Principles of Precision Prevention Science for Improving Recruitment and Retention of Participants

Prevention Science (2018) 19:689–694 https://doi.org/10.1007/s11121-018-0884-7 COMMENTARY Principles of Precision Prevention Science for Improving Recruitment and Retention of Participants Lauren H. Supplee 1 1 & Jenita Parekh & Makedah Johnson 1 Published online: 12 March 2018 # Society for Prevention Research 2018 Abstract Precision medicine and precision public health focus on identifying and providing the right intervention to the right population at the right time. Expanding on the concept, precision prevention science could allow the field to examine prevention programs to identify ways to make them more efficient and effective at scale, including addressing issues related to engagement and retention of participants. Research to date on engagement and retention has often focused on demographics and risk factors. The current paper proposes using McCurdy and Daro (Family Relations, 50, 113–121, 2001) model that posits a complex mixture of individual, provider, program, and community-level factors synergistically affect enrollment, engagement, and retention. The paper concludes recommending the use of research-practice partnerships and innovative, rapid cycle methods to design and improve prevention programs related to participant engagement and retention at scale. Keywords Precision prevention science . Participant engagement . Participant retention . Research-practice partnerships . Rapid cycle methods Precision medicine takes individual variability into account when designing and testing prevention and treatment options. The research conducted within a precision medicine framework identifies the most efficient and effective treatment for a specific person with a specific disease (Collins and Varmus 2015). The idea of precision has been expanded to public health to provide the right intervention to the right population at the right time. The concept is also applicable to prevention science (Khoury et al. 2016). A precision prevention science framework could allow the field to examine existing programs and identify ways to make models more efficient and effective at scale. Specifically, using this frame could help prevention scientists and practitioners tackle problems prevention programs face at scale, such as challenges related to participant recruitment and engagement, which prevent them from having their intended public health impact. * Lauren H. Supplee 1 Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA Challenges of Participant Engagement and Retention in Prevention Programs Underlying prevention programs is the belief that the children, youth, and families in the programs need to receive enough dosage of the content or services in order to achieve the outcomes desired (National Research Council and Institute of Medicine 2009; Holland et al. 2017). Challenges with low enrollment, retention, and engagement are pervasive through different kinds of prevention programs, particularly when brought to scale (e.g., home visiting, teen pregnancy prevention, youth substance abuse, relationship education programs, parenting programs) (Holland et al. 2017; Council 2009). Understanding how and why engagement patterns vary may inform efforts to better recruit and engage families. Does engagement increase over time if families can see how the program is working in their lives (Holtrop et al. 2014)? Does engagement decline if families have a close relationship with the provider and there is provider turnover (Holland et al. 2017)? Understanding the reasons for participant engagement across prevention programs can lead to the development of improved program designandtargeted enhancements to programsto address the issue. Research to understand the problem of enrollment and engagement of participants has often examined participant demographic and risk factors to explain variability. For example, 690 both Coatsworth et al. (2017) and Mauricio et al. (2017) in this special issue examined how engagement patterns varied by participant demographics and factors related to family dynamics. The literature examining demographics and risk factors, however, has mixed findings (Damashek et al. 2011; Smith et al. 2017). For example, in some programs, family distress is not only related to higher engagement, but also may be related to lower retention (Damashek et al. 2012; Smith et al. 2017). Some of the variation in findings could be because demographics and broad risk factors are proxies for other factors that explain more of the variation in findings. Spoth et al. (2013) proposed the Translation Science to Population Impact Framework (TSci Impact Framework) that illuminated the critical importance of examining the creation and implementation of evidence-based interventions at all phases, for different populations, and at all levels of the system. Aligned with this framework is the idea discussed in this paper to examine participant engagement with a similar systems lens. Precision medicineandpublichealthresearchare carefultodefinesubpopulations in more nuanced ways than in the past, segmenting into smaller groups who vary by specific factors such as susceptibility, intersection of risk, or response to specific treatments (Vaithinathan and Asokan 2017). Some prevention science research has begun to examine a broader range of systems level factors for subpopulations that affect engagement, including characteristics of the program delivery or organizational capacity (Holland et al. 2017). Factors Related to Participant Engagement and Retention McCurdy and Daro (2001) argue that high-level risk and demographic factors do not fully capture why participants may choose to enroll in and engage with prevention programs. Instead, a complex mixture of individual factors (both mutable and more stable), provider, program, and community-level factors synergistically may affect enrollment, engagement, and retention (McCurdy and Daro 2001). While papers in this special issue acknowledge the importance of all of these factors, none of the papers in this special issue empirically test factors at levels other than the individual, with the exception of Perrino et al.’s (2016) examination of facilitator experience. We posit in this commentary that taking a broader lens on the factors that may predict participant enrollment, engagement, satisfaction, and retention may better identify critical factors in the design and optimization of prevention programs. Precision prevention science would need to consider all of these factors in designing efficient, effective programs. Each factor is discussed in more detail below. Participant Level Individuals may choose to engage or not engage with prevention programs for a complex set of reasons including a sense of efficacy, motivation, cultural alignment, Prev Sci (2018) 19:689–694 community support or stigma, mental health issues, and others (National Research Council and Institute of Medicine 2009). Engaging in prevention effo (...truncated)