Abstract
Latinos are the largest minority population group in the United States, and Latino children currently account for one fourth of U.S. children under age 18. Family is a core value in the Latino culture, and fathers play a central role within the family, including making decisions that influence their children’s health. Nonetheless, Latino fathers are often underrepresented in child health research. This study was designed to describe effective strategies to recruit Latino fathers into five child health research studies. Using a data recruitment log, we collected quantitative and qualitative data on recruitment strategies used to reach and enroll Latino fathers into five child health research studies from 2016 to 2020. Methods classified as direct recruitment strategies involved interaction between potential participants with research staff, whereas indirect methods involved no interaction with research staff and potential participants. In total 113 Latino fathers, majority low-income, immigrant, participated in the studies. Direct recruitment methods in combination with snowball sampling were the most successful strategies for recruiting Latino fathers, contributing to approximately 96% (n = 107) of the total participants. Indirect methods were much less effective, with social media contributing to only 3.6% (n = 4) of total participants. Not a single participant was recruited through printed materials (e.g., flyers posted or distributed). Furthermore, qualitative findings revealed the importance of culturally and linguistically relevant approaches in efforts to recruit and enroll Latino fathers. Future research should consider directly asking Latino fathers’ preferences for recruitment and participation in child health research.
Introduction
Latinos are the largest minority population group in the United States (Pew Research Center [PRC], 2020). Latino children currently account for one fourth of U.S. children under age 18 and are projected to make up nearly one third of the child population by 2050 (PRC, 2020). Family is a core value in Latino culture, and fathers play a central role within Latino family, including decision making that influences their children’s health (Guillet & Echavarría, 2015).
Increasing evidence suggests that including fathers in pediatric research is critical to developing an understanding of both the unique and combined effects of fathers’ influences on their children’s health (Davison et al., 2018). Nonetheless, traditionally, researchers interested in understanding child health have relied on mothers as source of information, leaving fathers underrepresented in pediatric research (Davison et al., 2017). Such underrepresentation has been linked to a number of factors among which are perceived gender roles that view mothers as the primary caregiver, and perceived challenges of recruiting fathers (Davison et al., 2017). However, a recent study assessing fathers’ perceived reasons for their lack of inclusion in pediatric research found that over 80% of 303 respondents reported that fathers are underrepresented in research because they have not been asked to participate (Davison et al., 2017).
Given increasing evidence suggesting fathers’ influential role on their children’s health behaviors and health care decision making and the central role Latino fathers play within the family, it is important to identify effective strategies to recruit Latino fathers to participate in pediatric research. Therefore, this study was designed to describe effective strategies to recruit Latino fathers to participate in child health research.
Materials and Method
Study Design
We conducted five child health research studies involving multiethnic Latino fathers from 2016 to 2020. The five studies spanned two life stages including early childhood (2–8 years) and adolescence (11–19 years). The studies examined fathers’ beliefs, attitudes, and practices related to (1) early childhood energy balance–related behaviors (e.g., eating, physical activity, sedentary behavior, etc.) and (2) uptake of the human papillomavirus (HPV) vaccination. The studies employed qualitative and quantitative research designs and included multiple data collection methods (i.e., focus groups, semistructured interviews, and surveys; Table 1). Additional details of the studies can be found elsewhere (Lindsay, Delgado, et al., 2020; Lindsay, Le, et al., 2020; Lindsay et al., 2017; Lindsay, Pineda, et al., 2020; Lindsay, Wallington, Muñoz, & Greaney, 2018).
Study Characteristics, Recruitment Methods, and Number of Participants Recruited in Five Studies With Latino Fathers (N = 113)
For studies including both fathers and mothers, the number reflects only recruitment goal for number of fathers.
Recruitment Methods
Building on our previous community-engaged research with Latinos, we utilized a combination of direct and indirect recruitment strategies to enroll participants into the studies (Lindsay, Wallington, et al., 2020). Methods classified as direct recruitment strategies involved interaction between potential participants with research staff, whereas indirect methods involved no interaction with research staff and potential participants (Lindsay, Wallington, et al., 2020).
As shown in Table 1, direct recruitment strategies included on-site, in-person recruitment at worksite (e.g., university, food retail stores), community (e.g., consulate fairs, health fairs), sports (e.g., soccer practices), and church events (e.g., after mass coffee hour). Research staff also conducted outreach to members of their social networks to disseminate information and recruit potential research participants. Participants were also recruited using snowball sampling techniques by asking enrolled participants to provide names of their personal contacts (after obtaining permission) that they believed were also eligible for the study.
Indirect recruitment strategies included posting and distributing flyers at churches, barber shops, civic organizations (e.g., consulates), and community events (e.g., health fairs, cultural fairs, etc.) and using social media (posting study flyers on Facebook, or asking enrolled participants to disseminate study’s flyers using their social media). Participants received gift cards from Walmart or Target ($15–$25) in appreciation for their participation. The University of Massachusetts Boston Institutional Review Board approved all study protocols, including research materials. Informed consent was obtained from individuals participating in the studies.
Participants
Latino fathers were eligible to participate if they (1) self-identified as being of Hispanic ethnicity, (2) were ≥21 years, (3) had lived in the United States for 6 or 12 months depending on study, (4) had at least one child between 2 and 8 (early childhood studies) or 11 and 19 (HPV studies) years of age, and (5) had shared parental responsibilities for or cohabitated with said child (Lindsay, Delgado, et al., 2020; Lindsay et al., 2017; Lindsay, Le, et al. 2020; Lindsay, Pineda, et al., 2020; Lindsay, Wallington, Muñoz, & Greaney, 2018). In addition, in two of the studies an additional eligibility requirement included having a child enrolled in a Latino family child care home (Lindsay et al., 2017; Lindsay, Wallington, Lees, & Greaney, 2018).
Data Collection
We used a data recruitment log developed by our research team and used in prior studies to document recruitment efforts (Lindsay, Wallington, et al., 2020). The data recruitment log is a brief form that includes checklists of (1) recruitment methods and (2) participants’ preferred methods for follow-up (e.g., telephone, e-mail, WhatsApp, etc.). In addition, the log includes space for brief notes on staff’s contacts with participant (voicemail and email messages), participant’s work schedule, and space for referrals (Lindsay, Wallington, et al., 2020).
Data Analyses
Quantitative data from the recruitment log forms were entered into an Excel file and analyzed by calculating simple descriptive statistics (number and percentages) of the recruitment methods used by each study. Qualitative data were derived from several sources including notes and record of contacts (voicemail and email messages) included in the recruitment log, research memos written by principal investigator and research staff, and progress reports submitted to funding organizations.
Qualitative data were gathered, coded, and analyzed using a “lumping” approach for initial coding and general codebook development. This approach involves identifying broader categories that include items that share important features even if differences exist (Patton, 2001). The first author analyzed the data manually using thematic analysis, an analytical approach that uses an iterative multistep process of coding data in phases to create meaningful patterns (Patton, 2001). Themes identified from the analysis of the qualitative data were used to aid in the interpretation of findings and to generate “lessons learned.”
Results
Participants Characteristics
In total, 113 fathers were enrolled into the five studies. As part of their study involvement, participants also completed brief sociodemographic and acculturation surveys (see Table 2). Fathers’ mean age was 38.4 years (SD = 7.6). Most were married (85.8%; n = 97), reported low educational level (≤high school or GED: 85%; n = 96), and reported low (≤US$40,000/year) annual gross household income (62.8%; n = 71). Moreover, the majority of was foreign-born (85%; n = 96), originating from North American (2.1%; n = 2), Central American (54.2%; n = 52), South American (22.9%; n = 22), and Caribbean (20.8%; n = 20) countries. Foreign-born fathers reported living in the United States for an average of 12.2 years, the vast majority of fathers reported Spanish as their primary language (92%; n =104), and almost two thirds (73.5%; n = 83) reported low acculturation levels as measured by the Short Acculturation Scale for Hispanics (<2.99; Marin et al. 1987).
Sociodemographic Characteristics and Acculturation Level of Participants in Five Studies With Latino Fathers (N = 113)
Note. GED = general education degree; SASH = Short Acculturation Scale for Hispanics.
Born in the United States, excluding Puerto Rico (U.S. territory). bOnly for those born outside the United States excluding Puerto Rico. cCutoff chosen based on household annual income MassHealth Income Standards and Federal Poverty Guidelines in 2016.
Recruitment Strategies
Analyses of quantitative data derived from the recruitment log showed that direct recruitment strategies were the most effective and accounted for 96.4% (n = 107) of the total recruited participants. The most successful direct recruitment strategies included using snowball sampling by asking participants initially enrolled in the studies to identify other potential participants (36.1%, n = 40), followed by research staff’s personal contacts (e.g., family, friends; 25.2%, n = 28), and on-site, in-person contacts at community (10.8%, n =12), sports (9.9%, n = 11), worksites (9.0%; n = 10), and church (5.4%; n = 6) events (Table 1).
Indirect methods were much less effective, with social media contributing to only 3.6% (n = 4) of the participants enrolled in two of the five studies. It is worth noting that not a single participant was recruited through printed materials (e.g., flyers posted or distributed).
Lessons Learned
Findings from the qualitative analyses revealed that critical to outreach, recruitment, and enrolment of fathers in all five studies were research staff’s shared cultural identity and the use of linguistically and culturally (e.g., familism, personalism, respeto, simpatia, etc.) appropriate approaches that recognized and respected the cultural values, beliefs, worldview, and practices of Latinos, such as communication style; religious, cultural, and ethnic beliefs related to health and disease (e.g., fatalism); and cultural values closely associated with the role of Latino fathers within the family (e.g., family dynamics, gender roles). In addition, qualitative findings suggested the importance of our research staff’s interpersonal skills to effectively convey the utility and educational benefits of the research, while being flexible to adapting data collection (e.g., convenient and familiar location; flexible times, e.g., weekend, evenings) to meet the needs of participants.
Moreover, qualitative analyses showed that barriers to participation were lessened in studies that focused exclusively on fathers (fathers only vs. fathers and mothers), used individual data collection methods (interviews vs. focus groups), and centered on child health topics fathers felt most comfortable discussing (e.g., early healthy behaviors vs. HPV vaccination). Finally, findings found that recruitment efforts were shortened in the study conducted in male-dominant venues (e.g., soccer practices) by male research staff.
Discussion
This study contributes to research on effective strategies to reach, recruit, and engage low-income, immigrant Latino fathers in child health research. In our studies, direct recruitment involving in-person contact between research staff and participants was most effective. Snowball sampling was the most effective recruitment strategy in three of the five studies, followed by research staff’s personal contacts. These findings are consistent with prior research and suggest the importance of trust (confianza) in recruitment of immigrant populations who have legitimate concerns with disclosure of personal information (García et al., 2017; Yancey et al., 2006). Trust might have been especially important for the time frame when the studies were conducted, which overlapped with worsening immigration measures in the United States.
Furthermore, findings showed that on-site, in-person recruitment in places familiar and convenient to Latino fathers such as sports, community and church events, and worksite contributed to successful recruitment of participants in all five studies. Direct, in-person contact gave potential participants opportunity to ask questions before enrolling in the studies. These findings are supported by prior research suggesting Latinos preferences for direct contact with research staff, reflective of personalism (personalismo) and trust (confianza), which are core values in Latino culture (García et al., 2017; Lindsay, Wallington, et al., 2020)
Moreover, consistent with prior research, findings showed that recruitment efforts were streamlined and shortened in father-specific studies compared to studies focused on both parents (Davison et al., 2017). It is also worth noting that having a male staff as part of our research team proved to be important in recruiting Latino fathers. Future studies should continue to explore cultural norms and traditional gender roles when planning studies with ethnic minority populations (Yancey et al., 2006). Researchers should also continue to explore venues and activities typically enjoyed by Latino fathers such as children’s sports practices as these emerged more conducive to recruitment.
Study limitations should be considered. First, the five studies relied on relatively small sample sizes and did not require follow-up and retention. In addition, the percentage of foreign-born Latino fathers participating in our studies is high (85%) compared to the national trend documenting a decline among U.S. Latinos since 2000 (PRC, 2020). Also, we did not directly assess fathers’ experiences with recruitment, and this information would have been helpful to adjust recruitment efforts. Finally, we did not use respondent-driven sampling, as our studies involved relatively small sample sizes. Future studies with Latino fathers should consider the use of respondent-driven sampling as previous research has found it to be effective to recruit populations who have been historically underrepresented in research, including undocumented immigrants (Montealegre et al., 2013).
Conclusions
Identifying effective recruitment strategies is important to address barriers to fathers’ participation in pediatric research, thus ensuring an understanding of the unique and combined effects of fathers’ influences on their children’s health. The present study documented effective recruitment strategies to reach, recruit, and engage low-income, majority-immigrant Latino fathers in child health research. Although recruiting low-income, immigrant fathers into the five studies presented challenges (e.g., fathers’ work schedule, long working hours, etc.), was time intensive, and required perseverance on the part of research staff, after initial in-person contact and recruitment, fathers participating in our studies were eager to share information about their children and, even more, expressed the desire to learn and “do what’s best” for their children. As previous researchers have suggested, asking fathers to participate in research is a critical first step to increase fathers’ representation in child health research (Davison et al., 2017). Future research should consider directly asking Latino fathers about their preferences for recruitment and participation in pediatric research. Moreover, future studies should continue to document and disseminate lessons learned from recruiting and engaging fathers in pediatric research, and especially ethnic minority immigrant fathers such as the Latino fathers participating in our studies. This information will help researchers to continuously refine ways to reach, recruit, and engage fathers, thus increasing their representation in pediatric research.
Footnotes
Authors’ Note:
ACL participated in study design, data collection, data analysis, and manuscript preparation and review. MJV and JAP participated in data collection and data entry, and manuscript review. MAM participated in manuscript preparation and review. We are thankful to all the fathers who participated in the studies included in this article, and for the faith- and community-based agencies that collaborated in the studies. We thank Daniel Campos and Elizabeth N. Diaz for their help in outreach, recruitment, and enrollment of fathers in the early healthy behaviors study with Central American parents.
