Location: Delta Obesity Prevention ResearchTitle: Adaptation to study design challenges in rural health disparities community research Author
Submitted to: Government Publication/Report
Publication Type: Abstract Only
Publication Acceptance Date: 8/21/2012
Publication Date: 12/1/2012
Citation: Huye, H.F., Connell, C.L., Crook, L., Yadrick, K.M., Resavy, M.L., Elam-Perryman, B. 2012. Adaptation to study design challenges in rural health disparities community research [abstract]. 2012 NIH Summit on the Science of Eliminating Health Disparities. Poster No. F06-011. Interpretive Summary:
Technical Abstract: Intervention research in rural health disparities communities presents challenges for study design, implementation, and evaluation, thus threatening scientific rigor, reducing response rates, and confounding study results. A multisite nutrition intervention was conducted in the rural Lower Mississippi Delta (LMD) among members of women's organizations. Conceived as a randomized trial with delayed intervention control group, formative research identified significant challenges to study design and response rates. Challenges (1) Recruitment: Only 8 of 160 organizations identified responded for several reasons: fit within the organizational context; urgency to begin the program; (2) Study Design, Implementation, Evaluation: clustering effect of social, kindred, and employment connections in small communities; limited community resources for data collection; community events reducing intervention attendance. Adaptations (1) An LMD resident was hired to recruit organizations and identify data collection sites, resulting in 16 participating organizations from 11 counties. To retain participants between recruitment and enrollment, intervention timeframe was adjusted. (2) Study design was amended to 2-treatment, within groups design with initial enrollment and lag phase prior to the intervention. To reduce clustering effect, a stratified cluster sampling strategy was implemented using geographic distance, group size, and education attainment as strata. Conforming to organizational context and participants' busy lives promoted participation and attendance at education sessions. Intervention retention rate was 75%. Extensive formative research and indigenous intervention staff are necessary to effectively address design challenges facing health interventions in rural health disparity populations.