Recruitment and retention of older adults in influenza immunization study.

Abstract: Minority older adults have been under-represented in previous research studies in which Caucasian populations have been recruited. This article describes a consumer-centered model that addresses strategies to enhance recruitment and retention of a racially diverse healthy elderly population in an influenza immunization study. A consumer-centered model was employed in a 3-year research study that examined age-related changes in the immune responses to influenza vaccination. Four factors seem to be critical for successful recruitment and retention of African American, Latino and Caucasian elders: 1) building trust between the research team, and the community at large; 2) convenience (or inconvenience) to the volunteer; 3) timing of recruitment and data collection; and 4) incentives. Key Words: Recruitment and Retention, Minority Elders; Influenza Vaccination It is well documented that minorities participate far less in research protocols than do whites and that the recruitment and retention of older adults, especially minority older adults in research is difficult, time-consuming, and expensive (Levkoff, Prohaska, Weitzman, & Ory, 2000). Little is known, however, about how best to increase the participation and retention of minorities in behavioral and biomedical research. The successes and failures of various retention strategies are seldom reported in the literature. This article presents the use of a consumer-centered approach to recruitment and retention of a racially diverse healthy elderly population. The approach was used in a 3-year research study that examined agerelated changes in the immune responses to influenza vaccination. OVERVIEW OF THE RESEARCH STUDY Influenza infection is the fifth leading cause of death among persons aged 65 years and older (Thompson, Shay, Weintraub, Brammer, Cox, et al 2003). The risks for complications, hospitalization, and deaths from influenza infection are higher among persons aged 65 years and older than other age group (Simonsen, Clarke, Schonberger, Arden, Cox et al., 1998). It is estimated that the influenza vaccine can prevent thousands of deaths annually (CDC, 2002), yet the relative risk for influenza infection among older adults who received influenza immunization remains substantial (Gross, Hermogenes, Sacks, Lau, & Levandowski, 1995). One possible explanation for the relative risk for influenza infection among older adults is age-related decline in the immune response of older adults. Age-related decline in healthy elderly Caucasians to influenza is well documented (Gross, et al 1995). However, such age-related changes in immune responses of healthy elderly African Americans and Latinos are not well documented. The purpose of the 3-year study was to examine the age-related changes in the immune responses of influenza vaccination in African American, Latino, and Caucasian older adults. This article will address the use of a consumer-centered approach in the recruitment and retention of culturally diverse older adults in this study. Consumer-centered Approach Findings from a recent CDC report indicate that levels of participation in influenza vaccination among persons aged 65 and older were 57% among non-Hispanic whites, but only 31% among blacks, and 30% among Hispanics (CDC, 2002). Previous researchers have found that knowledge (Santibanez, Nowalk, Zimmerman, Jewell, Bardella et al., 2002; Nichol, Lof gren, & Gapinski, 1992), attitude ( Cornford & Morgan,1999; Allsup & Gosney, 2002), perceived risk and prior experiences with influenza vaccine (Chi & Neuzil, 2004; Telford & Rogers, 2003), and interaction with health care providers (Chi & Neuzil, 2004; Telford & Rogers, 2003) are associated with decisions to accept influenza vaccination among older adults. The challenge for investigators who conduct research with older adults, specifically minority populations, is to develop recruitment and retention methods that address the issues specific to older adults in a given community. …