Recruitment and Retention for Diabetes Prevention

1. Recruitment and Retention for Diabetes Prevention Sandra Sangster, BS, CLE, Dietetic Intern March 2006- Denver

2. Diabetes Prevention Program Clinics . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Southwest American Indian Center • Gila River Indian Community • Navajo Nation- Shiprock, New Mexico • Phoenix Urban Indian Community • Salt River Pima- Maricopa Indian Community • Zuni Pueblo Indian Community

4. Recruitment into the DPP • Recruitment phase 6/96-2/99 • 171 American Indians recruited • Recruitment Coordinator at each site • Team approach to support Recruitment Coordinator • Multi-layered recruitment approach • Recruitment oversight program

5. Shiprock Recruitment Number of participant contacts/ % of previous step Step 1 Screening 3,586 Step 2 OGTT 1,117 (31%) # with IGT 409 (37%) Step 3 start run-in 128 (31%) Step 3 End run-in 94 80 (63%) 20% from IGT Step 4 Join Study

6. Phoenix Urban Recruitment Number of participant contacts/ % of previous step Step 1 Screening 1,268 Step 2 OGTT 202 (16%) # with IGT 47 (23%) Step 3 start run-in 22 (46%) Step 3 End run-in 17 Step 4 Join Study 14 (30% IGT) 64% (End)

7. Strategies for Reservation Recruitment • One-on-One Contact and visibility • Use community events and locations • Local worksites • Leadership support • Community flyers • Community newspapers • Door-to-door

8. Urban Indian Recruitment • Targeted work place presentations • Pow-Wows • Phoenix Indian Medical Center/ Events • Brochures placed in work places • Community gatherings of American Indians • Local Native American Newspaper

9. Phone Contact/Written Contact • Establish phone number for program • Live voice best - Connect with person on day they call • Written materials include • Program location, walk-ins expected • Place to write appointment date/time • Appointment instructions ex: fasting

10. Keys to Recruitment Success • Flexible Clinic Schedule • Telephone reminders • Postcard reminders • Immediately follow-up a missed appointment • One-on-One support/ building relationship

11. Retention • Plan early and integrate • Long commitment to DPP • Begins at first contact • Recruitment is the key to retention

12. Retention and Participation • 99.6% of the study cohort alive at study end 93% completed study • 93% of annual visits completed • Average follow-up 2.8 years (range 1.8 - 4.6) • 86% joined DPPOS • Native American Participation & retention higher

13. Retention-Create Belonging • Group Events • Contracts • Incentives • Connection with staff • Mailings- newsletters, health information, holidays/birthday cards

14. Group Events • Gathering around a community event • Group walks or hikes • Community attractions • Coalition partners-include in plans • Learning a new skill • Include the entire family

15. Getting Started Your Recruitment Action Plan • Define your program objective • Define your recruitment goals/target groups • Assess your community resources • Prepare recruitment plan and timeline • Produce written materials, PSAs, mailings • Define talking points • Begin community contacts and presentations

16. RECRUITMENT PLAN MONTH EVENT STAFFING OUTCOME NOTES JULY AUGUST SEPTEMBER OCTOBER NOVEMBER

17. Recruitment Coordinator • Enthusiastic about program • Able to work independently/ team leader • Lead by example • Outgoing • Bi-lingual • Member of your community • Realistic amount of time to recruit if other job responsibilities • Visible to participants throughout the program

18. Recruitment is a TEAM Effort • Recruitment is everyone’s job • Always be prepared to be a spokes person for your project • Always carry recruitment information with you- brochures or flyers • Be willing and ready

19. Talking Points • Develop talking points • Practice-practice, by talking to people • Using blood sugar results as a spring board • Seek what motivates people though talking points: • “What concerns you about…” • “How ready are you to consider a change in..” • “On a scale from 1 to 10 how confident are you that you can make a change in__?” • “How do you feel about your blood sugar results”

20. Coalitions • Work on building partnerships to increase your effectiveness • Increase community “buy-in” • Partners usually have extended network of resources • Increase your capabilities • Feeling of ownership = work for success

21. Community Events • PowWows, tribal fairs, conferences, etc • Church events • Basketball/softball tournaments • Tribal dept.- presentations • Tag recruitment on to any type of social gathering you can think of

22. Community Meetings • Tribal /district meetings • Health Dept. meetings, e.g. BIA, IHS, • Urban Health Programs • Senior Programs/Centers • Churches • Schools-PTA/booster clubs

23. Media • Newspaper Ads in Tribal Papers • Radio station advertisement • Television- “Twentieth Century Native Americans” • Newsletter-e.g. school district letters, ask if you could submit information thru a newsletter

24. Coordinate with Clinics • Coordination: apt. mailings, brochures, booth set-up, referral from doctors, • Diabetes Clinic • Dental clinic • Eye clinic • Podiatry clinic • WIC clinics

25. Payroll Stuffing • Tribal payroll • Casinos • Tribally owned businesses • Schools • If you get permission to do this, offer to assist with stuffing

26. Door-to-Door • Prepare door knob hangers/flyers • Plastic baggies can also be stuffed with a small incentive like ink pens or magnets • Be prepared to answer questions • Take caution against dogs and signs of “unwelcome” (dog biscuits helpful)

27. Booths/Table • In front of hospital/clinic or in the lobby of hospitals • Banks, post-office, community store • Casino-employees lounge • Pow-Wow, fairs, fun-runs, cultural events, conferences • School events

28. Buddy Up Testing • Courtesy testing- offer to test two friends or family members at the same time • Family screenings-offer to meet with families to offers OGTs, with presentation, and feed them brunch • Get a gift for bringing in a friend/relative

29. Recruitment of Men • Host events that will attract men- “Mens Night Out” • Men’s Health Month- June • Basketball/softball tournaments: “Don’t Play with Diabetes it’s Not a Game” “Let’s Strike out Diabetes” “Don’t Let Diabetes Strike You Out” • Relay races • BBQ

30. Health Observances Calendar www.foodandhealth.com/calendar Pick a health theme for a particular month, and build around that theme. For example, Heart Month in February or National Diabetes Month in November.

31. Trouble Shooting • Keep track of numbers • Evaluate activities and events to see how successful each event was • Layering and re-layering, talking to people more than one time • back to basics-review communication strategies

32. Why track numbers? • Objectively evaluate activities • What are your best events, what’s working • What’s your yield for different types of events • Re-evaluate your recruitment plan • DPP got 1-2 participants for each event

33. Layered Approach • One on one contact • Brochure • Flyers and posters • Radio PSA’s and print ads • Newspaper article on program • Mailed/delivered program brochures • Presentations to health providers

34. Back to Basics • Re-examine goals and strategies • Refresh everyone’s memory and provide new information • Communicate continually with tribal councils, healthcare providers and media outlets • Make the most of every contact with community members, be a constant reminder of your program

35. GOALS and WORK A goal is a “Vision” with a timeline WORK to achieve goal Work means 1% inspiration and 99% prespiration

36. Quote “If you knock long and hard enough, someone will answer the door…” -Longfellow-

37. THANK YOU www.bsc.gwu.edu/dpp/