title: Patient responses to research recruitment and follow-up surveys: findings from a diverse multicultural health care setting in Qatar.
abstract: BACKGROUND
  Health care researchers working in the Arabian Gulf need information on how to optimize recruitment and retention of study participants in extremely culturally diverse settings. Implemented in Doha, Qatar in 2012 with 4 language groups, namely Arabic, English, Hindi, and Urdu, this research documents persons' responses to recruitment, consent, follow-up, and reminder procedures during psychometric testing of the Multicultural Assessment Instrument (MAI), a novel self- or interviewer-administered survey.
  
  
  METHODS
  Bilingual research assistants recruited adults in outpatient clinics by approaching persons in particular who appeared to be from a target language group. Participants completed the MAI, a second acculturation instrument used for content-validity assessment, and a demographics questionnaire. Participants were asked to take the MAI again in 2-3 weeks, in person or by post, to assess test-retest reliability. Recruitment data were analyzed by using nonparametric statistics.
  
  
  RESULTS
  Of 1503 persons approached during recruitment, 400 enrolled (27%)-100 per language group. The enrollment rates in the language groups were: Arabic-32%; English-33%; Hindi-18%; Urdu-30%. The groups varied somewhat in their preferences regarding consent procedure, follow-up survey administration, contact mode for follow-up reminders, and disclosure of personal mailing address (for postal follow-up). Over all, telephone was the preferred medium for follow-up reminders. Of 64 persons who accepted a research assistant's invitation for in-person follow-up, 40 participants completed the interview (follow-up rate, 63%); among 126 persons in the postal group with a deliverable address, 29 participants mailed back a completed follow-up survey (response rate, 23%).
  
  
  CONCLUSIONS
  Researchers in the Arabian Gulf face challenges to successfully identify, enroll, and retain eligible study participants. Although bilingual assistants-often from the persons' own culture-recruited face-to-face, and our questionnaire contained no health care-related content, many persons were reluctant to participate. This occurrence was observed especially at follow-up, particularly among participants who had agreed to follow-up by post.
authors.affiliation: Pediatric Clerkship, Weill Cornell Medical College in Qatar, Education City, PO Box 24144, Doha, Qatar. amk2005@qatar-med.cornell.edu.|Weill Cornell Medical College in Qatar, Olin Hall, Suite 432, 445 East 69 Street, New York, NY, 10022, USA. amk2005@qatar-med.cornell.edu.
authors.forename: Amal
authors.initials: A
authors.lastname: Khidir
authors.affiliation: Weill Cornell Medical College in Qatar, PO Box 24144, Doha, Qatar.|, Present address: Unit 42, 667 Pinerow Crescent, Waterloo, ON, N2T 2L5, Canada.
authors.forename: Humna
authors.initials: H
authors.lastname: Asad
authors.affiliation: The Center for Cultural Competence in Healthcare, Weill Cornell Medical College in Qatar, PO Box 24144, Doha, Qatar.
authors.forename: Huda
authors.initials: H
authors.lastname: Abdelrahim
authors.affiliation: The Center for Cultural Competence in Healthcare, Weill Cornell Medical College in Qatar, PO Box 24144, Doha, Qatar.
authors.forename: Maha
authors.initials: M
authors.lastname: Elnashar
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104-1213, USA.|, Present address: 435 Van Houten Ave. Apt #205, Passaic, NJ, 07055, USA.
authors.forename: Amal
authors.initials: A
authors.lastname: Killawi
authors.affiliation: University of Michigan, 1500 E. Medical Center Drive, L4000 Women's, Ann Arbor, MI, 48109, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Hammoud
authors.affiliation: Department of Medical Education, Hamad General Hospital, PO Box 3050, Doha, Qatar.
authors.forename: Abdul Latif
authors.initials: AL
authors.lastname: Al-Khal
authors.affiliation: Biostatistics, Epidemiology and Biomathematics Research Core, Research Department, Weill Cornell Medical College in Qatar, Education City, PO Box 24144, Doha, Qatar.|, Present address: 6 Rosenstrasse, 40479, Dusseldorf, Germany.
authors.forename: Pascale
authors.initials: P
authors.lastname: Haddad
authors.affiliation: Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA.|Mixed Methods Research and Scholarship Program, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA.|Japanese Family Health Program, University of Michigan, Japanese Family Health Program 24 Frank Lloyd Wright Dr., SPC 5795, Ann Arbor, MI, 48106-5795, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D018864:Cultural Diversity; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data; D018579:Patient Selection; D011594:Psychometrics; D011780:Qatar; D015203:Reproducibility of Results; D012107:Research Design; D011795:Surveys and Questionnaires; D055815:Young Adult
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