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Jones DL, Whitley RW, Eicher JL. Two strategies for recruiting rural faith-based organizations for a fall-prevention exercise intervention in a population with high rates of arthritis. Arthritis Rheumatology. 2015 Sep; 67 (suppl 10).

Monday, November 9, 2015


Background/Purpose: Rates of falls are higher in older adults, rural areas, and people with chronic conditions such as arthritis.  Translating evidence-based, fall-prevention programs into practice is a public health priority in these populations. The Tai Ji Quan: Moving for Better Balance (MFBB) program is an evidence-based, community-delivered, fall-prevention exercise intervention for older adults. There is a need to translate MFBB into more diverse settings, such as faith-based organizations (FBOs). A sample of 237 older adults, of which 63% had arthritis, enrolled in a 16-week translational study of MFBB in 20 rural FBOs. This study describes the methods and outcomes of the 2 strategies used to recruit the FBOs.

Methods: The FBOs in 7 rural counties were eligible to participate if they could secure a space for the class, identify a leader, host a 16-week class, recruit up to 15 class participants, and wanted to continue class after the study ended.  The intervention was delivered in 2 rounds.  The FBOs in round 1 were identified via mailing lists, internet and newspaper searches, Chambers of Commerce, Extension Service Agents, a Community Partnership Board, and a faith-based consultant. We used multi-stage purposeful random sampling to select 55 of the 164 FBOs in round 1 to receive a recruitment packet by mail.  A follow-up mailing was sent to non-responders, as well as the 109 FBOs not targeted in the first mailing.  Due to low response rates, we switched to a non-probability sampling method, snowball sampling, which relied on networking and word-of-mouth.  We “knocked on doors” of community constituents (e.g., clergy, congregants, fitness centers, senior centers, etc…) and attended church/prayer services, ministerial association meetings, and festivals, and volunteered at potluck dinners and food pantries.  We tracked response rates to the mailings, the number of trips and miles traveled, and the number of communications needed to recruit the FBOs.

Results: The study counties had higher rates of rural older adults and arthritis as compared to the US average. Only 6% and 2% of FBOs responded to the first and second mailings, respectively, which resulted in 3 (15%) of the 20 needed FBOs enrolling in the study.  Snowball sampling took 12 months, during which we made 289 telephone calls, sent 193 e-mails and 215 mailings, distributed brochures to 69 FBOs, and held 118 meetings, all to recruit the remaining 17 (85%) FBOs. This process involved 20 trips over 31 days for a total of 8933 miles traveled.  It took between 1 and 280 days (average 62 days) to recruit a FBO.  The FBOs were predominantly Mainline Protestant churches/organizations (70%). Two-thirds of the FBOs were small with fewer than 100 members.

Conclusion: There is a need for fall-prevention interventions in rural older adults with arthritis. In this study, FBO recruitment rates were greater when relying on networking and word-of-mouth rather than mailings. The snowball sampling approach, however, took 1 year to complete with substantial investments in time and travel. Future studies may want to factor in the additional time and costs associated with recruiting FBOs using this method during the planning phase of the study.