Rigorous research in prevention science often relies on persuading the right people to take part and keeping them involved. Recruitment and retention strategies used successfully to evaluate an anti-obesity programme in New Mexico show just how much foresight, care and effort it can take.
Community research, in particular, is an area where the recruitment and retention challenges can be formidable – not least when the evaluation requires parental consent for children to take part, and where families come from different ethnic and cultural groups, or live in sparsely populated, rural areas. Communities that mistrust researchers or have little previous experience of working with them may prove especially hard to engage.
In these circumstances, as researchers at the University of New Mexico have demonstrated, the ability to build and maintain relationships with the relevant communities holds the key to success.
To carry out a randomised controlled trial of their anti-obesity initiative known as the Child Health Initiative for Lifelong Eating Exercise (CHILE) they needed to recruit preschool children, parents, healthcare providers, early years Head Start centers and even grocery store owners in rural American Indian and Hispanic communities. To do this, they devised a range of strategies to recruit and retain the different groups – adjusting their plans in the light of experience.
Building on previous relationships where possible, the research team first undertook a formative assessment to understand the context and identify key community members. This led to the appointment of a “CHILE champion” within each community, who was an influential stakeholder and would advocate for the study. In return for help administering the study locally, each champion received a small stipend. This helped them build a local partnership and lay the foundations for trust.
The researchers also collaborated with each community to identify needs and priorities, promoting the sense of a shared agenda. When persuading tribal leaders and local Head Start centers to take part they factored-in extra time for administration and approval procedures to take place. They also recruited a social worker as their community engagement specialist with a remit to provide a single point of contact and keep communication channels open.
A formal Memorandum of Agreement was reached with Head Start centers detailing the commitments being made by the researchers and each site. These included the collection of data, such as children’s weight and height measurements and staff training arrangements. In the case of centers that were randomly allocated to a waiting-list control group they also included an annual payment of $1,000 until it was time to join the programme.
Children were recruited with the active permission of their parents, which was obtained after a series of orientation meetings for Head Start center staff and then parents. Presentations were made by bilingual facilitators. Parental consent was sought for the entire study duration, avoiding any need for re-enrollment each year.
To increase the retention of parents in the study, phone reminders were sent out before interviews. Additionally, following initial attendance problems, the research team deliberately “overbooked” 30 interviews at each site in the expectation that at least 20 parents would turn up. Interviews and meetings were held at convenient locations and with time demands kept to a minimum (meetings with health providers were scheduled over lunch).
Grocery stores near the project sites were asked to stock the “healthy” produce that families were encouraged to buy, including fresh fruit and wholegrain products. They also stocked relevant promotional literature, including recipe cards. However, the research team quickly learned to respect the imperative for storeowners to minimise losses caused by low demand and product “spoilage”.
Acknowledgement letters and study updates were sent to the grocery stores and health providers as ways of demonstrating respect for participation. Frequent site-visits also took place to ensure fidelity, maintain communication and promote engagement
The reward for all this effort was a well-conducted trial for which the initial goal of recruiting 640 children with parental consent was surpassed by 200 per cent. Overall, 1,879 children, 655 parents, 7 grocery stores and 14 healthcare providers were recruited, which either met or exceeded targets. Only one site that was approached declined to take part in the study and all other Head Start centers recruited were retained throughout the two-year intervention.
While the particular circumstances of the CHILE trial were unique to rural New Mexico, it holds important lessons for successful research implementation. Evaluators internationally will want to study the three-stage engagement, recruitment and retention process model that the researchers constructed for community research. This ranges from identifying a community champion and creating a shared agenda, through the adoption of formal agreements and on to the actions needed to foster partnerships and nurture relationships as an evaluation proceeds.
Cruz, T. H., Davis, S. M., FitzGerald, C. A., Canaca, G. F. & Keane, P. C. (2014). Engagement, Recruitment, and Retention in a Trans-Community, Randomized Controlled Trial for the Prevention of Obesity in Rural American Indian and Hispanic Children. Journal of Primary Prevention, 35 (3), pp. 135-149.Return to Features