Abstract: Background: Childhood obesity is a growing global epidemic, with significant racial, ethnic and socioeconomic disparities. While current efforts to stem the tide of the obesity epidemic have focused on public policy and individual level behaviors, little research has been done on community and family-based health interventions. In this study, a novel design of personalized text messages allowed flexible participation while relaying key lifestyle information on six major contributing factors to obesity. The patient population served by the Pediatric Mobile Clinic has been known to be difficult to reach in part because of their diverse range of cultures and languages, lack of access to affordable healthcare, housing instability, phone service capabilities, and access to individualized health related information. The purpose of this sub-analysis was to identify the most efficient and effective recruitment methods in order to reach a broader subset of underserved patient populations.
Methods: Literature review and research study personnel experience informed the design and implementation of 6 recruitment styles to increase participant engagement, such as a tracking sheet, in-person discussions, phone call tree, text message, email prompts, and Electronic Medical Record review, which lead to a pre-screen questionnaire to determine eligibility for enrollment.
Results: 39 persons were screened in person whereas 338 were screened via phone call tree. Telephone calls produced more people enrolled per month because telephone call recruitment volume was much greater than in person recruitment. In person recruitment was most effective with 11 of the enrolled having been recruited in person vs 8 enrolled via telephone calls. 377 patients were pre-screened resulting in 19 participants enrolling in the study, which is a 5% enrollment rate. Enrolling people in-person may be beneficial because you are able to make a connection which results in a greater conversion of prospective patients to consented participants, albeit regular clinic duties may preclude these in-depth discussions. Phone calling results in greater volume but may not be as efficient. The largest prescreen failure group was due to English not being a patient's primary language.
Conclusions: Contacting patients multiple times via different forms of communication (Text message; email; voicemail) helped increase recruitment numbers. This may be due to the busy lives of families that preclude the time to discuss study participation in clinic or during traditional hours. Recruiting patients via multiple and diverse methods may be beneficial for enrollment, particularly with underserved patients who live busy lives and may not be as accessible during clinic or traditional 9-5 hours. Future studies should consider expanding their recruitment base by applying for IRB approval of materials in multiple languages. The recruitment methodology and findings from this unique and underserved patient population could potentially inform and shape future community and family-based e-health studies.
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