Assets and Challenges to Recruiting and Engaging Families in a Childhood Obesity Treatment Research Trial: Insights From Academic Partners, Community Partners, and Study Participants

Abstract

Background: There is need for the childhood obesity treatment literature to identify effective recruitment and engagement strategies for rural communities that are more likely to lack supportive infrastructure for healthy lifestyles and clinical research relative to their urban counterparts. This community case study examines recruitment and engagement strategies from a comparative effectiveness research (CER) trial of two family-based childhood obesity (FBCO) treatment interventions conducted in a medically underserved, rural region. Guided by a Community Based Participatory Research (CBPR) and systems-based approach, the primary aim was to analyze interviews from academic partners, community partners, and parent study participants for recruitment and engagement assets, challenges, and lessons learned.Methods: Over the 3-year lifespan of the study, researchers conducted 288 interviews with Community Advisory Board members (n = 14), Parent Advisory Team members (n = 7), and study participants (n = 100). Using an inductive-deductive approach, interviews were broadly coded for recruitment and engagement assets, challenges, and recommendations; analyzed for descriptive sub-coding; and organized into stakeholder/organization and participant level themes. Codes were analyzed aggregately across time and examined for differences among stakeholders and parent study participants.Results: Adherence to CBPR principles and development of strong community partnerships facilitated recruitment and engagement; however, variability in recruitment and engagement success impacted partner confidence, threatened outcome validity, and required additional resources. Specifically, assets and challenges emerged around eight key needs. Three were at the stakeholder/organization level: (1) readiness of stakeholders to conduct CBPR research, (2) development of sustainable referral protocols, and (3) development of participant engagement systems. The remaining five were at the participant level: (1) comfort and trust with research, (2) awareness and understanding of the study, (3) intervention accessibility, (4) intervention acceptability, and (5) target population readiness. Future recommendations included conducting readiness assessments and awareness campaigns, piloting and evaluating recruitment and engagement strategies, identifying participant barriers to engagement and finding a priori solutions, and fostering stakeholder leadership to develop sustainable protocols.Conclusion: Collective findings from multiple perspectives demonstrate the need for multi-leveled approaches focusing on infrastructure supports and strategies to improve stakeholder and participant awareness of, and capacity for, recruiting and engaging medically underserved, rural families in a FBCO CER trial.

Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns

“…Second, we found that interviewees also valued support for interorganizational collaboration. These findings may be due to the unique focus on micropolitan and rural communities, and align with previous research examining FHWPs in micropolitan and rural areas, where members of a community advisory board highlighted the development of sustainable referral protocols that relied on engagement across community organizations [ 1 ].…”

Comparing two different family‐based childhood obesity treatment programmes in a medically underserved region: Effectiveness, engagement and implementation outcomes from a randomized controlled trial

“…Detailed description of our engagement findings are published elsewhere. 48 In brief, key participant-level factors influencing engagement included scheduling conflicts to attend synchronous sessions in a set location, geographical distances and lack of transportation, unexpected life events, dissatisfaction with the randomized programme assignment or exclusionary eligibility criteria, and conflicting family prioritization of lifestyle changes. Also, our findings indicate future opportunities to assess attendance barriers and readiness to make changes prior to enrollment and to help families set and monitor attendance goals.…”

“…Compared to our previous single‐group 3‐month pilot trial of i Choose ( n = 101 families, retention = 72%, 43% family class attendance, 62% call completion, 33% physical activity class attendance) in this region, 14 we were not any more successful with the addition of a PAT and other deliberate engagement and retention strategies for this trial (see Figure 1)—suggesting that programme features may be stronger predictors of engagement than the social support strategies targeting engagement. Detailed description of our engagement findings are published elsewhere 48 . In brief, key participant‐level factors influencing engagement included scheduling conflicts to attend synchronous sessions in a set location, geographical distances and lack of transportation, unexpected life events, dissatisfaction with the randomized programme assignment or exclusionary eligibility criteria, and conflicting family prioritization of lifestyle changes.…”

Materials and Methods for Recruiting Systematically Marginalized Youth and Families for Weight-Management Intervention Trials

“…17 To the authors' knowledge, only 2 studies investigating recruitment to weight-management intervention research among systematically marginalized youth include the voices/perspectives of the youth, 7,10 and none combine youth perspectives with those of other community stakeholders. By building upon existing community-engaged research frameworks, 8,22 this study seeks to help fill that gap by weaving together the perspectives of multiple stakeholder groups and, notably, highlighting the perspectives of youth to explore facilitators and barriers in recruiting systematically marginalized families in weight management studies. Specifically, this study explored perspectives of stakeholders on both recruitment materials and processes for 1 weight-management intervention study.…”

“…Although research has been done exploring facilitators and barriers to health-related research participation among systematically marginalized adults, [18][19][20][21] and there are studies of perspectives of parents concerning recruitment of youth into a weight management trial, 8,11,15 few studies have simultaneously explored various stakeholder perspectives in the recruitment of systematically marginalized youth into weight management trials. The 2 studies that examined various stakeholder perspectives on youth involvement in weightmanagement research were conducted with rural 22 and white Australian populations. 17 To the authors' knowledge, only 2 studies investigating recruitment to weight-management intervention research among systematically marginalized youth include the voices/perspectives of the youth, 7,10 and none combine youth perspectives with those of other community stakeholders.…”