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American Indians and Alaska Natives are difficult to reach by mail for research or health care reasons

It is difficult to reach by mail the 4 million American Indians and Alaska Natives (AI/ANs) who live in the United States to involve them in research or their own health care, concludes a new study. Prior studies have found that recruitment of AI/ANs into research trials was more successful when they were approached at community events such as powwows and traditional celebrations rather than through mailings. However, such approaches often result in a select rather than representative sample, note the study authors. In this study, they identified factors associated with receipt of postal mailings among patients seen at an urban Indian health clinic (60 percent of whom were AI/AN).

The researchers sent a Native art calendar (with preventive health information for one group and no health information for the control group) via first class mail to 5,633 patients who had been seen at the clinic during the prior 2 years. Based on initial mailings and in-person location efforts, only an estimated 61 percent of patients actually received the calendars. The mail verification process was significantly less likely to identify working addresses for patients who were AI/AN and those who were seen more than 3 months before the study. In fact, AI/ANs were about half as likely as non-AI/ANs to have accurate addresses.

The results suggest that it is difficult, but possible, to use the U.S. Postal Service to reach patients seen at an urban Indian health facility. Future studies should examine whether the use of mailing strategies aimed at highly mobile populations can achieve greater success when aligned with ongoing efforts that track group members after clinical or research visits. The study was supported in part by the Agency for Healthcare Research and Quality (HS10854).

See "Using mail to reach patients seen at an urban health care facility," by Donna Duffy, R.N., M.P.H., Jack Goldberg, Ph.D., and Dedra Buchwald, M.D., in the August 2006 Journal of Health Care for the Poor and Underserved 17, pp. 522-531.

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