Successful Recruitment of Low‐income and Minority Patients in the Southern United States: Implementation of Intensive Blood Pressure Control to Slow Cognitive Decline (IMPACTS‐MIND) Trial

Abstract Background Black communities, low‐income populations, and those living in the stroke belt bear a disproportionate burden of dementia and are underrepresented in previous trials on preventing cognitive decline and dementia. Improved methods to implement interventions to slow cognitive decline and reduce health disparities are needed. The Implementation of Multifaceted Patient‐Centered Treatment Strategies for Intensive Blood Pressure Control to Minimize Cognitive Decline (IMPACTS‐MIND) trial is testing a multifaceted strategy for implementing an intensive blood pressure (BP) intervention protocol on cognitive decline in racial minority and low‐income hypertensive patients in primary care. Method The IMPACTS‐MIND study is a cluster‐randomized trial in 10 primary care organizations with 40 clinics in Louisiana and Mississippi. The included organizations predominantly treat low‐income and minority patients, and 9 of the organizations (with 36 included clinics) are federally‐qualified health centers (FQHCs). We are recruiting a goal of 1,260 patients who are at least 40 years of age (2/3s over age 60 years) with have uncontrolled systolic BP. Recruitment has been conducted in partnership with primary care organizations. Using electronic health record systems, potentially eligible patients based on BP are contacted via a letter and phone call to assess willingness and preliminary eligibility. Provider and staff referrals are also encouraged and incentivized. Result We have enrolled 581 participants in the study to date. Participants are an average of 63.0 years of age, 68% are Black, and 59% are female. More than 60% have a high school education or less, and 72.8% have an annual household income <$25,000. Over 44% have diabetes, 28.9% depression, and mean body mass index of 33.6 kg/m2. Mean baseline Montreal Cognitive Assessment (MoCA) score is 19.7. Successful recruitment of low‐income and minority participants has hinged on strong relationships with primary care partners through study steering committee membership for each organization and state FQHC organizations, manuscript co‐authorship for all members, monthly meetings to support study conduct, and building research capacity and opportunities for partnering organizations. Conclusion Effectively recruiting low‐income and minority patients is possible through partnership with primary care providers who treat these patients. Building relationships with these organizations around common interests and priorities is critical to effective recruitment.

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