Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice

Abstract

Background: Obesity is a major risk factor behind some of the most common problems encountered in primary care. Although effective models for obesity treatment have been developed, the 'reach' of these interventions is poor and only a small fraction of primary care patients receive evidence-based treatment. The purpose of this study is to identify factors that impact the uptake (reach) of an evidence-based obesity treatment program within the context of a pragmatic cluster randomized controlled trial comparing three models of care delivery. Methods: Recruitment and reach were evaluated by the following measures: 1) mailing response rates, 2) referral sources among participants contacting the study team, 3) eligibility rates, 4) participation rates, and 5) representativeness based on demographics, co-morbid conditions, and healthcare utilization of 1432 enrolled participants compared to > 17,000 non-participants from the clinic-based patient populations. Referral sources and participation rates were compared across study arms and level of clinic engagement. Results: The response rate to clinic-based mailings was 13.2% and accounted for 66% of overall program recruitment. An additional 22% of recruitment came from direct clinic referrals and 11% from media, family, or friends. Of those screened, 87% were eligible; among those eligible, 86% enrolled in the trial. Participation rates did not vary across the three care delivery arms, but were higher at clinics with high compared to low provider involvement. In addition, clinics with high provider involvement had a higher rate of in clinic referrals (33% versus 16%) and a more representative sample with regards to BMI, rurality, and months since last clinic visit. However, across clinics, enrolled participants compared to non-participants were older, more likely to be female, more likely to have had a joint replacement but less likely to have CVD or smoke, and had fewer hospitalizations.Conclusions: A combination of direct patient mailings and in-clinic referrals may enhance the reach of primary care behavioral weight loss interventions, although more proactive outreach is likely necessary for men, younger patients, and those at greater medial risk. Strategies are needed to enhance provider engagement in referring patients to behavioral weight loss programs.(Continued on next page)

Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss Among Patients With Obesity in Rural Clinical Practice

“…Recruitment strategies included in-clinic referrals and direct mailings from clinic registries. Detailed recruitment methods have been previously described …”

Recruitment of Men Into a Pragmatic Rural Primary Care Weight Loss Trial

“…Patients screening eligible could then enroll in the study after receiving clearance to participate from their PCP and completing a BMI verification visit at their primary care clinic. Full recruitment details are previously described (Befort et al, 2020).…”

A Framework for Equitable Partnerships to Promote Cancer Prevention and Control in Rural Settings

“…In addition, bona fide engagement of local providers to demonstrate the potential gains from rural research participation (eg, increases in HEDIS measures) rather than reliance on practice databases to access patients will help ensure trials are clinically relevant and feasible in rural settings, have wider reach, and thus enhance referral rates ( 70 ). For example, a lifestyle behavioral intervention trial in rural primary care clinics found that high provider involvement doubled the proportion of participants who were referred to the trial by a provider ( 78 ). Strategies to engage providers need to be tailored to each clinic’s unique cultural and environmental context ( 79 ).…”