Community-Engaged Strategies for Recruitment and Retention of Asian Immigrant Women in a Church-Based Randomized Trial

Background: Ensuring adequate representation of underrepresented populations in clinical research is an essential part of the recruitment and retention process. To achieve this goal, it is vital that researchers engage stakeholders that serve or represent these communities in the development, implementation, and evaluation of recruitment and retention strategies. Cumulative evidence suggests that effective community engagement can overcome social and structural barriers to clinical research participation such as mistrust, stigma, or lack of adequate health knowledge that are common among ethnic minority communities (Centers for Disease Control and Prevention, 2011). Community engagement occurs via an iterative process by actively soliciting the knowledge, experience, and values of selected individuals to represent a broad range of interests including recruitment and retention (George, Duran, & Norris, 2014). Community health workers (CHWs) have been noted as an effective recruitment and retention agent when targeting culturally and linguistically isolated ethnic minority women for cancer screening intervention programs. Yet, there is little published documentation about recruitment and retention strategies used by CHWs as a key group of interest in research.

Purpose:  The purpose of this study was to explore effective recruitment and retention strategies used by CHWs in a church-based randomized clinical trial designed to promote breast and cervical cancer screening among Korean immigrant women in the United States.

Methods: We conducted 4 focus groups with 23 CHWs who enrolled Korean immigrant women in a church-based randomized trial to promote mammogram and Papanicolaou tests and retained them for 6 months (Han et al., 2016). Trained bilingual research assistants conducted interviews in Korean. Using an inductive content analytic approach, focus group data were analyzed. Two trained research assistants worked independently to identify common themes across focus groups.

Results:  Four themes emerged in relation to effective strategies for recruitment: personal networks, formal networks at churches, building on trust and respect, and facilitating a nonthreatening environment. These main themes characterized CHWs’ experiences related to recruitment through seven relevant subthemes: approaching people that I know, building on existing church groups, expanding personal network through referrals, public announcement in church bulletin/newsletter or by pastor, use of church directory, dovetailing an existing meeting or random encounters (often with food), and kind explanation/making them comfortable. The themes related to effective retention included: trust and realizing benefits. These themes were supported by five subthemes: good existing relationship, CHW competency, genuine attention and care, contributions to the church, and fulfilling additional needs of the participants using community resources.

Conclusions:  The findings suggest that qualified, well-trained CHWs can recruit and retain hard-to-reach immigrant women in a randomized trial by using multiple culturally sensitive strategies. Most themes identified in the study pertained to varying types of quality and characteristics of the CHWs; hence, for successful recruitment and retention, CHWs in a randomized intervention trial should be active, trustworthy, and culturally sensitive in their community. Addressing benefits of the participants and responding sensitively about their needs was also confirmed as useful retention strategies in this study. Sufficient training and ongoing support for CHWs would be important for CHWs to expand their social networks beyond immediate personal networks, maintain trust relationships, and help participants realize the benefits of study participation.