Recruiting South Asians to a lifestyle intervention trial: experiences and lessons from PODOSA (Prevention of Diabetes & Obesity in South Asians)

Abstract

BackgroundDespite the growing emphasis on the inclusion of ethnic minority patients in research, there is little published on the recruitment of these populations especially to randomised, community based, lifestyle intervention trials in the UK.MethodsWe share our experience of recruitment to screening in the PODOSA (Prevention of Diabetes and Obesity in South Asians) trial, which screened 1319 recruits (target 1800) for trial eligibility. A multi-pronged recruitment approach was used. Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practices. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations. Participants were encouraged to refer friends and family throughout the recruitment period.ResultsHealth care professionals referred only 55 potential participants. The response to written invitations via general practitioners was 5.2%, lower than reported in other general populations. Community orientated, personal approaches for recruitment were comparatively effective yielding 1728 referrals (82%) to the screening stage.ConclusionsThe PODOSA experience shows that a community orientated, personal approach for recruiting South Asian ethnic minority populations can be successful in a trial setting. We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches. Researchers should consider prioritising approaches that minimise interference with professionals' work and, particularly in the current economic climate, keep costs to a minimum. The lessons learned in PODOSA should contribute to future community based trials in South Asians.Trial RegistrationCurrent Controlled Trials ISRCTN25729565

Recruitment challenges in a diabetes prevention trial in a low- and middle-income setting

“…Challenges of recruiting and sustaining high-risk populations for a primary prevention translational trial in India have never been reported and literature from elsewhere is scant [17][18][19]. For the interventions like the highly effective U.S. Diabetes Prevention Program (DPP) [1] to work in LMIC settings like India, the interventions will need to be generalized to all people with prediabetes, culturally modified, made low cost and sustainable and be conducted in a 'real-life' setting.…”

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation.

“…Gill et al (2011) 383 reported that there was an association between time spent sitting and the 2-hour PG, but not with fasting PG, among all people who were screened for possible inclusions. Douglas et al (2011) 384 reported on the difficulties of recruitment of this group through the usual channels such as GPs and diabetes registers, but noted that there was much greater success using community associations and encouraging recruits to bring in others ('snowballing').…”

“…The Prevention of Diabetes and Obesity in South Asians (PODOSA) study 383,384 has screened 1300 people of Indian and Pakistani origin for hyperglycaemia, and has recruited 170 at high risk to an intervention study of healthy eating and increasing physical activity. It is due to report in 2013 (see progress at www.podosa.org/progress.html).…”

Raising the issue of overweight and obesity with the South Asian community

“…6,7 Studies have shown that using the appropriate approaches can aid participation and involvement of different communities 8,9 in order to inform healthcare services, research, policies, and practice.…”