Recruitment of American Indians in epidemiologic research: the Strong Heart Study

This paper describes the methods used to recruit American Indian (AI) populations for the Strong Heart Study (SHS), a community-based study of cardiovascular disease (CVD) and its risk factors in AI men and women. Recruitment strategies included personal contact by recruiters and drivers/recruiters in remote areas, SHS staff participation in community activities, and mass media. A total of 4,549 participants aged 45-74 years were recruited from 13 American Indian tribes and communities. Overall participation rates were 72&percnt, 55&percnt, and 62&percnt, respectively, for the three study centers (Arizona, the Dakotas, and Oklahoma). Participant feedback and educational material related to risk factor reduction and promoting a healthy lifestyle were emphasized. Participants were likely to be female, young, and nonsmokers. Barriers to recruitment included lack of telephones in a large proportion of households, conflicting beliefs about health/health care/research, fears, taboos, and occasional rumors about study examination procedures. Participants were referred for follow-up of health problems detected by the study. The strong commitment of the participating communities helped to insure the success of the SHS, which can be considered a model for recruitment in future American Indian population-based studies. Success was facilitated by the use of a variety of recruitment techniques.