Enrollment Strategies of the Healing and Empowering and Alaskan Lives Toward Healthy Hearts (HEALTHH) Study

Introduction: High rates of smoking, inactivity, hypertension and hypercholesterolemia in Alaska Native (AN) people contribute to increased risk for cardiovascular disease and death. The HEALTHH study is a telemedicine-delivered, multibehaviorally targeted, two-group RCT in the Norton Sound Region of Alaska, with 16 villages and populations from 107 to 3,695 (average=596). The study interventions target smoking and physical activity vs. medication compliance and a heart-healthy AN diet. Eligibility include: AN adult, living in the Norton Sound region, smoking 5+ cigarettes/day, with high blood pressure or high cholesterol, English speaking, BMI < 50, not pregnant, and not in a tobacco cessation program. Study staff travel to the villages with stays ranging from 1 to 8+ days. In this rural and geographically remote area, we summarize our recruitment efforts and identify best practices for enrolment.

Methods: We analyzed the screening and enrollment data since study start, summarizing (counts and percentages) the number of individuals screened and enrolled by village and day. We examined the association between village size and enrollment.

Results: Since June 2015, the team has made 46 trips to the villages screening 419 individuals. Of the 245 ineligible individuals, 38% had normal blood pressure or cholesterol. Most screenings occurred on Days 2 (n=98, 25%), 3 (n=102, 26%), and 4 (n=80, 21%), with Day 1 (n=31, 8%) focused on community outreach and coordinating with the clinic. To date, 104 participants enrolled into the study (53% women, 47% men; mean age =51, SD=14, R: 21 to 81). Enrollment has been greatest on Days 3 (n=21, 20%) and 4 (n=35, 34%), with waning return Days 5 through 8+ (15% to 2%). Village size is significantly correlated with enrollment (r=0.76, p<.001); a third of the sample is from the two largest villages. Recruitment challenges include harsh weather, poor internet connectivity, missed appointments, and historical mistrust of the community toward research.

Conclusion: Recruitment best practices include: tabling in busy areas, offering flexible times and locations for recruitment, attending community events, utilizing all forms of media (radio, print, and social), and collaborating with clinic staff. Quarterly recruitment numbers have increased from 17 to 27 per quarter due to strengthening of community-research relationships and word-of-mouth referrals. Study findings can inform future community-based research trials.