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      Retention strategies among those on community supervision in the South: Lessons learned during the COVID-19 pandemic

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          Abstract

          Objectives

          Cohort studies must implement effective retention strategies to produce internally valid and generalizable results. Ensuring all study participants are retained, particularly those involved in the criminal legal system, ensures study findings and future interventions will be relevant to this group, who are often lost to follow-up: critical to achieving health equity. Our objective was to characterize retention strategies and describe overall retention among an 18-month longitudinal cohort study of persons on community supervision prior to and during the COVID-19 pandemic.

          Methods

          We implemented various retention strategy best-practices (e.g., multiple forms of locator information, training study staff on rapport building, study-branded items). During the COVID-19 pandemic, we developed and describe new retention strategies. We calculated overall retention and analyzed differences between those retained and lost to follow-up by demographic characteristics.

          Results

          Prior to the start of the COVID-19 pandemic, 227 participants enrolled across three sites (N = 46 North Carolina; N = 99 Kentucky; N = 82 Florida). Of these, 180 completed the final 18-month visit, 15 were lost to follow-up, and 32 were ineligible. This resulted in an overall retention of 92.3% (180/195). While most participant characteristics did not differ by retention status, a greater proportion of those experiencing unstable housing were lost to follow-up.

          Conclusion

          Our findings highlight that when retention strategies are flexible, particularly during a pandemic, high retention is still achievable. In addition to retention best-practices (e.g., frequent requests for updated locator information) we suggest other studies consider retention strategies beyond the study participant (e.g., paying participant contacts) and incentivize on-time study visit completion (e.g., providing a bonus when completed the study visit on time).

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          Most cited references31

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          Structural racism and health inequities in the USA: evidence and interventions

          The Lancet, 389(10077), 1453-1463
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            A systematic review of the effect of retention methods in population-based cohort studies

            Background Longitudinal studies are of aetiological and public health relevance but can be undermined by attrition. The aim of this paper was to identify effective retention strategies to increase participation in population-based cohort studies. Methods Systematic review of the literature to identify prospective population-based cohort studies with health outcomes in which retention strategies had been evaluated. Results Twenty-eight studies published up to January 2011 were included. Eleven of which were randomized controlled trials of retention strategies (RCT). Fifty-seven percent of the studies were postal, 21% in-person, 14% telephone and 7% had mixed data collection methods. A total of 45 different retention strategies were used, categorised as 1) incentives, 2) reminder methods, repeat visits or repeat questionnaires, alternative modes of data collection or 3) other methods. Incentives were associated with an increase in retention rates, which improved with greater incentive value. Whether cash was the most effective incentive was not clear from studies that compared cash and gifts of similar value. The average increase in retention rate was 12% for reminder letters, 5% for reminder calls and 12% for repeat questionnaires. Ten studies used alternative data collection methods, mainly as a last resort. All postal studies offered telephone interviews to non-responders, which increased retention rates by 3%. Studies that used face-to-face interviews increased their retention rates by 24% by offering alternative locations and modes of data collection. Conclusions Incentives boosted retention rates in prospective cohort studies. Other methods appeared to have a beneficial effect but there was a general lack of a systematic approach to their evaluation.
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              Systematic review identifies number of strategies important for retaining study participants.

              Loss to follow-up threatens internal and external validity yet little research has examined ways to limit participant attrition. We conducted a systematic review of studies with a primary focus on strategies to retain participants in health care research. We completed searches of PubMed, CINAHL, CENTRAL, Cochrane Methodology Register, and EMBASE (August 2005). We also examined reference lists of eligible articles and relevant reviews. A data-driven thematic analysis of the retention strategies identified common themes. We retrieved 3,068 citations, 21 studies were eligible for inclusion. We abstracted 368 strategies and from these identified 12 themes. The studies reported a median of 17 strategies across a median of six themes. The most commonly reported strategies were systematic methods of participant contact and scheduling. Studies with retention rates lower than the mean rate (86%) reported fewer strategies. There was no difference in the number of different themes used. Available evidence suggests that investigators should consider using a number of retention strategies across several themes to maximize the retention of participants. Further research, including explicit evaluation of the effectiveness of different strategies, is needed.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: MethodologyRole: Writing – original draft
                Role: Data curationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Formal analysisRole: VisualizationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 April 2023
                2023
                5 April 2023
                : 18
                : 4
                : e0283621
                Affiliations
                [1 ] School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [2 ] School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [3 ] Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [4 ] Department of Sociology, University of Kentucky, Lexington, Kentucky, United States of America
                [5 ] Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [6 ] Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [7 ] Disability Rights of North Carolina, Raleigh, North Carolina, United States of America
                [8 ] Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, United States of America
                [9 ] Department of Sociology and Criminology, University of Miami, Miami, Florida, United States of America
                Beth Israel Deaconess Medical Center/Harvard Medical School, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-6046-6353
                Article
                PONE-D-22-30143
                10.1371/journal.pone.0283621
                10075476
                45af4b32-bc09-4b21-ac4b-f02edf97c825
                © 2023 Uhrig Castonguay et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 November 2022
                : 13 March 2023
                Page count
                Figures: 2, Tables: 3, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100006545, National Institute on Minority Health and Health Disparities;
                Award ID: R01MD013573
                Funded by: funder-id http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: P30 AI050410
                Funded by: funder-id http://dx.doi.org/10.13039/100000066, National Institute of Environmental Health Sciences;
                Award ID: T32ES007018
                Funded by: funder-id http://dx.doi.org/10.13039/100009633, Eunice Kennedy Shriver National Institute of Child Health and Human Development;
                Award ID: P2C-HD050924; T32-HD007168
                Funded by: NIMHD
                Award ID: F31MD017136
                Funded by: National Institutes on Drug Abuse
                Award ID: R25DA037190
                This work is supported by the National Institute on Minority Health and Health Disparities (NIMHD) [R01MD013573], The University of North Carolina at Chapel Hill Center for AIDS Research (CFAR), a National Institutes of Health (NIH) funded program P30 AI050410, National Institute of Environmental Health Sciences (NIEHS) (T32ES007018) and The Carolina Population Center provided general and training support (P2C-HD050924; T32-HD007168) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). This work was also supported by NIMHD (F31MD017136) and National Institutes on Drug Abuse (NIDA) – Lifespan/Brown Criminal Justice and Research Training Program (R25DA037190). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                Viral Diseases
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