Recruitment and Retention of Children in Behavioral Health Risk Factor Studies: REACH Strategies
Stephanie Schoeppe MSocialSc1, Melody Oliver PhD2, Hannah M Badland PhD3, Matthew Burke PhD4, Mitch J Duncan PhD1
1Central Queensland University, Institute for Health and Social Science Research, Centre for Physical Activity Studies, Rockhampton, Australia
2Auckland University of Technology, Human Potential Centre, Auckland, New Zealand
3The University of Melbourne, McCaughey VicHealth Centre for Community Wellbeing, Melbourne, Australia
4Griffith University, Urban Research Program, Brisbane, Australia
Corresponding author:
1Stephanie Schoeppe
Central Queensland University
Institute for Health and Social Science Research
Centre for Physical Activity Studies
Building 18, Bruce Highway
Rockhampton QLD 4702
Australia
Tel: +61 (0)7 4923 2271
Fax: +61 (0)7 4930 6402
E-mail:
Electronic supplementary material (Online Resources 1-4)
Online Resource 1Identification of primary studies and reviews published between January 1990 and January 2012
aSpecific empirical papers/case studies reported on recruitment and retention strategies in the fields of children's physical activity, dietary habits, or weight status (i.e. overweight, obesity). These health risk factors were the specific focus of this research.
bBroad empirical papers/case studies related to recruitment and retention strategies in health areas that were not the specific focus of this research, such as tobacco, alcohol and drug consumption, HIV prevention, mental and physical chronic diseases.
1
Online Resource 2Summary findings from the literature review of successful strategies for the recruitment and retention of children in behavioral health risk factor studies
Dimensions / Strategies(What to do?) / Implementation examples
(How to do it?) / Refrences
(Authors, year)
Recruit / Identify suitable recruitment tools / For example, children may be recruited via
- Advertisements in the media
- Posters and flyers in community settings or neighbourhoods
- Direct mail
- Telephone screening
- Child-specific settings, such as schools, youth organizations and sports clubs
Lim et al 2011
Dwyer et al 2010
Shahabi et al 2011
Story et al 2003
Jones et al 2011
Elder et al 2008
Duncan et al 2002
Cline et al 2005
CAMP 1999
Nguyen et al 2012
Identify suitable settings for recruitment /
- Settings include, for example, public and private schools, sports clubs and commercial gyms, youth organizations, community, community events, general population
Lim et al 2011
Trapp et al 2011
Douyon et al 2010
Story et al 2003
Sexton 2005
Provide incentives to settings involved in recruitment /
- Schools or other organizations involved may receive positive recognition in the community or monetary incentives/compensations for study participation and assistance with recruitment procedures
- Feed into / guide the school curriculum
Drews et al 2009
Use the local media /
- Advertise the study to raise interest in study participation and invite potential participants through various media such as television, radio, newspapers, weekly advertising publications or email newsletters
Bruzzese et al 2009
CAMP 1999
Nguyen et al 2012
Create program visibility/identity /
- Use study or organizational logos in written communications, flyers, posters, information packages, etc
- Circulate visually appealing posters and flyers in the recruitment settings
- Circulate pens with study logo/branding to participants when completing consent forms
Bruzzese et al 2009
Hold information sessions with children, parents and setting-specific personnel /
- Circulate handouts/flyers that are informative, and linguistically and visually appealing
- Use videos and slide shows for presentation at information sessions
Goodman & Petosa 1991
Trapp et al 2011
Binkley et al 1997
Jones et al 2001
Drews et al 2009
Ensure a correct and optimal consent process /
- Ensure informed signed assent from the participating child, and informed signed consent from the child’s parent/guardian
- Where appropriate, gain informed signed consent from setting representatives (e.g. school principal, board of trustees, teachers for school settings).
- Hand out consent and assent forms that are sufficiently informative, linguistically and visually appealing.
- Set up optimal, convenient ways of returning consent forms, such as through collection boxes and personnel support (e.g. teachers, community workers, administrative staff)
Lamb et al 2001
Provide incentives /
- Identify motivating factors for study enrolment for students and parents
- Hand out appropriate incentives or reimbursements to children/families, or school classes that returned signed consent forms
Rice & Broome 2004
Binkley et al 1997
Dwyer et al 2010
Elder et al 2008
Jones et al 2001
Drews et al 2009
Strycker et al 2006
Ely & Coleman 2007
Sexton 2005
Cline et al 2005
Send reminders for study consent /
- Follow up on eligible participants (e.g. via email, mail, telephone) who did not return signed parental and child consent forms
Engage / Create enthusiasm for the study among children, parents, setting-related personnel and researchers /
- Explain the purpose and benefits of the study. Show enthusiasm, be friendly and use simple language.
- Address potential safety issues raised by children, parents or setting-related personnel. Patiently answer all questions arising
Jones et al 2001
Logsdon et al 2008
Sexton 2005
Bruzzese et al 2009
Engage local advocates /
- Identify suitable local advocates (physical education/lead teachers, social workers, general practitioners, etc.) who could reassure children and their parents that this is an important project. Moreover, advocates could explain the benefits from study participation.
Lim et al 2011
Binkley et al 1997
Logsdon et al 2008
CAMP 1999
Find optimal ways to communicate with the children, their parent and setting-related personnel /
- Establish multiple appropriate communication channels for gathering or reminding participants to return forms/equipment, such as school microphones, notice boards, teachers, youth workers, in-class visits, etc.
Rice et al 2007
Communicate suitably to children /
- Use simple, non-academic language that clearly outlines the research
Binkley et al 1997
Peters et al 2011
Set up trained, cohesive and stable research teams /
- Set up cohesive research teams and ensure that they are not overworked with recruitment and data collection tasks.
- Ensure that researchers remain employed on the study to ensure program stability
- Develop one consistent point of contact between participants and the project. This enables relationship building, stability and continuity
Bruzzese et al 2009
Seibold-Simpson & Morrison-Beedy 2010
CAMP 1999
RetAin / Provide incentives to children, parents and/or setting-related personnel for the completion of study milestones and/or final completion /
- For example, vouchers, monetary incentives/compensations, gifts, school class competitions.
- Remind children, parents and setting-related personnel repeatedly on the benefits of participation for themselves and the broader community
Binkley et al 1997
Jones et al 2001
Drews et al 2009
Strycker et al 2006
Ely & Coleman 2007
Guzman et al 2009
Bruzzese et al 2009
Villarruel et al 2006
Pappas et al 1998
Build trust, partnerships and credibility between researchers and children, parents and setting-specific personnel /
- Address all questions and concerns by children, parents and setting-related personnel
- Mention repeatedly that the information provided will be confidential
- Use study or organizational logos in written and electronic communications/ data collection materials
- Fulfill promises made to children, parents and setting-specific personnel
- Conduct case management/various data collection time points by the same project staff year after year
- Emphasize the benefits of continued participation to children, parents and setting-related personnel
- If possible, use project staff who are known and connected to the community in which the study takes place.
Rice et al 2007
Lamb et al 2001
Trapp et al 2011
Douyon et al 2010
Dwyer et al 2010
Story et al 2003
Jones et al 2001
Stanford et al 2003
Ely & Coleman 2007
Guzman et al 2009
Cline et al 2005
Bruzzese et al 2009
Minimise participant burden /
- Carefully consider total time, days of the week or time of the day children and/or parents are required to devote to study participation
- Use age-appropriate surveys that are as short and clear as possible
- Allow flexibility in the data collection date/times/site for participants
Dwyer et al 2010
Duncan et al 2002
Ely & Coleman 2007
Guzman et al 2009
Conduct data collection/intervention conveniently for children, parents and setting-related personnel /
- Avoid collisions of data collection/intervention implementation with other activities, such as children’s social activities, school events (e.g. camps, sports days), parent’s daily schedules, personal work duties, etc.
- Conduct data collection/intervention implementation at sites where children are located (e.g. the home), or can easily travel to.
Guzman et al 2009
Remain in contact between study visits /
- Between data collection visits, maintain contact with participating children, parents and setting-related personnel, for example through a study website or regular newsletters reporting on study progress
Strycker et al 2006
Use extensive follow-up procedures /
- Use multiple and continual reminders of participation and upcoming data collection time points
- Follow up on participants who have not completed measurements, intervention steps or returned equipment (e.g. reminders via email, mail, phone or visits at schools/home/other organizations involved)
- Ask teachers to remind the children to return forms, measurements and equipment
- Explore reasons for non-participation and drop outs, for example, by talking to the children, parents or setting-related personnel. If possible, efforts should be made to address identified barriers.
Trapp et al 2011
Zand et al 2004
Drews et al 2009
Strycker et al 2006
Seed et al 2009
Bruzzese et al 2009
Pappas et al 1998
Meyers et al 2003
Child and family characteristics / Take child and family-related characteristics into account /
- For example, the child’s sex, age, developmental level, language ability, ethnicity and socio-economic status may influence study recruitment and retention. Suitable information materials, communications, data collection methods (including researchers) and intervention implementation methods should be applied.
Rice & Broome 2004
Walker et al 2011
Duncan et al 2002
Lakes et al 2011
Zand et al 2004
Strycker et al 2006
Bruzzese et al 2009
Seibold-Simpson & Morrison-Beedy 2010
Diviak et al 2006
Consider heterogeneity when targeting children from minority groups /
- Suitable information materials, communications, data collection methods and intervention implementation methods should be used that can be used across diverse groups
Shahabi et al 2011
Health risk
factor studies / Gain ethical clearance /
- Secure ethical approval prior to commencing the study.
- Ensure that sensitive issues around research with children are being addressed in ethics applications
Identify suitable data collection sites /
- For example, whole community, neighbourhoods, public/private schools, sports clubs, youth organizations
- Ensure the data collection site is safe, convenient to reach and appropriate in appearance for children, their parents and the research team
- Ensure that children’s parents can be reached easily, either through the site or directly. For example, in school-based studies, researchers may have limited access to parents, if they do not have their contact details. Limited access to parents may impede consent processes and data collection follow-ups.
- Be aware of any site-specific policies or guidelines related to data collection
Sexton 2005
Implement flexible and efficient data collection and data management procedures /
- Schedule data collection dates/times convenient for children, their parents or setting-related personnel
- Ensure that project staff can act flexibly regarding data collection dates, time points and sites (e.g. consider home visits)
Duncan et al 2002
Strycker et al 2006
Bruzzese et al 2009
CAMP 1999
Learn from pilot studies /
- Conduct a pilot study in the target population to test the recruitment strategy and materials, data collection process and measurements.
Consider conducting formative research /
- Conduct focus groups or interviews with targeted children and parents/caregivers to ask questions regarding best ways to recruit and retain targeted children.
Consider conducting participatory research /
- Get feedback from key setting-related personnel about issues regarding recruitment and data collection
- Include key setting-related personnel or the community in recruitment and data collection processes.
Trapp et al 2011
Jones et al 2001
Sexton 2005
Estimate the timeframes and costs of recruitment and retention strategies /
- Calculate the costs and in-kind resources needed for the recruitment and retention procedures prior to commencement of the study (e.g. in grant applications)
- Allow for additional timeframes and costs due to unexpected recruitment issues
Logsdon et al 2008
1
Online Resource 3Delphi study procedure (adapted from Vandelanotte et al. 2010)
1
Online Resource4 Results of the Round 2 and Round 3 Delphi study
Item / Second Round (n = 24) / Third Round (n = 18)% of experts rating strongly agree/agree; consensus ≥80% / X / Mdn / IQR / % of experts rating strongly agree/agree; consensus ≥80% / X / Mdn / IQR
Q1. How much do you agree that the following ‘strategies’ contribute to successful recruitment and retention of children in behavioral health risk factor studies? This may include engaging children, parents, researchers and study partners.
- Invest time in developing relationships with study partners, parents and children (e.g. through personal, face-to-face contacts; trust-building efforts)
- Clearly explain the study purpose, requirements, and benefits in participating for children, parents and study partners
- Create enthusiasm about the study among children, parents and study partners
- Have support from key stakeholders (e.g. parents, school, sports coaches, sports club presidents, Government department/ministry)
- Advertise the study in the local media (e.g. newspaper, radio, television, university newsletter/website)
- Organize other publicity activities (e.g. publishing study information in newsletters of community-based organizations such as schools
- Use a passive consent process (opt-out option)
- Use participatory approaches in the study planning and implementation (e.g. with children, parents, teachers)
- Have a project champion who promotes the recruitment and implementation of the study (e.g. school teacher, celebrity, community leader)
Include a fun component for children in the study implementation/data collection (e.g. using gadgets such as GPS, accelerometers, pedometers, disposable cameras; delivering enjoyable physical activity programs; collecting data at interesting venues such as museum/sports center) / 83.2% / 2.00 / 2 / 1 / _ / _ / _ / _
Provide incentives/rewards to children and/or parents for participating in the study (e.g. gift vouchers, prize draws, family vouchers) / 87.5% / 1.71 / 2 / 1 / _ / _ / _ / _
Provide incentives/rewards to study partners such as school teachers, sports club coaches or a school/child care center/sports club for coordinating participant recruitment and implementation (e.g. gift vouchers, money, school/sports equipment) / 87.5% / 1.81 / 2 / 1 / _ / _ / _ / _
Minimise participant burden (e.g. use brief questionnaires, fewer measurements, convenient data collection sites) / 100.0% / 1.43 / 1 / 1 / _ / _ / _ / _
Provide feedback about study results to children, parents, and study partners (including individual and group feedback) / 83.3% / 1.90 / 2 / 1 / _ / _ / _ / _
Design a feasible study (e.g. with sufficient staff and funding for the number of participants to be recruited) / 100% / 1.38 / 1 / 1 / _ / _ / _ / _
Use appealing study materials (i.e., easy to read, visually appealing, professionally looking information and consent materials for children and parents; age-appropriate questionnaires) / 100% / 1.38 / 1 / 1 / _ / _ / _ / _
Have good research leadership / 91.7% / 1.62 / 2 / 1 / _ / _ / _ / _
Create a study identity (e.g. through a study website, logo, branding) / 69.6% / 2.24 / 2 / 1 / 88.9% / 1.94 / 2 / 0
Tailor data collection processes to individual settings (e.g. data collection in schools may occur during lunch breaks or class-time depending on the preference of the school principal and teachers at each participating school) / 91.7% / 1.71 / 2 / 1 / _ / _ / _ / _
Enable researchers/research assistants to see benefits from their engagement with the study (e.g. career opportunities, publications) to increase their motivation for investing a lot of time and efforts in the recruitment and data collection / 75.0% / 2.14 / 2 / 1 / 66.7% / 2.28 / 2 / 1
Provide research training and quality control procedures for researchers/research assistants / 91.7% / 1,76 / 2 / 1 / _ / _ / _ / _
If the study is Government funded, make this clear in all study information provided to parents and study partners / 58.3% / 2.48 / 2 / 2 / 72.2% / 2.06 / 2 / 1
Use flexible data collection approaches (e.g. conduct assessments in the home environment or nearby location) / 91.7% / 1.67 / 2 / 1 / _ / _ / _ / _
_ / _ / _ / _
Q2. How much do you agree that the following ‘implementation examples of recruitment/retention/engagement strategies’ contribute to successful recruitment and retention of children in behavioral health risk factor studies?
- Ensure that there is sufficient funding for recruitment
- Conduct long-term recruitment (including follow-up of non-recruited children)
- Investigate the geographic, demographic and socio-economic profile of targeted settings for recruitment (e.g. schools, child care centers, sports clubs) prior to data collection
- Identify key stakeholders relevant for study recruitment and implementation
- Translate study materials if eligible participants are from culturally and linguistically diverse groups
- Hold information sessions for children, parents, and study partners prior to and during data collection
- Provide a study website or video
- Minimise additional burden to staff based in the settings where recruitment takes place (e.g. school teachers, sports club coaches, admin staff)
- Use attractive venues for data collection (e.g. museum, sports center)
Form a community council with research investigators and study collaborators to plan and implement the study / 54.2% / 2.10 / 2 / 2 / 77.8% / 1.94 / 2 / 1
Organize multiple visits when recruiting children in schools, child care centers, sports clubs and other community-based organizations / 87.0% / 1.76 / 2 / 1 / _ / _ / _ / _
Outline the benefits from participating in the study for the community-based organizations where recruitment takes place (e.g. schools, child care centers, sports clubs) / 91.7% / 1.71 / 2 / 1 / _ / _ / _ / _
Have strong support from the school principal when conducting a study in the school setting / 95.8% / 1.29 / 1 / 1 / _ / _ / _ / _
Record the contact details of parents whose children are participating in the study for follow-up measurements so that they can be reached during the study process (e.g. for sending reminders to return equipment or conducting follow-up measurements in school children who underwent the transition from primary to secondary school) / 75.0% / 1.71 / 1 / 2 / 94.4% / 1.22 / 1 / 1
Use multiple recruitment strategies (e.g. recruitment via settings such as schools, child care centers and sports clubs; letter box drops, local media) / 78.3% / 1.90 / 2 / 2 / 77.8% / 1.22 / 1 / 1
Recruit target groups in specific need for health promotion interventions (e.g. children from low socio-economic status or culturally and linguistically diverse backgrounds) / 69.6% / 2.29 / 2 / 2 / 77.8% / 2.06 / 2 / 2
Employ research assistants with a suitable cultural/linguistic background for the recruitment of culturally and linguistically diverse groups / 75.0% / 2.05 / 2 / 2 / 94.4% / 1.72 / 2 / 1