Maximizing EBP Implementation Success By Integrating RCT Recruitment and Retention Data and Lessons Learned

EBP can benefit from the many lessons learned from the RCT. In response to the need across the globe for female-tailored HIV interventions, the Health Improvement Project for Teens (HIPTeens), an evidence-based intervention, was developed and tested. HIPTeens is a sexual risk reduction intervention that is gender-specific and developmentally-and culturally-tailored for girls 15-19 years of age Morrison-Beedy, Jones, & Yinglin et al., 2012. Now recognized by the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control as an evidence-based intervention addressing HIV and pregnancy, the next step in translation is to move to implementation and dissemination into the “real world” environment. Data analyzed during the course of the randomized controlled trial specifically around recruitment and retention, as well as “lessons learned” while working within underserved communities, can be extremely useful in ensuring the success in implementation within communities. Rarely, however, are such data integrated into the “next steps” of translational science for evidence-based projects and interventions.

After developing extensive recruitment and retention protocols following a 50% attrition rate in some of our pilot studies, we successfully increased study completion in a year-long RCT to 80% (Morrison-Beedy, Carey, & Crean, et al., 2010).  We tracked multiple recruitment variables (e.g., length of work experience, type of recruitment site, types and number of contacts for scheduling, parental awareness of participation) across the course of the sexual risk reduction intervention trial for adolescent girls. We found significant differences in study completion rates based on the length of the recruiters work experience on the project and parental awareness of daughters’ participation in the project (Nelson & Morrison-Beedy, 2008). Girls recruited by more senior recruiters, and girls who made their parents aware of their study participation were more likely to complete the study. Specific contact information/options were significantly different between attendees and non-attendees; being able to leave a message at school or on a home message machine and providing an active cell phone number resulted in higher completion rates whereas direct mail and email addresses did not impact retention. Various living arrangements (with parents, alone, with boyfriend, extended family) did not directly impact retention rates although the age of the female participant did, with older girls less likely to complete the study if they lived with their sexual partner. Naming minimal collateral contacts was significantly associated with lack of project completion Nelson, & Morrison-Beedy, 2012).

The research team was not always prepared for some of the challenges faced working in an urban environment. Participants’ lives were often complicated by food and housing insecurity (Alvarez, Carmen, & Lantz, et al., 2015). Some girls in the study faced interpersonal violence issues and stalking by boyfriends. Group facilitators also had to address weapons being brought to the program. A few participants attempted to scam the recruiters in order to obtain the minimal stipends paid for attendance (Miller & Vaughn, 2015).

These data and lessons can inform EBP protocols as this intervention is moved for broad-based dissemination. Recruiters and facilitators for the EBP can identify girls at risk for attrition using the data provided from the RCT and develop protocols to address some of the issues that may impact recruitment and retention (Seibold-Simpson & Morrison-Beedy, 2010). Spending considerable time with participants to develop detailed contact information is critical. Inquiries into competing priorities (e.g., after school activities, employment, sports) and identifying best time to schedule project groups to facilitate attendance is necessary as is encouraging notification of parents and guardians. Recruiter effectiveness can be enhanced with training that includes role plays of challenging enrollment issues and approaches needed to delve into detailed contact information. Also of importance is the ability of the recruiter to speak about the benefits of participation and developing a “partnership” between participant and the intervention team to address attendance issues using a pre-emptive approach. Ongoing supervision to ensure stability of recruitment skills over time is imperative for those implementing EBP interventions in community-based and clinical settings (Merves, Rodgers, Silver et al., 2015).

Having an effective intervention alone to move into clinical or community settings does not ensure success. The planning logistics required can be augmented with lessons learned during the research trial to maximize implementation success of the EBP project.