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Population Health for Nurses

20.2 Recruitment and Retention of Program Participants

Population Health for Nurses20.2 Recruitment and Retention of Program Participants

Learning Outcomes

By the end of this section, you should be able to:

  • 20.2.1 Identify strategies to recruit and retain program participants.
  • 20.2.2 Describe ways to tailor recruitment and retention strategies to fit the sociocultural and linguistic needs of target populations.

Recruitment and retention of program participants is one of the most important components when planning for implementation because no matter how well a program is planned, it will not successfully meet goals with little or no participation. Recruitment is finding community members from the target population to participate in a community health program. Retention is continued participation in a community health program until its completion. To successfully recruit and retain participants, the program team must develop strategies that utilize evidence from the literature, previous experience with recruitment and retention, and knowledge of the target population’s values and beliefs. While several recruitment and retention strategies have been proven to be effective, a combination of strategies is needed to achieve the greatest success (Rural Health Information Hub [RHIhub], 2018b). Table 20.2 provides a description of recruitment strategies and tasks to complete each strategy.

Recruitment Strategy Tasks
Know the target population
  • Develop a clear description based on demographics, geography, values, culture, and needs
  • Ensure the program is relevant and meaningful for the target population
  • Address barriers to participation, such as transportation, childcare, stigma, previous negative experiences, and lack of knowledge about program benefits
Develop appropriate materials
  • Use more than one type of recruitment material, which can include flyers, newsletters, newspaper articles, radio or television advertisements, presentations, phone calls, and social media
  • Ensure materials are culturally and linguistically appropriate for the target population
Market strategically
  • Communicate the potential value of participation and what participation entails
  • Develop positive community relationships and use them to spread the word
  • Advertise using sources the target population commonly accesses
  • Build partnerships and collaborations to have a broad base of referral sources for the program
Encourage participation
  • Be enthusiastic in recruitment materials and messages
  • Create program strategies based on the target population’s interests
  • Motivate participants by using incentives
Utilize partnerships and members of the target population
  • Use program champions to spread the word and increase interest among the target population
  • Provide partners with recruitment materials for cross-promotion of programs
Revise strategies as needed
  • Assess effectiveness of recruitment strategies and revise if they are not working
Table 20.2 Participant Recruitment Strategies and Associated Tasks (See Barnes-Proby et al., 2017. RHIhub, 2018b.)

Theory in Action

Recruitment Strategies and Challenges

The mission of Denver’s MotherWise program is to empower women and their families to thrive during pregnancy and after a baby is born. This program focuses on motherhood, healthy relationships, communication and relationship skills, and connecting with a newborn. The following three short videos describe recruitment strategies and challenges. In the first two videos, program staff share experiences and challenges with participant recruitment. In the third video, participants share why they decided to join the program.

Watch each video, and then respond to the questions that follow.

Video 1

  1. What strategies does the MotherWise program use to recruit participants?

Video 2

  1. What challenges to recruitment did the MotherWise program staff note?
  2. How did the staff attempt to overcome those challenges?

Video 3

  1. Why did the participants decide to join the MotherWise program?
  2. Based on this information, what recruitment strategies can the nurse use to recruit the target population?

The program’s goals will likely be unmet if participants do not complete the program in its entirety. As such, the program team develops retention strategies to achieve participant completion goals. Table 20.3 presents strategies to maintain participation.

Strategies to Promote Participant Retention
Facilitate participant interest and motivation
  • Ensure interventions are of interest to participants
  • Provide incentives throughout the program
  • Incorporate social support into program interventions
Reduce barriers of retention
  • Incorporate strategies to reduce barriers such as inconsistent or lack of transportation, need for childcare, inconvenient program times, inconvenient program location, negative participant attitudes related to the program, and lack of knowledge
Train program implementers
  • Ensure implementers’ skills enable them to deliver program activities
  • Assess implementers’ attitudes regarding the program and target population and intervene if the attitudes are biased or negative
  • Train implementers in relationship building to establish trust and connection with participants
  • Create a welcoming environment
  • Maintain regular communication with implementers and participants
Incorporate continuous evaluation
  • Determine why participants enroll in, remain in, and exit the program
  • Revise retention and program strategies to meet the participants’ needs
  • Solicit participant feedback regarding program activities
  • Ensure program activities are flexible and varied
Table 20.3 Strategies to Promote Participant Retention (See Barnes-Proby et al., 2017; RHIhub, 2018a.)

Barnes-Prosby et al. (2017) provide a toolkit for the program team to enhance participant recruitment and retention. The toolkit includes five strategies, applicable activities, and examples to guide recruitment and retention planning.

Population Considerations: Health Care Providers

Some community health programs utilize health care providers (HCPs) to deliver interventions and assist with program planning, participant recruitment, and program evaluation. For example, community health workers (CHWs) are public health workers who liaise between health services and the community to improve access to services (Carter et al., 2016). One method to promote CHWs and link clients to them is to have HCPs refer their clients to or write prescriptions for a CHW. In these circumstances, the program team considers the recruitment and retention of HCPs and clients.

Multiple factors influence HCP participation. The program team designs strategies to enhance their recruitment and retention and reduce barriers to their participation. For example, HCPs are more likely to participate in community health programs when they understand the program’s value for themselves and their clients, the burden of performing the intervention is low, and the provider’s needs match community needs that are met by an evidence-based interventions (Krebs et al., 2021). Conversely, the HCP may be less likely to participate when they lack knowledge and training before program implementation, are inexperienced with client recruitment, have inadequate communication with the program team, and lack time to perform interventions (Krebs et al., 2021).

To successfully recruit and retain HCPs, Krebs et al. (2021) recommend including health care providers in all levels of planning, developing a recruitment strategy at the beginning of the planning process, training HCPs on how to recruit clients and implement the intervention, and using frequent, clear, goal-oriented communication.

Population Considerations: Youth

Facilitators and barriers to recruitment and retention may also differ when youth are the target population. Hull et al. (2022) provide a resource guide to enhance recruiting and retaining this demographic in community health programs, with strategies such as these:

  • Include youth and parents/caregivers in planning and recruitment
    • Assess youth needs, values, and motivators
    • Collaborate with youth to develop recruitment and program materials, including choice of marketing strategy such as type of social media
    • Host a youth and parent night to provide program information and address questions
    • Train a youth champion to participate in the program and promote the program
  • Identify barriers to recruitment and retention
    • Youth may need transportation, provide childcare for siblings, or have scheduling issues due to academics, athletics, or work
    • Consider offering the program during school hours, on weekends, and in shorter sessions
  • Establish partnerships with implementation location
    • School-based locations may be best due to fewer transportation issues, youth familiarity with the location, and the potential to incorporate the program into the school schedule
  • Provide incentives for participation, such as gift cards, non-tangible items, and/or food
  • Ensure the environment and program materials promote a safe and inclusive environment
    • Plan strategies that empower youth and allow their opinions to be heard
    • Clarify program goals, participant expectations, and benefits of participation
    • Translate material into languages and use images that represent the target population
    • Provide opportunities for youth engagement and the communication of values and beliefs
    • Incorporate real-life youth experiences into program activities
    • Ensure program staff are positive, respectful, and supportive of youth

Theory in Action

Creating Inclusive and Engaging Environments for Youth Programs

Youth participate and remain in community health programs for reasons that may differ from adults. In this video, adolescents describe their reasons for participating in health programs and provide strategies to enhance youth engagement, especially when programs have sensitive topics.

Watch the video, and then respond to the following questions.

  1. Why did the adolescents featured in the video participate in an Adolescent Pregnancy Prevention Program?
  2. What strategies did the adolescents suggest as ways to create a safe learning environment and promote youth participation?

Population Considerations: Sociocultural and Linguistic Needs

Facilitators and barriers to recruitment and retention may also differ based upon sociocultural and linguistic needs. The program team must understand the target population’s needs and incorporate them into recruitment and retention strategies. Cultural Influences on Health Beliefs and Practices discusses the impact of culture on individual health behaviors, values, and attitudes. Culturally and Linguistically Responsive Nursing Care and Culturally and Linguistically Appropriate Program Design describe strategies to meet the target population’s cultural and linguistic needs. Community programs are more effective when:

  • program planning, recruitment and retention planning, and program implementation include the target population;
  • linguistic needs are met through provision of materials and activities in English and in any other language used by program participants;
  • cultural values, beliefs, and needs are incorporated into program strategies; and
  • program staff provide a welcoming and inclusive environment, acknowledge and respect cultural differences, and know how to communicate with those from a different culture.

Prevention First (2022) provides a guide to increase cultural responsiveness of prevention programs. Table 20.4 lists actions to increase personal and program cultural responsiveness and provides examples of related actions.

Action Steps to Increase Cultural Responsiveness Examples
Build personal cultural awareness and reflect on cultural differences
  • Evaluate personal attitudes, beliefs, and implicit biases
  • Seek opportunities to learn about cultures other than your own
  • Respect cultural differences
Understand diverse community populations and their health needs
  • Conduct an assessment of community demographic makeup, current needs of all demographics, and community inequities
  • Assess the target population’s cultural and language preferences
Build relationships with diverse community members
  • Invite community members who are members of the diverse target population to assist with planning and implementation
Create a culturally responsive program structure
  • Use culturally and linguistically appropriate services (CLAS) to develop policies and procedures
  • Offer language assistance when needed
  • Adjust communication style based on the needs of the target population
Incorporate cultural and linguistic strategies into interventions
  • Create communication that includes images and language that is culturally relevant and easy to read
  • Incorporate strategies that align with the culture and values of the target population
Table 20.4 Actions to Increase Cultural Responsiveness of Community Health Prevention Programs (See Prevention First, 2022.)

Theory in Action

Incorporating Sociocultural and Linguistic Needs in Community Programs

The PA Fresh Food Financing Initiative is a statewide financing program to assist business owners in opening or expanding stores with the goal of increasing access to healthy, affordable foods and improving economic opportunities for low- to moderate-income community members in Pennsylvania.

Watch the video, and then respond to the following questions.

  1. How did the PA Fresh Food Financing Initiative incorporate the community’s sociocultural and linguistic needs when marketing the program?
  2. How did the PA Fresh Food Financing Initiative incorporate the community’s sociocultural and linguistic needs when recruiting and retaining participants?
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