Recruitment of New Immigrants Into a Randomized Controlled Prevention Trial: The Live Well Experience

Abstract

Minority populations are hard to reach with prevention interventions because of cultural and logistical barriers to recruitment. Understanding how to overcome these barriers is pertinent to reducing the elevated burden of obesity within these underserved communities. To inform this literature gap, we explore the processes and outcomes of recruitment for Live Well-a randomized controlled obesity prevention intervention targeting new immigrant mothers and children from Brazil, Latin America, and Haiti who were residing in the greater Somerville, MA area. We employed community-based participatory research principles to develop and implement five culturally-adapted recruitment activities (posters and flyers, media announcements, church outreach, participant referrals, and community organization partnerships) and tracked enrollment for the total and stratified samples of 406 dyads (37% Brazilian, 29% Latino, 33% Haitian). We describe how strategic partnerships were built and sustained within the intervention community, and detail the key adjustments that contributed to our success. Ultimately, community organization partnerships and participant referrals enrolled a collective majority of participants (34% and 25%, respectively); however, stratified analyses revealed variation by ethnicity: Haitian immigrants responded best to ethnic-based media announcements (44%), whereas Latino and Brazilian immigrants were most responsive to community organization outreach (45% and 38%, respectively). Implications from our findings enhance the literature on recruiting hard-to-reach communities into prevention research: some less integrated communities may respond more to grassroots activities with direct engagement, whereas communities with more social capital may be more responsive to top-down, community-wide collaborations. Furthermore, we suggest that strategic and trusting partnerships are key facilitators of recruitment, and future researchers must understand communities' culture and social networks when building relationships. Our analyses provide rare insight into best practices to overcome specific cultural barriers to recruitment which future investigators can use to better reach underserved communities with prevention research.

Recruitment and Retention Strategies Among Racial and Ethnic Minorities in Web-Based Intervention Trials: Retrospective Qualitative Analysis

“…In addition to bilingual capacity and cultural knowledge, the e-CHECC-up team mobilized ethnic churches as the main setting for direct recruitment. Faith-based organizations serve as epicenters for social, religious, and health promotion activities across diverse racial and ethnic minority and immigrant communities, including African American, Hispanic, and Asian Americans [ 33 , 36 , 42 , 43 ]. Building upon existing community strengths and resources, faith-based organizations are well-suited community partners for health research and for long-term and sustainable collaboration [ 42 ].…”

Facilitators and barriers of children's participation in nutrition, physical activity, and obesity interventions: A systematic review

“…The 26 records included in this review varied in research objectives and study designs. Four studies were randomized clinical trials involving only quantitative evaluation of recruitment (with the review of study records to evaluate recruitment and/or surveys or questionnaires about recruitment) 25–28 . Seven were qualitative studies (which included interviews or focus groups with potential participants to inform a future clinical trial) 29–35 .…”

“…Fifteen studies questioned parents and children about the facilitators and/or barriers to engaging in clinical trials, 29–33,41–49,52 and within these, only three studies assessed perceptions of both parents and children 47,48,52 . Also, 15 studies questioned research staff 25–28,34–40,44,46,50,51 . From all of these studies, two questioned children and parents and also researchers 44,46 .…”

“…From all of these studies, two questioned children and parents and also researchers 44,46 . Fifteen studies evaluated recruitment of children in obesity‐related trials, 25,28–31,34,37–39,44,46–48,51,52 and 10 studies in nutrition or physical activity interventions 26,27,32,33,35,36,40,45,49,50 . Sample size varied from 37 to 1,879 in the mixed methods studies, 23–306 in quantitative studies, and 16–1,355 in qualitative studies.…”

Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults

“…Even though ethnic minorities are often underrepresented in health research [33], some studies have shown effective methods to recruit immigrant participants. Namely, by providing bilingual program information, and by facilitating partnerships with community organizations, recruitment of immigrant participants could be improved [34,35]. Future implementation studies should take into account these methods in the planning of their interventions.…”