An Innovative Multiphased Strategy to Recruit Underserved Adults into a Randomized Trial of a Community-Based Diabetes Risk Reduction Program

Two large-scale clinical trials, the Diabetes Prevention Program and the Finnish Diabetes Prevention Study, have provided unequivocal evidence that type 2 diabetes mellitus in high-risk individuals can be prevented through lifestyle modifications, such as increased physical activity, weight loss, and dietary changes (Diabetes Prevention Program Research Group, 2002; Tuomilehto et al., 2001). Efforts to translate such lifestyle modification programs for individuals at risk of type 2 diabetes from health care settings into community settings are an important next step. A greater risk of diabetes is observed for ethnic minority (Centers for Disease Control and Prevention, 2008; Liao et al., 2004) and lower socioeconomic status (SES) groups (Robbins, Vaccarino, Zhang, & Kasl, 2005) compared to Whites of similar ages. Two issues in translating such lifestyle programs from medical to community settings to reach these vulnerable population groups are to identify a community organization that can deliver a lifestyle program within existing infrastructure and community-based methods for identifying people at risk of diabetes. To evaluate such programs through research also requires addressing study recruitment issues because ethnic minorities and individuals of lower SES are less likely than their counterparts to participate in interventions and randomized trials (Glasgow, Toobert, & Hampson, 1991; Yancey, Ortega, & Kumanyika, 2006). Addressing these recruitment and translational issues requires using existing community resources, collaborating with community organizations and leaders, and understanding and working within existing networks and relationships between these organizations and community members (Israel, Schulz, Parker, & Becker, 1998). This article describes a two-phased community-based approach to identify and recruit lower SES, ethnic minority, and Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle program to reduce risk through diet and physical activity. Our approach was designed to work within the community infrastructure and incorporate local resources. We describe our collaboration with community organizations, methods used to identify our target groups and screen for diabetes risk, and report the number of people who completed screening and their levels of risk using these different methods. We then describe methods for recruiting a subset of those found to be at risk into the randomized trial, report response rates and sampling bias assessment, and describe our enrolled sample.