Successful strategies for engaging rural and indigenous women in community health center based research

Background: Rural, low-income and indigenous communities suffer disproportionately from behavioral health problems. Consistent with other disparate communities, we found items on validated stress and coping (S/C) inventories yielded few endorsements from women in our community. This paper describes strategies used to engage participants for a study to develop inventories on S/C.

 Methods: The study was based at a community health center (CHC) serving a large rural, primarily indigenous, low-income community in Hawaii. Participants were recruited for a series of focus groups and administration of the community-informed S/C inventories. Recruitment and enrollment (R/E) strategies were based on an iterative process of continuous improvement and integrated the CHC staff, health providers and their clinic flow.

Results: Thirty-six women, representative of community demographics, participated in 6 focus groups used to gather data on routine stressors and coping mechanisms.  Over a short 5-week period, 178 women were enrolled to take the S/C inventories.  Engagement strategies included collaboration with CHC administration, providers, staff and research committee, flexibility in R/E to align with clinic flow, use of CHC-based behavioral health interns, and meaningful incentives.  The project received overwhelmingly positive responses and support at each stage from community members, participants and CHC staff and providers.

Conclusion: The development of appropriate measures and effective strategies to address health disparities requires community engagement and successful participant recruitment. Flexible R/E strategies based at a well-established CHC, and integrated with clinical staff and operations, supports community engagement and participation.