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"Fireside Chat" Approach to Addressing Barriers to Treatment Participation Effective in CTNs STRIDE Study

January 10, 2016
Northrup, TF, et al.
Northrup TF, et al. An Ounce of Prevention: A Pre-Randomized Protocol to Improve Retention in Substance Use Disorder Clinical Trials. Addictive Behaviors 2017;64:137-142.
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  • Back in the 1930s and 1940s, President Franklin Roosevelt hosted a series of informal radio conversations, known as “Fireside Chats.”
  • Using a down-to-earth approach, Roosevelt used these addresses to educate the public on policies like the New Deal, and to help reassure them about the two great crises of the era: the Depression and World War II. He believed that the best way to help the public cope with trying times was to engage with them early and often – and it worked.
  • The result, according to historians, was a remarkable turnaround in the public’s confidence.

Given this, it makes sense that the team in charge of the CTN’s “Stimulant Reduction Using Dosed Exercise” (STRIDE) study might choose the same name for a protocol they implemented with study participants aimed at helping those participants stay informed, identify barriers to retention, and build a foundation for ongoing retention efforts.

Missing data in longitudinal substance use disorder (SUD) research pose a significant problem for internal validity and drawing valid inferences, with 20% of participants routinely lost to follow-up after 3 months, and nearly 1/3 of participants missing data beyond 12 months. Participants miss sessions, or drop out of studies completely, for a variety of reasons, many of which can be addressed prior to becoming problematic – if those reasons can be identified early enough.

Protocol staff in the STRIDE study developed their “Fireside Chat” program in response to that very issue, developing a structured and formal retention-related program that could be implemented prior to randomization. The Chat occurred with each potential participant and included all members of a site study team. Sessions involved a conversation about the purpose for the study, as well as a series of questions related to common barriers to participation, like time involvement, work schedules, transportation, child care, planned recreational or social activities, and reservations about the project or treatment in general. Post-randomization, follow-up Chats were also scheduled to help participants who were missing sessions come up with solutions to identified barriers.

Fifteen participants were randomized in the STRIDE study prior to implementation of the Fireside Chat, and 14 were randomized after. Intervention and monthly follow-up attendance (before and after implementation) were compared at the site (N=29) that developed and rigorously implemented the Chat.

Analysis found that individuals in both intervention conditions of STRIDE (exercise or health education) who received the Chat attended significantly more intervention visits during the acute and continuation phases of the study.

Conclusions: The myriad barriers to research engagement that participants face require careful consideration by all stakeholders involved in research. The time investment for the Chat by potential participants and research staff is not trivial, but it could provide important benefits for the study. However, the increased validity of study results when less data are missing, and staff time savings as the study progresses (e.g., less need for efforts to contact participants who have missed visits) are both quite important, and so is making participants (and treatment clients in general) feel like collaborative partners in their own care. Franklin Roosevelt would be proud!

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