Person:

Warner, Erica

Background: Obesity and hypertension and their associated health complications disproportionately affect communities of color and people of lower socioeconomic status. Recruitment and retention of these populations in research trials, and retention in weight loss trials has been an ongoing challenge. Methods: Be Fit, Be Well was a pragmatic randomized weight loss and hypertension management trial of patients attending one of three community health centers in Boston, Massachusetts. Participants were asked to complete follow-up assessments every 6-months for two years. We describe challenges encountered and strategies implemented to recruit and retain trial participants over the 24-month intervention. We also identify baseline participant characteristics associated with retention status. Retention strategies included financial incentives, contact between assessment visits, building relationships with health center primary care providers (PCPs) and staff, and putting participant convenience first. Results: Active refusal rates were low with 130 of 2,631 patients refusing participation (4.9%). Of 474 eligible persons completing telephone screening, 365 (77.0%) completed their baseline visit and were randomized into the study. The study population was predominantly non-Hispanic Black (71.2%), female (68.5%) and reported annual household income of less than $35,000 (70.1%). Recruitment strategies included use of passive approval of potential participants by PCPs, use of part-time staff, and outsourcing calls to a call center. A total of 314 (86.0%) people completed the 24-month visit. Retention levels varied across study visits and intervention condition. Most participants completed three or more visits (69.6%), with 205 (56.2%) completing all four. At 24-months, lower retention was observed for males and the intervention condition. Retention strategies included building strong relationships with clinic staff, flexibility in overcoming participant barriers through use of taxi vouchers, night and weekend appointments, and keeping participants engaged via newsletters and social gatherings. Conclusion: We were able to retain 86.0% of participants at 24-months. Recruitment and retention of high percentages of racial/ethnic minorities and lower income samples is possible with planning, coordination with a trusted community setting and staff (e.g. community health centers and RAs), adaptability and building strong relationships. Trial registration Clinicaltrials.gov Identifier: NCT00661817

Background: Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC3) Network Program.

Objective: To describe the development of the Outer Setting Data Resource and characterize the county-level outer context across Centers.

Methods: Our Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests.

Results: ISC3 centers’ catchment areas include 458 counties and over 126 million people across 28 states. The median percentage of population living within ½ mile of a park is higher in ISC3 counties (38.0%, interquartile range (IQR): 16.0%–59.0%) compared to nationally (18.0%, IQR: 7.0%–38.0%; p < 0.0001). The median percentage of households with no broadband access is significantly lower in ISC3 counties (28.4%, IQR: 21.4%–35.6%) compared the nation overall (32.8%, IQR: 25.8%–41.2%; p < 0.0001). The median unemployment rate was significantly higher in ISC3 counties (5.2%, IQR: 4.1%–6.4%) compared to nationally (4.9%, 3.6%–6.3%, p = 0.0006).

Conclusions: Our results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.

COVID-19 vaccines are widely available in wealthy countries, yet many people remain unvaccinated. Understanding the effectiveness -- or lack thereof -- of popular vaccination campaign strategies is therefore critical. In this paper, we report results from two studies that tested strategies central to current vaccination outreach: (1) direct communication by health professionals addressing questions about vaccination and (2) efforts to motivate individuals to promote vaccination within their social networks. Near the peak of the Omicron wave, doctor- and nurse-produced videos were disseminated to 17.8 million Facebook users in the US and 11.5 million in France. In both countries, we cannot reject the null of no effect of any of the interventions on any of the outcome variables (first doses - US and France, second doses and boosters - US). We can reject very small effects on first doses during the interventions in both countries (0.16pp - US, 0.021pp - France). In contrast with similar campaigns earlier in the pandemic to encourage health-preserving behaviors, messaging at this stage of the pandemic -- whether aimed at the unvaccinated or those tasked with encouraging others -- did not change vaccination decisions.