Primary prevention studies and the healthy elderly: Evaluating barriers torecruitment

Although primary prevention studies are important tools in helping the heal thy elderly stay healthy, recruiting from a community based cohort of healt hy elderly individuals for a primary prevention study involves numerous bar riers. To better identify and understand these barriers, we conducted and e valuated a comprehensive recruitment strategy for a primary prevention stud y testing aspirin in an HMO population. In the recruitment phase, we identi fied healthy individuals (65 years of age or older) who were members of a l arge, group-model HMO in Oregon and Washington, and used computerized medic al database screening, statistical sampling, health plan mailings, e-mail c ommunication with primary care providers, and the experience of a well-esta blished research clinic in an effort to enroll health elderly in this prima ry prevention trial. Among a random sample of 47,453 eligible patients over the age of 65, 44% responded to recruitment efforts, but only 3% were enro lled-an overall yield of slightly less than 2%. To evaluate these results, we then conducted focus groups with 225 randomly selected "eligible refuser s." We determined that healthy elders were hesitant to give up their choice to use aspirin, unwilling to travel to the research center, and reluctant to risk their tenuous hold on good health to participate in a study of prim ary prevention. Awareness of these attitudes is an indispensable step rewar d designing effective recruitment strategies for primary prevention studies involving the healthy elderly.