Speaker
Description
Community-based approaches offer a scalable model to deliver exercise programming to cancer survivors; however, public health impact depends on reaching a large, representative population. Hybrid effectiveness-implementation (HEI) trials provide an opportunity to assess reach during program evaluation, as effectiveness-focused eligibility criteria and recruitment may constrain reach. This study examined recruitment reach, challenges, and adaptations during a Type I HEI study for breast cancer survivors (BCS).
The trial aims to recruit 160 BCS randomized to community-based exercise (n=80) or health education (n=80). Recruitment included active strategies (e.g., mailed letters, portal messages, clinician referrals to BCS identified via electronic medical records [EMR]) and passive strategies (e.g., social media, community flyers). Reach was operationalized as recruitment yield and sample representativeness. Recruitment source, challenges, and adaptations were documented.
To date, 1435 BCS were exposed to recruitment, 246 (17%) completed and 127 (9%) passed pre-screening, 95 (7%) completed full screening, and 56 were accrued (4% recruitment yield). Of note, 713 (50%) BCS were ineligible mainly due to being regularly active or outside required time since treatment. Further, 380 (26%) declined participation due to lack of interest or time. The sample is representative of the local BCS population based on ethnicity (78% non-Hispanic White versus 78% locally; 10% Hispanic versus 13% locally). Active and passive strategies accounted for 88% and 12% of accruals, respectively. Respondents to active versus passive strategies were 64.0±8.6 years-old, 76% non-Hispanic White and 63.5±6.0 years-old, 83% non-Hispanic White. Recruitment challenges included effectiveness-focused eligibility criteria, time-consuming telephone protocol, and fragmented cancer care locally. Adaptations included adding portal messages, revising contact protocol and eligibility criteria, and expanding community outreach.
Findings suggest active, EMR-supported recruitment strategies were essential for accrual, while maintaining representativeness. Modest yield, high ineligibility rates, and frequently declined participation highlight the tension between effectiveness-focused trial criteria and pragmatic recruitment for future implementation.
Keywords
Community-based exercise, Hybrid effectiveness-implementation, reach, cancer survivors
| Abstract submitters declaration | yes |
|---|---|
| Conflict of Interest & Ethical Approval | yes |
