A successful approach to minimizing attrition in racial/ethnic minority, low-income populations

Glenn Flores, Alberto Portillo, Hua Lin, Candy Walker, Marco Fierro, Monica Henry, Kenneth Massey

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition. Methods The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition. Results Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P < 0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk = 1.5; 95% confidence interval, 1.1–2.0). Conclusions A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.

Original languageEnglish (US)
Pages (from-to)168-174
Number of pages7
JournalContemporary Clinical Trials Communications
Volume5
DOIs
StatePublished - Mar 1 2017

Fingerprint

Poverty
Appointments and Schedules
Cultural Competency
Social Adjustment
House Calls
Mentors
Linguistics
Quality Improvement
Caregivers
Statistical Factor Analysis
Motivation
Outcome Assessment (Health Care)
Clinical Trials
Databases
Confidence Intervals
Population

Keywords

  • African Americans
  • Hispanic Americans
  • Minority groups
  • Patient dropouts
  • Randomized controlled trials
  • Research subject recruitment

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology

Cite this

A successful approach to minimizing attrition in racial/ethnic minority, low-income populations. / Flores, Glenn; Portillo, Alberto; Lin, Hua; Walker, Candy; Fierro, Marco; Henry, Monica; Massey, Kenneth.

In: Contemporary Clinical Trials Communications, Vol. 5, 01.03.2017, p. 168-174.

Research output: Contribution to journalArticle

Flores, Glenn ; Portillo, Alberto ; Lin, Hua ; Walker, Candy ; Fierro, Marco ; Henry, Monica ; Massey, Kenneth. / A successful approach to minimizing attrition in racial/ethnic minority, low-income populations. In: Contemporary Clinical Trials Communications. 2017 ; Vol. 5. pp. 168-174.
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AU - Henry, Monica

AU - Massey, Kenneth

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N2 - Background Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition. Methods The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition. Results Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P < 0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk = 1.5; 95% confidence interval, 1.1–2.0). Conclusions A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.

AB - Background Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition. Methods The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition. Results Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P < 0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk = 1.5; 95% confidence interval, 1.1–2.0). Conclusions A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.

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