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					Participant Recruitment in
Social Work Intervention
Research: Methodological
Issues and Cost-Effective
Strategies
Dr. Lisa Berger,
University of Wisconsin-Milwaukee, School of Social Welfare &
Center for Addiction & Behavioral Health Research
Dr. Audrey Begun,
The Ohio State University, College of Social Work
Dr. Laura Otto-Salaj,
University of Wisconsin-Milwaukee, School of Social Welfare &
Center for Addiction & Behavioral Health Research
          Outline
   Introductions to presenters (all presenters)
   Introduction/Background to workshop (Begun)
   Participant recruitment as 4 phase process
       Generating initial contacts (Berger)
       IRB & informed consent procedures (Otto-Salaj)
       Screening for eligibility (Otto-Salaj)
       Enrollment and retention (Otto-Salaj)
   Cost-effectiveness case example (Berger)
   Conclusions, issues and ideas from research
    practices (all presenters and participants) (Begun)
      Introduction to Presenters
 Lisa Berger, MSW, PhD
 MSW and PhD training both from University of
  Wisconsin-Milwaukee
 12 years at University of Wisconsin-Milwaukee
  School of Social Welfare
 a long-term Center Scientist with the Center for
  Addiction & Behavioral Health Research (CABHR)
        Introduction to Presenters
Lisa Berger (cont.)
 Sample Intervention Studies:
     Pharmacotherapy in combination with behavioral
      interventions for the treatment of alcoholism
      (COMBINE Study)
     Several other combined pharmacotherapy and
      behavioral intervention studies for alcoholism
      treatment
     Brief alcohol and drug intervention pilot study for
      hospitalized medical inpatients (Bridge to Change)
      Introduction to Presenters
 Audrey Begun, MSW, PhD
 BA, MSW, PhD training all from University of
  Michigan (social work & developmental psych)
 22 years at University of Wisconsin-Milwaukee
  School of Social Welfare
 a “founding” Center Scientist with the Center for
  Addiction & Behavioral Health Research (CABHR)
 Now at The Ohio State University College of
  Social Work
        Introduction to Presenters
Audrey Begun (cont.)
 Sample Intervention Studies:
     Measuring batterers’ readiness to change with
      batterer treatment intervention; partner perceptions
      of batterer readiness to change
     Impact of community awareness campaigns (violence
      against women and girls)
     Impact of jail in-reach alcohol/drug intervention with
      women at community reentry
     Impact of national effort to train social work
      educators to integrate NIAAA’s MSW alcohol
      curriculum
        Introduction to Presenters
   Laura Otto-Salaj, MA, PhD
   BS from University of WI-Madison, MA and PhD from
    Temple University (Social Psychology)
   8 years as a researcher at the Medical College of
    Wisconsin, Center for AIDS Intervention Research
   7 years at University of Wisconsin-Milwaukee School
    of Social Welfare
   Long-standing Center Scientist with the Center for
    Addiction & Behavioral Health Research (CABHR)
   NIH reviewer since 2000
        Introduction to Presenters
Laura Otto-Salaj (cont.)
 Sample Intervention Studies:
     Study of the efficacy of an HIV intervention for persons with
      serious and persistent mental illness with co-existing HIV
      sexual risk and AODA issues (NIMH)
     Study of the efficacy of a combined HIV/alcohol intervention
      for inner-city women with co-existing HIV sexual risk and
      alcohol use disorders (NIAAA)
     Current prospective study of intersection of sexual risk,
      trauma history, and substance use in African American
      women living in urban low income housing developments
      (NIDA/NIMH/NICHD)
         Acknowledgements
   A Randomized, Multi-Center, Double-Blind, Placebo-Controlled Study of the Efficacy and
    Safety of Aripiprazole In the Maintenance of Abstinence from Alcohol in Subjects with
    Alcoholism. Multi-site study. Bristol-Myers Squibb. Zweben, Longo, Begun (Co-PIs for
    Milwaukee site) 1/3/05-5/1/05
   Acamprosate Treatment of Alcohol Dependence in a Family Medicine Setting: A
    Randomized, Double-Blind, Placebo-Controlled Study. Forest Research Institute, CMP-
    MD-06B. Berger (PI) 1/15/07 – 6/30/10
   Assessing Prisoner Service Utilization at Community Reentry: Project RISE—Reentry
    Inventory of Service Engagement. Ohio Association of County Behavioral Health
    Authorities and the Office of Criminal Justice Services. Begun (PI) 7/15/09-12/31/10
   Brief HIV and Alcohol Combined Interventions for Women (Heart to Heart), funded by
    the National Institute on Alcohol Abuse and Alcoholism (Grant # R01-AA13848, L.L. Otto-
    Salaj, PI; Deidra Roach, MD, Project Officer). 2002-2008.
   Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence
    (COMBINE). NIH/NIAAA: U10-AA011773. Zweben (PI for Milwaukee site) 9/30/97 -
    8/31/05. Project Officer: Raye Litten.
   Cost-Effectiveness of the COMBINE Study, Health Services Study. NIAAA/NIH:R01
    AA12788. Zarkin (PI), Zweben, Begun (Co-PIs for Milwaukee site) 7/1/00 –7/31/07
    Project Officer: Raye Litten.
   Cutting Back. Robert Wood Johnson Foundation, RWJ 029620. Zweben (PI) 6/1/98 -
    6/30/00
           Acknowledgements
   Development of a LifeCourse Timeline FollowBack Approach of Assessing Alcohol
    Dependence Recovery and Change Attempts. The Lois and Samuel Silberman Fund. Begun
    (PI) 6/1/07-5/31/08
   Etiology of HIV Sexual Risk, Substance Use, and Trauma: A Bioecological Systems Model
    (Stories to Tell), funded by the National Institute on Drug Abuse, the National Institute of
    Mental Health, and the Eunice Shriver National Institute of Child Health and Human
    Development. (Grant # R01-DA23858, L.L. Otto-Salaj, PI; LeShawndra Price, PhD, Project
    Officer). 2008-2013.
   HIV Risk Reduction for Persons with Mental Illness (ARRIVE), funded by the National
    Institute of Mental Health. (Grant # R01-MH61178, L.L. Otto-Salaj, PI; David Stoff, PhD,
    Project Officer). 1999-2004.
   Phase3, Long-term Safety and Efficacy Study of Medisorb Naltrexone-Continuing Extension.
    Multi-site Study. Zweben, Longo, Begun (Co-PIs for Milwaukee site) 2/1/04-3/31/07
   Social Work Educator Alcohol Curriculum Training Project. NIAAA/NIH:R25AA014338-
    01A1. Begun (PI) 5/20/04-4/30/08 Project Officer: Peggy Murray
   Social Worker and Physician Administered Brief Alcohol Intervention for Hospitalized
    Patients (Bridge to Change). UW-Milwaukee/Graduate School Research Committee Award,
    101-343029-4. Berger (PI) 7/1/08 – 10/31/09
   Supporting Jails in Providing Substance Abuse Services to Women in Jail and Transitioning
    Back to the Community. Bureau of Justice Administration (BJA)/National Institute of
    Justice(NIJ): 2006-DD-BX-0195. Begun (PI) 6/1/06-8/31/08
    Acknowledgements (cont.)

 Dr. Allen Zweben, our mentor and first
  leader of the Center for Addiction &
  Behavioral Health Research (CABHR)
 Our project staff members on each study

 Our Research Participants!
          Intro/Background (cont.)
 Workshop emphasis is participant recruitment
  and retention (R&R) in social work
  INTERVENTION research
 Goal: To increase success potential for clinical
  trial and other intervention research, avoiding
  studies underpowered to adequately test
  hypotheses
       Objective: Tailor R&R to specific populations
       Objective: Tailor R&R to research design and sampling
        strategy plans
        Workshop Intro/Background
   Research education addresses issues
    of design, measurement,
    methodology (e.g., power analysis
    to determine sample sizes needed;
    randomization strategies)
   Doctoral training and research
    textbooks seem to offer LIMITED
    CONTENT on actual practices of
    participant recruitment & retention
    (R&R) in social work intervention
    studies
           Intro/Background (cont.)
   Study success is dependent on ability to recruit and
    retain appropriate, sufficient numbers and types of
    participants
   Under-powering in intervention studies has been
    termed “unethical” (Halpern, Karlawish, & Berlin,
    2002)
   “Recruitment” is defined as a continuous process
    from initial recruitment activities through the act of
    randomizing subjects into a clinical trial (Spilker &
    Cramer, 1992) and retaining the representative
    sample
   Unfortunately, we too often overestimate our
    ability to recruit, especially since fewer participants
    qualify once eligibility criteria are applied (Spilker &
    Cramer, 1992)
         Intro/Background (cont.)
   Unfortunately, we too
    often overestimate our
    ability to recruit,
    especially since fewer
    participants qualify once
    eligibility criteria are
    applied (Spilker & Cramer,
    1992)
          Intro/Background (cont.)
   Consequences of this training gap:
       Over-estimating recruitment potential
       Under-estimating recruitment & retention challenges
         • Insufficient financial resources to complete
           recruitment & retention activities
         • Staff numbers, time, effort limits for recruitment,
           retention, and screening out inappropriately
           recruited volunteers
         • Planning and monitoring efforts
         • Recruitment tools poorly adapted for target
           populations
          Intro/Background (cont.)
   Consequences (cont.)
       Generalizability of findings:
         • Diverse & representative samples are
           critical to generalizability of
           intervention research results,
         • Segments of the population differ in
           their willingness and ability to
           participate in intervention research
         • This affects both efficacy and
           effectiveness study implications
         Intro/Background (cont.)
For example:
 African Americans are less likely than majority population to
  respond to traditional recruitment approaches (e.g., Brown,
  et al., 2000).
 Among African Americans, those with knowledge of the
  Tuskegee Study were significantly less willing to participate
  in medical research than those with no knowledge of that
  study (e.g., Shavers, Lynch, & Burmeister, 2002)
 Women and older adults respond differently to recruitment
  approaches than men and younger adults
         Intro/Background (cont.)
Example (cont.):
 Positive correlation between responsiveness to recruitment
  and self-identified need for intervention (e.g., Winslow et
  al, 2009).
 Different strategies (proactive versus reactive recruitment)
  elicit individuals at different points in the readiness to
  change and level of problem experienced (e.g., Webb,
  Seigers, & Wood, 2009).
 Responses to recruitment are affected by individuals’ past
  experiences with research participation—especially
  suspicion engendered by “smash & grab” research style
  (presenters’ experience)
          Intro/Background (cont.)
   Consequences (cont.)
       Attrition affects fidelity of group and community level
        interventions (Lauby et al, 1996)
        Intro/Background (cont.)
 We will examine specific techniques for both
  Recruitment and Retention (R&R)
 We will NOT examine several strategies that
  are also important options to consider:
       Respondent-driven sampling (e.g., Tiffany, 2006)
       Community-driven model (e.g., Wyatt et al., 2003)
       Participant registries or “pools” (e.g., Harris, lane,
        & Biaggioni, 2005)
         Intro/Background (cont.)

We will examine R&R in context of IRB concerns
   NO recruitment before approval by IRB
   Human subjects protections
      Ethics and IRBs emphasize “distributive justice”
       aspect of intervention research
      Populations should not be unduly burdened by
       conduct of the research
      Populations should have equal access to the
       potential benefits of the research
   Consenting procedures can affect participant
    enrollment/retention over time
          Intro/Background (cont.)
   We will examine “Cost-effectiveness” of
    recruitment strategies as depending on:
       Financial costs of the media used
       Staff time/effort involved in the media efforts and
        screening of “false positive recruitment”
       Effectiveness in generating the participant types
        and numbers needed
       Effectiveness in generating participants who
        can/will be retained
       Effectiveness in generating participants who can
        provide valid, reliable data; adhere to the
        intervention and throughout follow-up data
        procedures
        Intro Conclusion: Viewing
        Participant Recruitment as a 4 Phase
        Process
1.   Generating initial contacts
2.   Consenting
3.   Screening for eligibility
4.   Enrollment and retention
       Participant Recruitment:
       Phase 1
1. Generating initial contacts: Activities to identify
   and solicit potential participants
 Examples from “wide reach” media (television,
   radio, newspaper, movie theatre advertising,
   “ValPaks,” posters/flyers)
 Direct mailings (and cultural sensitivity)
 Personal face-to-face recruitment appointments
   (used in the jails)
 Agency/practitioner partners and referral
   systems
        Participant Recruitment (Phase 1
        cont.)
   Media methods with broad reach, increasing
    relative expense for campaign type:
       Press Releases/Public Service Announcements
       Posters/Flyers/Brochures
       Mail/Email/Print Campaigns
       Bus Placards
       Radio/Television
        Participant Recruitment (Phase 1
        cont.)
   Referral Systems:
       Letters to Practitioners
       Meetings with Practitioners
       Practitioner Reminders (after initial letters and
        meetings)
        Participant Recruitment (Phase 1
        cont.)
1a. Different approaches may be differentially
    effective with different populations
   women vs. men
   racial/ethnic groups (it is not just about
    translation into a familiar language)
   younger vs. older (technology included)
   “stigmatized” populations
   workers (time and day messages are delivered)
   “problem” types (e.g., cognitive)
   social networks (e.g., the jail “gossip” network)
          Press Releases/Public Service
          Announcements
   Purpose
       To attract favorable attention to the research center
        (i.e., Public Relations)
       Publicize opportunities being offered
       To educate the public about intervention research
        and research participation
          Press Releases/Public Service
          Announcements (cont.)
   Advantages
       Low to no direct cost
       Large audience
       Capitalize on something new or different (e.g., the start of a
        new trial)
   Disadvantages
       Press releases may not be considered newsworthy (not
        picked up by reporters)
       Poor planning can leave negative impressions (e.g., generate
        calls that no one is available to answer)
        Press Releases/Public Service
        Announcements (cont.)

UWM and OSU have
Media Relations/
Communications
Departments that
write press releases
and connect with
local & national
media staff/health
reporters
                       31
Press Releases/Public Service
Announcements (cont.)
                          Example of public
                          service brochure
                          from community
                          partners—what to
                          know about
                          participating in a
                          study. It recruits for
                          clinical trials in
                          general, not a
                          specific study
    Press Releases/Public Service
    Announcements (cont.)
Example of
clinical trials
public
education
stand-up
poster
      Press Releases/Public Service
      Announcements (cont.)
                                              Websites for
   http://www.hhs.gov/ohrp/outreach/         informational
   http://www.cc.nih.gov/participate/_pdf/pa
                                              brochures
    rtners.pdf                                from OHRP
                                              and NIH
   http://clinicalresearch.nih.gov/who.html
   http://clinicalresearch.nih.gov/what1.html
        Public Service Announcements
        (cont.)
   Note: Specific             E.g., No “commanding”
    guidelines regarding        language
    wording allowed in             i.e., cannot say, “call this
                                    number” must say “the
    “free” public service           number to call is…”
    announcements              E.g., No use of the word
                                “free”
                                   i.e., no “free treatment”
                                    when what is meant is that
                                    participants will not be
                                    charged for their
                                    participation
          Participant Recruitment (Phase 1
          cont.): Posters/Flyers/Brochures
   Recommended Content
       “Come one, come all” –Broad Eligibility Criteria
       Potential Benefits of Participation
       Contact Information should be easy to take along
       Graphic design, colors, logos: attracting and appealing
          Participant Recruitment (Phase 1
          cont.): Posters/Flyers/Brochures

   Recommended Placements
       Public Kiosks
       Local Businesses
       Waiting Areas, hospital television
        service
       Dressing Rooms/“John” Doors
        (public but some privacy for reading
        and taking down information)
          Posters/Flyers/Brochures
          (cont.)
   Advantages
       Brief and to the point
       Generally inexpensive to produce and distribute
       Large potential audience in high-traffic areas
   Disadvantages
       Competing with other posters, flyers, and brochures
       Appeals to visual sense alone
       Requires reading, cognitive ability to understand
       Easily removed/discarded (or abused), might not be
        removed when out of date (study ended)
Posters/Flyers/Brochures (cont.)
      Posters/Flyers/Brochures (cont.)

NOTE: Tear
off tabs or
pads of tear
off sheets
mounted on
the poster—
inventory
needs to be
monitored!
   Posters/Flyers/Brochures (cont.)

Graphics, color
schemes help
your
announcement
stand out in
the “crowd”



                                      41
    Posters/Flyers/Brochures (cont.)
Appealing
graphic, unique
“logo” help
make your
brochure
recognizable,
“branding” your
project can be
important
        Participant Recruitment (Phase 1
        cont.): Mail/E-mail/Print Campaigns
   Recommended Content
       Can include more specific study
        information
       Potential benefits of participation or
        benefits of making a referral for clients to
        the study
       But, KEEP IT SHORT & SWEET to get it read
       Contact Information: easy to give to client
   Recommended Audiences
       Other Healthcare Providers (e.g., physician
        letters)
       Potential Participants
          Mail/E-mail/Print Campaigns
          (cont.)
   Advantages
       Can target your audience (helps to diversify)
       Large audience
       Flexible message presentation
   Disadvantages
       Competing with other mail/ads
       Need to obtain/pay for mailing lists (administrative
        and cost concerns arise)
       Print & mail are more expensive than posters, flyers,
        and brochures
       Email easier to ignore, disregard, be annoyed at
        receiving
    Mail/E-mail/Print Campaigns
    (cont.)
Example:
Letter to
community-
based
service
providers
for referring
participants
to the study
       Mail/E-mail/Print Campaigns (cont.)
Print campaign
example:
Study staff
submitted short
article to local
healthcare
newsletter delivered
to 25,000+
households;
placement on
outside last page
ensured visibility.
     Mail/E-mail/Print Campaigns
     (cont.)

Example of
newspaper
advertisement
          Mail/E-mail/Print Campaigns
          (cont.)
Electronic mail
campaign: UWM weekly
e-nnouncements sent to
all faculty and staff; OSU
one-page daily news
includes study ads for
campus recruitment.
Note: in addition to
calling the study site,
potential participants
can walk-in for              http://www.uwm.edu/News/e-nnounce/05.03/14/cabhr.html



screenings during set
times
           Participant Recruitment (Phase 1
           cont.): Bus Placards
   Recommended Content
       Broad Eligibility Criteria
       Potential Benefit(s)
       Contact Information
   Placements
       Inside of Bus
       Bus Exterior (side, rear)
       Bus Shelters
          Bus Placards (cont.)
   Advantages
       Can target your audience
       Brief and to the point (riders are readers of signs)
       Lower cost
       Can help studies earn credibility with the public
   Disadvantages
       Targets the same individuals day after day (may need
        to rotate to buses serving varied routes)
       Requires reading comprehension
       Difficult to take info with discretion
Bus Placards (cont.)
           Participant Recruitment (Phase 1
           cont.): Television/Radio/Movie
           Theaters
   Recommendations
       30 seconds in length
       Easy to remember information (e.g.,
        simple phone number)
       Keep it simple
       Graphics and headlines are
        important in television
       Timing of ad placement crucial to
        tailor for target audience
       Repetition is the key to success
          Television/Radio/Movies
          (cont.)
   Advantages
       Can target your audience
       Large audience potentially
       Appeals to more than one sense (visual, sound)
       Effective method
   Disadvantages
       Expensive
       May not be seen/heard by your target
        audience (e.g., Internet, iPod may replace TV,
        radio)
       Poor planning can render ineffective
Television/Radio/Movies
(cont.)
Television/Radio/Movies
(cont.)
          Participant Recruitment Phase 2:
          IRB & Consent
2. Consenting: Informing potential participants about the
    study, including risks/benefits to themselves
•   Consent as an issue of recruitment and retention:
    •   Respect and truthfulness influence enrollment and retention in
        this study
    •   Influence enrollment in future studies (research infrastructure)
    •   Continuation of process begun with marketing; people can still
        refuse to enroll at this stage
         • Influence of “word of mouth”: barrier to participant access
•   Consent as a data quality issue
         Participant Recruitment Phase 2:
         IRB & Consent (cont.)
Consent as a PROCESS not a single, one-time
  event (i.e., a signed consent form)
     Truly informed consent
       • e.g. signing after each page
       • List of bullets at end of consent: client-
         generated
   Reiteration/reminder of consent at each
    appointment
   Serial consent interviews
       • Rolling consent (“re-consenting”) throughout
         study period
          Participant Recruitment Phase 2:
          IRB & Consent (cont.)
   IRB Role in Review/Approval of
    Participant Advertising
       IRB reviews recruitment procedures
        and contents prior to approval and
        use of materials
       Are recruitment procedures coercive?
       Are benefits stated or implied beyond
        those in the protocol?
       Is access to benefits, risks shared
        equitably across populations?
          Participant Recruitment Phase 2:
          IRB & Consent (cont.)
   Payment may be mentioned but should
    not be emphasized (e.g., use of large or
    bold type)
       Arguments about whether any payment is
        consider coercive or “undue inducement” in
        targeting some populations
          • Distinctions between coercion and undue
            inducement
       Participants in intervention research are paid
        for their time and effort in the completion of
        assessments
         • Payment for treatment?
         • Appropriate payment schedule? Depends on
           population, time, participant burden…
         • Type of payment and safety issues
          Participant Recruitment Phase 3:
          Screening
3. Screening for eligibility: Determining whether
   or not potential participants are eligible for
   study participation
    •   Screening as inoculation
   Maximizing diversity while minimizing
    unnecessary exclusion
       Avoiding “creamed” samples
   Flexible screening procedures
       Repeat screening of ‘ineligibles’ due to temporary
        conditions
   Informing individuals who are study ineligible
             Participant Recruitment Phase 3:
             Screening (cont.)
   Cost Efficiency
       Prescreening potential participants (e.g. phone
        referral)
         • For example, in one study, 359 potential
           participants were telephone prescreened.
           216/359 progressed to a scheduled screening
           appointment; eventually 133/216 were enrolled.
       Order of screening procedures
         • Cost-efficient: Measures that have most ability to
           discriminate between eligible and non-eligible
           persons
         • Must be careful if nature of study may encourage
           people to self-select out unnecessarily
            Participant Recruitment Phase 3:
            Screening (cont.)
   Relationship between screening as part of
    the recruitment process and the retention of
    intervention participants
       Often first “personal” encounter with potential
        participants: persuasive argument (but not too
        much)
         • Personal treatment: rapport and listening
         • Belief of how data will be handled based on staff
           conduct at screen
         • Potential participant may be picturing what it
           would be like to spend (a lot of) time with
           you/your staff: need to rise to the challenge…
         Participant Recruitment Phase 4:
         Enrollment & Retention
4. Enrollment and retention:
   Randomizing eligible participants
   to intervention conditions and
   retaining them in the study
     Identification and problem-solving
      of barriers to participation early in
      study involvement
     Minimize time between screen,
      enrollment and study participation
           Participant Recruitment Phase 4:
           Enrollment & Retention, cont.
   Setting up tracking (“locator”) systems
       Database
         • Multiple contacts identified by participant
         • Community-based organizations (access
           points)
            • Staff
            • Other clients of CBO
         • Subscription databases (e.g. Accurint)
   When participant “tracking” can
    become participant “harassment”
    (“stalking”)…
         Participant Recruitment Phase 4:
         Enrollment & Retention (cont.)
   Sample letters “from”
    participants for
    research team to give
    to their identified
    “significant others”
    giving their
    permission to provide
    team with contact
    info after they
    become difficult to
    track
        Monitoring “Cost-effectiveness”
        of Recruitment Efforts
 Assessing, monitoring effectiveness
 2 Ratios (both have same denominator)
     Recruitment Yield Effectiveness: RYE
    RYE=(# of prescreened calls generated from each media
      method) divided by (number of participants actually
      enrolled/randomized)
     Recruitment Yield Cost-Effectiveness: RYC
    RYC=(direct advertising US $ cost of each media method
      used) divided by (number of participants actually
      enrolled/randomized)
          “Cost-Effectiveness” Case
          Example #1
   UWM/CABHR study site of the COMBINE trial testing
    various combinations of medications and behavioral
    interventions in the treatment of alcohol dependence
   Design: Randomized Clinical Trial (9 categories of
    medication, behavioral treatment combinations and
    placebos)
   Target Population: Individuals with alcohol dependency
    (strict screening criteria)
   N=133 (adult men & women)
   Study Duration:3 months of treatment, 12 months of
    follow-up [with re-consent for continuation studies]
 Recruitment
   Method           Direct Cost   Subject Yield   Cost/Subject
 Bus Placards         $1,000           2             $500
  Newsletters           $0             17             $0
Newspaper Ads         $3,667           17            $216
 Other Referral          ?             10              ?
 Posters/Flyers        $125            0           No Yield
 Press Releases         $0             4              $0
Provider Referral       $0             13             $0
  Radio Ads           $2,393           10            $239
Television Ads        $5,355           31            $173
Television News         $0             21             $0
   Unknown               ?             8               ?
     Total           $12,540          133             $95
          “Cost-Effectiveness” Case
          Example #1 (cont.)
   Findings/Conclusion #1:
       Local television news appearances, healthcare
        newsletter articles, referrals from providers, and
        press releases were low to no direct cost options for
        subject recruitment
         • television news appearances about the study by
           members of the investigative team and articles in
           healthcare newsletters were extremely effective.
         • Effective methods may still have high indirect costs
           (e.g., staff time in writing newsletters/articles and
           establishing provider referral networks higher than
           direct advertising; screening efforts may be more for
           some options than others)
          “Cost-Effectiveness” Case
          Example #1 (cont.)
   Findings/Conclusion #2:
       Television, newspaper, and radio ads were the most
        effective methods in terms of direct costs per
        subject/participant
         • TV and radio are initially more expensive (up front
           production and airtime costs) but when used over
           time, they cost less per subject because of their
           effectiveness
         • Newspaper ads also are effective and have lower start-
           up costs
      Cost-Effectiveness Case
      Example 2
 The HEART to HEART Study examined the
effectiveness of an HIV risk reduction intervention
following state-of-the-art alcohol and other drug
treatment
Design: Randomized Clinical Trial (following
treatment, women received either the experimental
HIV risk reduction intervention or HIV risk reduction
education)
Target Population: Inner-city women seeking alcohol
and/or other drug treatment
N = 148 (broader screening criteria)
Study Duration: 3 months of treatment, 12 months
of follow-up
            Cost-Effectiveness Case
            Example 2 (cont.)
 Recruitment
   Method        Direct Cost   Subject Yield   Cost/Subject
AODA Provider        $0             13             $0
 Non-AODA            $0             8              $0
  Provider
 Bus Placards      $1,500           1            $1,500
    Flyer         $382.50           23           $16.63
Mail Campaign    $13,671.76         2           $6835.88
Word of Mouth        $0             10             $0
    Total        $15,554.26         57
           Cost-Effectiveness Case
           Example 2 (cont.)
   Findings/Conclusions
       Referrals from AODA and non-AODA providers as well
        as word of mouth referrals served as low to no direct
        cost options for participant recruitment
         • Provider referrals consisted of staff time in developing
           and maintaining relationships (indirect costs)
       Flyers placed strategically in social services agencies
        were the most effective method in terms of direct
        costs per participant
          Conclusions and Tips:
          Developing a Strategic Plan
   Considerations
       Type and number of participants needed
       Stringency of eligibility criteria (more stringent
        requires more recruitment/retention resource
        allocation)
       Limit the geographic recruitment area (to enhance
        retention in longitudinal intervention studies—
        proximity to treatment sites)
       Ensuring adequate resources involves staff effort and
        monies
                               74
       Conclusions and Tips:
       Developing a Strategic Plan (cont.)
 Realistically estimate the number of subjects to
  be recruited, estimate attrition rates carefully &
  realistically
 Have specific staff members dedicated to
  recruitment efforts
 Track/monitor recruitment efforts and set
  weekly/monthly recruitment goals
 Develop a recruitment committee to create,
  monitor, modify, and implement the
  recruitment/retention plans
Concluding

 Additional tips, tricks, and experiences
 Group discussion, Q&A, workshop
  participant input
   Contacts and Web Resources


http://www4.uwm.edu/cabhr/training.cfm

  lberger@uwm.edu    (414)229-5008
  begun.5@osu.edu    (614)824-4514
  lottosal@uwm.edu   (414)229-5008

				
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