Improving Recruitment of Under-represented Patients in Multi-institution Studies

Objectives: Recruitment of under-represented patients in clinical research can be challenging, and electronic forms of recruitment can be unsuccessful. Our study aimed to assess and compare the success of two different screening strategies in identifying bothersome urinary incontinence and recruiting patients for inclusion in a study in a primary care urinary incontinence intervention.

Methods: Providers from two medical group (one private academic center and one safety-net hospital system) in Southern California and their female patients 18 years of age and older were invited to participate in this urinary incontinence quality improvement project between September 2022 and the present. Female patients at the private hospital were recruited via an email-based screening survey. Based on our prior experience with recruitment of underserved patients in the safety-net hospital, the majority of which are Spanish-speaking, those patients were recruited via a telephone-based screening survey. A chi-square test was used to compare proportions between hospital sites.

Results: We conducted 269 telephone surveys at the safety net hospital and 6710 e-mail screening surveys at the private hospital. Patients were significantly more likely to respond to the survey at the safety-net hospital compared to the private hospital (80/269 [29.7%] vs. 938/6710 [14.0%], respectively, p < 0.001), report bothersome urinary incontinence (50/80 [62.5%] vs. 308/938 [32.8%], p < 0.001), and agree to participate in the study (25/50 [50.0%] vs. 96/308 [31.2%], p = 0.014).

Conclusions: Screening for urinary incontinence is feasible both via telephone and via electronic survey. Telephone screening surveys were chosen at the safety net hospital as they were thought to be more accessible for our patients. Within the context of this study, they were a more effective screening strategy compared with electronic surveys; however, e-mail based surveys still achieved an acceptable recruitment rate while requiring fewer resources. Given the higher burden of urinary incontinence at the safety-net hospital, designing strategies to improve the inclusion of these patients in clinical research is of the utmost importance.