RESUMO
BACKGROUND: Interactive Nutrition Comics for Urban Minority Youth (Intervention INC) is an innovative, web-based interactive comic tool for dietary self-management, which aims to decrease obesity risk among urban minority preadolescents. The feasibility and acceptability of Intervention INC was assessed by implementing a two-group randomized pilot study. To date, intervention studies have typically faced various barriers in recruiting and retaining study participants. The purpose of this paper is to describe recruitment and retention activities from this study and in particular, discuss challenges faced, strategies implemented, and lessons learned. METHODS: Black/AA and Latino children (ages 9-12 years) and their parent/guardian were recruited from East Harlem/Harlem, New York. Recruitment strategies included flyering in the community, having a convenient study location, providing participation incentives, and partnering with community/school-based organizations. Potential participants were screened for eligibility; enrollees completed online surveys and interviews at baseline (T1), intervention midpoint (T2), intervention end (T3), and 3-months post-intervention (T4). Retention strategies included flexible scheduling, reminder calls/texts, incremental compensation, and consistent study staff. RESULTS: Eighty-nine enrolled dyads completed a T1 visit (August to November 2017) and were randomized to the experimental (E, n = 45) or comparison (C, n = 44) group. Enrolled dyads learned about the study through community events (39%), community flyering (34%), friend/referral (15%), or a community clinic partner (12%). T1 child demographics were mean age = 10.4 ± 1.0 years, 61% female, 62% Black and 42% Latino, and 51% overweight/obese; parent demographics were mean age = 30.8 ± 8.9 years, 94% female, and 55% Black and 45% Latino. Survey completion rates by dyad were high throughout the study: T2, 87%; T3, 89%; and T4, 84%. Average data collection per session was 65 min. Parents at T4 (n = 76) felt they received enough study information (97%) and that their questions were answered properly (80%). Eighty-one percent of children at T4 (n = 75) were very satisfied/extremely satisfied with how study staff communicated and interacted with them. CONCLUSION: Effective recruitment strategies consisted of community events and flyering, while a variety of retention strategies were also used to successfully engage urban Black/AA and Latino families in this study. Though our findings are limited to only Latino and Black families in low-income neighborhoods, we have identified successful strategies for this specific high-risk population and potentially similar others. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03165474, registered 15 May 2017.
RESUMO
BACKGROUND: Since the 1960s, school-based health centers (SBHC) in the United States have emerged and grown with the mission of providing primary medical, reproductive, and mental health services, as well as comprehensive health education, to all students who are enrolled in the participating school. SBHCs have demonstrated a unique ability to reduce barriers to medical care for underserved populations in New York City, including undocumented immigrants and those who are of lower income status. METHODS: The Mount Sinai Adolescent Health Center School-Based Health Program (MSAHC SBHP) was established in 1985 in order to increase access to care for New York City teens. After a change of physical location, one particular site of the MSAHC SBHP had a significant decrease in clinic visits and enrollment. Traditional outreach strategies were utilized, but the results of the efforts were disappointing. Applying the Community Health Worker model, as defined by the World Health Organization (WHO), the MSAHC SBHP developed the Student Ambassador Program, a student-organized community-engagement initiative. The program is based on the premise that youth can be effective at outreach and serving as community liaisons to increase awareness and use of the SBHC. The SBH staff provided recruitment, training, and support. The student ambassadors initiated peer-informed outreach projects to appeal to the student body. Upon completion of the Student Ambassador projects, clinic enrollment increased 4.3% and visits increased 32% over the prior year. CONCLUSIONS: School-based health centers in the United States have helped to provide comprehensive, multidisciplinary care to many children who would otherwise not be able to access care, but community engagement is critical to their success. Applying the WHO Community Health Worker Model to utilize school students for outreach to their school community is an effective way to increase utilization.