Recruitment and Retention for CVD Risk Reduction Carol Percy, RN, MS Shiprock DPPOS Program Coordinator Mary Hoskin, RD, MS Phoenix DPPOS Program Coordinator March 17, 2005

Diabetes Prevention Program Clinics

Southwest American Indian Center Gila River Indian Community Navajo Nation- Shiprock, New Mexico Phoenix Urban Indian Community Salt River Pima- Maricopa Indian Community Zuni Pueblo Indian Community

Recruitment into the DPP Recruitment phase 6/96-2/ American Indians recruited Recruitment Coordinator at each site Team approach to support Recruitment Coordinator Multi-layered recruitment approach Recruitment oversight program

Eligibility Talking Points Diabetes Prevention Program At least 25 years old. Non-diabetic with Impaired Glucose Tolerance. No serious illness or reason not to take any of the treatments. Willingness to participate in a six year program.

Eligibility Talking Points CVD Risk Reduction Age > 18 years Type 2 Diabetes Case management Length of time to participate Weight management Stop smoking Others?

Timeline to Join DPP Step 1- Initial contact(s) Step 2- Oral Glucose Tolerance Test Screening visit Step 3- Three week run-in period (three visits) Step 4- Join the Study (Randomization)

Shiprock Recruitment Step 1 Screening Step 2 OGTT Step 3 start run-in Step 3 start run-in Step 4 Join Study Number of participant contacts/ % of previous step 3,586 3,586 1,117 (31%) 128 (31%) 94 Step 3 End run-in Step 3 End run-in # with IGT 409 (37%) 80 (63%) 20% from IGT

Phoenix Urban Recruitment Step 1 Screening Step 2 OGTT Step 3 start run-in Step 3 start run-in Step 4 Join Study Number of participant contacts/ % of previous step 1,000 1, (20%) Step 3 End run-in Step 3 End run-in # with IGT 47 (24%) 14 (30%)

Timeline to Join CVD Risk Reduction Recruit 50 participants yearly Over-recruit to account for attrition Number of months to recruit first group If group activities, plan recruitment for groups

Layered Recruitment Approach One on one contact Brochure Flyers and posters Radio PSA’s and print ads Newspaper article on program Mailed/delivered program brochures off registry Presentations to health providers

Strategies for Reservation Recruitment One-on-One Contact and visibility Use community events and locations Local worksites Leadership support Community flyers Community newspapers Door to door

Urban Indian Recruitment Targeted work place presentations Pow-Wows Phoenix Indian Medical Center/ Events Brochures placed in work places Community gatherings of American Indians Local Native American Newspaper

Incentives 1 st level- talk to us 2 nd level- if interested make an appointment 3 rd level- complete step screening visit Establish honest and trusting relationship Motivation for joining-DM prevention Lifestyle Balance motivator is weight loss

Community Screening Talking points to attract people Blood glucose/cholesterol screening Blood pressure screening Person walks away with something written with location, phone

Phone Contact/Written Contact Establish phone number for program –Live voice best -Connect with person on day they call Written materials include –Program location, walk-ins expected –Place to write appointment date/time –Appointment instructions ex: fasting

Keys to Success Flexible Clinic Schedule Telephone reminders Postcard reminders Follow-up a missed appointment One-on-One support/ building relationship

Retention Plan early and integrate Long commitment to DPP for 3-5 years Begins at first contact Recruitment is the key to retention

Retention and Participation 99.6% of the study cohort alive at study end 93% completed study 93% of annual visits completed Average follow-up 2.8 years (range ) 86% joined DPPOS

Retention-Create Belonging Group Events Contracts Incentives Connection with staff Mailings- newsletters, health information, birthday cards

Group Events Gathering around a community event Group walks or hikes Community attractions Learning a new skill Include the family

Getting Started Your Recruitment Action Plan Define your program objective Define your recruitment goals/target groups Assess your community resources Prepare recruitment plan and timeline Produce written materials, PSA’s, mailings Define talking points Begin community contacts and presentations

Recruitment Coordinator Enthusiastic about program Able to work independently/ team leader Lead by example Outgoing Bi-lingual Member of your community Realistic amount of time to recruit if other job responsibilities Visible to participants throughout the program

Recruitment Oversight Centrally track recruitment progress Centrally produce written materials Yearly gathering of Recruitment Coordinators Phone check-ins with programs

THANK YOU