Recruitment presentation dmd by 2mX0O4J2


									Expanding Program Reach
 Participant Recruitment
   Diane M. Dowdy, PhD

      March 27, 2008
     Topics for Today
• Revisiting RE-AIM model: Reach
• Defining and enhancing Reach

• Know Your Target Market


                               How do I reach the



           nan                   population?

                  How do I
                                                    How do I know

              incorporate the

             intervention so it                     my intervention

             is delivered over                       is effective?
               the long-term?


                       How do I ensure    How do I develop
      Im               the intervention    organizational
          ple            is delivered     support to deliver
                  me      properly?       my intervention?
                                                                  t io
                       nt                                       p
                           ion                             Ado
           “Reach” Definition

• Participation rate among eligible individuals
• Representativeness of participants
                     Assessing Reach
  Public health goal is to have large and representative
    segments of target population included

  Who’s participating in the program/study?

  • What percentage of the target population was
    excluded due to
      – Exclusionary/inclusionary guidelines
      – Refusal to participate
  • Are participants similar to those who are excluded

Klesges et al 2005
      Strategies for Enhancing Recruitment

• Recruitment now legitimate topic for study
• Older people can be successfully recruited
  into prevention studies—ditto other
  previously hard to reach groups
• Lots of different recruitment strategies utilized
• Recruitment expense will vary by selection

                                           Ory et al 2002
  Strategies for Enhancing Recruitment (cont.)

• Two stage recruitment screening often utilized
• Effectiveness of recruitment strategies vary in
  different settings (e.g., media coverage)
• Modifications are often made over course of
  the study
• Diminishing returns in pursuit of reluctant

                                         Ory et al 2002
What Do We Know About Reaching Older Adults

   • Most older adults are concerned about
     their health
   • They have gotten general message that
     activity is good for you
   Then why aren’t more adults active and
     how can we reach them?
                     Messages that Motivate*
• Ordinary people doing ordinary things.
• Physical activity must look like fun – the “no
  pain, no gain” straining, sweating image is not
  motivating to 50+ audience.
• Stress the social aspect of physical activity.
• Be specific and concrete: e.g. 30 minutes/5x
• Provide information: direction, guidance,
  resource info. Also give places and times of

*AARP Focus Groups
   Marketing physical activity to older adult

• Clearly identify audience
• Have clear concept of what you want to
• Target your message to your audience’s
• Understand audience’s media habits
• Use a mix of media to deliver your message,
  but keep message consistent

          Wave One Advertising
Motivational ads, to
 generate requests for
 AFL handbook

“Retail” ads, to promote
  specific activities and
               Wave Two Advertising
               …as Easy as Walking…
• “Believable:” 68%

• “Meaningful:” 56%

• Definitely would
  consider walking as
  exercise: 82%

• Liked it very much or
     Recruiting and Retention in Underserved

•   Awareness of group customs and values
•   Appreciation of intra group differences
•   Emphasis on cultural assets vs deficits
•   Flexible menu of offerings vs one size fits all

                                       Yancey et al 2006
            Redefining Recruitment
              Strategy Successes

Strategies that build
recognition and
            What worked in A4L?
• Lots of variability depending
  on population and
  organizational setting
• Personal communications
  and networks
  (videos/teaser course)
• Tagging into existing
  membership lists
• Using respected authorities
• Need for combined
  approaches (follow-up calls)
             Strategies for Enhancing Retention

Multiple strategies often needed:

•   Emphasize benefits of participation*
•   Minimize respondent burden
•   Provide incentives
•   Give instrumental or tangible supports
•   Be patient yet persistent
•   Be flexible*
•   Enlist support from others
•   Maintain good tracking system*

                                                  Coday 2005
Defining and Getting to Know Your
        Target Population
      Adapted from presentation by Brigid Sanner,
                  September 2006
Mining the
marketing data:
What we can learn
to promote healthy
behaviors among
midlife and older
    Socio-demographic factors associated with physical
• 25% of adults with an advanced degrees engage in high levels of
  physical activity compared to 14% of those with less than a high
  school diploma.

• Adults with incomes below poverty level 75% as likely to be
  inactive as those in the highest income group.

• Married women more likely than never married women to
  engage in a high level of overall physical activity.

• Adults in the South more likely to be inactive than adults in any
  other region.

         HHS Report, Physical Activity Among Adults: U.S. 2000
      Socio-demographic factors associated
              with physical activity
• As people age they become less active, though males remain more
  active than females in the 65-74 and 75+ age groups.*

• Non-Hispanic white adults more likely to engage in regular leisure-
  time physical activity than Hispanic and non-Hispanic Black adults.*

• Low-income adults more likely than wealthier peers to feel limited
  in doing basic activities like climbing stairs and lifting objects.**

• People 55-64 living below poverty line 6 times more likely to say
  they have physical limitations.**

   •** New England Journal of Medicine. Aug. 17, 2006
   •Early Release of Selected Estimates Based on Data from the Jan. – Sept. 2005 NHIS
              Market segmentation
• Customer groups with varying needs and wants are

• Markets can be segmented on a variety of factors
  including age, gender, location, geographic factors,
  demographic characteristics, family life cycle, desire
  for relaxation or time pressures.

  Ohio State University Fact Sheet. Finding Customers: Market Segmentation.
  Small Business Series. Nancy H. Bull & Gregory R. Passewitz
      Segmenting the audience
• Age 45 + audience spans more than 60 years
  – Multiple generations
  – Variety of life stages
  – Different lifestyles

• Generational cohorts consider influencers
  – Social
  – Cultural
  – Economic

                             JWT Mature Market Basics 2005
          Generational cohorts
• WWII/Depression/GI Generation
  – Formative years 1930 – 1945

• Ikes/Silents
   – Formative years 1946 – 1963

• Baby Boomers
   – Leading edge – Formative years 1960 – 1970
   – Middle – Formative years 1967 – 1977
   – Trailing – Formative years 1974 – 1983
            WWII – Depression – GI
• Values:
    –   Thrifty
    –   Patriotic
    –   Sacrificing / Delayed reward / Duty before pleasure
    –   Adherence to rules
• 35% married
• 62% women (73% of those are single)
• Men age 76+ likely to be married
• Least diverse – almost 81% non-Hispanic white
  (10.5% Black, 5.8% Hispanic, 3% Asian)
• Less than 15% completed college
• Values
   – Status quo/ Don’t rock the boat
   – Respect authority / Adherence to rules
• 65% married
• Growth in diversity (12.4% Black, 7.8%
  Hispanic, 4.5% Asian)
• 22% completed college (GI Bill)
             Leading Baby Boomers
• Values
    –   Idealistic
    –   Relevance
    –   Ask questions/challenge status quo/rock the boat
    –   Acceptance of differences
    –   Informality/Non-conformity
    –   Youth (changing the concept of ‘growing old’)
•   Hippies
•   Demanding
•   Immediate gratification
•   First wave turning 60 now
            Middle Boomers
• Similar values at leading edge boomers
• More defined by end of Vietnam War,
  Watergate (question and challenge authority)
• Status conscious
• Disco
• Individualistic/anything goes
• Immediate gratification
             Trailing Boomers
• Beginning to merge with values of Gen X
  – Conservatism
  – Pragmatic
  – Health
  – Personal values
• Formative years in height of “fitness craze”
• Apolitical
• Fade to Gen X
  Cultural markers of age cohorts
   WWII           Ikes       Boomers         Gen X

Pearl Harbor     Korea       Viet Nam       Gulf War
                  Ike          JFK
   FDR                                      Reagan
                McCarthy       MLK
 United in                  Civil rights
                Suburbia                   Berlin Wall
  victory                   ♀’s rights
 Hiroshima      Cold War    Television     Technology
  Sinatra      James Dean    Beatles         MTV
John Wayne        Elvis       Dylan        Punk Rock
       Example of a market segmentation tool
                    PRIZM NE®

  PRIZM NE®, a product of Claritas, combines
  demographic and consumer behavior
  segmentation to identify, understand, and
  target audiences. It defines households in
  terms of 66 demographically and behaviorally
  distinct types, or "segments.”

Information about Prizm NE® accessed from Used with permission
Examples of Prizm segments

Different strokes, different folks
• Gray Power: Middle class, own home, aging in place,
  mostly white, 55+, suburban, HH Income $50,222.
  Trait example: Veterans’ clubs.

• Close-In Couples: High school educated, empty
  nesters, older city neighborhoods, diverse (Black,
  Hispanic), 55+, HH Income $38,613. Trait examples:
  Eat at Denny’s, read Sunday newspaper

Information about Prizm NE® accessed from Used with permission
Examples of Prizm segments

Different strokes, different folks
• Old Glories: Aging in place in older apartment complexes.
  Fixed incomes, home-centered lives. Ardent television fans,
  diverse (Black), 65+, some high school, HH Income $30,013.
  Trait examples: Bingo, veterans’ clubs, daytime TV.

• Old Milltowns: Retired singles and couples living on downscale
  incomes in pre-1960 homes. Mostly white, 55+, high school
  graduates, HH Income $28,404. Trait examples: Gardening,
  veterans’ clubs, and eating at casual restaurants.

Information about Prizm NE® accessed from Used with permission
Looking closely at the male audience
   Shrinking numbers
 Age           Males            Females

45 - 64    30,381,000 32,059,000
             48.6%      51.4%
65 - 84    13,212,000 17,582,000
             42.9%      57.1%

 85+       1,240,000           3,028,000
              29%                 71%
          U.S. Census Bureau
Male & female AFL participants
                 Males    Females
                 19.16%   80.73%
Pilot year
                  (174)    (733)
                 18.57%   81.43%
 Year 2
                  (356)   (1,561)
                 18.41%   81.59%
 Year 3
                  (515)   (2,282)

 Year 4          16.33%   83.61%
(Aug. 8, 2006)    (284)   (1,454)
     AFL male & female participants
       by site (data as of 8/8/06)
                        Male          Female
    Blue Shield      27.17% (219)   72.83% (587)
  Church Health       11.41% (92)   88.59% (714)
    First Health     19.14% (142)   80.86% (600)
      GDAHC          21.40% (159)   78.60% (584)
        JCA          19.39% (203)   80.52% (843)
       OASIS          10.90% (98)   88.99% (800)
San Mateo/Berkeley   16.12% (113)   83.88% (588)
     SW Ohio         14.61% (123)   85.39% (719)
       YMCA          23.23% (180)   76.77% (595)
Taking lessons from other fields
  •   Tobacco use/cessation
  •   Melanoma prevention
  •   STD prevention
  •   AIDS prevention
  •   9 A Day
  •   Worksite programs
  •   Adult education
           ♀ & ♂ Response to health messages
Tobacco use initiation
      – Girls: Stress, self-medication, weight control, improve self-
      – Boys: Friends who smoke, peer pressure, authoritative
        parenting, mother’s education

Tobacco cessation issues
      – Women: Stress, weight control, negative emotions often
        lead to relapse
      – Men: Social influences are more influential on men, as are
        nicotine replacement therapies

Sex Matters in Health Promotion and Disease Prevention, Phyllis Greenberger, Society of Women’s Health Research
             ♀ & ♂ Response to health messages
  Melanoma prevention
     – Women: Use sunscreen, wear protective clothing.
     – Men: Use sunscreen, get regular screenings.

  Sexually transmitted diseases
     – Women: Skill building techniques to better negotiate
       condom use with partner.
     – Men: Personal experience and direct condom use

Sex Matters in Health Promotion and Disease Prevention, Phyllis Greenberger, Society of Women’s Health Research
♀ & ♂ Response to health messages
   Talk with men about sexuality and safety. Link self-interest to
    responsibility for wives, partners, & children.

   Recognize that all sexually-active men may be at risk, not just
    those who appear promiscuous.

   Get men in the public eye to acknowledge issue and promote

         Department of Peace Studies, University of Bradford, UK
             Joining groups
 Based on study in Cancer Practice

• 33% of women diagnosed with breast cancer
  joined a support group

• 13% of men diagnosed with prostate cancer
  joined a support group
            Worksite programs
• Men welcome workplace-based health promotion
  campaigns targeted at them.

• Men are often under-represented in worksite
  health programs, this may be due to an emphasis
  on programs and activities attractive to women.
                      Adult education
• Women participate in non-work-related
  courses more than men.

• When women and men with the same labor
  force status are compared, women also
  participate in work-related courses at a higher
  rate than men.

Education Statistics Quarterly. Vol 3, Issue 4, Topic: Featured Topic: National
Household Education Surveys Program
                Give’m what they want

• When developing a weight control program, one may want to
  consider a separate program (with a name like Gut Busters) offered to
  men only.

• Disease avoidance is not a significant motivation for most men.

• Prevention of illness is not as exciting as the quest for optimal health.

   The Men’s Health Network of Washington, D.C.
♀ & ♂ Response to health messages

   Today's big portion sizes may affect your perception
   of what a "serving" is. Take a look at these real-life
   portions of a few fruits and vegetables that fit easily
   into what you eat every day — and that easily count
   up to 9 for the day.
♀ & ♂ Response to health messages

 If you eat fruits and vegetable throughout the day, it's easy
 to reach your 7 A Day goal. Servings are pretty small, so it's
 easy to eat 2 or 3 at a time. See how easy it really is.
Men aren't eating enough fruits and vegetables.
Men eat only about 4 1/2 servings of fruits and vegetables a day on average.
Only 4 percent of men say they eat the 9 servings of fruits and vegetables a day recommended as part
of an active lifestyle.

Men aren't aware of the benefits.
Men are significantly less likely than women to recognize the health benefits of fruits and vegetables, such as their
role in reducing the risk of many cancers, heart disease, high blood pressure, and diabetes.

Men have high rates of diet-related diseases.
Men have approximately 1 1/2 times the death rate of total cardiovascular diseases as women.
Men have approximately 1 1/2 times the death rate of total cancers as women.
Men have approximately 2 times the death rate of lung cancer as women.
Men have approximately 1 1/2 times the death rate of colorectal cancer as women.
More than two-thirds of men are overweight or obese.
Among Americans overall, at least 58 million have some form of cardiovascular disease, including high
blood pressure, and 8.2 million Americans alive today have a history of cancer.
♀ & ♂ Response to health messages

 Healthy is beautiful. Eating right and getting lots of physical activity can
 do wonders for your body. You feel more energetic — more confident in
 yourself. And when you feel good about yourself, it shows. Fortunately,
 you have some powerful friends in fruits and vegetables. After all, they're
 filled with many important nutrients our bodies need to stay healthy, like
 vitamins, minerals, fiber and disease-fighting phytochemicals. And when
 you combine fruits and vegetables with physical activity, it can help lead
 to a healthier, more beautiful you
         Why do people exercise?
•   94% to feel good about self
•   77% to reduce stress
•   77% to control weight
•   54% to fight aging
•   40% socialize with others (46% men)
•   25% active respondents more as aging to lose weight
•   Fewer than 25% good for them
•   Fewer than 25% health condition

             Physical Activity Survey. AARP April 2006
           Exercise and aging
• 31% of women cite weight reduction as
  reason to start exercising more as they age
  compared to 17% of men.

• 66% of active respondents age 65+ said they
  exercise the same amount now as they always

          Physical Activity Survey. AARP April 2006
Barriers to exercise among sedentary

•   58% tired and lack energy (73% in 55-64 age)
•   50% lack of time (65% w. low HHI, 53% for 45-54, 22% for 65+)
•   41% bad weather hinders routine
•   20% afraid of getting hurt (32% w. low HHI)
•   17% no sidewalks to walk or bicycle
•   17% self conscious

               Physical Activity Survey. AARP April 2006
      Sources of health information for adults
• 62% from their doctors (69% for 45-64 group)

• 54% from family and friends (47% for 45-64 group)

• 47% from health websites

• 32% from magazines, books, or newsletters

• 31% from nurses or physician’s assistants

• 26% from pharmacies or pharmacists

• 18% from health insurance plan or HMO website or documents

• 10% from health or fitness clubs

• 5% from grocery store displays, brochures, or employees

            Expanding Meanings of Health: Institute for the Future
   Anecdotal ideas – reaching men
• Seek out men where they work and spend time such as barber
  shops and in military related settings.

• Technology slant attracts men.

• Sports themes attract men.

• Competitive aspects of physical activity attract men.

• Engage wives.
   Anecdotal ideas – reaching men
• Wellness programs (incentives with time off work, reduction in
  insurance, etc.)

• Frame programs as master’s programs, coaches rather than
  leaders, teams rather than groups.

• Structure “men’s programs”.

• Use spokesmen men respect/admire (sports figures, community

• Frame messages with facts and action-based messages.
• Men prefer action to talking.

• Men prefer team activity or singular activity rather than

• The relationship development/nurturing aspects of group
  programs may not appeal to men.

• Physical decline impacts men as much as women: women
  concerned about appearance. Men also. Men also concerned
  about loss of masculinity/strength/vitality.

• Guys need space and place to be guys while being physically

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