Who enrolls in prevention trials? Discordance in perception of risk by professionals and participants

Experiences in our own Preventive intervention Research Center underscore that the way in which the program is presented may seriously influence which population subgroups are enrolled. Successful recruitment and retention often depend on whether there is congruence between the subjects' perceived needs and the stated agenda of the recruitment effort. Where there is discordance between the professionals' basis for concern and the client's agenda, there is potential for losing key segments of the target population. Solutions include recasting the intervention to maximize its relationship to the potential participants' perceived needs or integrating it into standard services. Research design should include collecting data from those who chose not to participate in the intervention or who drop out. Finally, it should be emphasized that many preventive interventions do not focus on risk status but use techniques intended to strengthen competence and skills and increase resiliency, and are directed at captive audiences or large scale populations (Roberts & Peterson, 1984). Such preventive interventions may be accepted on their intrinsic appeal or perceived merit, although they must avoid negative consequences and must not be viewed as too burdensome or they will discourage client participation. Regardless of the strategy selected, the only way to know the generalizability of the program is to collect data that provide an accurate description and documentation of how the sample and the intended target population differ.