Effectively recruiting for Family-central "E-health" research: Lessons from the Lifestyle Medicine Health Education and Intervention Program Study at a Pediatric Mobile Clinic

Abstract: Background: Childhood obesity is a growing global epidemic with significant racial, ethnic, and socioeconomic disparities. While current efforts to stem the tide of the obesity epidemic have focused on public policy and individual level behaviors, little research has been done on community and family-based health interventions. In this study, a novel design of personalized text messages allowed flexible participation while relaying key lifestyle information on six major contributing factors to obesity. The patient population served by the Pediatric Mobile Clinic has been known to be difficult to reach in part because of their diverse range of cultures and languages, lack of access to affordable healthcare, housing instability, phone service capabilities, and access to individualized health related information. The purpose of this sub-analysis was to identify the most efficient and effective recruitment methods to reach a broader subset of underserved patient populations. Methods: Literature review and research study personnel experience informed the design and implementation of 6 recruitment styles to help increase participant engagement. These styles included a tracking sheet, in-person discussions, phone call tree, text messages, email prompts and an Electronic Medical Record review, all of which led to a pre-screen questionnaire that determined eligibility for enrollment. Results: 377 potential patients were pre-screened resulting in 19 participants being enrolled into the study, which is a 5% enrollment rate. 39 of them were screened in person whereas the remaining 338 were screened via phone call tree. Telephone calls produced more people enrolled per month; however, telephone call recruitment required a greater volume of participants screened to produce one enrolled subject in comparison to in-person screening. In person recruitment was most effective overall with 11 of the enrolled having been recruited in person vs 8 enrolled via telephone calls. Phone calling results in greater volume but may not be as efficient. The largest prescreen failure group was due to the inability of being able to contact potential participants followed by English not being a patient's primary language. Conclusions: Enrolling people in-person may be beneficial because you are able to make a human connection which could result in a greater conversion of prospective patients to consented participants. Contacting patients multiple times via different forms of communication (Text message; email; voicemail) helped increase recruitment numbers. Recruiting patients via multiple and diverse methods may be beneficial for enrollment, particularly with underserved patients who live busy lives and may not be as accessible during clinic or traditional 9-5 hours. Future studies should consider expanding their recruitment base by applying for IRB approval of materials in multiple languages. The recruitment methodology and findings from this unique and underserved patient population could potentially inform and shape future community and family-based e-health studies.