Table t2.

Strategies to Overcome Challenges to Research in Urban Community Health Centers

STUDY DESIGN

Promote Rigorous Quasi-Experimental Designs: given small organizational size and variability in environment and targets, randomization by site, provider, or patient frequently not feasible (operationally or financially)

RECRUITMENT AND RETENTION

Budget for High Cost for Participant Recruitment Research assistant time needed for challenging environment and target population Time for primary care provider involvement to overcome distrust Some financial incentives generally required for partnering with other community organizations Allowance of extra time and resources for recruitment of research staff with passion and ties to community

Budget for High Cost for Participant Retention Telephone and mail contacts between study time points Race/ethnic matching among intervention staff and participants and research staff, and participation for data collection

QUALITY IMPROVEMENTS

Plan and Budget for Collaborative Quality Improvement Strategies: limitations in medical record and administrative data systems should be expected

INTERVENTION STRATEGIES

Enhanced Medical Education and Training for Providers Training in patient-centered counseling techniques to increase skills and self-efficacy Frequent coaching to compensate for low volume per resident and high physician turnover

Ecological Interventions: multilevel interventions that target patients, providers, and systems and are tailored to a specific setting and population