Recruiting worksites to participate in a health promotion research study

Innovative recruitment strategies for a comprehensive worksite wellness initiative

Recruiting for wellness initiatives is challenging. WorkWell KS, a statewide worksite wellness initiative, offers unique worksite recruitment strategies that may serve as lessons. From 2012 to 2018, WorkWell KS utilized champions, well-connected local leaders, to recruit worksites. A total of 784 worksites were recruited for at least one WorkWell KS workshop. A survey of champions requested identification of strategies, barriers and facilitators for successful recruitment and continued engagement. Forty-three champions reported on recruitment experiences. Sixty-three percent of respondents attributed recruitment success to having funding to complete their work. Face-to-face meetings was the most commonly reported successful strategy. Eighty-six percent of respondents reported that improving employee health was motivation for worksites to participate. Champions with a significant funding incentive for worksites commonly indicated that funding was a motivating factor. The most commonly selected factor for continued engagement was having a worksite staff member with wellness in their job description (67% of respondents). Forty-nine percent of respondents reported worksites' lack of time as a barrier to participation. The WorkWell KS initiative has implemented innovative recruitment methods that leverage well-connected leaders to recruit worksites to participate in a comprehensive worksite wellness initiative. Future worksite-based initiatives may benefit from adopting recruitment strategies presented here.

Comparing Strategies for Recruiting Small, Low-Wage Worksites for Community-Based Health Promotion Research

BACKGROUND

HealthLinks is a workplace health promotion program developed in partnership with the American Cancer Society. It delivers a package of evidence-based interventions and implementation support to small worksites in low-wage industries. As part of a randomized, controlled trial of HealthLinks, we studied approaches to recruiting these worksites.

AIMS

This study aims to guide future recruitment for community-based worksite health promotion interventions by comparing three approaches, including leveraging relationships with community partners.

METHOD

We recruited 78 small, low-wage worksites in King County, Washington, to participate in the trial via three approaches: phone calls to companies on a purchased list ("cold"), phone calls to a list of eligible companies provided by a health insurer ("lukewarm"), and personal referrals from local health insurers and brokers ("warm"). Eligible and interested worksites received an in-person visit from researchers and completed additional steps to enroll.

RESULTS

Of the worksites screened and deemed eligible, 32% of the "cold" worksites enrolled in HealthLinks, as did 48% and 60%, respectively, of the "lukewarm" and "warm" worksites. Compared with "warm" worksites, "cold" worksites were twice as likely to be ineligible.

DISCUSSION

Two distinct factors help explain why "warmer" worksites were more likely to enroll in HealthLinks. First, eligibility was significantly higher among warmer referrals. Second, most of the warm-referred worksites eligible for the study agreed to meet in person with the project team to hear more about the project.

CONCLUSIONS

"Warmer" recruitment approaches yielded higher recruitment. Leveraging relationships with community partners can help researchers identify and successfully recruit small, low-wage worksites.

Creating a Representative Sample of Small Manufacturing Businesses for an Integrated Workplace Safety and Smoking Cessation Intervention Study

OBJECTIVES

We aimed to recruit a representative sample of small manufacturing businesses (20 to 150 employees) for a group-randomized trial of an integrated workplace safety and smoking cessation program.

METHODS

An initial sample was drawn from commercial databases, screened for duplicates or ineligibility, and contacted. Participating and nonparticipating businesses were compared on size, location, and type. Employee demographics of participating businesses were compared to a US Census Bureau database of similar businesses.

RESULTS

From an initial sample of 2716 businesses, 328 were eligible and 47 (9%) agreed to participate. Participating companies tended to be larger. They were similar to employees in the Census Bureau dataset.

CONCLUSIONS

Considerable resources were required to identify eligible businesses; commercial databases are the best resource but may not be comprehensive or current. The sample seemed to be representative of small manufacturing businesses in the study region.

Organizational- and employee-level recruitment into a worksite-based weight loss study

BACKGROUND

Based on national estimates, the majority of working adults are overweight or obese. Overweight and obesity are associated with diminished health, productivity, and increased medical costs for employers. Worksite-based weight loss interventions are desirable from both employee and employer perspectives.

PURPOSE

To investigate organizational- and employee-level participation in a group-randomized controlled worksite-based weight loss trial.

METHODS

Using a set of inclusion criteria and pre-established procedures, we recruited worksites (and overweight/obese employees from enrolled worksites) from the North Carolina Community College System to participate in a weight loss study. Recruitment results at the worksite (organization) and employee levels are described, along with an assessment of representativeness.

RESULTS

Eighty-one percent (48/59) of community colleges indicated initial interest in participating in the weight loss study, and of those, 17 colleges were enrolled. Few characteristics distinguished enrolled community colleges from unenrolled colleges in the overall system. Eligible employees (n = 1004) at participating colleges were enrolled in the weight loss study. On average, participants were aged 46.9 years (SD = 12.1 years), had a body mass index (BMI) of 33.6 kg/m(2) (SD = 7.9 kg/m(2)), 83.2% were White, 13.3% African American, 82.2% female, and 41.8% reported holding an advanced degree (master's or doctoral degree). Compared with the larger North Carolina Community College employee population, participants most often were women, but few other differences were observed.

LIMITATIONS

Employees with reduced computer access may have been less likely to participate, and limited data on unenrolled individuals or colleges were available.

CONCLUSIONS

Community colleges are willing partners for weight loss intervention studies, and overweight/obese employees were receptive to joining a weight loss study offered in the workplace. The results from this study are useful for planning future worksite-based weight loss interventions and research studies that achieve high participation rates at the employee and organizational levels.

Worksite study promoting activity and changes in eating (PACE): design and baseline results

OBJECTIVE

Based on previous worksite-wide intervention studies and an ecological framework, we created a behavioral intervention program to maintain or reduce weight through healthy eating and physical activity. The design and evaluation plan of the group-randomized trial and the recruitment of worksites are described. Preliminary results regarding the dietary and physical activity behaviors associated with BMI are discussed.

RESEARCH METHODS AND PROCEDURES

The intervention used an ecological framework modified by qualitative methods that identified salient barriers and facilitators of behavioral change. Approximately 30 transportation, manufacturing, utilities, personal, household, and miscellaneous service companies in the greater Seattle area are being recruited to the trial. The study population for the present analysis consists of 18 worksites from the first two randomization waves. Dietary behavior was assessed, not by calories, but by behavioral measures related to BMI. Physical activity behaviors were surveyed. BMI is derived from reported height and weight at baseline.

RESULTS

The intervention has been developed with a specified minimum suite of strategies within the defined framework. Response rates to the baseline survey among the 18 worksites are 81% on average. After adjusting for age, gender, race, and education, BMI was associated with frequency of intensity-adjusted physical activity, sweat-inducing exercise, fast food meals, soft drinks, eating while doing another activity, and fruit and vegetable intake.

DISCUSSION

Worksite-wide intervention strategies can be adapted to target obesity prevention. Employees are willing to participate in surveys at high rates. Several measures of physical activity and eating choices are associated with baseline BMI.

Factors related to participatory employee advisory boards in small, blue-collar worksites

PURPOSE

To identify factors related to formation, participation, and characteristics of employee advisory boards (EABs) in blue-collar worksites.

DESIGN

This study used a nonexperimental qualitative design to assess EAB formation, activity, and enthusiasm levels and examined those factors relative to employee participation in worksite-wide health promotion activities.

SETTING

Twenty-two blue-collar worksites with a total of 113 EAB members in the greater Seattle area.

SUBJECTS

Individuals who agreed to serve on EABs in the intervention worksites.

INTERVENTION

Participants received training in involving employees in the 5-A-Day project intervention activities.

MEASURES

Measures include type of worksite, number of EAB members, method of EAB recruitment, and variables describing EAB functioning, including attendance at meetings, assistance at project activities, and level of enthusiasm.

RESULTS

All worksites formed EABs. There was no association between the way the EAB was formed and subsequent EAB attendance at meetings, participation in project activities, representativeness of the EAB, or level of EAB enthusiasm. Enthusiasm of the EAB was associated with employee participation, and EABs with a higher level of enthusiasm showed more participation by employees than worksites with less enthusiastic EABs.

CONCLUSIONS

It is possible to develop participatory structures in small, blue-collar worksites. More information is needed about factors related to levels of enthusiasm of EABs.

Design and analysis of group-randomized trials: a review of recent practices

We reviewed group-randomized trials (GRTs) published in the American Journal of Public Health and Preventive Medicine from 1998 through 2002 and estimated the proportion of GRTs that employ appropriate methods for design and analysis. Of 60 articles, 9 (15.0%) reported evidence of using appropriate methods for sample size estimation. Of 59 articles in the analytic review, 27 (45.8%) reported at least 1 inappropriate analysis and 12 (20.3%) reported only inappropriate analyses. Nineteen (32.2%) reported analyses at an individual or subgroup level, ignoring group, or included group as a fixed effect. Hence increased vigilance is needed to ensure that appropriate methods for GRTs are employed and that results based on inappropriate methods are not published.

Overcoming recruitment challenges in construction safety intervention research

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Challenges to improving the impact of worksite cancer prevention programs: comparing reach, enrollment, and attrition using active versus passive recruitment strategies

OBJECTIVE

The impact of worksite intervention studies is maximized when reach and enrollment are high and attrition is low. Differences in reach, enrollment, and retention were investigated by comparing 2 different employee recruitment methods for a home-based cancer-prevention intervention study.

METHODS

Twenty-two worksites (N = 10,014 employees) chose either active or passive methods to recruit employees into a home-based intervention study. Reach (e.g., number of employees who gave permission to be called at home), Enrollment (e.g., number of employees who joined the home intervention study), and Attrition (e.g., number who did not complete the 12- and 24-month follow-ups) were determined. Analysis at the cluster level assessed differences between worksites that selected active (n = 12) versus passive (n = 10) recruitment methods on key outcomes of interest. Employees recruited by passive methods had significantly higher reach (74.5% vs. 24.4% for active) but significantly lower enrollment (41% vs. 78%) and retention (54% vs. 70%) rates (all ps < .0001). Passive methods also successfully enrolled a more diverse, high-risk employee sample. Passive (vs. active) recruitment methods hold advantages for increased reach and the ability to retain a more representative employee sample. Implications of these results for the design of future worksite studies that involve multilevel recruitment methods are discussed.

Seattle 5 a Day worksite program to increase fruit and vegetable consumption

BACKGROUND

5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption.

METHODS

We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used.

RESULTS

The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention.

CONCLUSIONS

This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.

Seattle 5-a-Day Work-Site Project: process evaluation

The Seattle 5-a-Day Work-Site Project developed a community-based intervention to increase fruit and vegetable intake, using both environmental (including cafeteria and work-site-wide events) and individual strategies. The Employee Advisory Board developed its own protocol from a common skeleton and a minimum set of activities. Small work sites and work sites with fewer female employees delivered more displays, posters, and table tents per employee (p < .01 and p < .05, respectively). Dose was neither related to use of the intervention nor to change in fruit and vegetable intake. Use of informational materials increased fruit and vegetable intake in the cohort of employees with both baseline and follow-up data (p = .05). The intervention was associated both with increased employee use of the intervention (activities and materials) and with increased intake of fruit and vegetables. Work sites with medium average baseline intake were the most responsive. These findings can guide the development of more efficient community-based dietary interventions.