Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned

Abstract

Background: Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population. Methods: We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017. Results: We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals. Conclusion: Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.

Virtual recruitment and participant engagement for substance use research during a pandemic

“…Although recruiting and conducting studies via virtual methods offered multiple perquisites, careful consideration was needed on whether virtual methods of recruitment and/or study participation were feasible and accepted by the population of interest. In a prepandemic study that examined a program to prevent American Indian/Alaska Native adolescents from using alcohol and other substances, Dickerson et al embarked on numerous deliberate steps to develop collaborative partnerships with American Indian/Alaska Native communities [21 ▪▪ ]. The researchers elicited guidance from the communities regarding recruitment strategies and study materials, including the study logo which was created by an American Indian artist [21 ▪▪ ].…”

“…In a prepandemic study that examined a program to prevent American Indian/Alaska Native adolescents from using alcohol and other substances, Dickerson et al embarked on numerous deliberate steps to develop collaborative partnerships with American Indian/Alaska Native communities [21 ▪▪ ]. The researchers elicited guidance from the communities regarding recruitment strategies and study materials, including the study logo which was created by an American Indian artist [21 ▪▪ ]. American Indian/Alaska Native community members were also employed as study facilitators and recruiters [21 ▪▪ ].…”

Adapting narrative exposure therapy with a tribal community: A community‐based approach

“…More recently, several innovative interventions are emerging from the "ground-up." These Indigenous led and designed interventions restore traditional practices, ceremonies, and healing wisdom and have high rates of acceptability and preliminary promising outcomes (Dickerson et al, 2021). For example, incorporating traditional healing practice such as sweat lodges into AI health centers are promising approaches in reducing psychosocial symptoms and distress while improving emotional regulation, community connectedness, and overall life satisfaction (Gone et al, 2020).…”

“…Indeed, programs intended to preserve and promote traditional Native practices and rituals can reduce health disparities (Garrett et al, 2014; Rowan et al, 2014) and cultural identity is robustly protective against outcomes such as alcohol abuse and suicide (e.g., Allen et al, 2014; Cwik et al, 2019). More recently, several innovative interventions are emerging from the “ground‐up.” These Indigenous led and designed interventions restore traditional practices, ceremonies, and healing wisdom and have high rates of acceptability and preliminary promising outcomes(Dickerson et al, 2021). For example, incorporating traditional healing practice such as sweat lodges into AI health centers are promising approaches in reducing psychosocial symptoms and distress while improving emotional regulation, community connectedness, and overall life satisfaction (Gone et al, 2020).…”

Culturally Responsive Opioid and Other Drug Prevention for American Indian/Alaska Native People: a Comparison of Reservation- and Urban-Based Approaches

“…Despite long-term calls for respecting Indigenous traditional knowledge, cultural practices, and culturally specific prevention (Gone, 2012 ; Whitbeck, 2006 ; Whitbeck et al, 2012 ), there are few substance use prevention programs for AI/AN people that prioritize cultural practices or appropriately design culturally specific strategies with European American evidence-based prevention (Blue Bird Jernigan et al, 2020 ; Crump et al, 2020 , D'Amico, Dickerson et al, 2020 , Rasmus, 2014 ; Whitesell et al, 2020 ; Snijder et al, 2021 ). In response to community suggestions for culturally appropriate and resilience-based approaches to prevention in AI/AN communities (Allen et al, 2006 ; Dickerson et al, 2012 ; Blue Bird Jernigan et al, 2020 ; Dickerson et al, 2021 ; Rasmus et al, 2019 ), development of culturally centered interventions integrating Indigenous theories and knowledge systems with Western intervention paradigms have gained momentum across tribal populations (Allen et al, 2006 ; Allen et al, 2018 , Blue Bird Jernigan et al, 2020 ; Dickerson, D’Amico et al, 2021 ; Dickerson et al, 2021 ). In 2012, the NIH began a special funding initiative to address limited research in this area (Crump et al, 2020 ), which led to numerous studies with partnerships between researchers and AI/AN communities to develop and test culturally appropriate interventions for a variety of behaviors (Dickerson et al, 2020 ).…”