Recruitment and cardiovascular risk characteristics of African American and Caucasian midlife women

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.

Current state of unhealthy living characteristics in White, African American and Latinx populations

The United States (US) is similar to most industrialized countries in that it falls short on many of the basic metrics related to cardiovascular and overall health. These metrics include nutritional patterns, levels of physical activity (PA), cardiorespiratory fitness (CRF), and prevalence of overweight and obesity. These issues are even more apparent in underserved communities, among whom unhealthy living characteristics cluster and contribute to a disproportionate chronic disease burden. The reasons for these inequities are complex and include social and economic factors as well as reduced access to health care. CRF has been demonstrated to be a critically important risk factor that tends to be lower in disadvantaged groups. In this article we discuss the current state of health & lifestyle characteristics in the US, the impact of social inequality on health, and the particular role that CRF and PA patterns play in the current state of unhealthy living characteristics as they relate to underserved populations.

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.

Study protocol for a sequential multiple assignment randomized trial (SMART) to improve physical activity in employed women

INTRODUCTION

Physical activity monitors, motivational text messages, personal calls, and group meetings, have proven to be efficacious physical activity interventions. However, individual participant response to these interventions varies drastically. A SMART design (sequential multiple assignment randomized trial) provides an effective way to test interventions that start with an initial treatment and then transition to an augmented treatment for non-responders. We describe a SMART to determine the most effective adaptive intervention to increase physical activity (steps, moderate-to-vigorous physical activity) and improve cardiovascular health among employed women who are not regularly physically active. The SMART uses combinations of four treatments: 1) enhanced physical activity monitor (Fitbit wearable activity monitor and mobile app with goal setting and physical activity prescription), 2) text messages, 3) personal calls, and 4) group meetings.

METHODS

Participants (N = 312) include women ages 18-70 employed at a large academic medical center. Women will be randomized to an initial intervention, either an enhanced physical activity monitor or enhanced physical activity monitor + text messaging. Non-responders to the initial intervention at 2 months will be randomized to either personal calls or groups meetings for the next 6 months. At 8 months, all participants will return to only an enhanced physical activity monitor until their final 12-month assessment.

DISCUSSION

Results of this study will add to the literature on improving physical activity in employed women. This study will identify effective interventions for women who respond to less intensive treatments, while maximizing benefits for those who need a more intensive approach.

Cardiorespiratory Fitness Change and Mortality Risk Among Black and White Patients: Henry Ford Exercise Testing (FIT) Project

BACKGROUND

Little is known about the relationship of change in cardiorespiratory fitness and mortality risk in Black patients. This study assessed change in cardiorespiratory fitness and its association with all-cause mortality risk in Black and White patients.

METHODS

This is a retrospective, longitudinal, observational cohort study of 13,345 patients (age = 55 ± 11 years; 39% women; 26% black) who completed 2 exercise tests, at least 12 months apart at Henry Ford Hospital, Detroit, Mich. All-cause mortality was identified through April 2013. Data were analyzed in 2015-2016 using Cox regression to calculate hazard ratios (HR) for risk of mortality associated with change in sex-specific cardiorespiratory fitness.

RESULTS

Mean time between the tests was 3.4 years (interquartile range 1.9-5.6 years). During 9.1 years (interquartile range 6.3-11.6 years) of follow-up, there were 1931 (14%) deaths (16.5% black, 13.7% white). For both races, change in fitness from Low to the Intermediate/High category resulted in a significant reduction of death risk (HR 0.65 [95% confidence interval (CI), 0.49-0.87] for Black; HR 0.41 [95% CI, 0.34-0.51] for White). Each 1-metabolic-equivalent-of-task increase was associated with a reduced mortality risk in black (HR 0.84 [95% CI, 0.81-0.89]) and white (HR 0.87 [95% CI, 0.82-0.86]) patients. There was no interaction by race.

CONCLUSIONS

Among black and white patients, change in cardiorespiratory fitness from Low to Intermediate/High fitness was associated with a 35% and 59% lower risk of all-cause mortality, respectively.

Analysis of four recruitment methods for obtaining normative data through a Web-based questionnaire: a pilot study

BACKGROUND

Quality normative data requires a diverse sample of participants and plays an important role in the appropriate use of health outcomes. Using social media and other online resources for survey recruitment is a tempting prospect, but the effectiveness of these methods in collecting a diverse sample is unknown. The purpose of this study is to pilot test four methods of recruitment to determine their ability to produce a sample representative of the general US population.

METHODS

This project is part of a larger study to gather normative data for the Michigan Hand Outcomes Questionnaire (MHQ). We used flyers, e-mail, Facebook, and an institution-specific clinical research recruitment Web site to direct participants to complete an online version of the MHQ. Participants also provided comorbidity and demographic information.

RESULTS

The institution-specific recruitment Web site yielded the greatest number of respondents in an age distribution that mirrored the US population. Facebook was effective for recruiting young adults, and e-mail was successful for recruiting the older adults. None of the methods was successful in reaching an ethnically diverse sample.

CONCLUSIONS

Obtaining normative data that is truly representative of the US population is a difficult task. The use of any one recruitment method is unlikely to result in a representative sample, but a greater understanding of these methods will empower researchers to use them to target specific populations. This pilot analysis provides support for the use of Facebook and clinical research sites in addition to traditional methods of e-mail and paper flyers.

Low cardiorespiratory fitness in African Americans: a health disparity risk factor?

Low cardiorespiratory fitness (CRF) is a well-established risk factor for all-cause and cardiovascular disease mortality. African Americans have higher rates of cardiovascular disease compared with their Caucasian counterparts. However, the extent to which lower CRF levels contribute to the excess risk in African Americans has not been fully explored. The purpose of this review is to: (i) explore the literature evaluating the relationship between CRF and mortality specifically in African American populations; and (ii) critically evaluate the studies which have compared CRF between African American and Caucasians in epidemiological studies and clinical trials. We have further discussed several potential mechanisms that may contribute to the observation of lower CRF levels in African American compared with Caucasian adults, including potential racial differences in physical activity levels, muscle fiber type distribution, and hemoglobin levels. If lower CRF is generally present in African Americans compared with Caucasians, and is of a clinically meaningful difference, this may represent an important public health concern.

Recruitment of African American Women to a Walking Program: Eligibility, Ineligibility, and Attrition During Screening

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

Recruiting and Retaining Young, Sedentary, Hypertension-Prone African American Women in a Physical Activity Intervention Study

African American women have a high prevalence of hypertension and low level of physical activity compared with their counterparts. A sedentary lifestyle contributes to the development of hypertension, as well as other cardiovascular diseases, especially among African American women. Healthy People 2010 initiatives underscore the priority of reducing minority health disparities. To reduce health disparities, there has been recent emphasis on recruiting and retaining minority populations in clinical research studies. However, little information is available to guide researchers in the evaluation of impediments in successful recruitment and retention of young African American women. A first step is for researchers to report information concerning the efficacy of recruiting/retaining methods in order to facilitate minority participation in clinical trials and, ultimately, reduce health disparities. This report summarizes existing recruitment and retention methods from the literature, and describes how effective these strategies were in recruiting and retaining young, mildly hypertensive African American women to a physical activity intervention study. Multiple strategies, resources, and time were necessary to recruit and retain these women for the study. Among women enrolled, newspaper advertisements and flyers were the most effective recruiting strategies implemented (46% and 21%, respectively). Study retention was high (96%), which may have resulted from flexible scheduling, frequent contact, and a caring environment. Recruiting and retaining efforts need to be tailored to meet the needs of the target population.

Menopausal Status, Moderate-Intensity Walking, and Symptoms in Midlife Women

The purpose of this randomized clinical trial study was to determine the effectiveness of a 24-week, home-based, moderate-intensity, walking intervention in improving symptoms (vasomotor, uro-genital/sexual, sleep, psychological, cognitive, physical) experienced by midlife women. One hundred and seventy-three Caucasian and African American women aged 45 to 65 who were not on hormone therapy, had no major signs or symptoms of cardiovascular disease, and were sedentary in their leisure activity were randomly assigned to the moderate-intensity walking group or the nonexercise control group. The exercise prescription was walking at a frequency of 4 times a week for a duration of 20 to 30 minutes. The symptom impact inventory included the frequency, intensity, and bothersomeness of 33 symptoms collected at baseline and 24 weeks. Adherence was measured with a heart rate monitor and exercise log. Average adherence to frequency of walking was 71.6% of the expected walks. After 24 weeks, there were no differences between the walking and control group on change in symptoms. However, multiple regression revealed that frequency of adherence to walking along with change in physical symptoms and menopausal status were significant predictors of change in sleep symptoms. While walking did not improve most symptoms experienced by midlife women, frequency of walking may improve sleep.

Midlife women's adherence to home-based walking during maintenance

BACKGROUND

Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity.

OBJECTIVE

The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking.

METHODS

There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log.

RESULTS

Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase.

DISCUSSION

These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Recruitment and entrance of participants into a physical activity intervention for hypertensive African American women

Decreasing health disparities between White Americans and racial/ethnic minority populations is a public health priority. An ongoing inability to attract sufficient numbers of African Americans and other people of color to participate in research studies is a major barrier to accomplishing this goal. Participation of racial/ethnic minorities in intervention studies is especially critical to the development of appropriate strategies to promote health among these populations. This article examines the effectiveness of preintervention meetings as well as interactions between African American research team members and potential participants as recruitment strategies. Intersections between recruitment and health promotion are also addressed.

Cardiovascular Disease Risk Factors and Menopausal Status in Midlife Women from the Former Soviet Union

The purpose of this cross-sectional analysis is to examine modifiable CVD risk factors in relation to menopausal status, age, and length of residence in the U.S. of midlife women from the former Soviet Union. The analysis includes baseline data for 193 women, aged 40-70, who lived in the U.S. fewer than 8 years and were enrolled in an ongoing four-year study of post-immigration health and behavior change. Data collection was conducted in women's homes or other community locations. The presence of seven health risk indicators (obesity, dyslipidemia, high blood pressure, diabetes mellitus, sedentary lifestyle, smoking, and excessive alcohol use) was assessed. In addition, Framingham 10 year risk scores for heart disease, and the presence of metabolic syndrome, were calculated using recent National Cholesterol Education Program (ATP-III) guidelines. Consistent with the age distribution, 60% of the women were postmenopausal. Four risk indicators (obesity, dyslipidemia, high blood pressure, and sedentary lifestyle) were identified as significant areas of concern. Although the Framingham risk scores did not seem excessively high, almost 25% of the women had metabolic syndrome. Older and postmenopausal women had significantly higher scores on all risk estimates. When age and menopausal status were held constant, menopausal status remained an independent contributor for the number of CVD risk indicators. Issues specific to this group of women because of their pre- and post-migration lifestyles are discussed in relation to their CVD risk status.