Table 4.

Recruitment problems/challenges encountered and solutions to these problems/challenges by Center and project

Center and Study Names	Problems/Challenges	Solutions
Center for Interdisciplinary Health Disparities Research, University of Chicago
Social Environment, Stress and Health	Timing of initial interview close to surgery while patients are recuperating Potential participants reside outside of study boundaries Failure to return phone calls	Waited to schedule interview until at least 1 month post-surgery Created flexible scheduling to accommodate participants Extended study recruitment boundaries Staff traveled to residences of potential participants and leave a note and contact information in a sealed envelope taped to the front door Enlisted local hospital to assist in recruitment
The Boston Puerto Rican Center on Population Health and Health Disparities. Tufts/Northeastern Universities
All projects	Locating participants Participants cancel interview appointments	Made contact with local Hispanic organizations and community leaders Instituted media advertising campaign
Institute for Health Research and Policy Centers at University of Illinois at Chicago
Breast Cancer Care in Chicago, All projects	Completing the questionnaire Resolving a final contract with Illinois State Cancer Registry Patients identified within 45 days of diagnosis but not sufficiently adjusted to agree to participate Poor cooperation from local hospitals and physicians	Held in-person meetings with hospital cancer committee registrars Sent letters to all cancer chair physicians to inform about study Enlisted lawyers from the state to contact the hospitals and explain that the law making cancer reportable allowed the state to request the data mandated by the legislation anytime it was needed. Non-compliant hospitals were fined and began to reinterpret their policies; all hospitals are now on board.
The Ohio State University Center for Population Health and Health Disparities
Community Awareness, Resources and Education (CARE) Project, All Projects	Clinic staff too busy/short-staffed Clinics lack necessary equipment/personnel for specimen processing Coordination of IRB approvals for clinics HIPAA concerns Identifying rates of abnormal pap smears in the clinic Locating interested and eligible clinics Obtaining space in clinics to store study equipment Working with clinic administration Lack of understanding about research and benefits to community Mistrustful of healthcare and research Mobile/transient population Travel necessary due to large geographic area covered by project Busy schedules of interested participants Contacting potential participants during busy clinic schedule Difficult to reach potential participants via mail or phone Failure to return phone calls/mailings Fewer eligible participants than expected Participants cancel appointments Participants change their minds about participating Participants interact with multiple staff members throughout program Lower participation rates of smokers Management of off-site research staff Survey instrument length and complexity	Asked for input from community advisory board Conducted pilot study to assess feasibility, study procedures, abnormal Pap rate, and refusal rates Facilitated clinic contact with experts to address HIPAA concerns Hired research nurses to alleviate perceived clinic staff burden Implemented reminder system to check for current information Made contact with community representatives to help locate and enroll clinics Scheduled multiple in-depth meetings and presentations Developed intricate email-based notification and data tracking system Discontinued sending self-administered survey and consent form with interview confirmation letter prior to interview visit Emphasized benefit to future health of women in community Emphasized short time commitment of study Included recruitment incentives with initial mailings Instituted regular conference and individual calls with field staff Offered extra assurance of confidentiality Placed project awareness materials in clinic waiting rooms Searched for phone numbers and addresses using online white pages Created personalized letters from clinic staff Implemented 1–800 number for follow-up from participants Offered gift certificates as incentives Offered the option of a shorter baseline survey Study coordinator called hard to reach participants with permission of clinic Retrained interviewers in project presentation Revised recruitment procedures Revised recruitment goals
RAND Corporation Center for Population Health and Health Disparities
The role of parks in physical activity and health	Environmental factors: dogs, gangs, locked gates	None
Center for Population Health and Health Disparities at the University of Pennsylvania
Biological and Behavioral Predictors of Prostate Cancer	Time constraints for patient recruitment No space in clinic for staff to interview patients	None
Determinants of ethnic differences in quality of life following a prostate cancer diagnosis	Clinic doctors and staff do not make recruitment a priority	Instituted on-site recruitment in clinics by study staff Provided regular updates to physicians and staff regarding recruitment from their site Held regular strategic meetings at sites with low recruitment
University of Texas Medical Branch Center for Population Health and Health Disparities
Environmental Risk, Coping and Mexican American Health Study	Scheduling an interview Schedule a blood draw A tragic plant explosion occurred during the data collection stage Katrina Hurricane delayed data collection	Left a sticky note, on the door, indicating when the next day and time the interviewer will stop by and a phone number to schedule an interview Had nurses conduct home visits and set a clinic on Saturday mornings from 9–12 Ceased data collection for that day and continued normal interviewing the following day. Several rejects to interview sky – rocketed after the explosion. Developed and conducted a sub-study pre- and post-explosion Shipped all data to collaborating site in North Carolina. Project manager also carried the data (CD) to Houston, Texas and interviewers had their data backed up in a storage card.
The Liberty County Community-based Cancer Control Project	Project depends on prior two studies which are still pending Delayed work in one area to prevent contaminating ongoing work of a related project Budgetary reductions have delayed progress Time consuming and difficult to build partnerships with communities Reduction of available cancer screening services in study communities	Moved forward with first phase of project in area with other ongoing research project Worked with communities to identify alternative funding sources Engaged in special efforts to maintain the trust of the community following closure of local clinics Gathered data and developed presentations for advocacy with county policymakers Emphasized risk reduction education to align with priorities of community partners
Wayne State University Center of Urban and African American Health
Exploring Changes in Experiences and Lifestyles (EXCEL)	Organization/structure of referring cardiac rehab centers Potential participants unwilling to participate Busy schedules of participants Inadequate recruitment personnel to cover all referral sites Eligibility criteria too narrow and not consistent with culture	Instituted regular meetings between cardiac rehabilitation center staff and research staff Reshaped organizational structure to accommodate potential participants Offered home visits and extended office hours to accommodate schedules of participants Increased personnel efforts to accommodate new recruitment sites Revised eligibility criteria so they were congruent with culture
Obesity, Nitric Oxide, Oxidative Stress and Salt Sensitivity	Study population recruited from non-traditional clinic sources Potential participants excluded by high BMI Time commitment of study (39 weeks)	Established partnerships with community organizations Decreased length of study to 33 weeks Extended office hours to accommodate schedules of participants
Women Healthy Lifestyle Study (WHLS)	Poor communication between institutional cancer center clinic staff and study specific research recruitment coordinator Limited access to potential cancer center charts to 2 days per week	Continued checking clinic schedules for potentially eligible subjects Increased time spent on evaluation of potential participants to 5 days per week Expanded screening efforts by obtaining SEER cancer registry lists for entire region rather than for only study hospital Implemented weekly presentations to cancer survivor groups within the region