Recruitment and retention challenges and successes.

OBJECTIVE: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention. DESIGN: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women ≥ 15 years old) were recruited through a regional hospital. RESULTS: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study. DISCUSSION: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.

Relationship Between Eating Behavior and Dietary Intake in Rural Mexican-American Mothers.

We used Spearman's rho correlations and descriptive statistics (α = 0.05) to explore relationships between maternal eating behaviors (disinhibition, cognitive restraint, and susceptibility to hunger) and frequency of consumption of specific food groups (dairy, fruits, vegetables, meats) in a rural Mexican-American population. Analyses were based on the mothers' responses to the Three Factor Eating Questionnaire and Willett's Food Frequency Questionnaire. Cognitive restraint was associated with greater frequency of consumption of vegetables, whereas disinhibition was associated with less frequent consumption of fruit. Susceptibility to hunger may have indirectly influenced the latter by enhancing the level of disinhibition. Mean frequency of consumption of vegetables (1-3 times per month) and fruits (once per week) was less than Healthy People 2020 targets. Additional research is needed to better understand factors contributing to these eating behaviors and patterns. To do so will require developing diet assessment tools that reflect foods typically consumed by this population.

Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition.

Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.