Lessons learned for recruitment and retention of low-income African Americans.
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ABSTRACT:
SUBMITTER: Taani MH
PROVIDER: S-EPMC7083755 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
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Lessons learned for recruitment and retention of low-income African Americans.
Taani Murad H MH Zabler Bev B Fendrich Michael M Schiffman Rachel R
Contemporary clinical trials communications 20200122
Recruitment and retention of low-income African Americans in clinical trials is challenging. This paper reports recruitment and retention strategies that yielded high rates for both in a clinical trial pilot to improve hypertension self-management among low-income African Americans. The study successfully recruited 96.7% (59 of 61 participants) within a seven month period. Retention rates for the 1, 3, and 6-month post-baseline assessment visits were 91.5%, 88.1%, and 83.1%, respectively. Recrui ...[more]
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Project description:Urban environments are associated with a higher risk of adverse mental health outcomes; however, it is unclear which specific components of the urban environment drive these associations.Using data collected in 2002-2009 from 73,225 low-income, racially diverse individuals across the Southeastern U.S., analyses evaluated the cross-sectional relationship between a walkability index and depression. Walkability was calculated from population density, street connectivity, and destination count in the 1,200-meter area around participants' homes, and depression was measured using the Center for Epidemiologic Studies Depression Scale for depression symptomatology and questionnaire responses regarding doctor-diagnosed depression and antidepressant use. Data were analyzed in 2015.Participants living in neighborhoods with the highest walkability index had 6% higher odds of moderate or greater depression symptoms (score ?15, 95% CI=0.99, 1.14), 28% higher odds of doctor-diagnosed depression (95% CI=1.20, 1.36), and 16% higher odds of current antidepressant use (95% CI=1.08, 1.25), compared with those in the lowest walkability index. Higher walkability was associated with higher odds of depression symptoms in the most deprived neighborhoods only, whereas walkability was associated with lower odds of depression symptoms in the least deprived neighborhoods.Living in a more walkable neighborhood was associated with modestly higher levels of doctor-diagnosed depression and antidepressant use, and walkability was associated with greater depression symptoms in neighborhoods with higher deprivation. Although dense urban environments may provide opportunities for physical activity, they may also increase exposure to noise, air pollution, and social stressors that could increase levels of depression.
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| S-EPMC3599817 | biostudies-literature
Project description:BackgroundThere is limited published evidence of the effectiveness of adaptation in managing the health risks of climate variability and change in low- and middle-income countries.ObjectivesTo document lessons learned and good practice examples from health adaptation pilot projects in low- and middle-income countries to facilitate assessing and overcoming barriers to implementation and to scaling up.MethodsWe evaluated project reports and related materials from the first five years of implementation (2008-2013) of multinational health adaptation projects in Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Philippines, Russian Federation, Tajikistan, and Uzbekistan. We also collected qualitative data through a focus group consultation and 19 key informant interviews.ResultsOur recommendations include that national health plans, policies, and budget processes need to explicitly incorporate the risks of current and projected climate variability and change. Increasing resilience is likely to be achieved through longer-term, multifaceted, and collaborative approaches, with supporting activities (and funding) for capacity building, communication, and institutionalized monitoring and evaluation. Projects should be encouraged to focus not just on shorter-term outputs to address climate variability, but also on establishing processes to address longer-term climate change challenges. Opportunities for capacity development should be created, identified, and reinforced.ConclusionsOur analyses highlight that, irrespective of resource constraints, ministries of health and other institutions working on climate-related health issues in low- and middle-income countries need to continue to prepare themselves to prevent additional health burdens in the context of a changing climate and socioeconomic development patterns. https://doi.org/10.1289/EHP405.
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Project description:BackgroundThe Healthy Communities Study (HCS) was a national study of community programs and policies that aimed to address childhood obesity; it necessitated recruitment of a large sample of children from communities throughout the United States.ObjectiveThe HCS aimed to complete visits with an average of 45 children and 12 key informants from at least 120 communities, diverse with respect to region of the country, urbanicity, socioeconomic status, race, ethnicity and intensity of community programs and policies that aim to address childhood obesity.MethodsPurchased address lists were utilized to select households for recruitment during Wave 1 of the study, and recruitment of families through schools was employed for Wave 2.ResultsThe HCS successfully obtained approval from 149 school districts and 478 schools in 130 communities, recruited 5138 families, and interviewed 1421 key informants to allow for characterization of overall intensity of obesity prevention/treatment efforts in each community.ConclusionsLessons learned are presented. Future studies should plan for inclusion of the following in development of recruitment strategies: literature review, formative research, pilot testing, and ongoing monitoring and adjustment.
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Project description:Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.
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Project description:BackgroundThe Diabetes Prevention Program (DPP) and Look AHEAD studies demonstrated that modest weight loss and increased physical activity can significantly reduce the incidence of diabetes among overweight individuals with prediabetes. However, these studies involved costly interventions, all of which are beyond the reach of most real-world settings serving high-risk, low-income populations. Our project, De Por Vida, implemented a diabetes risk-reduction intervention for Hispanic women in a Federally Qualified Health Center and assessed the program's efficacy. This report describes the methodology used to develop and implement De Por Vida, the cultural adaptations made, the community-academic partnership formed to carry out this program, and the barriers and challenges encountered through the implementation process.MethodsOur goal was to translate the DPP and Look AHEAD programs into an intervention to prevent diabetes and reduce diabetes complications among high-risk Hispanic women at a federally qualified health center in Hillsboro, Oregon, where more than half of clinic patients are Spanish-speaking, and nearly all live in poverty. This randomized clinical trial targeted overweight Spanish-speaking women at risk for, or diagnosed with, type 2 diabetes. We developed a 12-month behavioral diabetes risk-reduction intervention that was responsive to the cultural practices of the Hispanic population and that could be implemented in low-income clinical settings. Study planning and implementation involved close collaboration among the clinic leadership, a research team from the Kaiser Permanente Center for Health Research, and Arizona State University.DiscussionCreating a fully informed partnership between research and clinical institutions is the first step in successful cooperative research projects. The adoption of a bidirectional, rather than a top-down, approach to communication between researchers and health-care providers, and between clinic management and the clinic frontline staff, gave the research study team crucial information about barriers, constraints, and needs that clinic staff experienced in implementing the program. This allowed clinic management and front-line clinic staff to play an active role in study implementation, identifying problem areas, and collaborating in finding practical solutions.Clinical trial registrationwww.clinicaltrials.gov, NCT03113916.
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