, semi-structured, telephone interviews with investigators (N= 31) experienced with minority populations. Through the analysis of this coherent narrative, we uncovered both the symbolic and surface-level assumptions regarding minority recruitment to expose a deep structural understanding of race, ethnicity, and social context that is critical for bridging the true social difference between researchers and participants.