Recruitment Challenges in Qualitative Breast Cancer Research With Older African-American Women

Background and Purpose: A qualitative study was conducted that had the primary aims to understand the experiences of older African-American women diagnosed with breast cancer and family members regarding diagnosis and treatment decisions. In order to reach the intended study population, multiple recruitment strategies were undertaken, including those identified in existing literature that suggested that  the most efficient ways were referrals through primary medical or cancer treatment providers, religious institutions, and community support groups (Patterson, et al., 2005; Pal, et al., 2008).  Difficulties in recruitment of study participants were experienced, so a secondary aim of the study became to specifically identify these challenges and identify which recruitment strategies were successful among this population. 

Methods: The study utilized a qualitative phenomenological approach. In-depth, semi-structured interviews were conducted with 23 African American women (45 years and older) diagnosed and treated for breast cancer and 15 family members involved in the treatment experience with these women.  Data were collected through face-to-face and telephone interviews.  Participants received a $50 gift card as compensation for their time.  Interviews were conducted by a female African American interviewer. Several recruitment strategies were employed to reach an adequate sample size including recruitment through local cancer treatment centers’ staff, flyer distribution on local university campuses, and information on  social networking sites and public service announcements (PSAs) on local radio stations with a large African American audience. 

Results: Each recruitment strategy yielded successfully enrolled participants.  Initial recruitment at local cancer centers yielded six participants in eight months, but this strategy was determined as not sufficient to reach enrollment goal.  Subsequent strategies (flyer distribution and use of social network sites) yielded an average of one per month over four months (n=4).  Use of PSAs on local popular radio proved the most effective strategy yielding the remaining patient participants in one month. Challenges were experienced with each strategy and included: 1) heavy patient volume and daily demands of local cancer center staff; 2) an extended geographic recruitment area as a result of use of social networking sites and flyer distribution; thus requiring changes in the data collection plan from face-to-face to telephone interviews in some cases; and 3) script development, identification of optimal “air” times, and cost associated with PSAs.  The need for institutional review board approval of each recruitment modification arguably posed the most significant challenge to the study timeline. Scheduling and completing interviews posed additional challenges, particularly among family members.

Conclusions and Implications:  Experiences in this study indicated recruitment of participants by medical staff may be ineffective as it places additional burden on these professionals even though they have “good intentions” to help in research efforts.  PSAs on popular radio geared toward the targeted age group, gender, and race demographics may maximize the reach for a study.  These findings have implications for social work researchers who endeavor to understand the experiences of populations that may receive less than optimal care seek and design interventions that may minimize health disparities.