Exploring how enrollment strategies, social support, and network densities influence reach, engagement, retention, and behavior change among intervention participants in southwest Virginia

Successful recruitment and engagement of participants is essential for large-scale dissemination and implementation efforts, yet it is especially challenging in socioeconomically disadvantaged communities. This mixed-methods study is a secondary analysis of a behavioral intervention targeting Appalachian adults, and examines the effect of enrolling with others versus enrolling alone in regards to reach, engagement, retention, and behavior change, as well as perceived barriers to program participation. Further, this study explores how engagement, retention, and behavior change are influenced by social networks. Contrary to our hypothesis, using an 'enrolling with others' recruitment strategy did not improve reach, engagement, retention, or behavior change; rather, enrolling alone was associated with greater significant differences in engagement in classes (p=.042), missed class calls (p=.005), total activities (p=.001), and retention (p<.001). Qualitative responses reveal barriers to engagement by both groups of participants. Network density scores had a significant impact on participant engagement in classes (p=.001), total activities (p=.024), and retention (p<.001), and qualitative responses identified the participant's relationship to other participants had a positive impact on their enrollment and behavior change in SIPsmartER. However, these findings are limited by the small sample size and high enrollment of a worksite with a high network density and high engagement. The findings and limitations paired with the enrolling with others and social network literature suggest the need for exploration with a larger study population to better understand the impact on reach, engagement, retention, and behavior change in behavioral interventions targeting individuals from socioeconomically disadvantaged communities.