Table 2 Be Fit, Be Well retention strategies and results

RAs call participants from their assigned health center two weeks before an upcoming follow-up appointment, one-week before and the day of to confirm. Calls made during day, evenings and weekends to home, cell and work numbers

• Unable to reach participant

1. Prepaid phones for research assistants to facilitate evening and weekend calls;

1. RA night and weekend calls increased with use of prepaid phones;

2. RAs called participants not from their primary health center;

2. Calls to participants from different research assistants were not effective

3. $5 Gift card mailing to request updated contact information;

3. $5 gift card mailings yielded few updates to contact information. Most of the people that responded were people for whom we already had correct information;

4. Surveyed participants on economic hardships at 24-month visit to understand the role this may have played;

4. Of the 144 participants surveyed, 39 (27.3%) said their phone had been disconnected in the past 24-months.

RAs attempt to contact participants with missed appointments by phone, email and mail.

• Repeated missed appointments

1. RAs met patient at clinic when scheduled to see their provider and measure weight only

1. Difficult to coordinate schedules to be at clinic for patient doctor appointments; Some patients not keeping appointments with BFBW were also not seeing their provider.

Missed follow-up visits for participants inactive in the intervention arm

2. Primary care provider reengagement message;

2. Provider reengagement messages were not consistently delivered to participants. Providers found it hard to keep track of who was in need of messaging;

3. Offered gift cards from missed visits as incentive to complete last visit;

3. Of the 158 people eligible to receive gift cards from missed visits, 108 completed their 24-month visit; 52 of those completions occurred after the mailing;

4. Taxi vouchers;

4. Taxi vouchers were used by less than 20 participants overall. Those using vouchers tended to be elderly and were generally reliant on family members for transportation;

5. Home visits at 24-months only

5. Completed a total of five home visits. In response to our offer of coming to their home, several people said things like, ‘You don’t have to go to all that trouble. I can come to the clinic.’ Several of these people did complete their visit at the clinic.

6. Use any clinic measured weight within three months of the scheduled assessment date

6. We were able to get clinic weights for several participants. However, many patients that missed appointments with BFBW also were not seeing their PCP.

7. Community health workers (CHW) help with scheduling.

7. Among those intervention participants in contact with their CHW, having the CHW give reminders about upcoming follow-up visits and help reschedule missed visits was successful.

Maintain participant contact with holiday and birthday cards

Disengagement among participants

1. Each quarter we sent out a newsletter with our contact information, updates on the study and an appeal to complete study visits to all participants. It included health articles like how to avoid overindulging during the holidays or ways to get out and enjoy Boston in the spring.

1. Quarterly newsletters were well received and occasionally prompted a phone call from a participant trying to find out if they were supposed to come in for a follow-up visit soon;

2. Social gatherings were held quarterly. To prevent unblinding, only intervention participants and control participants that had completed the program were invited. We encouraged to bringing family and friends.

2. We held four social gatherings and each had between 25–50 attendees. Those that came reported that they enjoyed themselves.

Follow-up visits occur at health centers in assigned BFBW space or in available patient exam rooms

Difficult to maintain consistent space for follow-up visits at health centers

1. Space administrators were given a copy of our visit schedule a week in advance for space planning. Front desk staff was provided with a BFBW info card and the RA contact information. Each day they received a list of expected participants. We placed removable placards on the door of our visit space that announced that it was in use by BFBW and included a schedule for the day.

1. Communication with staff on the part of the project director and the research assistants was essential. These relationships greatly facilitated our ability to complete follow-up visits at the clinics.