A Conceptual Framework for Barriers to the Recruitment and Retention of Rural CVD Participants in Behavior Intervention Trials

Abstract

Background-Rural residents diagnosed with cardiovascular disease (CVD) or with CVDrelated risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials.Objective-The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials.Methods-We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks.Results-We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients' intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. Conclusion and Implication of result-The findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.

Population-Level Reach of Cardiovascular Disease Prevention Interventions in a Rural Community: Findings from the Heart of New Ulm Project

“…Residents of rural and other underserved communities have been underrepresented in clinical trials of behavioral modification, and face several barriers to participation in research and health improvement initiatives. 20,21 The Heart of New Ulm (HONU) is a community-wide CVD prevention project implemented in a rural Minnesota community. 22,23 After 6 years of HONU implementation, CVD risk was lower in a cohort of New Ulm residents relative to a cohort of residents from a rural comparison community served by the same health system (matched on baseline demographics and CVD risk markers), suggesting moderate effectiveness for the HONU project.…”

Recruiting and Retaining Youth and Young Adults in the Policy and Communication Evaluation (PACE) Vermont Study: Randomized Controlled Trial of Participant Compensation

“…Similarly, 94% of young adults aged 18 to 29 years and 65% of adults in rural communities own a smartphone [ 20 ]. Adoption of web-based surveys for data collection is likely to appeal to young people, who grew up with computers and use them in virtually all aspects of their lives, while reducing transportation and other costs that serve as barriers to engaging in traditional clinical trials [ 21 - 24 ]. With respect to retaining young people in longitudinal studies, there was no clear recommendation on incentives to maximize retention, as previous studies had identified multiple means, including increasing participant payments, conducting sweepstakes, providing bonuses, and sending reminder postcards [ 25 - 28 ].…”

Recruiting and Retaining Youth and Young Adults in the Policy and Communication Evaluation (PACE) Vermont Study: Randomized Controlled Trial of Participant Compensation (Preprint)

“…Similarly, 94% of young adults aged 18 to 29 years and 65% of adults in rural communities own a smartphone [20]. Adoption of web-based surveys for data collection is likely to appeal to young people, who grew up with computers and use them in virtually all aspects of their lives, while reducing transportation and other costs that serve as barriers to engaging in traditional clinical trials [21][22][23][24]. With respect to retaining young people in longitudinal studies, there was no clear recommendation on incentives to maximize retention, as previous studies had identified multiple means, including increasing participant payments, conducting sweepstakes, providing bonuses, and sending reminder postcards [25][26][27][28].…”