Table 2.
Challenge | Strategy | Lessons learned |
---|---|---|
Head Start (HS) Centers | ||
1. High staff turnover | Increased number of site visits to intervention communities |
HS staff turnover necessitated frequent site visits for planning and training and to ensure fidelity |
2. Reduced engagement among comparison sites |
Increased number of site visits to comparison communities |
Extra visits to comparison sites were necessary to maintain their engagement in the research. |
3. Inconsistent implementation |
Provided process data to intervention sites on a quarterly basis instead of annually |
More frequent feedback to sites increased engagement and participation at the HS intervention sites HS administrators used process data to evaluate their site’s performance and make changes |
4. Barriers to implementation |
Integrated participant feedback into the intervention on an on- going basis where possible without sacrificing fidelity |
Incorporating HS staff suggestions throughout the study improved implementation Participants should be encouraged to make recommendations even when it was not feasible to incorporate all of them |
Children | ||
1. Confusion around eligibility limited recruitment |
Used formative assessment results to determine target populations for recruitment |
Formative assessment was invaluable in determining the recruitment strategy |
2. Permission forms turned in after baseline data collection |
Changed permission forms to allow for retro-active abstraction and use of data |
Using permission forms that allowed for retro-active abstraction and use of data increased the amount of data available for analysis |
3. Participants could be lost to follow-up |
Created permission forms that remained in effect for the duration of the study |
Obtaining permission for children to participate for the duration of the study negated the need to re-enroll each year |
4. History of distrust of researchers |
Provided and participated in community events in addition to orientation/recruitment activities |
Actively engaging children and families at events that were not strictly for recruitment or research demonstrated respect and built trust |
5. Low enrollment | Developed additional strategies for enrolling participants |
Using multiple recruitment strategies increased enrollment and participation. |
Parents | ||
1. Participants failed to show for interviews |
Over-scheduled participant interviews |
Over-scheduling by 50 % increased participation and made effective use of research staff time when traveling long distances to a research site |
2. Participants failed to show for interviews |
Changed interview process to include reminder calls |
Reminder calls to participants the day before their interviews reduced the number of parents that failed to show |
3. Schedulers and interviewers were not proactively contacting a sufficient number of participants |
Revised protocol to emphasize the need to actively pursue an interview goal for each site |
Protocols for schedulers and interviewers needed to focus on the importance of contacting and following-up with a specific number of participants |
4. Participation by CHILE championsa waned over the course of the school year |
Revised payment schedule for CHILE champions |
Stipends paid in two installments (one at the beginning of the school year and one at the end) encouraged more active participation throughout the year |
5. Lack of repeated measures for Parent Interviews |
Offer greater incentives for follow-up interviews (not done during this study) |
Increasing incentives for parents returning for follow-up interviews would reflect the importance of repeat interviews and may have increased the number of return visits |
Grocery Stores | ||
Grocery store personnel had limited time to devote to the project |
Project staff ensured that intervention materials were properly stocked and displayed |
Stores vary in the amount of support for an intervention. Projects need to be flexible, and not expect stores to dedicate employee time to intervention efforts |
Lack of understanding of the intervention by employees led to removal of intervention materials |
Increased frequency of store visits and engagement with employees |
Information about the intervention was not necessarily transmitted from the store owners and managers to other employees. Project staff needed to do this. |
Healthcare Providers | ||
1. Limited response by healthcare providers |
Recruited physician to physician |
Using an enthusiastic physician to contact and interact with healthcare providers improved access and engagement |
2. Limited healthcare provider time |
Met over lunch and provided lunch |
With limited time, the most effective strategy for respecting healthcare provider time constraints was to meet over lunch and provide the food |
3. Limited healthcare provider engagement |
Maintain regular contact and provide reminders |
While healthcare providers are interested in participating, time constraints make it difficult. Building a relationship with participating providers over time helped retain their interest and keep them involved |
CHILE champions were community members that served as the primary contact for each Head Start center, advocated for CHILE at the Head Start center and within the community, and assisted with logistics for recruitment and data collection