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Mobile health (mHealth) interventions are promising avenues to promote cardiovascular (CV) health among African-Americans (AAs) and culturally tailored technology-based interventions are emerging for this population.
The objectives of this study were to use a community-based participatory research (CBPR) approach to recruit AAs into a pilot intervention study of an innovative mHealth CV health promotion program and to characterize technology use patterns and eHealth literacy (EHL).
Community partners from five predominately AA churches in southeast Minnesota collaborated with our academic institution to recruit AA congregants into the pilot study. Field notes as well as communications between the study team and community partners were used to design the recruitment strategy and its implementation with a goal of enrolling 50 participants. At its core, the recruitment strategy included community kickoff events to detail the state-of-the-art nature of the mHealth intervention components, the utility of CV health assessments (physical examination, laboratory studies and surveys) and the participants’ role in advancing our understanding of the efficacy of mHealth interventions among racial/ethnic minority groups. Detailed recruitment data were documented throughout the study. A self-administered, electronic survey measured sociodemographics, technology use and EHL (eHEALS scale).
A total of 50 participants (70% women) from five AA churches were recruited over a one-month period. The majority (>90%) of participants reported using some form of mobile technology with all utilizing these technologies within their homes. Greater than half (60% [30/50]) reported being “very comfortable” with mobile technologies. Overall, participants had high EHL (84.8% [39/46] with eHEALS score ≥26) with no differences by sex.
This study illustrates the feasibility and success of a CBPR approach in recruiting AAs into mHealth intervention research and contributes to the growing body of evidence that AAs have high EHL, are high-users of mobile technologies, and thus are likely to be receptive to mHealth interventions.
African-American (AA) participation in mobile health (mHealth) studies is expanding in parallel to their increased adoption of mobile technologies [
AA faith communities offer a promising avenue to foster recruitment into and deliver mHealth interventions as technology integration into health promotion activities at church may facilitate their implementation, dissemination and sustainability [
In this report, we describe our recruitment strategy design incorporating a CBPR approach in addition to its effectiveness and challenges. We also report participant baseline characteristics, technology use patterns, and EHL.
The Fostering African-American Improvement in Total Health (FAITH!) program is a behavioral theory–informed, culturally tailored, community-based CV health and wellness program implemented as an academic-community partnership with our institution and local AA churches [
Within the current
Inclusion criteria were the following: AA, aged ≥18 years, basic Internet navigation skills, at least weekly Internet access (such as at home, a family member’s or friend’s home, church, library/community center, school/university, Internet café, etc), active email address, minimal fruit/vegetable intake (less than 5 servings/day), no regular physical activity program (less than 30 minutes/day of moderate physical activity), able to engage in moderate physical activity (such as brisk walking, dancing, aerobics, gardening, weight lifting without restrictions including physical disability, use of a wheelchair daily or serious medical condition). Individuals were ineligible if they were unable to walk up at least two flights of stairs or walk at least one city block without assistance or stopping, pregnant, had visual/hearing impairment or mental disability that would preclude independent use of the app or were past participants of the face-to-face CVD prevention program [
A series of jointly-led meetings were held over a 6-month period to outline a clear and culturally appropriate plan for recruitment from five local churches. Participating churches designated church liaisons (FAITH! Partners) to engage in these meetings to design and tailor a recruitment strategy. We collaborated with eight FAITH! Partners (seven which were AA women). Each church had at least one FAITH! Partner with three churches designating two representatives. Community kickoff events were suggested by the FAITH! Partners to serve as our primary recruitment tools to outline the study timeline and specific expectations of potential study participants. The FAITH! Partners highly suggested that the study team provide an overview of the mHealth intervention with an emphasis on how the
The FAITH! Partners also recommended that interested participants complete a “Registration/Program Interest Form” at the events. The form included contact information and questions corresponding to inclusion/exclusion criteria. Use of the interest form was affirmed as an essential recruitment tactic by our community partners in order for potential participants to better understand the eligibility requirements and for the study team to gauge the number of eligible participants from each church. The FAITH! Partners also suggested that we utilize self-administered, electronic surveys (rather than written) throughout the pilot study for participant convenience and to facilitate more thoughtful responses. They also felt that participants would find this appealing and would aid in their willingness to enroll in the study.
To remain in alignment with CBPR principles, the group mutually agreed upon stressing the importance of research participation among AAs to advance knowledge on the efficacy of mHealth lifestyle interventions in racial/ethnic minority groups. Efforts were made to underscore how their participation in the study would contribute to the AA community at-large and society as a whole. The presence of the study principal investigator and church leadership (ie, church pastor or FAITH! Partner) at the events was deemed critical by our FAITH! Partners for full transparency and to demonstrate a collaborative and equitable partnership in all research phases—a central CBPR tenet [
The study team and FAITH! Partners developed uniform recruitment tools including church announcement scripts, flyers and a promotional video containing testimonials from prior study participants and FAITH! Partners regarding the program benefits with integrated motivational spiritual messaging (see
FAITH! Partners promoted kickoff events through church announcements and flyers. Three kickoff events were held in June 2016 (two at churches in MSP, MN, one at a community health club in Rochester, MN) and were led by both the study principal investigator (LB) and FAITH! Partners. The events were approximately two hours in duration and held at the convenience of the participating churches (ie, following Sunday worship service or integrated into weekly evening Bible Study). Each event included an introduction to the study team, prior research study findings/accomplishments, an overview of the current research project (timeline, intervention components, health assessments, etc) including the promotional video and open discussion. Healthy refreshments were provided at all events. Interested participants completed the “Registration/Program Interest Form” which was returned to the church designated FAITH! Partner and then forwarded to the study team. Subsequently, the study coordinator contacted the interested participants to reiterate study details and complete eligibility screening. Upon confirmation of eligibility, participants were then invited to the baseline health assessments (two held in July 2016 at community health clubs) and to complete the baseline electronic survey. All participants provided written informed consent at the baseline health assessments.
Approximately 100 individuals attended the three kickoff events.
Participants were predominately women (70% [35/50]) and employed full time (64% [34/50]) with mean age of 49.6 (SD 12.7) years (
Recruitment process and participant flow. Reasons for exclusion are not mutually-exclusive. One participant withdrew from intervention due to difficulty with the technology.
Participant demographics and self-reported mobile technology use.
Characteristic | Total (N=50 unless |
|||
Female | 35 (70.0%) | |||
Mean (range), years | 49.6 (26.0-72.0) | |||
Single | 9 (18.0%) | |||
Divorced | 7 (14.0%) | |||
Widowed | 2 (4.0%) | |||
Married/in committed relationship | 32 (64.0%) | |||
Some high school | 1 (2.0%) | |||
High school graduate or GED equivalent | 5 (10.0%) | |||
Some college | 12 (24.0%) | |||
Technical degree or Associate's degree | 11 (22.0%) | |||
College graduate/advanced degree | 21 (42.0%) | |||
Employed, full-time (32+ hours/week) | 34 (68.0%) | |||
Employed, part-time (less than 32 hours/week) | 3 (6.0%) | |||
Unemployed | 17 (34.0%) | |||
Less than $20,000 | 5 (10.2%) | |||
$20,000 to $34,999 | 9 (18.4%) | |||
$35,000 to $49,999 | 10 (20.4%) | |||
$50,000 to $74,999 | 9 (18.4%) | |||
≥$75,000 | 12 (24.5%) | |||
Chose not to disclose | 4 (8.2%)) | |||
Smartphones | 46 (92.0%) | |||
Tablet | 37 (74.0%) | |||
Laptop | 36 (72.0%) | |||
Personal physical activity monitor | 13 (26.0%) | |||
No mobile technology use | 1 (2.0%) | |||
Home | 49 (100.0%) | |||
Family member's home | 16 (32.7%) | |||
Friend’s/neighbor's home | 12 (24.5%) | |||
Work | 34 (69.4%) | |||
Library/community center | 6 (12.2%) | |||
Internet cafe | 11 (22.4%) | |||
School/university | 13 (26.5%) | |||
Church | 26 (53.1%) | |||
Home | 40 (81.6%) | |||
Family member's home | 1 (2.0%) | |||
Work | 7 (14.3%) | |||
Church | 1 (2.0%) | |||
0 to 2 hours | 10 (20.4%) | |||
2 to 4 hours | 13 (26.5%) | |||
4 to 6 hours | 8 (16.3%) | |||
6 to 8 hours | 4 (8.2%) | |||
8 or more hours | 14 (28.6%) | |||
Very comfortable | 30 (60.0%) | |||
Somewhat comfortable | 18 (36.0%) | |||
Neither comfortable nor uncomfortable | 2 (4.0%) | |||
Yes, wireless | 47 (94.0%) | |||
Yes, non-wireless | 4 (8.0%) | |||
No access in home | 1 (2.0%) | |||
Government websites | 15 (30.0%) | |||
Non-profit organization websites | 17 (34.0%) | |||
Hospital/Clinic websites | 31 (62.0%) | |||
Commercial websites | 26 (52.0%) | |||
Non-Medical websites | 11 (22.0%) | |||
Do not access health information on the Internet | 4 (8.0%) | |||
Not useful | 1 (2.2%) | |||
Unsure | 7 (15.2%) | |||
Useful | 30 (65.2%) | |||
Very useful | 8 (17.4%) | |||
Not important | 3 (6.5%) | |||
Unsure | 2 (4.3%) | |||
Important | 25 (54.3%) | |||
Very important | 16 (34.8%) | |||
Mean (SD) | 30.4 (4.6) | |||
Range | (21-40) | |||
Low (<26), n (%) | 7 (15.2%) | |||
High (≥26), n (%) | 39 (84.8%) | |||
Not very skilled | 4 (8.0%) | |||
Fairly skilled | 17 (34.0%) | |||
Very skilled | 22 (44.0%) | |||
Expert | 7 (14.0%) |
This paper outlines the successful application of a CBPR approach to “re-design” a highly accepted, yet resource-intensive face-to-face program to promote CV health within an mHealth intervention to support broader dissemination capability for the AA community. Leveraging the expertise and insights of our community partners in development of the intervention and the recruitment strategy was crucial to the success of our recruitment efforts. By doing so, we were able to keep the needs of our prioritized population at the forefront which facilitated our participant enrollment. Our investment of resources in face-to-face engagement through kickoff events was important to this community and enhanced transparency and mutual understanding of the intervention goals. Consistent with prior studies of AA adults [
A recent systematic review revealed the low representation of AAs in mHealth research [
To foster recruitment of racial/ethnic minority populations into clinical research whether technology-based or not, it takes an in-depth understanding of their multifactorial, perceived barriers and facilitators to research participation. Having the intent at conception and design of a study to enroll minorities and not having to make midstream adjustments to recruitment efforts have been associated with minority recruitment success rates among study principal investigators [
When translating community-based, face-to-face health programs to mHealth interventions, it is advantageous to have community “buy in” for trust-building and to overcome challenges to enrollment [
We acknowledge limitations to our recruitment methods. We did not collect detailed data on the time and number of attempts required by our study coordinator to reach prospective participants, yet this information would assist other investigators seeking to recruit from AA faith communities by providing them with an estimate of the time allocation required [
Our study supports the effectiveness of integration of a CBPR approach to translate culturally relevant mHealth lifestyle interventions to AAs to maximize recruitment success. Our results also contribute to the growing evidence that AAs have high EHL, are high-users of mobile technologies, and thus are likely to participate in mHealth interventions.
FAITH! program promotional video.
African-American
body mass index
cardiovascular
cardiovascular disease
community-based participatory research
eHealth literacy
eHealth Literacy Scale
Fostering African-American Improvement in Total Health
mobile health
The authors are grateful to the original FAITH! team members, Mr Brian Buta, Ms Deneen Hamlin, and church leadership including Reverend Michael Palmer previously of New Friendship Baptist Church, Baltimore, MD for their contributions to the initial intervention conceptualization and implementation in Baltimore, MD. The authors are indebted to the participating Rochester and Minneapolis-St Paul area churches including church leadership (Pastor Donald Barlow of Rochester Community Baptist Church, Pastor William Land of St Albans Church of God in Christ, Pastor Runney Patterson of New Hope Baptist Church, Pastor Kenneth Rowe of Christ’s Church of the Jesus Hour), FAITH! Partners (Mrs Frances Ellis, Ms Margaret Frye, Mrs Jacqueline Johnson, Mr Clarence Jones, Mrs Ramona Norwood, Ms LaTasha Perkins, Ms Monisha Washington, Reverend Marcia Wyatt) and study participants. We would also like to thank Southside Community Health Services, Incorporated (Mr Clarence Jones and Ms Monisha Washington) for their assistance with identifying interested congregations in the Minneapolis-St Paul, MN area. The authors would also like to show gratitude to Mr Jeffrey Gansen for his assistance with the promotional video production. Last but not least, we acknowledge our study coordinator, Mrs Jessica Bauman for her contributions to study recruitment and enrollment.
LCB is supported by the Building Interdisciplinary Research Careers in Women’s Health Scholars Program (award number K12 HD065987-07) from the National Institutes of Health Office of Research on Women's Health, Mayo Clinic Women's Health Research Center and the Center for Translational Science Activities Grant Program from the National Center for Advancing Translational Sciences (UL1 TR000135, KL2TR002379). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of National Institutes of Health. This study was further supported by the Mayo Clinic Center for Innovation, Mayo Clinic Department of Cardiovascular Medicine and the Mayo Clinic Office of Health Disparities Research.
None declared.