title: A successful approach to minimizing attrition in racial/ethnic minority, low-income populations.
abstract: BACKGROUND
  Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition.
  
  
  METHODS
  The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition.
  
  
  RESULTS
  Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P<0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk=1.5; 95% confidence interval, 1.1-2.0).
  
  
  CONCLUSIONS
  A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.
authors.affiliation: Medica Research Institute, Minneapolis, MN, United States; Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States; and Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States; address: Medica Research Institute, MR-CW105, P.O. Box 9310, Minneapolis, MN 55440, United States.
authors.forename: Glenn
authors.initials: G
authors.lastname: Flores
authors.affiliation: Department of Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, NA2.110, Dallas, TX, 75390, United States.
authors.forename: Alberto
authors.initials: A
authors.lastname: Portillo
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
authors.forename: Hua
authors.initials: H
authors.lastname: Lin
authors.affiliation: Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, United States.
authors.forename: Candy
authors.initials: C
authors.lastname: Walker
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
authors.forename: Marco
authors.initials: M
authors.lastname: Fierro
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Henry
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Massey
keywords: African Americans; Hispanic Americans; Patient dropouts; minority groups; randomized controlled trials; research subject recruitment