Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study

Abstract

African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.

Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes

“…More details about recruitment are available elsewhere. 12 The study was approved by the Rush University Medical Center and Cook County Health and Hospitals System (CCHHS) Institutional Review Boards. All participants gave written informed consent.…”

A systematic review of recruitment and retention of ethnic minorities and migrants in obesity prevention randomised controlled trials

“…Of the 25 studies, majority of the studies were conducted in the USA (N = 23) [2, 3, 8-10, 13, 30-45] except 1 that was conducted in UK [46] and 1 in Australia [47]. Seven RCTs were exclusively conducted among Latino Americans [30,34,[38][39][40][41]44], 4 among African Americans [31,35,37,45], and 1 among Mexican descent immigrants in the USA [43] and 1 among Brazilian immigrants in the USA [11]; 3 RCTs combined Latino and African American population [8,33,36], 1 combined Hispanic and Latino population [32] and 1 combined Hispanic and non-Hispanic black population [3]. The remaining studies were a combination of populations from different ethnic backgrounds [2,9,10,13,42,46].…”

“…Four studies mentioned a lack of trust as a barrier to effective recruitment and retention of ethnic and migrant communities [2,10,30,35]. According to these studies, participants had a history of distrust with researchers particularly medical care and research, including previous experience of disrespect, poor quality of medical care and researchers not following through commitments.…”

“…Employing culturally sensitive strategies Eight of the 25 studies conducted with low-income ethnic minorities and migrants living in the US [2,10,11,33,35,40,43] and Australia [47] documented culturally sensitive strategies (e.g. cultural competency, recruiting bilingual and culturally sensitive staff, translating recruitment and study materials into participants' languages) as a critical facilitator of recruitment and retention of participants.…”

“…For example, a study with Brazilian immigrants in the US found that staff member's understanding of participants' sociocultural context and the application of linguistically and culturally sensitive recruitment strategies helped meet the needs of participants and facilitated their successful recruitment and enrolment [11]. Bilingual staff who were culturally competent and sensitive to participants were able to effectively deliver study materials and presentations in the participant's languages [2,10,33,35,40,43]. Such culturally sensitive strategies increased participants' recruitment and retention, in particular when bilingual and bicultural staff were provided with indepth training before recruiting participants in health research [40].…”