Recruitment strategies and challenges: Lessons learned from a coal ash and children's health study

Abstract

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal‐burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including “shoe leather” or door‐to‐door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well‐designed plan, it is important to re‐examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.

Nail Samples of Children Living near Coal Ash Storage Facilities Suggest Fly Ash Exposure and Elevated Concentrations of Metal(loid)s

“…53 Recruitment methods have been described. 54 In brief, to recruit participants that were representative of the study area population, Geographical Information Systems (GIS) methods, similar to those of Allpress et al (2008), were used. 55 The study area was stratified using five buffer zones at 2 mile intervals from the centroid of the straight line that connects the two power plants.…”

Proximity to coal-fired power plants and neurobehavioral symptoms in children

“…The final weakness of this study is that the participants we have recruited may be subject to spatial sampling errors or selection biases. Although we have used multiple recruitment strategies and did not highlight that this study was about neurobehavioral symptoms on recruitment materials, households who are more knowledgeable about coal ash or whose children have health problems may have been more likely to participate [ 47 , 55 ]. Therefore, future research should adopt more innovative strategies to improve the geographic and demographic coverage of participants recruitment, thus warranting a more holistic diagnosis of the detrimental impacts of coal ash on children’s neurobehavioral symptoms who live in proximity to coal-fired power plants.…”

“…1 ). These 20 sampling units cover an area of 157 square miles encompassing the southwestern portions of Jefferson and northern Bullitt counties in Kentucky [ 47 ]. Small portions of A4 and A5 (i.e., small areas located on the north side of the Ohio River) were excluded for sampling because they fall in the state of Indiana.…”

“…We used linear and nonlinear regression methods to investigate factors associated with neurobehavioral symptoms and employed global and local geospatial statistical methods to explore the geographical disparities in neurobehavioral symptoms among the children being surveyed. The data for this paper comes from a larger community-based study that is exploring the relationship between coal ash exposure and children’s health [ 31 , 47 ]. This is the first study to map hot spots of neurobehavioral symptoms in children in the vicinity of coal-fired power plants located in a large urban community.…”

Papers on research methods: The hidden gems of the research literature

“…The next two papers focus on recruitment. The first paper presents the challenges of recruiting participants in community‐based studies (Odoh et al, ). This study focused on the impact of coal ash from a power plant on the health of children living nearby.…”