Abstract A34: Church-based recruitment and retention of Appalachian adults in an eHealth program to reduce obesity
Authors: Baltic Ryan , Paskett Electra D. , Kennedy Stephenie , Lengerich Gene , Roberto Karen , Schoenberg Nancy , Lesko Samuel , Dignan Mark 
Published: May 2015

Abstract
Purpose: Appalachia is a socioeconomically-disadvantaged region with limited preventive health services. The ACCN is a NCI-funded research initiative that collaborates with community-based cancer coalitions to increase awareness, provide education, and promote cancer prevention. Using CBPR principles, ACCN researchers are testing in a group randomized trial a faith-based program focused on obesity, a modifiable risk factor for cancer. The primary outcome is change in body mass index from baseline to twelve months. Secondary outcomes are changes in physical activity, diet and blood pressure, and the maintenance of the intervention effect during a sustainability period. This paper focuses on participant recruitment to this faith-based program and retention of enrolled participants throughout the 12-month intervention phase.
Methods: The project employed CBPR strategies to recruit participants following principles put forth in the Accrual to Clinical Trials (ACT) Framework. The program is based on Social Cognitive Theory and the Transtheoretical Model. The research team includes ACCN, Viocare, Inc., community coalitions, community members, and churches. Community coalitions assisted in identifying churches and designing educational sessions. Participants were recruited through bulletins and announcements from the pulpit. Individuals attended an information/screening session conducted by regional and local staff, or completed a private screening with local staff.
In order to keep participants engaged in the program throughout the 12-month intervention phase, education sessions were held monthly and included activities, games, trivia, healthy snacks, and prizes. Gift cards were given to all participants who completed 12-month outcome screenings.
Results: As of 8/31/2013, 22 churches have enrolled into the study. 715 church members were screened. Of those, 606 (84.8%) were determined to be eligible, and 566 (93.4%) of those eligible enrolled as participants. Main reasons for ineligibility included BMI &lt; 25 (53.2%), not completing all baseline screenings (25.7%), and existing dietary restrictions (7.3%). To date, 47 participants have withdrawn from the study (8.3%), with the most cited reason having to do with time constraints.
Conclusion: Congregation size most significantly limited recruitment in that it was more difficult to recruit at smaller churches. This may be avoided by discussing congregation size and interest with church leaders before selecting churches. Geographical barriers in rural Appalachia impacted participant recruitment and retention in some churches, but assistance from church navigators and field staff helped to abate this. Distrust of outsiders, a common characteristic in Appalachia, slowed recruitment, but regional staff presence at church and community events supported successful recruitment. Recruitment strategies will continue to be modified as accrual is completed in Fall 2013.
Although the intervention phase is ongoing in the majority of the churches, it has been observed that motivated and engaged church navigators and leaders positively impact participant involvement.
Citation Format: Ryan Baltic, Electra D. Paskett, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Samuel Lesko, Mark Dignan. Church-based recruitment and retention of Appalachian adults in an eHealth program to reduce obesity. [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 A34. doi:10.1158/1538-7755.DISP13-A34