Targeted Recruitment of Adults With Type 2 Diabetes for a Physical Activity Intervention

Abstract

Recruiting sufficient numbers of participants for physical activity trials for individuals with diabetes can be difficult because there are often many behavioral demands for participants, and inclusion and exclusion criteria can be extensive. This study examined the recruitment strategies used for a randomized, controlled trial designed to investigate the efficacy of an automated telephone intervention to promote physical activity in adults with type 2 diabetes in an urban Veterans Administration health care system. Traditional recruitment approaches of posting flyers and obtaining referrals from clinicians did not yield sufficient numbers of interested patients. Using the electronic medical record system to identify patients with uncontrolled diabetes allowed staff to send targeted mailings to participants, and 77% of participants were recruited using this method. The targeted mailing approach elicited a positive response rate of 12% (328 of 2,764 potential participants identified) and appeared to produce a more representative and appropriate sample than other recruitment methods used. Lessons learned in this study may be helpful to researchers in future trials who attempt to recruit participants with diabetes for physical activity protocols.

Recruitment of older adults with type 2 diabetes into a community-based exercise and nutrition randomised controlled trial

“…This result is not unexpected as there is recent evidence that approximately 30 % of adults with type 2 diabetes were found to meet physical activity guidelines [ 1 ]. A finding which is much smaller compared to another recent RCT recruiting type 2 diabetes patients to an automated, interactive voice-response telephone intervention to promote physical activity behaviours in adults with type 2 diabetes, which excluded 26 % of potential participants due to physical activity levels [ 4 ].…”

“…While it is difficult to compare the success rate of our mass mail-out campaign to other trials given the varying eligibility criteria, our rate is slightly above that reported in the Diabetes Prevention Program (DPP) conducted in the United States, where 29 % of its randomised participants were recruited via direct mass mail-outs into their multi-centre RCT aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with oral diabetes medication could prevent or delay the onset of type 2 diabetes in those at high risk for the condition [ 15 ]. The ability of mass mail-outs to target a large number of participants at a relatively low cost, combined with the reported success of this strategy to yield a high number of eligible participants in both healthy and clinical populations, has in recent years led to this approach becoming an integral part of many recruitment plans [ 4 , 16 – 18 ]. From our experience, when implementing mass mail-outs as a recruitment strategy it is the choice of the mail-out lists which are likely to contribute to its effectiveness.…”

“…Therefore it is often difficult for these people to commit to a long-term behavioural change program that is central to these types of studies. Common barriers and reasons that have been identified for why many adults (including those with type 2 diabetes) do not participate in exercise trials include inconvenience, a lack of time to dedicate when managing work/family commitments and a lack of understanding of the potential health benefits of participating in such trials [ 3 , 4 ].…”

“…Currently there is limited data on successful recruitment strategies suitable for older adults with type 2 diabetes into community-based exercise and nutrition programs. One study has previously described the experiences and strategies used to recruit type 2 diabetic patients into an RCT to assess the efficacy of an automated, interactive voice-response telephone intervention to promote physical activity (PA) behaviour [ 4 ]. This study found that targeted mail-outs were the most effective method of recruitment compared to traditional recruitment strategies such as flyers and brochures which were posted and distributed in various healthcare settings and only provided a basic description of the study [ 4 ].…”

“…One study has previously described the experiences and strategies used to recruit type 2 diabetic patients into an RCT to assess the efficacy of an automated, interactive voice-response telephone intervention to promote physical activity (PA) behaviour [ 4 ]. This study found that targeted mail-outs were the most effective method of recruitment compared to traditional recruitment strategies such as flyers and brochures which were posted and distributed in various healthcare settings and only provided a basic description of the study [ 4 ]. However, there still remains a large degree of paucity in data available describing successful recruitment strategies suitable for older adults with type 2 diabetes into community-based exercise and nutrition programs, and no information on cost estimates.…”