Recruitment and Retention

for CVD Risk Reduction Carol Percy, RN, MS

Shiprock DPPOS Program CoordinatorMary Hoskin, RD, MS

Phoenix DPPOS Program CoordinatorMarch 17, 2005

Diabetes Prevention Program ClinicsDiabetes Prevention Program Clinics

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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 6/96-2/99• 171 American Indians recruited• Recruitment Coordinator at each site• Team approach to support Recruitment

Coordinator• Multi-layered recruitment approach• Recruitment oversight program

Eligibility Talking PointsDiabetes 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 PointsCVD 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 Step 1 ScreeningScreening

Step 2 Step 2 OGTTOGTT

Step 3 Step 3 start run-instart run-in

Step 4 Step 4 Join StudyJoin Study

Number of participant contacts/Number of participant contacts/% of previous step% of previous step

3,5863,586

1,117 (31%)1,117 (31%)

128 (31%)128 (31%)

9494 Step 3 Step 3 End run-inEnd run-in

# with IGT

409 (37%)

80 (63%)20% from IGT

Phoenix Urban Recruitment

Step 1 Step 1 ScreeningScreening

Step 2 Step 2 OGTTOGTT

Step 3 Step 3 start run-instart run-in

Step 4 Step 4 Join StudyJoin Study

Number of participant contacts/Number of participant contacts/% of previous step% of previous step

1,0001,000

200 (20%)200 (20%)

Step 3 Step 3 End run-inEnd 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

• 1st level- talk to us• 2nd level- if interested make an

appointment• 3rd 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 1.8 - 4.6)

• 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 YOUwww.bsc.gwu.edu/dpp/