Abstract A63: Recruitment strategies in a community-based colorectal cancer study of men and women of African ancestry: The story within the story
Authors: Davis Stacy N. , Jackson Brittany , Govindaraju Swapomthi , Abdulla Rania , Vadaparampil Susan , Quinn Gwen , Shibata David , Roetzheim Richard , Meade Cathy D. , Gwede Clement K. 
Published: May 2015

Background: Colorectal cancer screening (CRCS) saves lives, but utilization rates are low, especially among ethnically diverse Blacks. An innovative, community-based trial “Increasing Access to Colorectal Cancer Testing (I-ACT)” is underway to promote CRCS with the immunochemical fecal occult blood test among average risk individuals. Recruiting a representative population requires multipronged recruitment strategies. This abstract describes these strategies as well as the feasibility, challenges and lessons learned in recruiting a diverse sample of Blacks. We assessed enrollment yield by recruitment method, gender, and foreign born status and reasons for ineligibility.

Methods: A variety of recruitment strategies were employed based on the literature, community advisory board feedback, and prior experiences with community-based projects. Strategies included a) passive recruitment (i.e. flyers posted within community, direct mail marketing, advertising in ethnic media channels), b) active recruitment (i.e. face-to-face intercepts, health fairs, community events), and c) snowball recruitment (i.e. referrals). For each strategy we recorded the recruitment yield, number of individuals reached and enrolled, and reasons for ineligibility.

Results: Potential reach varied widely by method. Overall, 309 interested individuals were evaluated for eligibility, 211 were eligible. Primary reason for ineligibility was being up to date with CRCS, 54 (55%) of 98 individuals. A total of 185 participants (60%) are currently enrolled in the study; 52% female and 8% foreign born. Passive recruitment was the most successful method accounting for 163 of 309 (53%) individuals. Of the 163 evaluated, 114 (70%) were eligible, and of these 100 (88%) enrolled. Active recruitment reached 96 of 309 individuals (31%). Of the 96, 64 (67%) were eligible, and of these 55 (86%) enrolled. Snowballing reached 50 of 309 individuals (16%). Of these 50, 35 (70%) were eligible, and of these 30 (86%) enrolled. The largest enrollment yields for passive methods were from ethnic newspapers (47%) and direct mailing (34%), whereas flyers and local magazines were least successful. The largest enrollment yields for active methods were health fairs (67%) and cultural organizations (11%), whereas the direct intercepts around the community were the least successful. Female participants responded to passive methods (66%), while male participants were recruited via passive and active methods, 42% and 38% respectively. Of the 14 participants enrolled who are foreign born, 85% were recruited via active methods. However, only 42% of non-foreign born participants were recruited via active methods.

Conclusions: Challenges to recruitment include low response associated with ethnic media channels and direct mailing, increase proportion eligible individuals enrolled, and difficulty reaching foreign born individuals. Active recruitment was more successful in reaching men and foreign born individuals, perhaps because this approach allows an opportunity for questions and concerns to be addressed. Although labor intensive, a stronger effort must be made to increase active recruitment to include the diversity within the Black community. These lessons have informed adjustments in our ongoing recruitment strategies to increase the number of potentially eligible people who express interest in the study.

Citation Format: Stacy N. Davis, Brittany Jackson, Swapomthi Govindaraju, Rania Abdulla, Susan Vadaparampil, Gwen Quinn, David Shibata, Richard Roetzheim, Cathy D. Meade, Clement K. Gwede. Recruitment strategies in a community-based colorectal cancer study of men and women of African ancestry: The story within the story. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A63. doi:10.1158/1538-7755.DISP13-A63