Recruitment of Mexican-American adults for a diabetes intervention trial

Objective:

Mexican-American adults suffer disproportionately high diabetes rates compared to non-Hispanic whites. New interventions are needed to correct this disparity. Limited intervention research targeting this population has resulted in a lack of consensus on the most effective recruitment methods for interventions. This presentation evaluates the multiple recruitment methods used in a diabetes trial with urban Mexican-American adults.

Methods:

The Mexican American Trial of Community Health Workers (MATCH) study is a NIH-funded randomized controlled trial testing the effectiveness of an intensive 36-visit behavioral intervention to improve disease self-management for Mexican-Americans with type 2 diabetes. 144 participants were needed for the 2-year trial. Initial eligibility criteria included: 1) Mexican heritage, 2) type 2 diabetes, 3) treatment with an oral diabetes medication, 4) residence in one of two zip code areas, 5) planned residence in the area for the 2-year study period, and 6) enrollment in a specific insurance plan. The insurer was intended to be the primary recruitment source.

Results:

Recruitment through the insurer resulted in only one randomized participant. Subsequent recruitment efforts included local advertising, presentations at churches and events, postings in clinics, partnerships with community providers, community health worker (CHW) outreach, and relaxation of inclusion criteria. Recruitment was completed in three years, two years longer than expected. CHW outreach, which resulted in 53% of randomized participants, proved to be the most effective recruitment method.

Conclusions:

Despite high prevalence rates and limited treatment options for Mexican-American adults with diabetes in the target community, recruitment for this behavioral intervention trial proved difficult. Researchers identified three key barriers to participation: the study intensity and duration, lack of financial incentives, and challenges in establishing trust with potential participants. Lessons learned from this trial will benefit future intervention research with this high-risk population.