Discussion
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RECRUITMENT
This recruitment study has been able to successfully examine the factors that may contribute to a participant’s choice to be recruited into the CP@home program. It revealed many challenges and opportunities that future studies on frequent 9-1-1 callers could consider as part of their recruitment process.Hard-to-reach populations, such as frequent 9-1-1 callers, often have low socioeconomic status; they often suffer from chronic health problems and/or mental illness, and may have precarious employment and living arrangements [We found that young adults (aged 18–29) and older adults (aged 65 and older) answered their phone or door more frequently than the middle age group. On the other hand, older adults aged 50–64 and 65 + who were contacted were most likely to participate in CP@home. These results should be considered in participant recruitment for future studies. For example, one should consider the need to oversample certain age groups that are harder to reach. Although the youngest age group was the most likely to respond to contact attempts, their participation rate was substantially lower than the older age groups suggesting that this group is highly contactable but has very little interest in participating. Their ability to be contacted could be a result of the frequent mobile phone usage in this group and not evidence of their interest in the program [Our recruitment analysis shows that older adults have a higher participation rate compared to younger age groups. Literature has shown that there are some common barriers in recruiting all ages of adults for health research and that language, culture, ill health and time and resources all play similar roles [Understanding the most effective way of contacting potential participants and the reasons for calling 9-1-1 is helpful in determining where to direct recruitment efforts for a home visit program. Among participants requiring a lift assist as a reason for calling, a significantly higher proportion were contacted through a home visit. Home visits were more likely to yield a response than phone calls as some people may be hesitant to answer the phone if they don’t know the number due to the high volume of scam calls [This paper had some limitations. The external generalizability of our study is limited because the vast majority of participants were of white ethnicity and therefore the findings may not be applicable to other ethnicities. Furthermore, there were discrepancies in data reporting between the four sites. Gender data was not reported for three of the sites, which limited the ability to examine recruitment differences by gender. Similarly, a reason for not participating was not recorded for most people who had consented to participate, but did not actually participate. This information could have been useful in providing an explanation into reasons for declining to participate after providing informed consent. The data was missing because paramedic services had difficulty in providing gender due to their restrictions with privacy and also the difficulties of extracting the information from their electronic medical records (EMRs). Lastly, reasons for calling 9-1-1 were categorized into groups, some of which were vague and non-descriptive (e.g., pain/unwell, other) which is how they are documented in the EMRs. This restricted the potential to compare more specific reasons for calling 9-1-1 across age groups of participants. However, each of these generic categories accounted for a small proportion of the total number of callers. Thus, the categorization method likely did not have any substantial impact on the analysis.