Challenges and lessons learnt in the recruitment of rural residents for a diabetes screening program — the TREND project

Objective

Conducting diabetes screening programs in rural areas represents unique challenges with respect to participation of the rural residents. This study focussed on understanding the real-life challenges encountered and lessons learnt in the recruitment of rural residents for a population-based cross-sectional study in Tamil Nadu, South India.

Methods

In-depth interviews (IDIs) were conducted among a multidisciplinary research team comprised of field investigators (n = 8), field technicians (n = 8), telemedicine technicians (n = 2), and site coordinator (n = 1) who worked in the TREND study (Telemedicine PRoject for screENing Diabetes and its complications in rural Tamil Nadu). The IDIs explored the real-life challenges and potential strategies used to facilitate a high response rate in the recruitment of rural participants through a semi-structured guide. IDIs are conducted for 35–40 min and recorded after obtaining consent from each staff. The recordings were then transcribed into text, coded, and analysed using thematic analysis through NVIVO software version 10.0.

Results

A total of 10 IDIs were conducted. Seven major themes such as lack of awareness; transportation issues; stigma — fear of being diagnosed with diabetes; distrust on healthcare providers; cultural beliefs and practices; language barriers; and competing priorities were identified as the reasons for inactive participation. Building rapport and trust, patience and counselling skills aided the staff to handle non-respondents. Display of pamphlets in the public places, the village head’s support in campaigning, helped in the active participation of rural residents.

Conclusion

By identifying and addressing barriers to participation, healthcare providers and community stakeholders can work together to improve the health of rural communities.