All ETDs from UAB

Advisory Committee Chair

Retta R Evans

Advisory Committee Members

Cynthia I Joiner

Suzanne E Judd

John Lowman

Cathy Roche

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

EFFECTIVE RECRUITING FOR SUBGROUPS IN THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL (SPRINT) THOMAS MARSHALL RAMSEY HEALTH EDUCATION / HEALTH PROMOTION ABSTRACT Background: The Systolic Blood Pressure Intervention Trial (SPRINT) recruitment focused on participants > 50 years old with systolic blood pressure of > 140 mm Hg (hypertension) with no evidence of diabetes or previous stroke. Priority participants were targeted in non-clinical subgroups (women and minorities) as well as three clinical subgroups (pre-existing cardiovascular disease, pre-existing chronic kidney disease, > 75 years old). Objective: The objective of this secondary analysis is to determine which of the five recruiting strategies was most effective? Which recruitment method best met overall study goals, specific subgroup goals, including clinical sub-studies related to dementia in hypertensive participants. Methods: From November 2010 to March 2013 (28-months), a simultaneous, decentralized, and multifaceted recruitment strategy was deployed in ninety-six clinics managed by five clinical center networks, to recruit participants into a large, long-term, randomized control clinical trial involving hypertension. Various recruitment methods were described including mass media, chart review, referrals, brochures and posters, and specifically targeted mass mailings. The recruiting methods from three previous large, long-term, hypertension clinical trials were reviewed to compare the trials recruiting effectiveness and subsequent clinical outcomes with SPRINT. Results: In just over 28-months, 14692 volunteers were screened with 9361 of those being randomized. 33% of those screened through mass mailing lists were enrolled, followed by 23% through chart review, 17% through referral networks with included friends and healthcare providers, 11% were from brochures in the waiting area, and 12% from all other recruiting efforts combined. A greater emphasis was placed on subgroup recruitment which bolstered the recruitment yield (number randomized/number screened) in the subgroups. 77% of those screened with cardiovascular disease were enrolled, 79% with chronic kidney disease, 70% were > 75-years old, 55% were women, and 61% were minorities. Targeted mass mailings were the primary recruitment tool for all subgroups except those with chronic kidney disease where referral networks were the primary method. Conclusion: The author determined the greatest benefit from recruitment comes from a simultaneous, multi-faceted, decentralized recruiting strategy, focusing on specifically targeted mass mailing to contact subgroups in previously untreated population who may need an intervention the most, as well utilizing the referral networks for those patients who cannot be reached by traditional recruiting methods. Keywords: Clinical Center Network (CCN), Subgroup, Recruitment, Hypertension Clinicaltrials.gov identifier SPRINT Trial NCT01206602

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