Thisarticlehighlightschallenges,successes,andlessonslearnedregardingrecruitmentandretentionofPWOAandtheirpartnersforacouple-focusedstudythatusedfourdistinctrecruitmentmethods,severalofwhichwerecommunitybased.Ithastwoobjectives:(1)todescribefourmethodsusedtorecruitcouples,and(2)tocontrastthesemethodsintermsoftheproportionofparticipantsthatcompletedtherecruitmentprocess,sampledemographiccomposition,retention,andrequiredresources.Ouroverarchinggoalistoinformbestpracticesforrecruitingpartnersintocouple-focusedOAinterventionstudiesand,potentially,otherstudiesofcouplesbyprovidingconcreterecommendationsbasedonpracticalissuesweexperiencedandlessonswelearned.
PALSusedfourapproachestorecruitcouplesinNorthCarolinacommunitiesnearUNCbetweenApril2014andNovember2015:(1)visitingcommunitysites,(2)sendingemailstoUNCaffiliates,(3)contactingpatientsidentifiedinUNChospitalelectronicmedicalrecords(EMRs),and(4)partneringwithanexistingOAlongitudinalresearchcohort.Onerecruitmentmethodwasusedtocontactparticipants,althoughitispossibleparticipantsmayhavelearnedaboutthestudythroughmultiplemethods.
Werecruitedcouplesatthreecontinuingcareretirementcommunities(CCRCs),fourpublicseniorcenters,andseveralcommunityeventsnearUNC.WemetwithCCRCadministrators,seniorcenterfacilityadministrators,andCCRCresidentresearchcommitteestogainapprovaltorecruitattheirsites.CCRCrepresentativesannouncedthestudyincorrespondencetoresidentsandthroughbulletinboardnotices.WeofferedpresentationsaboutOA,exercise,andthestudytointerestedgroupsattheCCRCs.Additionally,recruitmentatseniorcenterswasconductedinassociationwithexerciseclasses,withtheassistanceofon-sitephysicaltherapystaff,andateventssuchasearlyvotingandhealthfairs.
WeannouncedthestudytoUNCfaculty,staff,andstudentswhooptedtoreceivenoticesthroughtheuniversitymassemailsystem.Emailsdescribedthestudyeligibilitycriteria,compensation,contactinformation,institutionalreviewboardapproval,andstudyfunding.Interestedindividualscontactedthestudyteam.
WeusedtheEMRsoftheUNChospitalsystemtoidentifypotentialparticipantswhohadICD-9codesforOAorOAsymptoms,weremarried,andlivedwithin50milesofthestudysite.Theseindividualsweremailedrecruitmentlettersdescribingthestudy,andreceiveduptothreefollow-upphonecallstodeterminetheirinterestinparticipating.
WeapproachedPWOAfirst,obtainedconsentforscreening,andcompletedbriefscreeninginterviewsofapproximately20min.Forthosewhometeligibilitycriteriaandallowedustoapproachtheirpartners,weobtainedconsentforscreeningfrompartners,andcompletedbriefscreeninginterviews(10min).Mostscreeninginterviewswereconductedbyphone.Acouplewasconsideredenrolledafterprovidingconsentatthebaselinevisit,afterwhichtheyreceivedbaselinequestionnaires,accelerometers,andinstructions.
Eachparticipantearned$40afterattendinganALCandsubmittingtheirbaselineassessment;$20afterreturningmaterialsforFU1,FU2,andFU3;and$40forreturningmaterialsforFU4.Thus,incentivesforstudycompletionpotentiallytotaled$140perindividual.Additionally,participantsreceivedtotebags,pens,refreshments,brochuresaboutOAandPA,andworkbooksattheALC.
Eachrecruitmentmethodproducedchallengesforevaluatingthenumberofpotentiallyeligiblepeopleexposedtostudyinformation.Forcommunityrecruitment,wecouldnottrackthenumberofpeoplewholearnedofourstudybutdidnotcontactstaff.Byemail,weannouncedthestudytoapproximately7,000UNCfaculty,staff,andstudents,thoughwewereunabletodetermineifemailswereread.Emailsreachedabroadaudience,manyofwhomwerelikelyineligible(i.e.,peoplewithoutOA).ForEMRrecruitment,wemailedrecruitmentletterstoapproximately2,115patientswithstrongpotentialtobeeligibleaccordingtomedicalrecords.However,wecouldnotdeterminehowmanylettersreachedorwerereadbytheaddressees.Althoughweattemptedtophonepatients,wecannotknowwhetherthosewewereunabletocontactwereuninterestedorunreachableforotherreasons.FortheJoCocohort,wewereabletotrackallpotentialparticipantswhointeractedwithstudystaffandtheirstatus.
Acrossthefourrecruitmentmethods,nearlyallpartnersofeligiblePWOAconsentedtoscreeningandmeteligibilitycriteria.BecausethehighestproportionofeligiblePWOAwererecruitedbyemail,thehighestproportionofpartnerscompletingthesestepswaslikewiserecruitedbythismethod(screened44.2%,eligible44.2%).ThisproportionwashigherthantheproportionofpartnersscreenedandfoundeligiblefromEMRs(screened27.9%,p=0.0051;eligible27.6%,p=0.0043)andJoCo(screened22.8%,p=0.0004;eligible21.9%,p=0.0002)methods.
Of747potentialparticipantscontactedacrossallmethods,173couples(23.2%)enrolledinthestudy.Thelargestproportionofenrolledcoupleswasrecruitedbyemail(35.1%),followedbythecommunity(26%)andfromEMRs(22.0%).ThesmallestproportionwasrecruitedfromJoCo(19.6%).
Materialsincurredduringrecruitmentinvolvedprintingbrochures,flyers,screeningmaterials,andrecruitmentletters.Brochuresandflyerswereusedwiththecommunitymethodandwerepostedateachrecruitmentsite.PersonalizedletterswereusedfortheEMRmethod,whichincludedsuppliessuchaspaper,envelopes,mailinglabels,returnaddresslabels,andpostage.Emailrecruitmentrequiredtheleastmaterialsasthismethodonlyrequiredsendinganemail.
Theaccessibilityofrecruitmentmethodsalsovaried.TheuseoftheJoCodatabasetorecruitparticipantsrequirednotonlytheavailabilityofthecohort,butapprovalfromandcoordinationwiththeJoCostudyprincipalinvestigator.UsingEMRswaspossiblebecauseofouraffiliatedmedicalcenter,butrequiredIRBapprovalandaformaldatarequest.Similarly,theuseofauniversitymassemailsystemwaslimitedtouniversityaffiliatesandrequiredinstitutionalapproval.Communityrecruitmentoftenrequiredapprovalofofficialorunofficialgatekeepers,butgenerallyinvolvedfewerformalbarrierstoaccessandislikelytobemoreeasilyavailabletoresearchersatvarioustypesofinstitutions.Finally,theskillsandresourcesrequiredvariedacrossrecruitmentmethods.Communityrecruitmentwasuniqueinitsneedfortravelandin-personcontact.
Duringtheplanningstagesofourstudy,wefoundlimitedinformationregardingbestpracticesforrecruitingandretainingoldercouplesinresearchstudiesandnoinformationspecifictorecruitingcouplesintoOAstudies.However,employingfourdistinctrecruitmentapproachesallowedustomeetenrollmentgoalswhileprovidinganopportunitytocompareapproaches.Givensomedifferencesinthecharacteristicsofparticipantsrecruited,usingfourrecruitmentmethodsprovideduswithasamplethatrepresentedabroader,morediversecross-sectionofourpopulationofinterestthanusingonerecruitmentmethodwouldhaveoffered.
AfterPWOAexpressedinterestandweredeterminedtobeeligible,werecruitedmostpartners.Limitedpartnereligibilitycriterialikelycontributedtothehighproportionofeligiblepartners.SimilarnumbersofPWOAandpartnerscontinuedtoparticipatethroughoutthislongitudinalstudy,suggestingthatacouple-focusedapproachcanmaintainparticipationevenamongparticipantswhodonotexperiencetheconditionofinterest.EffortstoensurebothmembersofthecouplefeltimportanttothestudymayalsohavecontributedtoretentionofPWOAandpartners.
Recruitmentfromlocalsiteswasmorelabor-intensivethanotherapproachesduetothenumberofonsitemeetingsnecessarytobuildpartnershipsandobtainaccesstopotentialparticipants.Furthermore,additionalstafftimewasincurredtocreatetailoredpresentations.Tocombatthechallengeoflowenrollmentfromcommunitysites,wewidenedthegeographicscopeofthestudytoincludetwocountiesnotinitiallyconsidered.Thismethodyieldedlimitedoverallsuccessinrecruitmentinproportiontothelevelofstaffandmaterialresourcesrequired.
Theuseofamassemailtoolpresenteduniquechallengesandbenefits.Amajorlimitationofthismethodwasitsexclusionofcampuscommunitymemberswhodidnotopttoreceivemassemailmessages.Aftersendingemailmessages,staffspenttimefieldinginquiriesviaemailandphone.Thismethodyieldedoverallsuccessinrecruitment,especiallyinproportiontothelimitedeffortrequired.Includinggeneraleligibilitycriteriaandthestudydescriptioninemailsallowedrecipientstoconsiderifthestudysuitedthemwithoutdirectstaffcontact.
TheuseofEMRsallowedstafftoeasilyidentifypotentiallyeligibleindividualsbyfilteringdatawithuniqueinclusioncriteria.Evenso,seekingapprovaltoaccessprotectedhealthinformationandlearningtouseacomplexdatabaserequiredadditionalstafftime.Furthermore,becausetherehadbeennopriorcontactbystudypersonnel,wehadtoengageandeducatepotentialparticipantsaboutthestudyandhowtheyhadbeenidentifiedforrecruitment.Thismethodreachedalargenumberofpotentialparticipantsandresultedinsimilarrecruitmentoutcomesastheothermethods.
Workingwithanexistingcounty-basedresearchcohorthadthepotentialtobeanefficientrecruitmentstrategy;itallowedstudypersonneltoquicklyidentifyindividualswhowerelikelytomeetinclusioncriteriaandhadalreadydemonstratedwillingnesstoparticipateinresearch.However,onlyindividualswhoconsentedaprioritobecontactedaboutfutureresearchstudieswerecontacted,raisingconcernsaboutthegeneralizabilityoffindingstonon-volunteerpopulations.Inaddition,agreater-than-expectedproportionofpotentialparticipantsfromJoCowerenotinterestedinourstudy,andmanydidnotmeetourcomplexeligibilitycriteria.
RecruitmentanddatacollectionforthisstudywerecompletedunderthesupervisionofCR.DC,AP,CC,KE,MA,LC,SB,andCRconceivedofthispaper.DC,AP,andCCdraftedthepaperwithmajorsectioncontributionsandeditingofthemanuscriptfromKE,MA,LC,SB,andCR.Allauthorsapprovedthefinalversionofthismanuscript.
Theauthorsdeclarethattheresearchwasconductedintheabsenceofanycommercialorfinancialrelationshipsthatcouldbeconstruedasapotentialconflictofinterest.
ThePartnersinActiveLivingStudy(PALS)issupportedbytheNationalInstituteofArthritisandMusculoskeletalandSkinDiseasesMultidisciplinaryClinicalResearchCenter5P60AR064166awardedtotheUniversityofNorthCarolinaatChapelHillThurstonArthritisResearchCenter(PI:LeighCallahan).ProjectIDs:5104886and5104889.
PALSisalsosupportedbytheNationalCenterforAdvancingTranslationalSciences(NCATS),NationalInstitutesofHealth,throughGrantAwardNumberUL1TR001111.
ThecontentissolelytheresponsibilityoftheauthorsanddoesnotnecessarilyrepresenttheofficialviewsoftheNIH.
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Keywords:physicalactivity,arthritis,couples,aging,chronicdisease,recruitment,retention
Citation:CarthronDL,PhillipsA,CuthbertsonCC,EllisKR,AltpeterM,CallahanLF,BahorskiSandRiniC(2018)FourMethodsofRecruitingCouplesIntoaLongitudinalStudyofPhysicalActivityinPeopleWithOsteoarthritis:Recruitment,Retention,andLessonsLearned.Front.PublicHealth6:197.doi:10.3389/fpubh.2018.00197
Received:13April2018;Accepted:27June2018;Published:18July2018.
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*Correspondence:DanaL.Carthron,Y2FydGhybzFAbXN1LmVkdQ==
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