Rural health, Heart failure, Self-management, Recruitment and Retention Strategies, Behavioral intervention.


Self-management plays a vital role in improving health outcomes and reducing costs in patient with cardiovascular disease (CVD) and associated risk factors. Based on existing studies, rural residents with CVD and/or risk factors show low engagement in self-management behaviors. Due to low participation in behavioral intervention trials, the most promising mechanism to promote self-management among rural populations is unknown. In turn, the purpose of this article is to review the evidence that supports strategies to recruit and retain rural patients to participate in behavioral intervention trials aimed to promote self-management of CVD and its risk factors. This review is expected to assist researchers in identifying effective solutions to overcome barriers in the recruitment and retention processes when conducting intervention research studies on the self-management of CVD in rural communities.

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This work is licensed under a Creative Commons Attribution 4.0 License.



Baquet, C. R., Commiskey, P., Daniel Mullins, C., & Mishra, S. I. (2006). Recruitment and participation in clinical trials: Socio-demographic, rural/urban, and health care access predictors. Cancer Detection and Prevention, 30(1), 24-33. doi:S0361-090X(06)00003-1 [pii]

Befort, C. A., Bennett, L., Christifano, D., Klemp, J. R., & Krebill, H. (2014). Effective recruitment of rural breast cancer survivors into a lifestyle intervention. Psycho‐Oncology, doi:10.1002/pon.3614

Befort, C. A., Klemp, J. R., Fabian, C., Perri, M. G., Sullivan, D. K., Schmitz, K. H., . . . Shireman, T. (2014). Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors. Contemporary Clinical Trials, 37(2), 261-271. doi:10.1016/j.cct.2014.01.010

Bergeron, C., Foster, C., Friedman, D., Tanner, A., Kim, S., Friedman,Caroline Bergeron Caroline Foster Daniela, & Kim, A. T. S. (2013). Clinical trial recruitment in rural south carolina: A comparison of investigators’ perceptions and potential participant eligibility. Rural and Remote Health, 13(2567)

Comis, R. L., Miller, J. D., Aldige, C. R., Krebs, L., & Stoval, E. (2003). Public attitudes toward participation in cancer clinical trials. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 21(5), 830-835. doi:10.1200/JCO.2003.02.105

Cosby, A. G., Neaves, T. T., Cossman, R. E., Cossman, J. S., James, W. L., Feierabend, N., . . . Farrigan, T. (2008). Preliminary evidence for an emerging nonmetropolitan mortality penalty in the united states. American Journal of Public Health, 98(8), 1470-1472. doi:10.2105/AJPH.2007.123778 [doi]

Cudney, S., Craig, C., Nichols, E., & Weinert, C. (2012). Barriers to recruiting an adequate sample in rural nursing research. Online Journal of Rural Nursing and Health Care, 4(2), 78-88.

Dibartolo, M., & McCrone, S. (2003). Recruitment of rural community-dwelling older adults: Barriers, challenges, and strategies. Aging & Mental Health, 7(2), 75-82. doi:10.1080/1360786031000072295

Ford, J. G., Howerton, M. W., Lai, G. Y., Gary, T. L., Bolen, S., Gibbons, M. C., . . . Bass, E. B. (2008). Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review. Cancer, 112(2), 228-242. doi:10.1002/cncr.23157 [doi]

Gillies, C. L., Abrams, K. R., Lambert, P. C., Cooper, N. J., Sutton, A. J., Hsu, R. T., & Khunti, K. (2007). Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis. BMJ (Clinical Research Ed.), 334(7588), 299. doi:bmj.39063.689375.55 [pii]

Green, L. A., & Hickner, J. (2006). A short history of primary care practice-based research networks: From concept to essential research laboratories. Journal of the American Board of Family Medicine : JABFM, 19(1), 1-10. doi:19/1/1 [pii]

Health Data Interactive. (2014). Health data interactive. Retrieved from http://www.cdc.gov/nchs/hdi.htm

Kulynych, J., & Korn, D. (2003). The new HIPAA (health insurance portability and accountability act of 1996) medical privacy rule: Help or hindrance for clinical research? Circulation, 108(8), 912-914. doi:10.1161/01.CIR.0000080642.35380.50 [doi]

Lindbloom, E. J., Ewigman, B. G., & Hickner, J. M. (2004). Practice-based research networks: The laboratories of primary care research. Medical Care, 42(4 Suppl), III45-9. doi:00005650-200404001-00008 [pii]

Long, K. A., & Weinert, C. (1989). Rural nursing: Developing the theory base. Scholarly Inquiry for Nursing Practice, 3(2), 113-127.

Melvin, C. L., Corbie-Smith, G., Kumanyika, S. K., Pratt, C. A., Nelson, C., Walker, E. R., . . . Workshop Working Group on CVD Prevention in High-Risk Rural Communities. (2013). Developing a research agenda for cardiovascular disease prevention in high-risk rural communities. American Journal of Public Health, 103(6), 1011-1021. doi:10.2105/AJPH.2012.300984 [doi]

Minkler, M., & Wallerstein, N. (2010). Community-based participatory research for health: From process to outcomes John Wiley & Sons.

Miyamoto, S., Henderson, S., Young, H., Ward, D., & Santillan, V. (2013). Recruiting rural participants for a telehealth intervention on diabetes Self‐Management. The Journal of Rural Health, 29(1), 69-77. doi:10.1111/j.1748-0361.2012.00443.x

Mold, J. W., & Peterson, K. A. (2005). Primary care practice-based research networks: Working at the interface between research and quality improvement. Annals of Family Medicine, 3 Suppl 1, S12-20. doi:3/suppl_1/s12 [pii]

National Center for Health Statistics. (2012). Health, united states, 2011: With special feature on socioeconomic status and health. Hyattsville (MD): doi:NBK54381 [bookaccession]

Parra-Medina, D., D'antonio, A., Smith, S. M., Levin, S., Kirkner, G., Mayer-Davis, E., & POWER study. (2004). Successful recruitment and retention strategies for a randomized weight management trial for people with diabetes living in rural, medically underserved counties of south carolina: The POWER study. Journal of the American Dietetic Association, 104(1), 70-75. doi:10.1016/j.jada.2003.10.014 [doi]

Penman, D. T., Holland, J. C., Bahna, G. F., Morrow, G., Schmale, A. H., Derogatis, L. R., . . . Cherry, R. (1984). Informed consent for investigational chemotherapy: Patients' and physicians' perceptions. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 2(7), 849-855.

Pribulick, M., Willams, I. C., & Fahs, P. S. (2010). Strategies to reduce barriers to recruitment and participation. Online Journal of Rural Nursing and Health Care : The Official Journal of the Rural Nurse Organization, 10(1), 22-33.

Reddy, P., Hernan, A. L., Vanderwood, K. K., Arave, D., Niebylski, M. L., Harwell, T. S., & Dunbar, J. A. (2011). Implementation of diabetes prevention programs in rural areas: Montana and south‐eastern australia compared. Australian Journal of Rural Health, 19(3), 125-134. doi:10.1111/j.1440-1584.2011.01197.x.

Reddy, P., Dunn, A. B., White, C. M., Tsikouris, J. P., Giri, S., & Kluger, J. (2002). An economic analysis of amiodarone versus placebo for the prevention of atrial fibrillation after open heart surgery. Pharmacotherapy, 22(1), 75-80.

Sateren, W. B., Trimble, E. L., Abrams, J., Brawley, O., Breen, N., Ford, L., . . . Christian, M. C. (2002). How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 20(8), 2109-2117. doi:10.1200/JCO.2002.08.056

Tanner, A., Kim, S., Friedman, D. B., Foster, C., & Bergeron, C. D. (2014). Barriers to medical research participation as perceived by clinical trial investigators: Communicating with rural and african american communities. Journal of Health Communication, (ahead-of-print), 1-9. doi:10.1080/10810730.2014.908985

Taylor, D., Stone, S., & Huijbregts, M. (2012). Remote participants' experiences with a group-based stroke self-management program using videoconference technology. Rural Remote Health, 12, 1-15.

Viswanathan, M., Ammerman, A., Eng, E., Garlehner, G., Lohr, K. N., Griffith, D., Lux, L. (2004). Community‐based participatory research: Assessing the evidence: Summary. doi:NBK11852[bookaccession]