Who is the "Community" in Community Outreach?

background: Chronic disease self-management programs (CDSMP) have been shown to improve health outcomes, especially among populations with disproportionately high chronic disease prevalence.  However, recruitment of hard-to-reach populations into these programs is a challenge and barrier to participation.  This study sought to identify specific barriers to recruitment of African American adults into CDSMP.

methods: Key informant interviews (n=8) were conducted with community health professionals who conduct outreach to African American adults in Tompkins County, NY.  Interviewees were selected using a snowball sampling approach.  Responses were coded thematically and used to inform a focus group held with representatives from community agencies that support CDSMP. The purpose of the focus group was to develop strategies to address recruitment barriers to CDSMP. Grounded Theory was used to guide key informant and focus group questions and analysis.

results: Findings from key informant interviews identified the absence of a community ambassador, lack of trust and ownership of CDSMP, and limited referrals by physicians as recruitment barriers. The focus group concentrated on physician involvement and identified two strategies for increasing awareness and program referrals: 1) Grand Rounds presentations at the community medical center and 2) producing and distributing newsletters to primary care physician offices.

conclusion: Engaging secondary stakeholders, such as community physicians, as a strategy for addressing recruitment barriers of hard-to-reach populations into CDSMP may be a promising approach because the foundational relationship building already exists. Supplementing this with more focused efforts on community-wide relationship building may promote sustainable engagement of multiple community members.