title: Using a social marketing framework to evaluate recruitment of a prospective study of genetic counseling and testing for the deaf community.
abstract: BACKGROUND
  Recruiting deaf and hard-of-hearing participants, particularly sign language-users, for genetics health service research is challenging due to communication barriers, mistrust toward genetics, and researchers' unfamiliarity with deaf people. Feelings of social exclusion and lack of social cohesion between researchers and the Deaf community are factors to consider. Social marketing is effective for recruiting hard-to-reach populations because it fosters social inclusion and cohesion by focusing on the targeted audience's needs. For the deaf population this includes recognizing their cultural and linguistic diversity, their geography, and their systems for information exchange. Here we use concepts and language from social marketing to evaluate our effectiveness to engage a U.S. deaf population in a prospective, longitudinal genetic counseling and testing study.
  
  
  METHODS
  The study design was interpreted in terms of a social marketing mix of Product, Price, Place, and Promotion. Price addressed linguistic diversity by including a variety of communication technologies and certified interpreters to facilitate communication; Place addressed geography by including community-based participation locations; Promotion addressed information exchange by using multiple recruitment strategies. Regression analyses examined the study design's effectiveness in recruiting a culturally and linguistically diverse sample.
  
  
  RESULTS
  271 individuals were enrolled, with 66.1% American Sign Language (ASL)-users, 19.9% ASL + English-users, 12.6% English-users. Language was significantly associated with communication technology, participation location, and recruitment. Videophone and interpreters were more likely to be used for communication between ASL-users and researchers while voice telephone and no interpreters were preferred by English-users (Price). ASL-users were more likely to participate in community-based locations while English-users preferred medically-based locations (Place). English-users were more likely to be recruited through mass media (Promotion) while ASL-users were more likely to be recruited through community events and to respond to messaging that emphasized inclusion of a Deaf perspective.
  
  
  CONCLUSIONS
  This study design effectively engaged the deaf population, particularly sign language-users. Results suggest that the deaf population's cultural and linguistic diversity, geography, and forms of information exchange must be taken into account in study designs for successful recruitment. A social marketing approach that incorporates critical social determinants of health provides a novel and important framework for genetics health service research targeting specific, and hard-to-reach, underserved groups.
authors.affiliation: Department of Human Genetics, University of California, Los Angeles, California, USA. cpalmer@mednet.ucla.edu.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Patrick
authors.initials: P
authors.lastname: Boudreault
authors.forename: Karin
authors.initials: K
authors.lastname: Hill
authors.forename: Janet S
authors.initials: JS
authors.lastname: Sinsheimer
authors.forename: Christina G S
authors.initials: CG
authors.lastname: Palmer
mesh_terms: D000328:Adult; D003144:Communication Barriers; D003638:Deafness / Q000235:genetics*; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012813:Sign Language; D040241:Social Marketing