Lessons Learned: Patient Strategies for a Type 2 Diabetes Intervention in a Primary Care Setting

Abstract

PURPOSE

this study reports on methods and strategies employed to increase participation rates in diabetes interventions and discusses the reach and representativeness of the Diabetes Priority Program.

METHODS

A passive mail-out procedure was used to contact patients of participating primary care physicians. Patients who did not return the refusal postcard were contacted. Several attempts were made to contact potential participants. Brochures, "wrong number" postcards, posters, and reports for clinic staff were strategies used to increase participation.

RESULTS

The recruitment process resulted in a participation rate of 83% among patients who were contacted and eligible. These participants appeared to be representative of both nonparticipants and persons with diabetes in Colorado. In contrast, a low percentage of primary care physicians, estimated at 3%, took part in the program despite efforts to make the program brief, nonintrusive, and compatible with usual care.

CONCLUSIONS

Recruitment is currently challenging and will become even more difficult with the privacy regulations that affect healthcare research and the public distrust of solicitations. To increase participation rates, it is important that the clinic staff promotes and supports the program, and that participant lists are accurate and adequate in size.

Get full access to this article

View all access options for this article.

References

1. Glasgow RE , Toobert DJ , Hampson SE . Participation in outpatient diabetes education programs: how many patients take part and how representative are they? Diabetes Educ. 1991;17:376-380.

2. Glasgow RE , Eakin EG , Toobert DJ . How generalizable are the results of diabetes self-management research? The impact of participation and attrition. Diabetes Educ. 1996;22:573-585.

3. van der Windt DA , Koes BW , van Aarst M , Heemskerk MA , Bouter LM . Practical aspects of conducting a pragmatic randomized trial in primary care: patient recruitment and outcome assessment. Br J Gen Pract. 2000;50:371-374.

4. Peto V , Coulter A , Bond A. Factors affecting general practitioners' recruitment of patients into a prospective study. Fain Pract. 1993;10:207-211.

5. Margitic S , Sevick MA , Miller M , et al. Challenges faced in recruiting patients from primary care practices into a physical activity intervention trial. Activity Counseling Trial Research Group. Prev Med. 1999;29:277-286.

6. Silagy CA , Campion K , McNeil JJ , Worsam B , Donnan GA , Tonkin AM . Comparison of recruitment strategies for a large-scale clinical trial in the elderly. J Clin Epidemiol. 1991;44:1105-1114.

7. Bell-Syer SEM , Moffett JAK . Recruiting patients to randomized trials in primary care: principles and case study. Fam Pract. 2000;17:187-191.

8. Verboncoeur CJ , Stewart AL , King AC , Rush S , McLellan BY , Mills K. The use of refusal postcards in recruiting older adults. Ann Behav Med. 2000;22:330-333.

9. Anderson LA , Fogler J , Dedrick RF . Recruiting from the community; lessons learned from the Diabetes Care for Older Adults Project. Gerontologist. 1995; 35:395-401.

10.

10. Glasgow RE , Bull SS , Gillette C , Klesges LM , Dzewaltowski DA . Behavior change intervention research in health care settings: a review of recent reports with emphasis on external validity. Am J Prev Med. 2002;23:62-69.

11.

11. United States Census. 2000. Available at: http://quickfacts.census.gov/qfd/states/08000.html. Accessed February 2003.

12.

12. Centers for Disease Control and Prevention . Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention; 2001.

13.

13. Toobert DJ , Strycker LA , Glasgow RE , Bagdade JD . If you build it, will they come? Reach and adoption associated with a comprehensive lifestyle management program for women with type 2 diabetes. Patient Educ Counsel. 2002.;48:99-105.

14.

14. Putnam RD . Bowling Alone: The Collapse and Revival of the American Community. New York: Simon & Schuster; 2000.

15.

15. Kusek JW , Coyne T , de Velasco A , et al. Recruitment experience in the full-scale phase of the Modification of Diet in Renal Disease Study. Control Clin Trials. 1993;14:538-557.

16.

16. Collins JF , Williford WO , Weiss DG , Bingham SF , Klett CJ . Planning patient recruitment: fantasy and reality. Stat Med. 1984;3:435-443.

17.

17. Veitch C , Hollins J , Worley P? Mitchell G. General practice research. Problems and solutions in participant recruitment and retention. Aust Fam Physician. 2001;30:399-406.

18.

18. Glasgow RE . Outcomes of and for diabetes education research. Diabetes Educ. 1999;25:74-88.

19.

19. Wagner EH , Glasgow RE , Davis C , et al. Quality improvement in chronic care: a collaborative approach. J Joint Commission on Health Care Quality. 2001;27:63-80.