Recruiting Pregnant Indigenous Women Who Smoke into a High Contact Incentivized Cessation Trial: A Feasibility Study

Smoking prevalence among pregnant indigenous women is disproportionately higher than for nonindigenous pregnant women. Incentives have been shown to increase retention in and the effectiveness of smoking cessation programs. To trial if this could work for indigenous women, we aimed to recruit and observe retention of Māori (New Zealand indigenous people) pregnant women that smoke into a cessation program using incentives.

A parallel group, randomized controlled feasibility trial was undertaken in New Zealand. Pregnant Māori women who smoked were recruited through health practitioners, social media, and general media advertising. Outcomes included ease of recruitment, enrollment rate, retention, cost, and time and distance traveled to visit participants.

Seventy-four women were referred for the trial over 7 months. The highest enrollment rate was among self-referrals from media (6 of 10), then women referred from cessation providers (47%, 8 of 17). About three-quarters of women referred from health professionals did not enroll. Only 32% (24) were randomized. Nine women completed the intervention, three withdrew, and 12 were lost to follow-up. On average, it took less time to contact abstinent participants (29 vs. 43 minutes for nonabstinent women). No deception was noted.

Recruitment was difficult and varied by source of first contact. Once enrolled, it was feasible to maintain intensive contact with participants who stayed engaged. The number lost to follow-up was high. We concluded that the tenor of trial promotion could have influenced recruitment and retention rates. Further research with indigenous women is needed to identify better recruitment and retention methods.

With the rising cost of research and the increased competition for funds, it is important to have evidence that intervention studies with minority group pregnant women who smoke are feasible. Maintaining contact with participants seemed feasible, but the tenor of trial promotion and type of recruitment strategy could influence enrollment and retention of sufficient numbers of participants. Nonjudgmental supportive advertising and invitations direct to women may work better than relying on health professionals as recruiters.