Recruitment, participation and barriers to weight loss program participation among economically disadvantaged women

Background: Economically disadvantaged women have high rates of obesity and chronic disease but face barriers to weight loss program participation. Methods: Overweight and obese women, ages 25-50 years, from high-poverty (≥25%) neighborhoods were recruited via multiple venues and randomized to a 16-week culturally-tailored intervention, with 8 weeks of telephone support, or control group. Process evaluation tracked recruitment, participation, and barriers. Extensive contact and incentives were used to facilitate retention and address transportation, child care and participation costs. Results: In years 1 and 2, 437 women inquired; 199 were eligible, and 154 (77%) provided baseline measures. They were 89% African American, 71% employed, 91% ≥ high school education. Mean age was 38.5; BMI range=28-70. Most heard of the program via word-of-mouth or fliers (82%). Of the 154 enrolled, 20 were excluded (mainly for medical contraindications), 29 lost contact (disconnected phone, no answer/reply, and/or returned mail), and 105 were randomized. In year 1 (n=47), after randomization, 3 were excluded, 9 lost to followup, and 3 dropped out. Return rates for key behavioral data were high (97% for accelerometer data and 97% completion for 3 dietary recalls). Class attendance averaged 22%-100%. Top two reasons for absence were illness and family obligations. Completion of phone support calls was 53%-73%. Family and other competing responsibilities were among the top barriers to behavioral maintenance. Conclusions: Competing family and other responsibilities represent barriers to participation and behavioral maintenance among economically disadvantaged women in a weight loss intervention, even with culturally tailored, enhanced retention efforts.