Factors influencing subject willingness to participate in clinical gerontologic research

Maximizing clinical research participation in vulnerable older persons: identification of barriers and motivators

OBJECTIVES

To identify barriers and motivators to participation in long-term clinical research by high-risk elderly people and to develop procedures to maximize recruitment and retention.

DESIGN

Quantitative and qualitative survey.

SETTING

Academic primary care medicine and pre-anesthesia testing clinics.

PARTICIPANTS

Fifty patients aged 70 and older, including 25 medical patients at high risk of hospitalization and 25 patients with planned major surgery.

MEASUREMENTS

Fifteen- to 20-minute interviews involved open- and closed-ended questions guided by an in-depth script. Two planned study protocols were presented to each participant. Both involved serial neuropsychological assessments, blood testing, and magnetic resonance brain imaging (MRI); one added lumbar puncture (LP). Participants were asked whether they would be willing to participate in these protocols, rated barriers and incentives to participation, and were probed with open-ended questions.

RESULTS

Of 50 participants (average age 78, 44% male, 40% nonwhite), 32 (64%) expressed willingness to participate in the LP-containing protocol, with LP cited as the strongest disincentive. Thirty-eight (76%) expressed willingness to participate in the protocol without LP, with phlebotomy and long interviews cited as the strongest disincentives. Altruism was a strong motivator for participation, whereas transportation was a major barrier. Study visits at home, flexible appointment times, assessments shorter than 75 minutes, and providing transportation and free parking were strategies developed to maximize study participation.

CONCLUSION

Vulnerable elderly people expressed a high rate of willingness to participate in an 18-month prospective study. Participants identified incentives and barriers that enabled investigators to develop procedures to maximize recruitment and retention.

Engaging older adults in high impact volunteering that enhances health: recruitment and retention in The Experience Corps Baltimore

Engagement in social and generative activities has benefits for the well-being of older adults; hence, methods for broadly engaging them in such activities are desired. Experience Corps Baltimore, a social model for health promotion for older adult volunteers in public schools, offers insight to such successful recruitment and retention. We report on data over a 4-year period in Baltimore City, Maryland, and describe a five-stage screening process implemented to recruit a diverse group of senior volunteers who would remain in the program for at least 1 year. The sample consisted of 443 older adults expressing an interest in and screened for volunteering. Comparisons were made with Chi-square and Fisher's t-test between those who entered the program and those who did not and those who were retained in the program. Gender, race, age group, and prior volunteering were significant in ultimate volunteer service in the schools. Overall, 38% of 443 persons recruited entered the schools; 94% of participants were over 60 years (p = 0.05) with a mean age of 69 years; 90% were women (p = 0.03), and 93% African-American (p = 0.005); 57% had not volunteered in the past year (p = 0.004). Ninety-two percent were retained in the first year; 80% returned a second year. Among the latter, 83% had <12 years of education (p = 0.001). Participants remained in the program for a second year of volunteering regardless of baseline MMSE score, self-reported health, and motivation for volunteering. In conclusion, it is possible to recruit and retain a diverse pool of older adults to participate in a high-intensity volunteer program, including non-traditional volunteers. Of special note is the success in recruiting African-American women and those with lower education, who may particularly benefit from health promotion.

Overcoming recruitment challenges in construction safety intervention research

BACKGROUND

Recruiting workers in small construction companies and securing their participation in voluntary safety programs or safety research poses unique challenges. Worker turnover and worksite changes contribute to difficulties in locating and enrolling participants. Economic pressures and time demands potentially threaten ongoing participation.

METHODS

Six simulation exercises designed to reduce back and fall injuries in small construction companies were developed based on data from focus groups of workers and company owners. Working with a workers' compensation insurer, we had access to owner-operators of general, heavy, and special trade construction companies reporting less than $10,000 in payroll expenses. Recruitment methods included a participation incentive, mailed invitations followed by phone contacts, and follow-up reminders.

RESULTS

Despite using recruitment methods recommended in the literature, participation rates were low over a 2-year intervention period. Because of these difficulties, factors affecting participation or nonparticipation became an additional research focus. Owners' perceptions of already having a good safety record and of the time demands of participation were the most commonly cited reasons for not participating.

CONCLUSIONS

Literature on recruitment emphasizes processes and procedures under investigator control rather than understanding potential participants' judgments about the adequacy of their existing practices and the potential benefits of intervention participation relative to potential time and productivity trade-offs. Greater attention to such judgments may enhance recruitment and participation in under-studied and difficult to access populations.

Weighted stair climbing in mobility-limited older people: a pilot study

OBJECTIVES

To evaluate weighted stair climbing exercise (SCE) as a means of increasing lower extremity muscle power in mobility-limited older people.

DESIGN

Single-blinded, randomized controlled pilot study.

SETTING

Human physiology laboratory of a metropolitan university.

PARTICIPANTS

Forty-five community-dwelling people aged 65 and older who had baseline mobility limitations manifested by scores of 11 or lower on the Short Physical Performance Battery (SPPB).

INTERVENTIONS

Subjects were randomized into one of two 12-week exercise programs. The intervention group (SCE) (n = 23) ascended and descended stairs, at a set pace, while wearing a weighted vest. The control group (WALK) (n = 22) participated in a standardized walking program.

MEASUREMENTS

Primary and secondary outcomes included measures of muscle power and strength, submaximal aerobic capacity, and physical performance.

RESULTS

SCE produced 17% improvement in double leg press peak power in comparison with WALK (P =.013) and significant improvement in stair climbing power from baseline (12%). Improvement in submaximal aerobic performance was equivalent for both groups. Although not statistically significant, effect size estimates suggest that SCE can potentially influence knee extension power and strength. Stair climb time was improved in both groups, whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants.

CONCLUSIONS

These findings suggest that SCE maybe a useful component of a home exercise program designed to enhance lower extremity muscle power, aerobic capacity, and functional performance. Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training.

The relationship between leg power and physical performance in mobility-limited older people

OBJECTIVES

The purpose of this study was to assess the influence of leg power and leg strength on the physical performance of community-dwelling mobility-limited older people.

DESIGN

Cross-sectional analysis of baseline data from a 12-week randomized controlled exercise-intervention study.

SETTING

Exercise laboratory within the Department of Health Science of an urban university.

PARTICIPANTS

Forty-five community-dwelling mobility-limited people (34 women, 11 men), aged 65 to 83.

MEASUREMENTS

Health status, depression, cognition, physical activity, and falls efficacy; physiological measures of lower extremity strength and power; and measures of physical performance.

RESULTS

Through bivariate analyses, leg power was significantly associated with physical performance as measured by stair-climb time, chair-stand time, tandem gait, habitual gait, maximal gait, and the short physical performance battery describing between 12% and 45% of the variance (R2). Although leg power and leg strength were greatly correlated (r = .89) in a comparison of bivariate analyses of strength or power with physical performance, leg power modeled up to 8% more of the variance for five of six physical performance measures. Despite limitations in sample size, it appeared that, through quadratic modeling,the influence of leg power on physical performance was curvilinear. Using separate multivariate analyses, partial R2 values for leg power and leg strength were compared, demonstrating that leg power accounted for 2% to 8% more of the variance with all measures of physical performance.

CONCLUSION

Leg power is an important factor influencing the physical performance of mobility-limited older people. Although related to strength, it is a separate attribute that may exert a greater influence on physical performance. These findings have important implications for clinicians practicing geriatric rehabilitation.

The cost of recruiting Alzheimer's disease caregivers for research

OBJECTIVES

This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study.

METHODS

Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant.

RESULTS

Recruitment rates varied by method implemented and referral source. Overall, 100 participants were enrolled for a total cost of $10,127, yielding an average per participant cost of $101.00. The Formal Recruitment Method, used at agencies with large participant pools, emerged as the most cost-effective strategy.

DISCUSSION

Recruitment costs varied greatly, depending on the referral sites and their available pool of participants. Substantial time, money, and personnel need to be budgeted for recruitment efforts given the expected costs, the competing pressures in the health care region, and the variability of participant response.