Reaching the hard-to-reach: Lessons learned in promoting health of women with mobility impairments

Promoting Access to Health Services (PATHS) is a randomized controlled trial of the efficacy of a patient activation intervention to increase receipt of clinical preventive services among women with mobility impairments. Previous research in this area typically recruits a more affluent, educated and medically better-served sample. This presentation describes a recruitment methodology to reach “hard-to-reach” women, and the unanticipated characteristics of the resulting sample as observed from baseline survey data and interactions with intervention participants.

The recruitment strategy used enrollee rosters of Oregon's Medicaid provider and a durable medical equipment vendor within a geographically designated area in Oregon. Two rounds of mailings requesting interested recipients contact the intervention team were sent to women aged 35 – 64 identified with mobility impairments. Women who were not current with recommended guidelines for regular mammography, Papanicolou tests, and/or clinician weight checks were eligible for the study.

Baseline survey results indicate that participants (n=144) report very low incomes (65.7% annual family income < 10,000), education levels (52.5% ≤ high school graduate), and experience very high rates of obesity (60% with BMI > 30; 38% with BMI > 40).

Revelations during intervention workshops indicate other unanticipated characteristics of this group. These include frequent reporting of sexual abuse, domestic violence histories, and mental health issues of participants. Many participants do not use mobility aids and have “invisible” disabilities affecting mobility. Participants cite obesity as a major barrier to preventive screening receipt. Methods used to address these issues and implications for researchers and program planners will be discussed.