New Insights into Maternal and Paternal Recruitment and Retention: Findings from the Community Child Health Network

Study of Preconception Health

Bowen Chung, Robin Gaines Lanzi, Peter Schafer, Maxine Vance, Elizabeth Clark-Kauffman, Latoya Sahedeo, Felica Jones

5138.0 Improving Pregnancy Outcomes: Findings from the Community & Child Network Preconceptional Study

American Public Health Association Annual Meeting

American Public Health Association Annual MeetingSan Francisco, CA

Wednesday, October 31, 2012

Funded by NICHD and NINR

Presenter DisclosuresNo relationships to disclose.

• Understanding father’s impact on perinatal outcomes and child development requires high quality data

• No studies that we are aware of examined what factors, maternal and paternal, are associated with father participation in this research

Background

Goals

• To describe • Maternal and paternal participants• Attrition rates• Procedure modifications to increase enrollment• Variables associated with recruitment and retention

CCHN Phase 2 Study Sample

• Mean age – 25.7 years• 53% African American, 24%

Latino, 22% White• 19% <HS;43% HS

diploma/GED/tech diploma; 22% some college; 14% 4 year degree

• 43% below federal poverty; 27% 100-200% federal poverty; 30% >200% federal poverty

• 31% married

• Mean age – 29.6 years• 38% African American, 24%

Latino, 23% White• 21% Less than HS diploma;

37% HS diploma/GED/tech diploma; 11% some college; 18% 4 year degree

• 26% below federal poverty; 19% 100-200% federal poverty; 36% >200% federal poverty

• 39% married

Fathers/PartnersN=1179

MothersN=2510

Mothers T0(recruited)

T1(enrolled) T2

N (%) 3080 (100%) 2510 (81.5%) 1782 (71.0%)

Difference

-18.5%

-9.5%

Mother Attrition Rate

Father/Partner Attrition Rate

Mothers T1(enrolled)

In a relationship or involved

Gave permission

N (%) 2510 (100%) 2305 (91.8%) 1923 (83.4%)

Difference-18.5%

-9.5%

Fathers Eligilble T1(enrolled) T2

N (%) 1923 1216 (100%) 728 (59.8%)

Difference -40.1%

Factors Impacting Retention• Research perceptions: experiences with research

• Participants social instability: Frequently moves, phone numbers changing/disconnected

• Inconvenience of study procedures: number and length of interviews, biomarker collections

• Competing demands on time and resources (work)

• Mother’s encouragement around father participation in child’s life and study.

Community-Academic Steps to Address Recruitment and Retention Issues

• Community Experiences and Insights

• Academic Researchers Experiences and Insights

• Review of the Literature

Recruitment and Retention Strategies

• Study staff were hired to be reflect local community• Hired staff from local communities• Hired males to interview fathers

• Improvements in Interviewer tools and support• Each interview has own caseload• Use interviewer specific tracking sheets• Tailored caseload discussion

• Extend recruitment window• Flexible about interview location• Provide incentives at time of assessment

Recruitment and Retention Strategies

• Improvements in recruitment and retention resources• Individualized mailings

• Cards: Birthdays, For new babies, I’ve moved cards

• Branded materials: Study magnets and calendars

• Books: Children’s books, Healthy Start/Grow Smart books• Miscellaneous items: food, cribs, pack n play, diapers• Family photographs• Pregnancy resource information

• Father specific changes• Father Advisory Council at each of 5 sites • Resources adapted for fathers, e.g. books and resource

guides

Mothers T0(recruited)

T1(enrolled) T2 T3

N (%) 3080 (100%) 2510 (81.5%) 1688 (54.8%) 1729 (56.1%)

Difference

-18.5%

-26.7%

+1.3%

Improvements in Maternal Recruitment

CCHN Mother Enrollment By Month

Jump in recruitment:function of new recruitment

strategies

Improvements in father recruitment

Mothers T1(enrolled)

In a relationship

Gave permission

N (%) 2510 (100%) 2305 (91.8%) 1923 (83.4%)

Difference-18.5%

-9.5%

Fathers Eligilble T1(enrolled) T2 T3

N (%) 1923 1216 (100%) 728 (89.7%) 747 (61.4%)

Enrollment Changes

S0 (T1+T2) at 6 months N=112 S1 (T1+T2+T3) at 12 months N=108

Additional fathers 220

Total Fathers enrolled 1436

Difference +18.09

CCHN Father Enrollment By Month

Jump in recruitment:function of new recruitment

strategies

Maternal characteristics offering permission for T0Mothers gave permission

Yes (N=1923) No (N=382)

Age Years 25.9 ± 5.7 25.2 ± 5.6

Race African-American 1113 (77.7) 319 (22.3)

  White 544 (90.8) 55 (9.2)

  Latina 630 (86.9) 95 (13.1)

  Multi Racial 52 (86.7) 8 (13.3)

  Other 2 (50.0) 2 (50.0)

Education < HS 332 (79.0) 88 (21.0)

 HS, GED,

Certificate, Technical797 (82.8) 166 (17.2)

  Some college 428 (82.9) 88 (17.1)

  ≥ 4-yr degree 314 (90.5) 33 (9.5)

  Other, No information 54 (88.5) 7 (11.5)

Maternal characteristics offering permission for T0

Mothers gave permission

Yes No

Language (Latinas only, n=556)

English 194 (89.8) 22 (10.2)

Spanish 298 (86.9) 45 (13.1)

Born (Latinas only, n=154) In the US 137 (89.0) 17 (11.0)

Yes (n=1923) No (n=382)

Relationship 

Married 701 (92.0) 61 (8.0)

Not married, but in a romantic relationship

951 (83.3) 190 (16.7)

Not married and not currently in a romantic

relationship

190 (63.8) 108 (36.2)

Living Together

No 314 (71.4) 126 (28.6)

Yes, all the time1262 (90.2) 137 (9.8)

Yes, some of the time 162 (82.2) 35 (17.8)

Variables for Regression Dependent measures

Model 1) Maternal permission to contact the father Model 2) Father enrollment and completing of T1 Model 3) Father completion of T3

Co-variates Race & household income (1&2), income only (3)

Independent measures Age, income (≤ 100 FPL, ≤ 200% FPL, > 200% FPL),

employment, relationship status, relationship quality, interpersonal violence, language spoken, problems with alcohol, drugs, partner wanted pregnancy, born in the U.S, # moves in past year.

Model 1: Maternal permission to contact the father Older Age, being married or in a relationship, living

together, want future of relationship, and moves in last year (p<0.001)

Model 2: Father enrollment and completing of T1 living together all the time (p=0.0001)

Model 3) Father completion of T3 Higher income, HS degree equivalent or above

maternal education (P<0.05)

Variables significant in regressions

LA Fatherhood substudy• Sub-study to ascertain perceived barriers and benefits of participating in

research • Lead by Healthy African American Families II

• Attempted to contact 340 fathers who participated at any time point in CCHN

• Offered 5 phone calls• Contacted 54 men

• Asked questions such as:• 1. What would help/helped you be a part of a study like CCHN?• 2. What would help/helped you stay a part of a study like CCHN?

LA Fatherhood substudyWhat would help/helped you participate in a study like CCHN? N %To understand, to learn and to help my kids and family 12 22.2%

“It helped me get to know my son a little better.”

My participation was influenced by my girlfriend or wife 4 7.4%

Well it is something that my wife asked me to do and I just agreed to do it.

For me to help others 9 16.7%

“I’m not expecting anything out of it. I’m just helping you.”

Education / Information 6 11.1%

“This is information that will help out in the future.”

Study Conduct 23 42.6%

“having payments was good and incentives”

LA Fatherhood substudyWhat would help/helped you be stay a part of a study like CCHN? (n=46) N %Knowing and receiving results 4 8.7%

“”I just wanted to be aware of how the results are used.”

To understand, to learn, and to help my kids and family 16 34.8%

Participant’s commitment to the study 4 8.7%

“mostly because I said I would do it and I had to keep doing it.”

More time 3 6.5%

“if I had the time to do it, would be no problem, I would do it.”

My Participation was influenced by my wife or girlfriend 3 6.5%

Study Conduct 20 43.4%

Positive 13

Neutral 1

Negative 6

LA Fatherhood substudyWhat would help/helped you be stay a part of a study like CCHN? (n=46) N %Knowing and receiving results 4 8.7%

“”I just wanted to be aware of how the results are used.”

To understand, to learn, and to help my kids and family 16 34.8%

Participant’s commitment to the study 4 8.7%

“mostly because I said I would do it and I had to keep doing it.”

More time 3 6.5%

“if I had the time to do it, would be no problem, I would do it.”

My Participation was influenced by my wife or girlfriend 3 6.5%

Study Conduct 20 43.4%

Positive 13

Neutral 1

Negative 6

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The Child Community Health Network (CCHN) is a community-based participatory research network supported through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226-05S1, U HD44245-06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929). CCHN reflects joint endeavors of five local sites: 1) Baltimore: Baltimore City Healthy Start and Johns Hopkins University (Community PI Maxine Vance, Academic PI Cynthia S. Minkovitz); 2) Lake County, Illinois: Lake County Health Department and Community Health Center and the Northshore University Health System (Community PI Kim Wagenaar, Academic PI Madeleine Shalowitz); 3) Los Angeles: Healthy African American Families, Cedars-Sinai Medical Center, and University of California, Los Angeles (Community PI Loretta Jones, Academic PI Calvin J.Hobel, Academic Co PIs Christine Dunkel-Schetter, Michael Lu); 4) East Carolina University, NC Division of Public Health, NC Eastern Baby Love Plus Consortium, and University of North Carolina, Chapel Hill (Community PIs Sharon Evans, Richard Woolard, Academic PI John Thorp); 5) Washington, DC: Georgetown Center on Health and Education, Washington Hospital Center, and Developing Families Center (Community PI Loral Patchen, Academic PI Sharon L. Ramey, Robin Lanzi Academic Co PI, Lorraine Klerman). Critical contributions to CCHN were also made by the Data Coordination and Analysis Center at the Pennsylvania State University (PI Vernon M. Chinchilli), Steering Committee Chairs Mark Phillippe and Elena Fuentes-Afflick*, and NIH Program Scientists (V. Jeffrey Evans, Tonse Raju) and Program Officers (Yvonne Bryan*, Michael Spittel, Linda Weglicki, Marian Willinger). We thank the hospitals and other facilities sponsoring participant recruitment and the local community advisory boards at each site. *Indicates those who participated in the planning phase of the CCHN.

Acknowledgements