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Tsang KCH, Pinnock H, Wilson AM, Salvi D, Shah SA. Predicting asthma attacks using connected mobile devices and machine learning: the AAMOS-00 observational study protocol. BMJ Open 2022; 12:e064166. [PMID: 36192103 PMCID: PMC9535155 DOI: 10.1136/bmjopen-2022-064166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Supported self-management empowering people with asthma to detect early deterioration and take timely action reduces the risk of asthma attacks. Smartphones and smart monitoring devices coupled with machine learning could enhance self-management by predicting asthma attacks and providing tailored feedback.We aim to develop and assess the feasibility of an asthma attack predictor system based on data collected from a range of smart devices. METHODS AND ANALYSIS A two-phase, 7-month observational study to collect data about asthma status using three smart monitoring devices, and daily symptom questionnaires. We will recruit up to 100 people via social media and from a severe asthma clinic, who are at risk of attacks and who use a pressurised metered dose relief inhaler (that fits the smart inhaler device).Following a preliminary month of daily symptom questionnaires, 30 participants able to comply with regular monitoring will complete 6 months of using smart devices (smart peak flow meter, smart inhaler and smartwatch) and daily questionnaires to monitor asthma status. The feasibility of this monitoring will be measured by the percentage of task completion. The occurrence of asthma attacks (definition: American Thoracic Society/European Respiratory Society Task Force 2009) will be detected by self-reported use (or increased use) of oral corticosteroids. Monitoring data will be analysed to identify predictors of asthma attacks. At the end of the monitoring, we will assess users' perspectives on acceptability and utility of the system with an exit questionnaire. ETHICS AND DISSEMINATION Ethics approval was provided by the East of England - Cambridge Central Research Ethics Committee. IRAS project ID: 285 505 with governance approval from ACCORD (Academic and Clinical Central Office for Research and Development), project number: AC20145. The study sponsor is ACCORD, the University of Edinburgh.Results will be reported through peer-reviewed publications, abstracts and conference posters. Public dissemination will be centred around blogs and social media from the Asthma UK network and shared with study participants.
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Affiliation(s)
- Kevin Cheuk Him Tsang
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew M Wilson
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norwich University Hospital Foundation Trust, Colney Lane, Norwich, UK
| | - Dario Salvi
- Internet of Things and People Research Centre, Malmo University, Malmo, Sweden
| | - Syed Ahmar Shah
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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Clark KJ, Mitchell MM, Fahmy C, Pyrooz DC, Decker SH. What if They Are All High-Risk for Attrition? Correlates of Retention in a Longitudinal Study of Reentry from Prison. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020:306624X20967934. [PMID: 33153354 DOI: 10.1177/0306624x20967934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Longitudinal data are essential to research in criminology and criminal justice. Despite attrition's implications for validity, understanding its sources is underexplored empirically. We examine the correlates of retention using covariates organized into domains of prediction, prevention, and projection. Data from the LoneStar Project, a three-wave longitudinal reentry study of 802 males recently released from prisoners in Texas, were analyzed to examine the correlates of proximal, distal, and any study retention. The best correlates of study retention are prevention techniques used by researchers to reduce attrition. In contrast, only a few covariates traditionally associated with attrition and no covariates used for attrition projection were related to retention. What researchers do matters more for retention than the characteristics of individuals they are trying to retain. The findings underscore how researchers can improve study retention in longitudinal research while also correcting for non-random attrition in current longitudinal data sources.
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Heyman RE, Baucom KJW, Slep AMS, Mitnick DM, Halford WK. An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples. FAMILY RELATIONS 2020; 69:849-864. [PMID: 33542587 PMCID: PMC7853666 DOI: 10.1111/fare.12431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples. BACKGROUND We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce. METHOD Couples (n = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later. RESULTS Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline. CONCLUSION CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty. IMPLICATIONS Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.
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Rabie S, Bantjes J, Gordon S, Almirol E, Stewart J, Tomlinson M, Rotheram-Borus MJ. Who can we reach and who can we keep? Predictors of intervention engagement and adherence in a cluster randomized controlled trial in South Africa. BMC Public Health 2020; 20:275. [PMID: 32106835 PMCID: PMC7045524 DOI: 10.1186/s12889-020-8357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Engaging and retaining young men in community-based interventions is highly challenging. The purpose of this study was to investigate the individual factors that predict intervention engagement and adherence in a sample of at-risk South African men. METHODS Baseline data were collected as a part of a cluster randomised control trial (RCT) situated in Khayelitsha and Mfuleni, two peri-urban settlements situated on the outskirts of Cape Town, South Africa. Neighbourhoods were randomised to one of three intervention conditions. We performed univariate descriptive statistics to report neighbourhood and individual socio-demographic factors, and ran multivariate models, adjusting for entry of study, to determine if high adherence and consistency of engagement with the intervention were associated with socio-behavioural demographics and risk behaviours, such as hazardous substance use, gangsterism, and criminal activity. RESULTS Total of 729 men were on average 22.5 years old (SD 2.8), with a mean of 10 years of education. More than half of the sample were single (94%), lived with their parents (66%) and had an income below ~$30 (52%). The overall mean of adherence is 0.41 (SD 0.24) and mean of consistency of engagement is 0.61 (SD 0.30). Our data indicated that completing more years of education, living with parents, and having higher socioeconomic status were significantly associated with higher rates of engagement and adherence. Men with a history of gang membership demonstrated higher levels of adherence and consistent engagement with the intervention, compared with other men who were recruited to the intervention. Crucially, our data show that young men with a history of substance use, and young men who report symptoms of depression and high levels of perceived stress are equally likely as other young men to adhere to the intervention and attend intervention sessions consistently. CONCLUSION Our results may contribute to a better understanding of young men's patterns of engagement and adherence to public health interventions. The results may have important implications for policy and practice, as they may be useful in planning more effective interventions and could potentially be used to predict which young men can be reached through community-based interventions. TRIAL REGISTRATION ClinicalTrials.gov registration, NCT02358226. Prospectively registered 24 November 2014.
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Affiliation(s)
- Stephan Rabie
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa.
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
| | - Ellen Almirol
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California, 90024, USA
| | - Jackie Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California, 90024, USA
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Bulling LJ, Baucom KJW, Heyman RE, Smith Slep AM, Mitnick DM, Lorber MF. Predicting Program Retention in a Flexibly-Delivered Relationship Education Program for Low-Income, Unmarried Parents. JOURNAL OF FAMILY SOCIAL WORK 2019; 23:234-256. [PMID: 33536725 PMCID: PMC7853667 DOI: 10.1080/10522158.2019.1681337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 06/12/2023]
Abstract
Participation rates in couple relationship education (CRE) programs for low-income couples are typically low. We examined predictors of session attendance and early dropout (i.e., dropout after 1 session) among a sample of low-income, unmarried parents of a newborn (N = 467 couples) enrolled in an evidence-based CRE program. Predictors included demographics and socioeconomic status, as well as baseline indicators of relationship commitment, family and individual functioning, infant health, preventive health care utilization, and CRE coach perceptions of participant engagement and alliance in the first session of the program. Couples attended an average of 4.4 (SD = 2.5) of the 7 sessions, with nearly a quarter of couples dropping out after the first session. Attendance at fewer sessions was predicted by younger age. Early dropout was predicted by lower ratings of females' engagement and both partners' therapeutic alliance and, unexpectedly, by commitment. We discuss considerations for engaging low-income couples in CRE.
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Mogoba P, Gomba Y, Brittain K, Phillips TK, Zerbe A, Myer L, Abrams EJ. Re-recruiting postpartum women living with HIV into a follow-up study in Cape Town, South Africa. BMC Res Notes 2019; 12:461. [PMID: 31349853 PMCID: PMC6660934 DOI: 10.1186/s13104-019-4509-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Recruitment and retention present major challenges to longitudinal research in maternal and child health, yet there are few insights into optimal strategies that can be employed in low-resource settings. Following prior participation in a longitudinal study following women living with HIV through pregnancy and breastfeeding in Cape Town, women were re-contacted at least 18 months after the last study contact and were invited to attend an additional follow-up visit. We describe lessons learnt and offer recommendations for a multiphase recruitment approach. Results Using telephone calls, home visits, clinic tracing and Facebook/WhatsApp messages, we located 387 of the 463 eligible women and successfully enrolled 353 (91% of those contacted). Phone calls were the most successful strategy, yielding 67% of enrolments. Over half of the women had changed their contact information since participation in the previous study. We recommend that researchers collect multiple contact details and use several recruitment strategies in parallel from the start of a study. Participants in longitudinal studies may require frequent contact to update contact information, particularly in settings where mobility is common. Electronic supplementary material The online version of this article (10.1186/s13104-019-4509-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Phepo Mogoba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. .,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa.
| | - Yolanda Gomba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
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Wynne J, Muwawu R, Mubiru MC, Kamira B, Kemigisha D, Nakyanzi T, Kabwigu S, Nakabiito C, Kiweewa Matovu F. Maximizing participant retention in a phase 2B HIV prevention trial in Kampala, Uganda: The MTN-003 (VOICE) Study. HIV CLINICAL TRIALS 2018; 19:165-171. [PMID: 30370830 DOI: 10.1080/15284336.2018.1513711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The success of longitudinal trials depends greatly on using effective strategies to retain participants and ensure internal validity, maintain sufficient statistical power, and provide for the generalizability of study results. OBJECTIVE This paper describes the challenges and specific strategies used to retain participants in a Phase 2B safety and effectiveness study of daily oral and vaginal tenofovir formulations for the prevention of HIV-1 infection in the MTN-003 (VOICE) trial in Kampala, Uganda. METHODS Once enrolled, participants were seen every 28 days at the research site and their study product was re-filled. Challenges to retention included a mobile population, non-disclosure of study participation to spouse/family, and economic constraints. Strategies used to maintain high participation rates included the use of detailed locator information, a participant tracking database, regular HIV/STI testing, and the formation of close bonds between staff and subjects. RESULTS We enrolled 322 women out of the 637 screened. The overall retention rate was 95% over a 3 year follow up period. Only 179 (3%) out of the 6124 expected visits were missed throughout study implementation. Reasons for missed visits included: participants thinking that they did not need frequent visits due to their HIV negative status, time constraints due to commercial sex work, and migration for better employment. CONCLUSIONS With the implementation of multi-faceted comprehensive follow-up and retention strategies, we achieved very high retention rates in the MTN-003 study. This paper provides a blueprint for effective participant retention strategies for other longitudinal HIV prevention studies in resource-limited settings in Sub-Saharan Africa.
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Affiliation(s)
- Joshua Wynne
- a Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Rosemary Muwawu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Michael C Mubiru
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Betty Kamira
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Doreen Kemigisha
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Teopista Nakyanzi
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Samuel Kabwigu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Clemensia Nakabiito
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Flavia Kiweewa Matovu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda.,c Department of Epidemiology and Biostatistics , Makerere University School of Public Health, Makerere University College of Health Sciences , Kampala , Uganda
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Xu X, Tupy S, Robertson S, Miller AL, Correll D, Tivis R, Nigg CR. Successful adherence and retention to daily monitoring of physical activity: Lessons learned. PLoS One 2018; 13:e0199838. [PMID: 30235221 PMCID: PMC6147478 DOI: 10.1371/journal.pone.0199838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.
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Affiliation(s)
- Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
- * E-mail:
| | - Samantha Tupy
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Stephen Robertson
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Ashley L. Miller
- Department of Psychology, University of Oregon, Eugene, Oregon, United State of America
| | - Danielle Correll
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, United States of America
| | - Rick Tivis
- Idaho Center for Health Research, Idaho State University, Meridian, Idaho, United States of America
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, Idaho, United States of America
| | - Claudio R. Nigg
- Office of Public Health Studies, University of Hawai’i at Manoa, Honolulu, Hawaii, United States of America
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Goldman H, Fagnano M, Perry TT, Weisman A, Drobnica A, Halterman JS. Recruitment and retention of the Hardest-to-Reach families in community-based asthma interventions. Clin Trials 2018; 15:543-550. [PMID: 30101615 DOI: 10.1177/1740774518793598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Engaging underserved populations in research requires substantial effort for recruitment and retention. The objective of this study is to describe the effort needed to recruit and retain urban participants in pediatric asthma studies and to characterize the Hardest-to-Reach group by demographics and asthma severity. METHODS We included 311 children (3-10 years) with persistent asthma enrolled in two school-based asthma interventions in Rochester, NY. Contact logs were collected at four time points (baseline, 2 month, 4 month, 6 month). We defined "Hardest-to-Reach" (vs "Easier-to-Reach") as being unable to reach a family by telephone at any given contact attempt due to disconnected or wrong numbers. Chi-square and Mann-Whitney tests were used to compare groups. RESULTS Overall, we enrolled 311 children (60% Black, 29% Hispanic, 70% Medicaid, response rate 70%). On average, 3.1 contact attempts were required for recruitment (range 1-15), and 35% required rescheduling at least once for the enrollment visit. All but 12 participants completed each follow-up (retention rate = 96%). Completion of follow-ups required an average of 7.6 attempts; we considered 38% of caregivers "Hardest-to-Reach." Caregivers in the Hardest-to-Reach group were slightly younger (33 vs 36 years, p = 0.007) with more depressive symptoms (41% vs 29%, p = 0.035) and smokers in the home (59% vs 48%, p = 0.048). Furthermore, more of the Hardest-to-Reach children had moderate-severe versus mild persistent asthma (64% vs 52%, p = 0.045). Importantly, even the Easier-to-Reach families required many contact attempts, with 52% having >5 attempts for at least one follow-up. CONCLUSION In conclusion, we found that among an already vulnerable population, the Hardest-to-Reach families demonstrated higher risk and had children with significantly worse asthma. This study highlights the importance of persistence in reaching those in greatest need.
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Affiliation(s)
- Hillary Goldman
- 1 Department of Pediatrics, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Maria Fagnano
- 1 Department of Pediatrics, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Tamara T Perry
- 2 Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ariel Weisman
- 1 Department of Pediatrics, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Amanda Drobnica
- 1 Department of Pediatrics, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Jill S Halterman
- 1 Department of Pediatrics, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
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Dareng EO, Olaniyan Y, Adebamowo SN, Eseyin OR, Odutola MK, Obiefuna EM, Offiong RA, Pharoah PP, Adebamowo CA. Age, HIV status, and research context determined attrition in a longitudinal cohort in Nigeria. J Clin Epidemiol 2018; 100:32-43. [PMID: 29679747 PMCID: PMC8015251 DOI: 10.1016/j.jclinepi.2018.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We explored determinants of attrition in a longitudinal cohort study in Nigeria. STUDY DESIGN AND SETTING We enrolled 1,020 women into a prospective study. Of these, 973 were eligible to return for follow-up. We investigated the determinants of attrition among eligible women using a sequential mixed methods design. We used logistic regression models to compare the baseline characteristics of responders and nonresponders. At the end of the parent study, we conducted four focus group discussions and eight key informant interviews with nonresponders. RESULTS Of the 973 women included in the quantitative analysis, 26% were nonresponders. From quantitative analysis, older women were less likely to drop out than younger women (reference: women ≤30 years; OR 0.46; 95% confidence interval [CI] 0.30-0.70, P < 0.001 women 31-44 years; and OR 0.31; 95% CI 0.17-0.56, P < 0.001 women ≥45 years). HIV-positive women were also less likely to drop out of the study (OR 0.45; 95% CI 0.33-0.63, P < 0.001). From qualitative analysis, contextual factors that influenced attrition were high cost of participation, therapeutic misconceptions, inaccurate expectations, spousal disapproval, unpleasant side effects, challenges in maintaining contact with participants, and participant difficulties in locating the study clinic. CONCLUSION Several participant-, research-, and environment-related factors influence attrition. Retention strategies that address these barriers are important to minimize attrition.
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Affiliation(s)
- Eileen O Dareng
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Yinka Olaniyan
- Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria
| | - Sally N Adebamowo
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Olabimpe R Eseyin
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Michael K Odutola
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Elonna M Obiefuna
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Richard A Offiong
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Paul P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
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11
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Mavandadi S, Patel S, Benson A, DiFilippo S, Streim J, Oslin D. Correlates of Caregiver Participation in a Brief, Community-Based Dementia Care Management Program. THE GERONTOLOGIST 2018; 57:1103-1112. [PMID: 27927725 DOI: 10.1093/geront/gnw127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/22/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose of the Study The evidence base for dementia care management interventions for informal caregivers (CGs) is strong, yet enrollment and sustained engagement in academic and community-based research trials is low. This study sought to examine rates and correlates of participation in a community-based, telephone-delivered dementia care management program designed to address logistic and practical barriers to participation in CG trials and services. Design and Methods Participants included 290 CGs of older, community-dwelling, low-income care recipients (CRs) who met criteria for enrollment in a collaborative dementia care management program that provides assessment, psychosocial support and education, and connection to community resources via telephone. Cross-sectional analyses examined the association between CG-related (e.g., financial status, relationship to CR, caregiving burden) and CR-related (e.g., functional limitations, symptom severity) factors and CG enrollment and engagement. Results The majority of CGs were non-Hispanic White, female, financially stable, and adult children of the CRs. Over half of CGs lived with the CR and provided 20 or more hours of care per week. Roughly half of CGs refused care management services. Adjusted logistic regression models revealed that perceived caregiving burden and financial status were related to initial enrollment and engagement in services once enrolled, respectively. Implications A significant proportion of CGs refuse free, convenient, evidence-based dementia care management services, underscoring the need for further examination of correlates of program acceptance. Nonetheless, community-based programs that address barriers may improve enrollment and engagement rates among CGs, including those who are especially vulnerable to negative CG and CR outcomes.
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Affiliation(s)
- Shahrzad Mavandadi
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Samir Patel
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Amy Benson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Suzanne DiFilippo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joel Streim
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David Oslin
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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12
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Browne S, Carter T, Eckes R, Grandits G, Johnson M, Moore I, McNay L. A review of strategies used to retain participants in clinical research during an infectious disease outbreak: The PREVAIL I Ebola vaccine trial experience. Contemp Clin Trials Commun 2018; 11:50-54. [PMID: 30003168 PMCID: PMC6041371 DOI: 10.1016/j.conctc.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction This article describes a retrospective review of participant follow-up and retention strategies in the Partnership for Research on the Ebola Virus in Liberia (PREVAIL) I Vaccine Trial. It illustrates and analyzes strategies used to retain participants in an emergency clinical research response vaccine trial conducted during the 2014 Ebola outbreak in Liberia. Methods An anecdotal review of participant retention strategies developed and employed during the PREVAIL I vaccine trial. Results Though other factors likely contributed to the high retention rate of trial participants, the unique PREVAIL I follow-up process described resulted in an exceptionally high participant retention rate (97.8%) through 12 months of follow-up, increased the ability to obtain meaningful trial results, and provided a platform through which to respond to social issues in an emergency clinical research response setting. Conclusion Successful strategies were developed and employed in the PREVAIL I vaccine trial that resulted in extraordinarily high participant retention and follow-up rates during an infectious disease outbreak. This review illustrates that employing host country social mobilization concepts within a modified clinical research management framework is highly correlated to elevated rates of retention and minimal loss to follow-up. These strategies also contributed to increased data quality and enhanced adherence to protocol requirements. The increased ability to respond to social issues such as stigma, job retention and relationship conflicts was an additional and significant benefit of this follow-up methodology.
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Affiliation(s)
- Sarah Browne
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Tarweh Carter
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Risa Eckes
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Washington, DC, United States
| | - Greg Grandits
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Melvin Johnson
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Irene Moore
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Laura McNay
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Washington, DC, United States
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13
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Lee RE, Reese-Smith JY, Mama SK, Medina AV, Wolfe KL, Estabrooks PA. Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis. Transl Behav Med 2017; 7:106-114. [PMID: 27256575 DOI: 10.1007/s13142-016-0385-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values < .05). This study showed moderate levels of reach but overrepresented higher educated, wealthier, and older women at the completion of the study. Representativeness can change over the course of the study and impact the practicality of translating research to practice.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA.
| | - Jacqueline Y Reese-Smith
- Department of Psychology, Jackson State University, 1400 J.R. Lynch Street, LIB Rm 232, Jackson, MS, 39217, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Ashley V Medina
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Kristin L Wolfe
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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14
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Huntington C, Newton JT, Donaldson N, Liossi C, Reynolds PA, Alharatani R, Hosey MT. Lessons learned on recruitment and retention in hard-to-reach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia. BMC Oral Health 2017; 17:122. [PMID: 28882136 PMCID: PMC5590238 DOI: 10.1186/s12903-017-0411-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.
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Affiliation(s)
- C Huntington
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK.
| | - J Timothy Newton
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - N Donaldson
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - C Liossi
- University of Southampton and Great Ormond Street Hospital for Children NHS Trust, Southampton, UK
| | - P A Reynolds
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - R Alharatani
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
| | - M T Hosey
- King's College London Dental Institute, Bessemer Road, London, SE5 9RS, UK
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15
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Mucka LE, Dayton CJ, Lawler J, Kirk R, Alfafara E, Schuster MM, Miller N, Ribaudo J, Rosenblum KL, Muzik M. MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM. Infant Ment Health J 2017; 38:536-550. [PMID: 28665536 DOI: 10.1002/imhj.21652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.
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16
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Wu V, Abo-Sido N, Espinola JA, Tierney CN, Tedesco KT, Sullivan AF, Camargo CA. Predictors of successful telephone follow-up in a multicenter study of infants with severe bronchiolitis. Ann Epidemiol 2017; 27:454-458.e1. [PMID: 28645568 PMCID: PMC5550350 DOI: 10.1016/j.annepidem.2017.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/12/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify the characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis. METHODS We analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child's age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts. RESULTS 798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income $60,000 or more, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with 3 or more children. In multivariable analyses, follow-up was more likely among parents of females, and, compared with the South, in the Northeast and Midwest (all P < .05). Compared with non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with 3 or more children (all P < .05). CONCLUSION Sociodemographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.
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Affiliation(s)
| | | | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Courtney N Tierney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
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17
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Phipatanakul W, Koutrakis P, Coull BA, Kang CM, Wolfson JM, Ferguson ST, Petty CR, Samnaliev M, Cunningham A, Sheehan WJ, Gaffin JM, Baxi SN, Lai PS, Permaul P, Liang L, Thorne PS, Adamkiewicz G, Brennan KJ, Baccarelli AA, Gold DR. The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2017; 60:14-23. [PMID: 28619649 DOI: 10.1016/j.cct.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.
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Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Petros Koutrakis
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Choong-Min Kang
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Jack M Wolfson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Stephen T Ferguson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Carter R Petty
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Mihail Samnaliev
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan M Gaffin
- Boston Children's Hospital, Division of Respiratory Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peggy S Lai
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States
| | - Perdita Permaul
- Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, MA, United States
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Peter S Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, United States
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Kasey J Brennan
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Andrea A Baccarelli
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Diane R Gold
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, United States
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18
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Re-recruiting young adult women into a second follow-up study. Contemp Clin Trials Commun 2017; 5:160-167. [PMID: 29740632 PMCID: PMC5936695 DOI: 10.1016/j.conctc.2017.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/23/2016] [Accepted: 02/11/2017] [Indexed: 11/24/2022] Open
Abstract
Background Recruitment among young adults presents a unique set of challenges as they are difficult to reach through conventional methods. Purpose To describe our experience using both traditional and nontraditional methods in the re-recruitment of young adult women into the second follow-up study of the Trial of Activity for Adolescent Girls (TAAG). Methods 589 adolescent girls were re-recruited as 11th graders into TAAG 2. Re-recruitment efforts were conducted when they were between 22 and 23 years of age (TAAG 3). Facebook, email, postal mail, and telephone (call and text) were used. Descriptive statistics were used to summarize cohort characteristics. Discrete categorical variables were compared using Pearson chi-square or Fisher's exact test, while Wilcoxon rank sum or t-tests were calculated for continuous variables. Pearson's chi square test, analysis of variance, and the Kruskal-Wallis test were also used. Logistic regression was used to calculate adjusted models. Results All 589 cohort members were located and 479 (81.3%) were re-recruited. Participants who reported living in a two parent household or with their mothers only, and who did not perceive a lot of crime in their neighborhood were more likely to consent to participate in TAAG 3 (p = 0.047 and p = 0.008, respectively). Perceived neighborhood crime remained significant in the adjusted model (OR 0.48, 95% CI 0.25-0.90, p = 0.02). Early and late consenters differed by race/ethnicity (p = 0.015), household type (p = 0.001), and socioeconomic status (p = 0.005). In the adjusted model, Black participants were more likely to consent later than White participants (OR 1.83, 95% CI 1.07-3.13, p = 0.03). Conclusions A number of recruitment strategies and outreach attempts were needed to recruit young adult women into a follow-up study. Persistent efforts may be needed to recruit participants with race/ethnic diversity and lower socioeconomic status.
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19
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Berlin NL, Momoh AO, Qi J, Hamill JB, Kim HM, Pusic AL, Wilkins EG. Racial and ethnic variations in one-year clinical and patient-reported outcomes following breast reconstruction. Am J Surg 2017; 214:312-317. [PMID: 28215963 DOI: 10.1016/j.amjsurg.2017.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/05/2017] [Accepted: 02/05/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Existing studies evaluating racial and ethnic disparities focus on describing differences in procedure type and the proportion of women who undergo reconstruction following mastectomy. This study seeks to examine racial and ethnic variations in clinical and patient-reported outcomes (PROs) following breast reconstruction. METHODS The Mastectomy Reconstruction Outcomes Consortium is an 11 center, prospective cohort study collecting clinical and PROs following autologous and implant-based breast reconstruction. Mixed-effects regression models, weighted to adjust for non-response, were performed to evaluate outcomes at one-year postoperatively. RESULTS The cohort included 2703 women who underwent breast reconstruction. In multivariable models, Hispanic or Latina patients were less likely to experience any complications and major complications. Black or African-American women reported greater improvements in psychosocial and sexual well-being. CONCLUSIONS Despite differences in pertinent clinical and socioeconomic variables, racial and ethnic minorities experienced equivalent or better outcomes. These findings provide reassurance in the context of numerous racial and ethnic health disparities and build upon our understanding of the delivery of surgical care to women with or at risk for developing breast cancer.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Adeyiza O Momoh
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Ji Qi
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer B Hamill
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Edwin G Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
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20
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Ward DS, Vaughn AE, Burney RV, Østbye T. Recruitment of Family Child Care Homes for an Obesity Prevention Intervention Study. Contemp Clin Trials Commun 2016; 3:131-138. [PMID: 27617326 PMCID: PMC5013830 DOI: 10.1016/j.conctc.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Critical to the success of any intervention study is successful recruitment. The aim of this paper was to examine the recruitment process of a randomized controlled trial evaluating an intervention conducted with family child care home providers. Specifically, the recruitment challenges, the efforts employed to address the challenges, and their impact on participant recruitment are discussed. METHODS The study's original recruitment protocol was employed during waves 1 and 2 (out of 5). However, recruitment tracking showed a failure to meet enrollment targets, particularly in wave 2. Low enrollment prompted an all-day retreat to discuss potential revisions and enhancements to recruitment strategies. Four strategies to enhance the recruitment protocol emerged from the retreat: improving recruitment materials to enhance communication, increasing engagement with community partners, addressing provider concerns about participation and study burden, and facilitating parent engagement. RESULTS The study successfully recruited 166 family child care home providers across the 5 waves. There was a significant impact on the recruitment of waves 3-5 versus waves 1-2 using the enhanced recruitment protocol. There was a dramatic increase in those who "consented" (43% vs. 60%, respectively) and a corresponding decrease in the percent of "interested and eligible" who then "failed to consent" (57% vs. 40%, respectively). CONCLUSION Results of these enhanced recruitment strategies demonstrate the many lessons learned about successful recruitment of a difficult-to-reach population, family child care homes; specifically, the importance of building relationships, communicating clearly, and identifying key motivators.
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Affiliation(s)
- Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2207 McGavran-Greenberg Hall, CB 7461, Chapel Hill, NC 27599-7461, USA
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA
| | - Regan V Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main St., Suite 600, Room 621, DUMC Box 104006, Durham, NC 27705
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21
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Buchholz SW, Wilbur J, Schoeny ME, Fogg L, Ingram DM, Miller A, Braun L. Retention of African American Women in a Lifestyle Physical Activity Program. West J Nurs Res 2015; 38:369-85. [PMID: 26475680 DOI: 10.1177/0193945915609902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the article is to examine how well individual characteristics, neighborhood characteristics, and intervention participation predict study retention and staff level of effort needed for retention, using a cohort of African American women enrolled in a physical activity program. Secondary data analysis was conducted from a randomized clinical trial. Participants were aged 40 to 65 years without major signs/symptoms of cardiovascular disease. Assessments were conducted at community sites in/bordering African American communities. Study retention was 90%. Of those retained, 24% required moderate/high level of staff effort for retention. Retention was predicted by being older, having lower perceived neighborhood walkability, living in neighborhoods with greater disadvantage and crime, and having greater program participation. More staff effort was predicted by participants being younger, having more economic hardships, poorer health, or lower intervention participation. We may be able to identify people at baseline likely to require more staff effort to retain.
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Affiliation(s)
| | | | | | - Louis Fogg
- Rush University, College of Nursing, Chicago, IL, USA
| | | | - Arlene Miller
- Rush University, College of Nursing, Chicago, IL, USA
| | - Lynne Braun
- Rush University, College of Nursing, Chicago, IL, USA
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22
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Palmer VJ, Chondros P, Piper D, Callander R, Weavell W, Godbee K, Potiriadis M, Richard L, Densely K, Herrman H, Furler J, Pierce D, Schuster T, Iedema R, Gunn J. The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting. BMJ Open 2015; 5:e006688. [PMID: 25805530 PMCID: PMC4386225 DOI: 10.1136/bmjopen-2014-006688] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. METHODS An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. ETHICS AND DISSEMINATION The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry ACTRN12614000457640.
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Affiliation(s)
- Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Donella Piper
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Rosemary Callander
- Carer Research and Evaluation Unit, Tandem Representing Victorian Mental Health Carers, Abbotsford, Victoria, Australia
| | - Wayne Weavell
- Consumer Research and Evaluation Unit, Victorian Mental Illness Awareness Council, East Brunswick, Victoria, Australia
| | - Kali Godbee
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Maria Potiriadis
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Lauralie Richard
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Konstancja Densely
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - David Pierce
- Rural Health Academic Centre, Melbourne Medical School, The University of Melbourne, Ballarat, Victoria, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Rick Iedema
- School of Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
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Huffaker M, Phipatanakul W. Introducing an environmental assessment and intervention program in inner-city schools. J Allergy Clin Immunol 2014; 134:1232-1237. [PMID: 25441649 DOI: 10.1016/j.jaci.2014.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
Home-based environmental interventions have demonstrated clinical benefit for children with asthma. Although much is known about school-based exposures, few studies have comprehensively examined the role the school environment plays in asthma and how effectively changing the environment might reduce morbidity when adjusting for exposures in the home. This review summarizes the importance and common challenges of school-based environmental assessment and intervention studies linked to health effects. We focus on the key components of study development and the challenges and benefits to implementation.
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Affiliation(s)
- Michelle Huffaker
- Brigham and Women's Hospital, Boston, Mass; Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Idoko OT, Owolabi OA, Odutola AA, Ogundare O, Worwui A, Saidu Y, Smith-Sanneh A, Tunkara A, Sey G, Sanyang A, Mendy P, Ota MOC. Lessons in participant retention in the course of a randomized controlled clinical trial. BMC Res Notes 2014; 7:706. [PMID: 25298043 PMCID: PMC4200120 DOI: 10.1186/1756-0500-7-706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are increasingly being conducted as new products seek to enter the market. Deployment of such interventions is based on evidence obtained mainly from the gold standard of randomized controlled clinical trials (RCCT). A crucial factor in the ability of RCCTs to provide credible and generalisable data is sample size and retention of the required number of subjects at completion of the follow-up period. However, recruitment and retention in clinical trials are hindered by prevalent peculiar challenges in Africa that need to be circumvented. This article shares experiences from a phase II trial that recorded a high retention rate at 14 months follow-up at a new clinical trial site. METHODS Mothers bringing children less than two months of age to the health facility were given information and invited to have their child enrolled if the inclusion criteria were fulfilled. Participants were enrolled over 8 months. Trial procedures, duration and risks/benefits were painstakingly and sequentially explained to the communities, parents and relevant relatives before and during the trial period. The proportions of participants that completed or did not complete the trial were analyzed including the reasons for failure to complete all trial procedures. RESULTS 1044 individuals received information regarding the trial of which 371 returned for screening. 300 (81%) of them who fulfilled the inclusion criteria and did not meet any exclusion criteria were enrolled and 94% of these completed the trial. Consent withdrawal was the main reason for not completing the trial largely (75%) due to the father not being involved at the point of consenting or parents no longer being comfortable with blood sampling. CONCLUSIONS Participant retention in clinical trials remains a crucial factor in ensuring generalisability of trial data. Appropriate measures to enhance retention should include continuous community involvement in the process, adequate explanation of trial procedures and risks/benefits; and innovative tracing of participants adapted for the setting.
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25
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Carlson M, Jackson J, Mandel D, Blanchard J, Holguin J, Lai MY, Marterella A, Vigen C, Gleason S, Lam C, Azen S, Clark F. Predictors of retention among African American and Hispanic older adult research participants in the Well Elderly 2 randomized controlled trial. J Appl Gerontol 2014; 33:357-82. [PMID: 24652865 DOI: 10.1177/0733464812471444] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to document predictors of long-term retention among minority participants in the Well Elderly 2 Study, a randomized controlled trial of a lifestyle intervention for community-dwelling older adults. The primary sample included 149 African American and 92 Hispanic men and women aged 60 to 95 years, recruited at senior activity centers and senior residences. Chi-square and logistic regression procedures were undertaken to examine study-based, psychosocial and health-related predictors of retention at 18 months following study entry. For both African Americans and Hispanics, intervention adherence was the strongest predictor. Retention was also related to high active coping and average (vs. high or low) levels of activity participation among African Americans and high social network strength among Hispanics. The results suggest that improved knowledge of the predictors of retention among minority elders can spawn new retention strategies that can be applied at individual, subgroup, and sample-wide levels.
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Affiliation(s)
- Mike Carlson
- University of Southern California, Los Angeles, CA, USA
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26
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Brueton VC, Tierney J, Stenning S, Harding S, Meredith S, Nazareth I, Rait G. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2013:MR000032. [PMID: 24297482 PMCID: PMC4470347 DOI: 10.1002/14651858.mr000032.pub2] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Loss to follow-up from randomised trials can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to reduce loss to follow-up and improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention on the proportion of participants retained in randomised trials and to investigate if the effect varied by trial strategy and trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, EMBASE, PsycINFO, DARE, CINAHL, Campbell Collaboration's Social, Psychological, Educational and Criminological Trials Register, and ERIC. We handsearched conference proceedings and publication reference lists for eligible retention trials. We also surveyed all UK Clinical Trials Units to identify further studies. SELECTION CRITERIA We included eligible retention trials of randomised or quasi-randomised evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We contacted authors to supplement or confirm data that we had extracted. For retention trials, we recorded data on the method of randomisation, type of strategy evaluated, comparator, primary outcome, planned sample size, numbers randomised and numbers retained. We used risk ratios (RR) to evaluate the effectiveness of the addition of strategies to improve retention. We assessed heterogeneity between trials using the Chi(2) and I(2) statistics. For main trials that hosted retention trials, we extracted data on disease area, intervention, population, healthcare setting, sequence generation and allocation concealment. MAIN RESULTS We identified 38 eligible retention trials. Included trials evaluated six broad types of strategies to improve retention. These were incentives, communication strategies, new questionnaire format, participant case management, behavioural and methodological interventions. For 34 of the included trials, retention was response to postal and electronic questionnaires with or without medical test kits. For four trials, retention was the number of participants remaining in the trial. Included trials were conducted across a spectrum of disease areas, countries, healthcare and community settings. Strategies that improved trial retention were addition of monetary incentives compared with no incentive for return of trial-related postal questionnaires (RR 1.18; 95% CI 1.09 to 1.28, P value < 0.0001), addition of an offer of monetary incentive compared with no offer for return of electronic questionnaires (RR 1.25; 95% CI 1.14 to 1.38, P value < 0.00001) and an offer of a GBP20 voucher compared with GBP10 for return of postal questionnaires and biomedical test kits (RR 1.12; 95% CI 1.04 to 1.22, P value < 0.005). The evidence that shorter questionnaires are better than longer questionnaires was unclear (RR 1.04; 95% CI 1.00 to 1.08, P value = 0.07) and the evidence for questionnaires relevant to the disease/condition was also unclear (RR 1.07; 95% CI 1.01 to 1.14). Although each was based on the results of a single trial, recorded delivery of questionnaires seemed to be more effective than telephone reminders (RR 2.08; 95% CI 1.11 to 3.87, P value = 0.02) and a 'package' of postal communication strategies with reminder letters appeared to be better than standard procedures (RR 1.43; 95% CI 1.22 to 1.67, P value < 0.0001). An open trial design also appeared more effective than a blind trial design for return of questionnaires in one fracture prevention trial (RR 1.37; 95% CI 1.16 to 1.63, P value = 0.0003).There was no good evidence that the addition of a non-monetary incentive, an offer of a non-monetary incentive, 'enhanced' letters, letters delivered by priority post, additional reminders, or questionnaire question order either increased or decreased trial questionnaire response/retention. There was also no evidence that a telephone survey was either more or less effective than a monetary incentive and a questionnaire. As our analyses are based on single trials, the effect on questionnaire response of using offers of charity donations, sending reminders to trial sites and when a questionnaire is sent, may need further evaluation. Case management and behavioural strategies used for trial retention may also warrant further evaluation. AUTHORS' CONCLUSIONS Most of the retention trials that we identified evaluated questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. Monetary incentives and offers of monetary incentives increased postal and electronic questionnaire response. Some other strategies evaluated in single trials looked promising but need further evaluation. Application of the findings of this review would depend on trial setting, population, disease area, data collection and follow-up procedures.
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Affiliation(s)
| | - Jayne Tierney
- Meta-analysis Group, MRC Clinical Trials Unit at UCLLondon, UK
| | | | - Seeromanie Harding
- Social and Public Health Sciences Unit, Medical Research CouncilGlasgow, UK
| | | | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
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27
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Ezell JM, Saltzgaber J, Peterson E, Joseph CLM. Reconnecting with urban youth enrolled in a randomized controlled trial and overdue for a 12-month follow-up survey. Clin Trials 2013; 10:775-82. [PMID: 23983157 DOI: 10.1177/1740774513498320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Retention of study participants in randomized controlled trials (RCTs) is crucial to study validity. PURPOSE We analyzed the results of four retention strategies used to reconnect with urban teens enrolled in a school-based RCT and overdue for a 12-month follow-up survey. METHODS Traditional retention strategies used to reconnect with teens categorized as 'unable to contact' were weekly redials of nonworking telephone numbers and mailings to the student's home. Nontraditional retention strategies were obtaining assistance from school administration and performing outreach on Facebook. RESULTS Of the 422 students enrolled, 125 (29.5%) were overdue for a 12-month follow-up survey, but had no working telephone number (unable to contact). We made 196 attempts to contact these 125 students, of which 82 attempts (41.8%) were successful in 'reconnecting' with the student. Using 'mailed reminder letters' as the referent category, odds ratios (95% confidence intervals) for the association between the strategy used and reconnecting were 4.60 (1.8-11.8), 1.94 (1.01-3.73), and 2.91 (0.58-14.50), respectively, for telephone number redials, Facebook outreach, and school administration assistance. Of the 422 students, 380 (90%) ultimately completed the 12-month follow-up survey. LIMITATIONS Retention strategies were not applied hierarchically or systematically. We were unable to determine student preference for a particular strategy. Findings are likely only applicable to similar study populations. CONCLUSION A mix of traditional retention strategies and more contemporary methods was effective in reconnecting with urban teenagers enrolled in a school-based RCT and in controlling attrition during the 12-month follow-up survey period.
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Affiliation(s)
- Jerel M Ezell
- aDepartment of Public Health Sciences, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
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Yoshida S, Takano H, Nishikawa M, Miao H, Ichinose T. Effects of fetal exposure to urban particulate matter on the immune system of male mouse offspring. Biol Pharm Bull 2012; 35:1238-43. [PMID: 22863919 DOI: 10.1248/bpb.b110708] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Urban particulate matter (UPM) has been shown to have an aggravating effect on Th2-associated immune systems in adult mice. However, the effects of fetal exposure to UPM on immune response in offspring have not been elucidated. In the present study, we administered UPM (200 µg/animal) by intratracheal injection to pregnant dams on days 7 and 14 of gestation. Subsequently, 9- and 24-week-old male offspring were intratracheally injected with ovalbumin (OVA) (four times at 2-week intervals) to create a mouse model of bronchial asthma. We then evaluated the progression of allergic manifestations in the offspring through histological findings, the number of inflammatory cells in bronchoalveolar lavage fluid (BALF), and protein concentration of cytokines and chemokines in BALF 5, 10, 15, and 30 weeks after birth. Histological examination showed that fetal exposure to UPM alone caused slight eosinophil and lymphocyte infiltration in the submucosa of the airway and bronchial epithelium and significant increases in the number of macrophages. Moreover, postnatal intratracheal administration of OVA to offspring exposed to UPM in utero caused significant increases in the numbers of macrophages, eosinophils, and lymphocytes and in the concentrations of their relevant cytokines and chemokines, showing that fetal exposure to UPM aggravated the chemically sensitized immune system of male offspring.
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Affiliation(s)
- Seiichi Yoshida
- Department of Health Sciences, Oita University of Nursing and Health Sciences, Japan.
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29
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Kramer JR, Bayless ML, Lorenzi GM, Ziegler GK, Larkin ME, Lackaye ME, Harth J, Diminick LJ, Anderson KL, Braffett BH, Cleary PA. Participant characteristics and study features associated with high retention rates in a longitudinal investigation of type 1 diabetes mellitus. Clin Trials 2012; 9:798-805. [PMID: 23027646 DOI: 10.1177/1740774512458986] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study has sustained an extraordinarily high level of participant involvement for over two decades. PURPOSE In order to identify specific characteristics of EDIC that contributed most strongly to retention, study-designed questionnaires were distributed to 1334 participants. METHODS Confidential questionnaires were completed during EDIC Years 15-17. Participants were classified as Completely Adherent (completed all visits), Partly Adherent (missed >1 visit or major portion of a visit), or Inactive (did not participate for >5 years). Questionnaire items addressed specific aspects of clinic visits, evaluation procedures, staff-participant relationships, and medical/health-care support provided by EDIC. RESULTS The most commonly cited reasons for continuing participation were Cutting Edge Tests to assess diabetes complications (79.3%), Annual Evaluations (67.7%), a desire to Help Others (65.2%), and Better Care for Diabetes (61.6%). Women chose Cutting Edge Tests as their first or second most important reason significantly more often than men, whereas men chose Better Care for Diabetes more frequently. Individuals with at least three diabetes-related complications were more likely than those with fewer complications to choose Annual Evaluations as their first or second reason for continued involvement. LIMITATIONS The small proportion of individuals who discontinued participation restricted our ability to identify factors associated with suspended involvement. In addition, our analysis is limited to a cohort with type 1 diabetes followed in an observational study after an average participation time of 6.5 years in a randomized trial. CONCLUSIONS The primary reasons identified by respondents for their long-term commitment are consistent with shorter-term studies and underscore the importance of expert medical care, supportive staff-participant relationships, and involvement with clinically and scientifically meaningful research.
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Affiliation(s)
- John R Kramer
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, 52242-1000, USA.
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Jandorf L, Stossel LM, Cooperman JL, Graff Zivin J, Ladabaum U, Hall D, Thélémaque LD, Redd W, Itzkowitz SH. Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer 2012; 119:612-20. [PMID: 22833205 DOI: 10.1002/cncr.27759] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/08/2012] [Accepted: 06/27/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patient navigation (PN) is being used increasingly to help patients complete screening colonoscopy (SC) to prevent colorectal cancer. At their large, urban academic medical center with an open-access endoscopy system, the authors previously demonstrated that PN programs produced a colonoscopy completion rate of 78.5% in a cohort of 503 patients (predominantly African Americans and Latinos with public health insurance). Very little is known about the direct costs of implementing PN programs. The objective of the current study was to perform a detailed cost analysis of PN programs at the authors' institution from an institutional perspective. METHODS In 2 randomized controlled trials, average-risk patients who were referred for SC by primary care providers were recruited for PN between May 2008 and May 2010. Patients were randomized to 1 of 4 PN groups. The cost of PN and net income to the institution were determined in a cost analysis. RESULTS Among 395 patients who completed colonoscopy, 53.4% underwent SC alone, 30.1% underwent colonoscopy with biopsy, and 16.5% underwent snare polypectomy. Accounting for the average contribution margins of each procedure type, the total revenue was $95,266.00. The total cost of PN was $14,027.30. Net income was $81,238.70. In a model sample of 1000 patients, net incomes for the institutional completion rate (approximately 80%), the historic PN program (approximately 65%), and the national average (approximately 50%) were compared. The current PN program generated additional net incomes of $35,035.50 and $44,956.00, respectively. CONCLUSIONS PN among minority patients with mostly public health insurance generated additional income to the institution, mainly because of increased colonoscopy completion rates.
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Affiliation(s)
- Lina Jandorf
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA.
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31
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Hughes S, Harris J, Flack N, Cuffe RL. The statistician's role in the prevention of missing data. Pharm Stat 2012; 11:410-6. [PMID: 22807372 DOI: 10.1002/pst.1528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/02/2012] [Accepted: 06/18/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sara Hughes
- Clinical Statistics; GSK Research & Development; Stockley Park West Uxbridge UB11 1BT UK
| | - Julia Harris
- Infectious Diseases Statistics; GSK Research & Development; Stockley Park West Uxbridge UB11 1BT UK
| | - Nancy Flack
- Center for Project and Study Excellence; GSK Research and Development; Research Triangle Park NC 27709 USA
| | - Robert L. Cuffe
- Statistics; ViiV Healthcare; 980 Great West Road Brentford TW8 9GS UK
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32
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Marcus PM, Childs J, Gahagan B, Gren LH. Tracking and tracing of participants in two large cancer screening trials. Contemp Clin Trials 2012; 33:601-5. [PMID: 22561392 PMCID: PMC3361574 DOI: 10.1016/j.cct.2012.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 04/02/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Many clinical trials rely on participant report to first learn about study events. It is therefore important to have current contact information and the ability to locate participants should information become outdated. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and the Lung Screening Study (LSS) component of the National Lung Screening Trial, two large randomized cancer screening trials, enrolled almost 190,000 participants on whom annual contact was necessary. Ten screening centers participated in both trials. Centers developed methods to track participants and trace them when necessary. We describe the methods used to keep track of participants and trace them when lost, and the extent to which each method was used. METHODS Screening center coordinators were asked, using a self-administered paper questionnaire, to rate the extent to which specific tracking and tracing methods were used. RESULTS Many methods were used by the screening centers, including telephone calls, mail, and internet searches. The most extensively used methods involved telephoning the participant on his or her home or cell phone, or telephoning a person identified by the participant as someone who would know about the participant's whereabouts. Internet searches were used extensively as well; these included searches on names, reverse-lookup searches (on addresses or telephone numbers) and searches of the Social Security Death Index. Over time, the percentage of participants requiring tracing decreased. CONCLUSIONS Telephone communication and internet services were useful in keeping track of PLCO and LSS participants and tracing them when contact information was no longer valid.
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Affiliation(s)
- Pamela M. Marcus
- National Cancer Institute, 6130 Executive Blvd, Room 4106, Bethesda, MD 20892-7344, USA
| | - Jeffery Childs
- University of Utah, 391 Chipeta Way, Suite A, Salt Lake City UT 84108, USA
| | - Betsy Gahagan
- University of Pittsburgh, Suite 4C - CPAV, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Lisa H. Gren
- University of Utah, 391 Chipeta Way, Suite A, Salt Lake City UT 84108, USA
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Trask C, Mathiassen SE, Wahlström J, Heiden M, Rezagholi M. Data collection costs in industrial environments for three occupational posture exposure assessment methods. BMC Med Res Methodol 2012; 12:89. [PMID: 22738341 PMCID: PMC3439320 DOI: 10.1186/1471-2288-12-89] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background Documentation of posture measurement costs is rare and cost models that do exist are generally naïve. This paper provides a comprehensive cost model for biomechanical exposure assessment in occupational studies, documents the monetary costs of three exposure assessment methods for different stakeholders in data collection, and uses simulations to evaluate the relative importance of cost components. Methods Trunk and shoulder posture variables were assessed for 27 aircraft baggage handlers for 3 full shifts each using three methods typical to ergonomic studies: self-report via questionnaire, observation via video film, and full-shift inclinometer registration. The cost model accounted for expenses related to meetings to plan the study, administration, recruitment, equipment, training of data collectors, travel, and onsite data collection. Sensitivity analyses were conducted using simulated study parameters and cost components to investigate the impact on total study cost. Results Inclinometry was the most expensive method (with a total study cost of € 66,657), followed by observation (€ 55,369) and then self report (€ 36,865). The majority of costs (90%) were borne by researchers. Study design parameters such as sample size, measurement scheduling and spacing, concurrent measurements, location and travel, and equipment acquisition were shown to have wide-ranging impacts on costs. Conclusions This study provided a general cost modeling approach that can facilitate decision making and planning of data collection in future studies, as well as investigation into cost efficiency and cost efficient study design. Empirical cost data from a large field study demonstrated the usefulness of the proposed models.
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Affiliation(s)
- Catherine Trask
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, SE-80176 Gävle, Sweden.
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Abstract
Compelling scientific evidence suggests that a strong association exists between housing-related hazards and the health and safety of their residents. Health, safety, and environmental hazards (such as asthma and allergy triggers), unintentional injury hazards, lead-based paint hazards, and poor indoor air quality are interrelated with substandard housing conditions. This article describes a Healthy Homes initiative to address these hazards in a coordinated fashion in the home, rather than taking a categorical approach, even in the presence of multiple hazards. It also provides an overview of Oklahoma's Healthy Homes initiative and its pilot project, the Tulsa Safe and Healthy Housing Project, which is currently administered in Tulsa in collaboration with Children First, Oklahoma's Nurse-Family Partnership program. This pilot project seeks to open new areas of research that can lead to a greater understanding of environmental health issues related to substandard housing in the United States, which will eventually make homes safer and healthier.
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Affiliation(s)
- Fahad Khan
- Oklahoma State Department of Health, Oklahoma Childhood Lead Poisoning Prevention Program, Oklahoma City, OK, 73117, USA.
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Schepens T, Morreel S, Florence E, Koole O, Colebunders R. Incidence and risk factors associated with lost to follow-up in a Belgian cohort of HIV-infected patients treated with highly active antiretroviral therapy. Int J STD AIDS 2011; 21:765-9. [PMID: 21187359 DOI: 10.1258/ijsa.2010.010303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Being lost to follow-up (LTFU) is a major problem in caring for persons with HIV infection. We describe the proportions and characteristics of LTFU in a Belgian outpatient HIV clinic. All patients treated with highly active antiretroviral therapy (HAART) who attended at least two consultations were included. Patients not returning within the following year were considered LTFU. Multivariate analysis using logistic regression was performed. The LTFU rate was 5.5% on average and remained stable over the years. Patients LTFU were more often intravenous drug users (odds ratio [OR] = 3.48), not covered by health insurance (OR = 6.69), living outside the province (OR = 1.49) and treated with a complex initial HAART regimen (OR = 5.80). Increased age was also associated with a higher risk of LTFU. Patients at risk for LTFU after starting HAART should be the targeted for reinforced counselling and HIV treatment centres should establish systems to trace patients LTFU.
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Affiliation(s)
- T Schepens
- Epidemiology and Social Medicine, University of Antwerp, Belgium
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Hinnant JB, Elmore-Staton L, El-Sheikh M. Developmental trajectories of respiratory sinus arrhythmia and preejection period in middle childhood. Dev Psychobiol 2011; 53:59-68. [PMID: 20882584 DOI: 10.1002/dev.20487] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Autonomic nervous system (ANS) activity has been linked repeatedly to children's socioemotional and behavioral adaptive functioning and development, yet the literature on how various indexes of ANS activity develop in childhood is sparse. We utilized latent growth modeling to investigate the development of respiratory sinus arrhythmia (RSA), an established index of parasympathetic nervous system (PNS), and preejection period (PEP), a marker of sympathetic nervous system (SNS) influence on the heart, in children aged 8-10 years. At age 8, 251 children (128 girls, 123 boys; 162 European American, 89 African American) participated. Longitudinal data were collected during two additional waves when children were 9 and 10 years of age, with a 1-year lag between each wave. Children's RSA and PEP exhibited significant stability over time. Marginally significant variability was found among children in how RSA changed over time (slope), but there was no significant interindividual variability in PEP changes over development. A conditional growth curve model (i.e., one with predictor variables) showed that initial levels of RSA and PEP and the slope of RSA over time were predicted by several demographic factors including the child's sex and race; RSA of European American children showed significant increases over time while African American children had higher initial RSA but no significant change over time. Findings extend basic knowledge in developmental biopsychology and have implications for research focusing on ANS measures as important predictors, moderators, and mediators of childhood adaptation.
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Affiliation(s)
- J Benjamin Hinnant
- Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849, USA.
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Brueton VC, Rait G, Tierney J, Meredith S, Darbyshire J, Harding S, Stenning S, Nazareth I. Strategies to reduce attrition in randomised trials. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.mr000032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nicholson LM, Schwirian PM, Klein EG, Skybo T, Murray-Johnson L, Eneli I, Boettner B, French GM, Groner JA. Recruitment and retention strategies in longitudinal clinical studies with low-income populations. Contemp Clin Trials 2011; 32:353-62. [PMID: 21276876 DOI: 10.1016/j.cct.2011.01.007] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 01/05/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Conducting longitudinal research studies with low-income and/or minority participants present a unique set of challenges and opportunities. PURPOSE To outline the specific strategies employed to successfully recruit and retain participants in a longitudinal study of nutritional anticipatory guidance during early childhood, conducted with a low-income, ethnically diverse, urban population of mothers. METHODS We describe recruitment and retention efforts made by the research team for the 'MOMS' Study (Making Our Mealtimes Special). The 'multilayered' approach for recruitment and retention included commitment of research leadership, piloting procedures, frequent team reporting, emphasis on participant convenience, incentives, frequent contact with participants, expanded budget, clinical staff buy-in, a dedicated phone line, and the use of research project branding and logos. RESULTS Barriers to enrollment were not encountered in this project, despite recruiting from a low-income population with a large proportion of African-American families. Process evaluation with clinic staff demonstrated the perception of the MOMS staff was very positive. Participant retention rate was 75% and 64% at 6 months and 12 months post-recruitment, respectively. We attribute retention success largely to a coordinated effort between the research team and the infrastructure support at the clinical sites, as well as project branding and a dedicated phone line. CONCLUSIONS Successful participant recruitment and retention approaches need to be specific and consistent with clinical staff buy in throughout the project.
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Madson TJ, Cieslak KR, Gay RE. Joint Mobilization vs Massage for Chronic Mechanical Neck Pain: A Pilot Study to Assess Recruitment Strategies and Estimate Outcome Measure Variability. J Manipulative Physiol Ther 2010; 33:644-51. [DOI: 10.1016/j.jmpt.2010.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 08/05/2010] [Accepted: 08/11/2010] [Indexed: 11/25/2022]
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van der Waerden JEB, Hoefnagels C, Jansen MWJ, Hosman CMH. Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention. BMC Public Health 2010; 10:588. [PMID: 20920371 PMCID: PMC2965718 DOI: 10.1186/1471-2458-10-588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 10/05/2010] [Indexed: 11/23/2022] Open
Abstract
Background Recruitment, willingness to participate, and retention in interventions are indispensable for successful prevention. This study investigated the effectiveness of different strategies for recruiting and retaining low-SES women in depression prevention, and explored which sociodemographic characteristics and risk status factors within this specific target group are associated with successful recruitment and retention. Methods The process of recruitment, willingness to participate, and retention was structurally mapped and explored. Differences between women who dropped out and those who adhered to the subsequent stages of the recruitment and retention process were investigated. The potential of several referral strategies was also studied, with specific attention paid to the use of GP databases. Results As part of the recruitment process, 12.1% of the target population completed a telephone screening. The most successful referral strategy was the use of patient databases from GPs working in disadvantaged neighborhoods. Older age and more severe complaints were particularly associated with greater willingness to participate and with retention. Conclusions Low-SES women can be recruited and retained in public health interventions through tailored strategies. The integration of mental health screening within primary care might help to embed preventive interventions in low-SES communities.
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Zook PM, Jordan C, Adams B, Visness CM, Walter M, Pollenz K, Logan J, Tesson E, Smartt E, Chen A, D'Agostino J, Gern JE. Retention strategies and predictors of attrition in an urban pediatric asthma study. Clin Trials 2010; 7:400-10. [PMID: 20571137 DOI: 10.1177/1740774510373798] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Urban Environment and Childhood Asthma (URECA) study is a multicenter prospective birth cohort study designed to examine factors related to the development of childhood asthma and allergies in an inner-city population. The retention of these participants has been challenging due to high mobility, inconsistent phone service, custody issues, and stressful life situations. PURPOSE In this article, we describe the specific retention challenges we encountered during the first 2 years of follow-up in URECA and the strategies we utilized to address them. We also examine how selected maternal characteristics and other factors are related to retention and missed study visits. METHODS Strategies implemented to engage participants included: collecting updated and alternative contact information, after-hours phone calls to participants, culturally competent staff, flexible study event scheduling, clinic visit transportation, quarterly newsletters, retention events, drop-in home visits, and cell phone reimbursements. An internally developed web-based data management system enabled close monitoring by site teams and the coordinating center. The rate of deactivations was calculated using survival analysis. Characteristics of active and deactivated participants were compared using the chi-squared test with a Cochran-Mantel - Haenszel adjustment for study site. The proportion of missed visits of the total expected in the first 2 years was calculated and compared by family characteristics using an ANOVA model or a trend test controlling for study site. All analyses were performed using SAS version 9.1 (Cary, NC). RESULTS The 2-year retention rate was 89%. Participation in the first study event predicted subsequent engagement in study activities. Mothers who did not complete the first visit were more likely to miss future events (46.1% vs. 8.9%, p<0.0001) and to be deactivated (38.5% vs. 4.5%, p<0.0001). Mothers under 18 years of age were more likely to leave the study compared to older mothers (22.7% vs. 10.1%, p = 0.02). Also, mothers who were married missed fewer events than those not married (8.8% vs. 15.6%, p = 0.01). In addition, deactivations were more common when the child had entered daycare by 3 months of age (10.9% vs. 3.6%, p = 0.05). LIMITATIONS The URECA population is predominantly minority, thus our findings might not be generalizable to other populations. Furthermore, we may not be able to observe the effects that might exist in a more diverse population. For example, 86% of the mothers are unmarried, making it difficult to reliably examine the effect of marital status. CONCLUSION In research, successfully engaging and retaining participants is essential for achieving the study objectives. Identifying factors related to missed visits and deactivations are the initial step in recognizing the potential at-risk participants and can enable the design of targeted strategies to retain participants.
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Affiliation(s)
- Patricia M Zook
- Statistical and Clinical Coordinating Center - Rho Federal Systems Division, Inc., Chapel Hill, NC, USA.
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Leeman-Castillo B, Beaty B, Raghunath S, Steiner J, Bull S. LUCHAR: using computer technology to battle heart disease among Latinos. Am J Public Health 2009; 100:272-5. [PMID: 20019305 DOI: 10.2105/ajph.2009.162115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Many promising technology-based programs designed to promote healthy behaviors such as physical activity and healthy eating have not been adapted for use with diverse communities, including Latino communities. We designed a community-based health kiosk program for English- and Spanish-speaking Latinos. Users receive personalized feedback on nutrition, physical activity, and smoking behaviors from computerized role models that guide them in establishing goals in 1 or more of these 3 areas. We found significant improvements in nutrition and physical activity among 245 Latino program users; however, no changes were observed with respect to smoking behaviors. The program shows promise for extending the reach of chronic disease prevention and self-management programs.
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Mahabee-Gittens EM, Gordon JS, Krugh ME, Henry B, Leonard AC. A smoking cessation intervention plus proactive quitline referral in the pediatric emergency department: a pilot study. Nicotine Tob Res 2009; 10:1745-51. [PMID: 19023825 DOI: 10.1080/14622200802443494] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of adult tobacco users who utilize the emergency department as patients or parents is disproportionately higher than the national average rates of tobacco use. Thus, it is advised that the emergency department be utilized as a venue for providing tobacco cessation counseling to adult tobacco users. Using a randomized control trial design, this pilot study evaluated the effect of a brief tobacco cessation intervention for tobacco using parents of children brought to a pediatric emergency department. Participants received either usual care or a brief tobacco cessation intervention based on the first 2 of the 5A's of the Clinical Practice Guidelines and fax referral to the Quitline. The primary outcome was self-reported repeated point prevalence of tobacco use at 6 weeks and 3 months following the intervention. Secondary aims included number of quit attempts, increases in readiness to quit, comparisons of participants who were successfully retained, and contact rates by Quitline counselors. At 3-month follow-up, compared to the Usual Care Control group, intervention participants were more likely to have made at least one quit attempt (59% vs. 34%; p<.01), be seriously thinking about quitting (68% vs. 37%; p<.001), and have higher Ladder scores (6.2 vs. 5.3; p<.05). Study personnel were able to contact 68% and 52%, respectively, of participants at 6-week and 3-month follow-up. Quitline counselors were unable to reach 54% of participants. Our results reveal increased intentions to quit and trends toward quitting, however we experienced difficulties with participant retention. Suggestions for improvements in point prevalence and retention are given.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
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Predictors of study completion and withdrawal in a randomized clinical trial of a pediatric diabetes adherence intervention. Contemp Clin Trials 2009; 30:212-20. [PMID: 19470311 DOI: 10.1016/j.cct.2009.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 01/17/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE Loss of participants in randomized clinical trials threatens the validity of study findings. The purpose of this study was to determine pre-randomization predictors of study completion status throughout the course of a randomized clinical trial involving young children with type 1 diabetes and their primary caregivers. METHODS An intervention to improve adherence to the diabetes treatment regimen was delivered as part of the child's regular 3-month diabetes clinic visit. The study protocol involved 7 clinic visits across 18 months for the Immediate Treatment group and 9 clinic visits across 24 months for the Delayed Treatment group. Among those who completed the study and regardless of treatment group, participants were categorized into two groups: On-Time Completers (n=41) and Late Completers (n=39). Demographic, disease, and psychosocial characteristics of children and their primary caregivers measured prior to study randomization were tested for their association with the participants' completion status (i.e., On-Time Completers, Late Completers, or Withdrawals). RESULTS Of the 108 participants, 28 (25.9%) withdrew and 80 (74.1%) completed the study. On-Time Completers (i.e., study completed within 4 months of expected date) were more likely to have private insurance and primary caregivers with some college education. Late Completers (i.e., study completion took longer than 4 months) were more likely to be boys and to have primary caregivers who reported mild to moderate levels of depression. Children who subsequently withdrew from the study reported poorer diabetes-related quality of life and poorer school-related quality of life at study inception and were more likely to have primary caregivers who did not work outside the home. CONCLUSIONS Pre-randomization screening of participants on both demographic and psychological variables may help identify those at greatest risk for study withdrawal or poor study protocol adherence, permitting the investigators to develop retention strategies aimed at this high-risk group.
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Elder JP, Shuler L, Moe SG, Grieser M, Pratt C, Cameron S, Hingle M, Pickrel JL, Saksvig BI, Schachter K, Greer S, Bothwell EKG. Recruiting a diverse group of middle school girls into the trial of activity for adolescent girls. THE JOURNAL OF SCHOOL HEALTH 2008; 78:523-531. [PMID: 18808471 PMCID: PMC2764409 DOI: 10.1111/j.1746-1561.2008.00339.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND School-based study recruitment efforts are both time consuming and challenging. This paper highlights the recruitment strategies employed by the national, multisite Trial of Activity for Adolescent Girls (TAAG), a study designed to measure the effectiveness of an intervention to reduce the decline of physical activity levels among middle school-aged girls. TAAG provided a unique opportunity to recruit large cohorts of randomly sampled girls within 36 diverse middle schools across the United States. METHODS Key elements of the formative planning, coordination, and design of TAAG's recruitment efforts included flexibility, tailoring, and the use of incentives. Various barriers, including a natural disaster, political tension, and district regulations, were encountered throughout the recruitment process, but coordinated strategies and frequent communication between the 6 TAAG sites were helpful in tailoring the recruitment process at the 36 intervention and control schools. RESULTS Progressively refined recruitment strategies and specific attention to the target audience of middle school girls resulted in overall study recruitment rates of 80%, 85%, and 89%, for the baseline, posttest, and follow-up period, respectively. DISCUSSION The steady increase in recruitment rates over time is attributed to an emphasis on successful strategies and a willingness to modify less successful methods. Open and consistent communication, an increasingly coordinated recruitment strategy, interactive recruitment presentations, and participant incentives resulted in an effective recruitment campaign.
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Affiliation(s)
- John P. Elder
- Professor, (), Division of Health Promotion, Graduate School of Public Health, San Diego State University, San Diego, CA 92182
| | - LaVerne Shuler
- Research Associate/Program Manager, (), Health Sciences South Carolina, Columbia, SC 29201
| | - Stacey G. Moe
- Coordinator, (), Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454
| | - Mira Grieser
- Research Associate, (), Department of Kinesiology, College of Health and Human Performance, University of Maryland, College Park, MD 20742
| | - Charlotte Pratt
- Program Director, (), National Heart, Lung, and Blood Institute, Division of Prevention and Population Sciences, MSC 7936, Bethesda, MD 20892
| | - Sandra Cameron
- Recruitment and Measurement Coordinator, (), Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112
| | - Melanie Hingle
- Research Associate, (), Department of Nutritional Sciences, University of Arizona, PO Box 210093, Tucson, AZ 85721
| | - Julie L. Pickrel
- Project Manager, (), Center for Behavioral and Community Health Studies, Graduate School of Public Health, San Diego State University, San Diego, CA 92123
| | - Brit I. Saksvig
- Research Assistant Professor, (), Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, RM 2316, SPH Bldg, College Park, MD 20742
| | - Kenneth Schachter
- Professor, (), Division of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724
| | - Susan Greer
- Coordinator, (), Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC 27514
| | - Elizabeth K. Guth Bothwell
- Research Manager, (), Center for Behavioral and Community Health Studies, Graduate School of Public Health, San Diego State University, San Diego, CA 92123
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Fair AM, Wujcik D, Lin JMS, Egan KM, Grau AM, Zheng W. Timing is everything: methodologic issues locating and recruiting medically underserved women for abnormal mammography follow-up research. Contemp Clin Trials 2008; 29:537-46. [PMID: 18289943 DOI: 10.1016/j.cct.2008.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 12/21/2007] [Accepted: 01/10/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Recruiting underserved women in breast cancer research studies remains a significant challenge. We present our experience attempting to locate and recruit minority and medically underserved women identified in a Nashville, Tennessee public hospital for a mammography follow-up study. STUDY DESIGN The study design was a retrospective hospital-based case-control study. METHODS We identified 227 women (88 African-American, 65 Caucasian, 36 other minority, 38 race undocumented in the medical record) who had undergone screening mammography and received an abnormal result during 2003-2004. Of the 227 women identified, 159 women were successfully located with implementation of a tracking protocol and more rigorous attempts to locate the women using online directory assistance and public record search engines. Women eligible for the study were invited to participate in a telephone research survey. Study completion was defined as fully finishing the telephone survey. RESULTS An average of 4.6 telephone calls (range 1-19) and 2.7 months (range 1-490 days) were required to reach the 159 women contacted. Within three contact attempts, more cases were located than controls (61% cases vs. 49% controls, p=0.03). African-American women cases were four times likely to be recruited than African-American controls, (OR, 4.07; 95% CI, 1.59-10.30) (p=0.003). After 3 months of effort, we located 67% of African-American women, 63% of Caucasian women, and 56% of other minorities. Ultimately, after a maximum of 12 attempts to contact women, 77% of African-American women and 71% of Caucasian women were eventually found. Of these, 59% of African-American women, 69% Caucasian women, and 50% other minorities were located and completed the study survey for an overall response rate of 59%, 71%, and 47% respectively. CONCLUSIONS Data collection and study recruitment efforts were more challenging in racial and ethnic minorities. Continuing attempts to contact women may increase minority group study participation but does not guarantee retention or study completion.
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Affiliation(s)
- Alecia Malin Fair
- Department of Surgery, Meharry Medical College, 1005 Dr. D.B. Todd Boulevard, Nashville, TN 37208, USA.
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El-Khorazaty MN, Johnson AA, Kiely M, El-Mohandes AAE, Subramanian S, Laryea HA, Murray KB, Thornberry JS, Joseph JG. Recruitment and retention of low-income minority women in a behavioral intervention to reduce smoking, depression, and intimate partner violence during pregnancy. BMC Public Health 2007; 7:233. [PMID: 17822526 PMCID: PMC2020481 DOI: 10.1186/1471-2458-7-233] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 09/06/2007] [Indexed: 11/17/2022] Open
Abstract
Background Researchers have frequently encountered difficulties in the recruitment and retention of minorities resulting in their under-representation in clinical trials. This report describes the successful strategies of recruitment and retention of African Americans and Latinos in a randomized clinical trial to reduce smoking, depression and intimate partner violence during pregnancy. Socio-demographic characteristics and risk profiles of retained vs. non-retained women and lost to follow-up vs. dropped-out women are presented. In addition, subgroups of pregnant women who are less (more) likely to be retained are identified. Methods Pregnant African American women and Latinas who were Washington, DC residents, aged 18 years or more, and of 28 weeks gestational age or less were recruited at six prenatal care clinics. Potentially eligible women were screened for socio-demographic eligibility and the presence of the selected behavioral and psychological risks using an Audio Computer-Assisted Self-Interview. Eligible women who consented to participate completed a baseline telephone evaluation after which they were enrolled in the study and randomly assigned to either the intervention or the usual care group. Results Of the 1,398 eligible women, 1,191 (85%) agreed to participate in the study. Of the 1,191 women agreeing to participate, 1,070 completed the baseline evaluation and were enrolled in the study and randomized, for a recruitment rate of 90%. Of those enrolled, 1,044 were African American women. A total of 849 women completed the study, for a retention rate of 79%. Five percent dropped out and 12% were lost-to-follow up. Women retained in the study and those not retained were not statistically different with regard to socio-demographic characteristics and the targeted risks. Retention strategies included financial and other incentives, regular updates of contact information which was tracked and monitored by a computerized data management system available to all project staff, and attention to cultural competence with implementation of study procedures by appropriately selected, trained, and supervised staff. Single, less educated, alcohol and drug users, non-working, and non-WIC women represent minority women with expected low retention rates. Conclusion We conclude that with targeted recruitment and retention strategies, minority women will participate at high rates in behavioral clinical trials. We also found that women who drop out are different from women who are lost to follow-up, and require different strategies to optimize their completion of the study.
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Affiliation(s)
- M Nabil El-Khorazaty
- Statistics and Epidemiology Unit, RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD 20852-3903, US
| | - Allan A Johnson
- Division of Allied Health Sciences, College of Pharmacy, Nursing and Allied Health Sciences, Howard University, Washington, DC 20059, US
| | - Michele Kiely
- Collaborative Studies Unit, DESPR/NICHD/NIH, 6100 Executive Blvd., Rm 7B05, Rockville, MD 20852-7510, US
| | - Ayman AE El-Mohandes
- Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University Medical Center, 2175 K Street, NW, Washington, DC 20037, US
| | - Siva Subramanian
- Division of Neonatology, Georgetown University Hospital, 3800 Reservoir Road NW, Washington D.C. 20007, US
| | - Haziel A Laryea
- c/o Allan A. Johnson, Division of Allied Health Sciences, College of Pharmacy, Nursing and Allied Health Sciences, Howard University, Washington, DC 20059, US
| | | | - Jutta S Thornberry
- Statistics and Epidemiology Unit, Research Triangle InstituteInternational, 6110 Executive Blvd., Suite 902, Rockville, MD 20852-3903, US
| | - Jill G Joseph
- Center for Health Services and Community Research, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, US
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Villacorta V, Kegeles S, Galea J, Konda KA, Cuba JP, Palacios CFC, Coates TJ. Innovative approaches to cohort retention in a community-based HIV/STI prevention trial for socially marginalized Peruvian young adults. Clin Trials 2007; 4:32-41. [PMID: 17327244 PMCID: PMC2853960 DOI: 10.1177/1740774506075869] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The conduct of longitudinal clinical trials must involve effective strategies to retain study participants in order to ensure internal validity, adequate statistical power and generalizability of results. PURPOSE In a large trial in Peru, we implemented various retention strategies to maintain high participation rates over time. METHODS Novel participant retention strategies were used to follow highly marginalized populations for two years because traditional locator information, such as telephone numbers and official identification (eg, passport, driver's license, the local equivalent of a social security number) were often unreliable or unavailable. These strategies included detailed preliminary ethnographic research to identify the behaviours of key target groups, approaches to develop strong informal bonds between project staff and participants outside of study settings, and methods to enhance positive participant attitudes towards the study. RESULTS The overall study retention rate after two years was 84%, even though only 26% of the study populations supplied complete locator information (telephone, address and the names of two friends). LIMITATIONS The retention strategies used were labour intensive and iterative, which could prove difficult to replicate. CONCLUSIONS The two-year retention rate in this study was sufficient to maintain required sample sizes. The methods used to maintain contact with the populations were labour intensive, low tech and adequate for these populations and could be used to retain study participants in other marginalized, urban, low-income areas.
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Davis LL, Weaver M, Habermann B. Differential attrition in a caregiver skill training trial. Res Nurs Health 2006; 29:498-506. [PMID: 16977645 DOI: 10.1002/nur.20138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Participant attrition in randomized trials can reduce statistical power and bias outcomes. However, elective withdrawals are seldom discussed in trial reports. We examined factors associated with elective withdrawals for the first 131 Alzheimer's disease (AD) and Parkinson's disease (PD) caregiver participants that entered Project ASSIST (Assistance, Support and Self-health Initiated through Skill Training), an on-going trial of caregiver skill training interventions. After 20 months of recruitment, 14 (11%) of the 131 ASSIST participants had electively withdrawn before completing the final assessment. Survival analysis demonstrated AD caregivers and non-spousal caregivers dropped out earlier than PD and spousal caregivers, even after controlling for selected baseline covariates. Findings suggest caregiver trial contact strategies may need to be tailored to retain different caregiver groups.
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Wisniewski SR, Leon AC, Otto MW, Trivedi MH. Prevention of missing data in clinical research studies. Biol Psychiatry 2006; 59:997-1000. [PMID: 16566901 DOI: 10.1016/j.biopsych.2006.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 10/24/2005] [Accepted: 01/26/2006] [Indexed: 11/30/2022]
Abstract
Missing data is a problem that is ubiquitous to all clinical studies and a source of multiple problems from an analytic point of view (reduced statistical power, increased the type I error, bias) Statistical approaches have been developed to analyze data collected from trials with missing data. Understanding and implementing the appropriate statistical technique is essential but should be differentiated from preventive approaches that are designed to reduce rates of missing data In this article, we draw attention to these preventive efforts. Seven steps to minimizing the amount of missing data are defined as documentation, training, monitoring reports, patient contact, data entry and management, pilot studies, and communication. Although the implementation of these approaches is time consuming and costly, the overall quality of the study is increased. Despite efforts devoted to areas, no study is without missing data. Once the study is completed, it is essential to assess the pattern of missing data and apply the appropriate statistical analysis.
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Affiliation(s)
- Stephen R Wisniewski
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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