When recruiting women, targeted methods work best

Recruitment expert offers these strategies

Clinical trial investigators and sites increasingly may need to rely on recruitment experts in coming years as community-based research increases and the industry evolves.

"In a certain sense, clinical trial recruiters have the ability to make or break a product because [poor recruitment] can hold up a study and keep a product from being developed," says Jennifer Higgins, PhD, a research associate/recruitment specialist at Springfield Neurology Associates in Springfield, MA.

By focusing on improving recruitment strategies and training, Springfield Neurology Associates has had success with meeting and exceeding recruitment goals, Higgins says.

"We work hard at recruitment, and any trial center that works hard and puts more of its focus on the grassroots level will have more success," Higgins notes.

"The efficiency and effectiveness of the process of recruitment is enhanced by training," Higgins says. "What I observed is that people are often running in different directions and wasting a good amount of time that if they were focused or had better training they wouldn't waste."

The clinical research (CR) industry will need to focus on recruitment training or face the consequences of longer drug development pipelines and continuing to under-enroll women and the elderly.

Outcomes data needed

Recruitment is its own arts and science, requiring outcomes data on strategies that work best with specific demographic groups and with patients who have various diseases, Higgins says.

"You need to know what is a good incentive for recruitment and how to recruit and give informed consent without dissuading people from participating," she explains. "We walk a fine line between being up front about the side effects and also meeting the bottom line of the corporate sponsors."

Research staff that are trained in volunteer recruitment develop better relationships with participants and consumers because of their knowledge of where to find people willing to enroll in trials.

"They have the ability to bring together a disparate stream of knowledge and activity that is helpful and could move the industry forward more expediently than before," Higgins says. "Recruiters can develop proposals that could be floated with sponsors."

It takes training, recruitment research or performance improvement projects, and experience to develop efficient recruitment strategies. As an example of how to improve one's recruitment techniques, Higgins offers these suggestions for how to increase enrollment of women in a clinical trial:

• Target areas where women congregate. There are housing sites and geographical areas where there are greater numbers of women than men, Higgins says.

"I do a lot of work with older women, and we also look at lifestyle issues," she explains.

For example, Higgins sometimes targets areas and venues that attract lesbians to find women to enroll in trials.

An added benefit is that lesbians tend to have poor preventive health and have greater access to other women and support networks, Higgins says.

"So they'll have more chronic health problems, needing the extra [medical] help, and they may be more amenable to being recruited," Higgins says.

• Recruit at women's organizational events. "I target community events like women's golf tournaments, church organizations, retired teacher events, caregiver support groups, and beauty pageants and fashion shows," Higgins says.

When Higgins meets with women at these venues, they'll often say that a particular clinical trial would be good for their neighbor, aunt, or daughter, she notes.

"Women are always cued in to how they can help one another," Higgins says.

• Gear recruitment to disease-specific venues. Some diseases impact women more than men, and so recruitment efforts could take that into consideration. For example, if a clinical trial is for a treatment of multiple sclerosis (MS), then it'd be a good strategy to visit a community walk for MS awareness, Higgins suggests.

"While I'm there I'd make a concerted effort to target the women who are there," Higgins says. "It's helpful to use social marketing."

Likewise, CR recruiters might attend disease-specific events like fundraisers for breast cancer or other diseases where minority women might be found, as well.

Black women, rural women, and other minorities also are underrepresented in clinical trials, Higgins notes.

Rural women, for example, tend to be more trusting of studies than women in general, and so if the transportation hurdle can be handled, these women might be more likely to participate in clinical research, Higgins says.

"Rural women also may tend to have less health care options and be under- or uninsured," Higgins adds.

Higgins will attend the support groups for a disease for which she's recruiting.

She lets the support group attendees know who she is, and she offers to provide them with resources and disease information if they have any questions.

"I send out electronic announcements to these group leaders and their members," Higgins says. "I also offer to do presentations on caregiver stress and burnout and women's health issues."

By offering free presentations, Higgins gains greater access to people at all levels in the community, including business leaders, she notes.

• Use an atypical advertising campaign. "I start out with advertising in ways people haven't thought of before with women," Higgins says.

"I put posters on web sites for employee assistance programs," she says.

Higgins also advertises in locations that feature information for adults who are caregivers for their parents. Some of these messages are listed on university staff web sites.

"Another atypical ad I send out is a trial announcement to beauty parlors, dermatology practices, and attorneys that specialize in lesbian and gay rights," Higgins says.

Higgins has put advertisements in pageant and fashion show booklets, as well.

"I also attend meetings for women business and veterans associations and put fliers in public schools where there are teachers who may participate or have knowledge of people who would participate in trials," Higgins adds.

Likewise, she attends churches and senior centers and sends these organizations mailings and newsletters.

"I submit articles that could be published in any of these outlets about the diseases we're studying, and I keep up our visibility," Higgins says. "I also capitalize on my own involvement in my church and organizations."