Literature - recruitment

HEALTH EDUCATION RESEARCH
Theory & Practice

Vol.21 no.5 2006
Pages 611–620
Advance Access publication 9 June 2006

Recruiting and retaining couples for an HIV
prevention intervention: lessons learned
from the PARTNERS project

Abstract
Intervening with both members of a couple has
been recommended as an important strategy
for human immunodeficiency virus prevention.
Analyses of focus groups and in-depth interviews with project personnel involved in
recruitment and retention for the Partners
Against Risk-Taking: A Networking and Evaluation Research Study project identified, at the
termination of the project, barriers and facilitators to recruiting couples. Barriers included
logistical problems of coordinating two people’s
schedules, sensitivity of the topic and challenges
related to recruitment efforts focused on one
partner only. Strategies to overcome such barriers were to increase availability of project
personnel and recruit both partners simultaneously, with recruitment teams consisting of
men and women. Challenges related to recruit-

1

US Centers for Disease Control and Prevention, Atlanta,
GA 30030, USA, 2Lawton VA Outpatient Clinic, Fort Sill,
OK 73503, USA, 3Public Health Institute, Berkeley, CA
94704, USA, Center for the Study of Women in Society,
4
University of Oregon, Eugene, OR 97403, USA,
Department of Public Health, 5Oregon State University,
Corvallis, OR 97331, USA and 6Children’s Hospital of
Orange County, Orange, CA 92868, USA
*Correspondence to: K. A. Pappas-DeLuca, US Centers for
Disease Control and Prevention/Division of Reproductive
Health/Women’s Health and Fertility Branch, 4770 Buford
Highway, NE, Mailstop K-34, Atlanta, GA 30341, USA.
E-mail: [email protected]
**The findings and conclusions in this article are those of
the authors and do not necessarily represent the views of
the Centers for Disease Control and Prevention.

Published by Oxford University Press [2006].

ing and retaining couples remain significant
and should be considered before undertaking
couples interventions.

Introduction
Increases in the number of cases of heterosexual
transmission of human immunodeficiency virus
(HIV) and acquired immunodeficiency syndrome
(AIDS) in the United States from 1999 to 2002
suggest the need for effective HIV prevention
programs for heterosexuals [1]. Research suggests
that couples interventions addressing both partners’
motivations for engaging (or not) in safer sexual
behaviors may be needed to address the needs of
heterosexuals in relationships, particularly for those
in close relationships (e.g. those with primary
partners) [2–7].
In recognition of this need, investigators have
developed and evaluated couples interventions
[8, 9]. Despite their promise in promoting safer
sexual behaviors [8, 10], couples interventions
face recruitment and retention challenges that
may limit their impact. Problems in recruiting
participants to and retaining them in studies can
also limit the generalizability and internal validity
of the studies, leaving questions about whether
and under what conditions the interventions are
effective. Despite a growing body of literature on
how to overcome barriers for recruiting individuals, including hard-to-reach populations [11–17],
few address the challenges and strategies that are
unique to the recruitment and retention of couples
[18–20]. In this paper, we describe the recruitment
and retention challenges and the lessons we learned

doi:10.1093/her/cyl030

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Katina A. Pappas-DeLuca1*, Joan Marie Kraft1, Sherri L. Edwards2,
America Casillas3, S. Marie Harvey4,5 and Heather C. Huszti6

K. A. Pappas-DeLuca et al.
implementing one couples intervention study in the
United States, the Partners Against Risk-Taking: A
Networking and Evaluation Research Study
(PARTNERS) project.

The PARTNERS project

The PARTNERS intervention and
comparison sessions
Couples in the one-session comparison condition
received information from trained facilitators about
HIV transmission and prevention, other STDs and
contraception. Facilitators then led a question-andanswer period. All the couples randomized to this
session finished the 1.5- to 2-hour session.
Couples in the intervention group participated in
three sessions, each lasting 2.5 hours, over 3
consecutive weeks. In addition to reviewing the
same information provided in the comparison
session, each intervention session included skillbased interactive activities to address psychosocial
factors and relationship dynamics designed to
improve couple communication and enhance relationships. The first session focused on increasing
612

Recruitment and retention of couples in
the PARTNERS project
Like most other intervention studies, we used active
and passive strategies to recruit women and their
partners. In active recruitment sites (e.g. health
centers, shopping malls, STD clinics, community
colleges, housing projects and universities), recruiters approached women to give them information about the project. The recruiters were women
and were often of the same race, ethnicity and age
range as potential participants. Information about
the project included a description of the intervention and the steps in the research process. Interested
women participated in a short screening interview
to determine eligibility. For passive recruitment,
recruiters placed printed materials (e.g. posters and
brochures) that described the project and listed
a toll-free number in community locations and
advertised in local media. When women called,
they received information about the project, including a description of the intervention, and were
invited to participate in a screening interview.
Eligibility criteria were designed to identify
couples at risk in their relationships. Women were
eligible if they were 18–25 years old; had a male
partner aged 18 or older, whom they identified as
a primary sexual partner (defined as someone ‘like
a husband or steady boyfriend’); had sex without a
condom at least once in the past 3 months and met
one or more of the following criteria: (i) engaged in
risk behavior in the past (e.g. had other sexual
partners in the past year, had an STD and ever used
intravenous drugs), (ii) knew or thought their
partners brought risk to their relationship (e.g. had

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The PARTNERS project was designed to reduce
the risk of acquiring HIV and other sexually
transmitted diseases (STDs) and of having an
unintended pregnancy among 18–25 year old
women and their Primary male Partners. We
evaluated the intervention in a randomized comparison trial in which couples were randomized to
one of two conditions: the three-session intervention condition or a one-session educational comparison session for couples. Couples were recruited
from the Los Angeles, CA, and Oklahoma City,
OK, areas. Within several weeks of participating in
a baseline interview, couples came to an initial
group meeting at which they were randomly
assigned to either the comparison or the intervention condition. Both conditions were standardized
across the sites with some site-specific tailoring.
Three-month follow-up interviews were conducted
with women and men, and 6-month follow-up
interviews were conducted with women only.

perceived vulnerability to HIV and other STDs and
on increasing motivation to engage in protective
behaviors. The second session focused on building
communication and other skills needed for each of
the three preventive strategies: abstinence, consistent condom use or mutual monogamy and testing.
The last session focused on enhancing couples’
communication and making a joint plan for the
prevention strategy they would use. More than
90% of the couples assigned to the intervention
condition completed all three sessions.

Recruiting and Retaining Couples for Interventions
and 11.3% of the men reported that they had an
STD during the past year and 13.8% of the women
and 7.6% of the men reported having had sex with
an injecting drug user.

Methods
To better understand recruitment and retention
challenges and how they were addressed, we
interviewed PARTNERS project staff from both
sites after the intervention phase of the project was
complete. Because they made decisions about or
implemented recruitment and retention strategies,
our sample included recruiters, recruiter helpers
(i.e. men who accompanied female recruiters to
recruitment sites to talk to potential participants),
interviewers, project coordinators and principal
investigators (PIs) from both sites. They participated in telephone interviews (PIs, coordinators,
recruiter helpers and interviewers) or telephone
focus group discussions (recruiters) led by a female
moderator who did not work on the project.
Telephone interviews and focus groups were conducted to encourage participation. Staff (excluding PIs) who were interviewed worked for the
project for just under 2 years (on average) and had
previous experience working with the target population or on public health studies.
Each of the 11 interviews and 2 focus groups
lasted ;40 min to 2 hours. The moderator used
semi-structured guides to ask participants to describe productive recruitment sites, recruitment
barriers, effective recruitment strategies and retention barriers and strategies. All interviews were
audiotaped and transcribed.
To analyze the data, three of the co-authors of
this report independently sorted the data from
transcripts using categories based on a conceptual
framework to identify barriers and strategies to
recruiting couples that had not been documented in
the literature [21]. Next they identified the range of
responses or main themes (codes). Each transcript
was coded independently by two coders who
compared and discussed codes until they reached
consensus. It should be noted that one of the coders
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an STD, had other partners in the past year and had
sex with men) or (iii) thought they or their partners
would have sex with someone else in the next year
while they were still together. Women who were
pregnant, intended to become pregnant within the
year or reported being HIV positive were not
eligible. Women in Los Angeles had to self-identify
as Latina or Hispanic and women in Oklahoma
City could be of any race or ethnicity. A focus
on recruiting Latinos in the Los Angeles site was
decided for two reasons: first, individuals of
Hispanic ethnicity comprise 47% of Los Angeles’
total population and, second, Hispanics are heavily
affected by AIDS, comprising over one-quarter of
Los Angeles County’s AIDS cases. In both sites,
recruiters asked eligible women to invite their
primary partners to participate and both partners
had to agree to participate for a couple to be
enrolled in the study.
Of the women screened, approximately half
(49% in Oklahoma City and 51% in Los Angeles)
were eligible. (We cannot estimate the number of
women ‘contacted’ because we do not know how
many people saw project materials but did not call
for information and because it was not possible for
recruiters to document the number of people they
talked to at crowded events such as state fairs or
bars.) Although almost all eligible women agreed to
participate, less than half of eligible women and
their partners completed baseline interviews (26%
in Oklahoma City and 41% in Los Angeles). Of 435
couples who completed baseline interviews, 301
(69.2%) were randomized to a condition. A total of
249 women and 237 men completed 3-month
follow-up interviews (82% of women and 78% of
men who were randomized). Two hundred thirtytwo (77.1%) of the 301 women completed a
6-month interview.
Despite difficulty in recruiting, we did recruit
couples at risk for HIV infection. For instance,
almost half of the men and women who completed
baseline interviews (45.4% women and 44.4%
men) had other sex partners during the past year
but only 6% reported 100% condom use for vaginal
sex with their primary partners in the past 90 days.
In addition, nearly one-fifth (18.4%) of the women

K. A. Pappas-DeLuca et al.

Results
Recruiters and other project staff described the
challenges to recruitment and retention that were
specific to recruiting and retaining both partners
in a couple. Where quotations from interviewees
are used, research study site (Oklahoma City, Los
Angeles) and project role (e.g. recruiter) are noted.

Identifying and overcoming couplespecific challenges to recruitment
and retention
As indicated previously, attrition from screening to
baseline interviews was a problem. Participants
reported that face-to-face or over-the-phone interactions with potential PARTNERS participants
suggested that some recruitment challenges were
unique to recruiting couples and determining
eligibility through the women and others were
complications to general recruitment barriers. Overcoming both types of challenges required ongoing
modifications to recruitment strategies.

Recruiting couples through women versus
recruiting both partners
A key recruitment barrier for the PARTNERS
project resulted from determining couple eligibility
by screening the female partner only and thus
focusing early recruitment efforts on women, rather
than on couples. As a result, women had to introduce the project to and ‘recruit’ their partners. More
specifically, women were required to accurately
present information about the project to their
partners (that the women only recently learned),
determine what aspect of the project would appeal
to them and answer their questions to persuade their
partners to participate.
614

I think that’s what was the biggest barrier ... the
fact that it would depend on the partner ... we’re
only talking to the women. And, not only is the
guy, you know, getting second-hand information
because it’s whatever she understood from what
we said, but it’s just, like, whether he’s going to
want to do it or not anyway. (Los Angeles,
recruiter)
Some women were hesitant to talk with their
partners about the project because of concerns
about their partners’ reactions. Recruiters and other
staff reported that in follow-up calls, many eligible
women said it was difficult to talk to their partners
because they judged (sometimes correctly and
sometimes not) that their partners ‘would never
do something like this’. Even when staff talked with
male partners first, the same barrier would often
arise. This exchange in a focus group for female
recruiters from the Oklahoma City site illustrates
this point and underscores the benefit of approaching both partners at the same time—a strategy that
was adopted in response to women’s concerns
about talking to their partners about the project:
Recruiter A: I would say the woman was key (to
recruiting the couple) because a guy ... might be
kind of interested, but he’d say something like, ‘I
don’t know, I have to talk to her’, or ‘I’d never
get my girlfriend to do this’.
Recruiter B: It was the opposite.... If you could
get the man to agree, the woman would go along
with it.... A lot of times, the women were having
a hard time talking their boyfriends into doing it.
To facilitate recruitment in situations where only
one partner was approached, both sites hired and
trained male recruiter helpers to accompany female
recruiters to sites so that they could answer men’s
questions, ‘role play’ with women on how to
approach their partners or let women know that
they could contact or be contacted by male partners
at a later time. ‘Take-home’ materials were also
developed and given to women whose partners
were not with them so they had something to show
their partners and to refer to when talking to them
about the project. These materials were designed

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participated in an interview for this assessment. To
reduce the potential for bias, she did not code her
own transcript or code any interview or focus group
transcript of staff from the site at which she had
worked. Analyses presented here focus on barriers
to recruiting couples (as opposed to general recruitment barriers) and strategies for overcoming them.

Recruiting and Retaining Couples for Interventions

And another example of rotating [recruitment
sites] was the [mall] ... we tried to find good
times to go ... near Valentine’s might be a good
time because a lot of couples go out and look at
things, right? So we tried to find strategic times
to go to certain places, particularly in places
where we couldn’t be all the time. (Los Angeles,
investigator)
At couple recruitment sites, female recruiters and
male recruiter helpers had conversations concerning the project with both members of the couple,
answering questions and gauging interest.
Recruiter A: [W]hen it comes to ... the couple
itself, sometimes when we were at the colleges,
we would see couples walking by. Or, even at the
mall we see couples walking by. And we’d talk
to both.
Recruiter B: I think that made it easier because
they both got first-hand information. (Los Angeles,
recruiters)
It was always easier right there in one spiel. Then
you can ... get them both brought into it ... ‘you
guys look like you’d be perfect for this.’ ... So if

one’s on the fence, then ... maybe a little bit of
enthusiasm ... the other one might see that’s
going to push the other one into it. (Oklahoma
City, recruiter helper)
Talking to both members of the couple during
recruitment was also helpful because it enabled the
recruiters to emphasize different types of incentives
for participating, in addition to providing basic
information about the project. For example, improving the relationship through communication
was considered an incentive for some, as was
learning about effective safer sex strategies. Some
recruiters felt there was a clear divide between what
made men and women ‘tick’ in this regard, but
others said that both sexes could be equally enticed
by each incentive. In the end, recruiters had to
determine which incentive would be more appealing, recognizing that both partners may be drawn by
different things.

Sensitivity to the topic and making
participants feel comfortable
Although there were benefits to adding couple
recruitment sites, there were some problems as
well. Specifically, discussion of and references to
sexual behavior and condoms were considered
taboo or inappropriate in some settings. For example, although malls were identified as good venues
for approaching couples together, many had rules
about what was appropriate and what could and
could not (i.e. condoms) be displayed so as not to
offend patrons.
[W]e had an area designated for recruitment and
we couldn’t go out of that area because ... we had
to be respectful to all the people at the mall and it
was more like ‘...If they approach you it’s okay,
but we don’t want you guys to really bother these
people who are here.’ (Los Angeles, female
project coordinator)
To maintain access to such locations and the
couples who went there, the sites followed the rules
they were given.
[T]hat barrier, we overcame it ... We were careful
what we put on our table. We didn’t hang things
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to be attractive, easy to read and comprehensive
in responding to questions and misconceptions
potential participants might hold. All materials
were reviewed for acceptability by members of
the target audience.
To further address the barrier posed by talking to
one partner only, both sites added and focused
attention on active recruitment sites where couples
were together. According to one of the PIs, they
found places they could ‘catch couples together so
that [they] could explain the study to both partners
at the same time’. Such places included malls,
universities and colleges, bars, sports venues and
special events (e.g. concerts) and allowed female
recruiters and male recruiter helpers to talk to both
members of the couple at the same time.
Because ‘couple recruitment sites’ offered more
opportunities to talk to both partners together, it
was important to find the ‘right time’ to go to the
sites to recruit couples.

K. A. Pappas-DeLuca et al.
[project posters] around. We did exactly what
they asked of us and we still were able to recruit
a lot of people there. (Los Angeles, investigator)

This was a typical college town bar ... the bars are
to go out and hang out and drink. And so, you
know, some people were getting buzzed and ... I
don’t know how effective my message was with
recruiting. It didn’t stop me from doing my
thing.... In the bars, you have to be pretty quick
about it. Just say ‘Here, take it [print materials].’
(Oklahoma City, female recruiter)
These kinds of recruitment sites were compared
with places like Planned Parenthood centers where
the audience (mostly women) was ‘captive’ and
where there was usually enough privacy to discuss
the project.
To some extent, almost all couple recruitment sites
lacked privacy. In some sites, however, recruiters
were able to ‘carve out’ a significant degree of
privacy so that they could talk to couples in more
detail about the project. Malls and college campuses were places where this was more likely to
occur. Recruiters often mentioned trying to talk to
couples away from the ‘main path’ or away from
the recruitment table or booth in order to create
some privacy.

Other complications of recruiting and
retaining couples
Some recruitment barriers faced by most studies
were more complicated in this study because we
were recruiting couples. For example, recruiters and
other staff noted problems for couples due to
concerns about confidentiality, sensitivity to the
topic and logistical barriers.
Complications due to confidentiality and sensitivity to the topic took two forms. First, many
616

Depending on people’s reactions to [test] results.... For example, someone who got results
back that they had an STD ... there [were] some
women that would come and talk to me afterwards and there was a lot of anger and frustration
with their partner.... So, it was really dependent
on whether or not they felt open enough to talk,
or they just needed to be angry. (Oklahoma City,
recruiter)
Other women at STD clinics were reluctant to
participate in the project because they believed that
everyone in the group sessions or the research staff
would know they had an STD.
The only site I think that was probably the hardest
was ... the crew from the STD clinic ... because
they knew we were recruiting from an STD clinic,
they probably felt like everyone who was going
to be in the group had an STD.... They didn’t
realize all the places that we were recruiting from
... So they just assumed, yeah, everybody’s going
to know. (Oklahoma City, recruiter)
In some cases, recruiters successfully pointed out
the potential benefits (e.g. more open communication) of participating in the intervention or stressed
that they recruited from a variety of sites to help
overcome concerns about confidentiality and topic
sensitivity.
I would have a lot of women who would be
excited about the idea ... to communicate with
their partner and all these kind of exciting things
that you could learn in the [intervention] sessions. (Oklahoma City, recruiter)
Confidentiality was also important in another way.
Sensitive relationship and sexual information,

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In addition, many of the couple recruitment sites had
problems because of the nature of the activities or
the characteristics of the sites. For instance, bars and
special events were not conducive to long conversations about the project. In some cases noise was
a problem (e.g. sporting events) and in other cases
the nature of the activities was a problem (e.g. bars).

eligible women were found in STD clinics. However, because many had just received an STD
diagnosis, they considered discussion of relationship issues too sensitive or private. The fact that
women were often there because their partners may
have given them an STD left some women very
upset with their partners and unwilling to talk to
them about the project despite the potential relevance of the program:

Recruiting and Retaining Couples for Interventions

Discussion
Our experience with the PARTNERS project indicates that it is possible to recruit and retain at-risk
heterosexual couples for intervention research studies. Recruiting and retaining couples did, however,

take substantial amounts of time, effort and resources. Despite early efforts to address known barriers
to recruitment and retention, difficulties in recruiting
couples required that we identify and understand
couple-specific barriers in order to modify our
recruitment efforts during the project. Specifically,
we targeted both members of the couple (as opposed
to women only), addressed couple-specific concerns
regarding participation and increased staff availability and persistence to enhance recruitment.
Identifying and reaching out to both members of
a couple reduced the burden on women of recruiting their partners and provided an opportunity to
provide both with accurate information about the
project, answer their questions and identify and
appeal to their potentially different interests in
participating in the project. Through this strategy,
we could also address concerns regarding issues of
trust in the project and trust in the relationship. For
instance, by addressing both members of the
couple, female recruiters and male recruiter helpers
could talk directly to women and men in community settings to allay their fears about participating
in the research and to assure them that the intervention focused on things such as communication and relationships (and thus might not raise
questions of trust between the partners).
Although targeting both members of the couple
was considered to be a successful modification to
recruitment strategies for this project, it is worth
noting that McMahon et al. [19] report that
recruiting couples through the women only may
provide protection to women in potentially abusive
relationships, giving them the authority to refuse
participation without consulting their partner. Although we lack the data to comment on experience
of abuse within current relationships of PARTNERS participants, all eligible women were given
the option to privately refuse participation as a part
of the screening process, regardless of if they had
been approached individually or as a couple. Including an option for the woman to ‘opt out’ in
private may be one way to retain the woman’s
authority to refuse participation on behalf of the
couple (due to fear of abuse or other reasons)
while approaching couples together. In addition,
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which partners may not have shared or have been
ready to share with each other, was asked about in
baseline interviews. We had a strategy in place to
address some of these concerns at the outset.
Specifically, male and female partners were simultaneously interviewed by separate interviewers to
instill confidence that the partner would not be able
to find out what had been said. Throughout the
project, we developed additional strategies to respond to concerns about confidentiality. Print
materials that included responses to ‘frequently
asked questions’ detailed what would not be required during the intervention (e.g. facilitators
would not ask questions about participants’ sexual
behavior) and we asked past program participants
to participate in recruitment activities to answer
questions about what did and did not occur in the
interviews and intervention sessions.
Finally, practical barriers, including lack of time
and child care needs, were multiplied by needing to
accommodate two people. Strategies used to address these issues, such as flexible staff schedules to
accommodate both partners’ schedules and providing staff contact information so couples could
reschedule interviews when necessary, helped facilitate the continued participation of both members
of the couple. In addition, recruiters reported the
need for even greater persistence in contacting
couples to remind them of upcoming events (e.g.
interviews and intervention sessions) and to try to
find times when both partners could attend events to
ensure that couples joined and stayed in the study.
This required regular contact by phone and frequent
updating of participant contact information. Finally,
in addition to reimbursing for child care and
transportation costs incurred by participants, additional staff members were also often available on
site to accommodate last minute child care needs.

K. A. Pappas-DeLuca et al.

618

First, although efforts to recruit and retain at-risk
couples can be successful, researchers must acknowledge and budget for the increased costs
necessary to work with couples. Although it may
be easier to recruit couples for interventions than for
intervention research studies (e.g. no need to
commit to and schedule interviews), it may still
be difficult to convince couples to participate in an
intervention unless issues of trust are addressed and
logistical barriers are reduced. The former may
require personal contact from both male and female
recruiters, and the latter may require financial resources (e.g. child care and transportation allowance).
Next, despite improvements in recruiting and
retaining couples, questions regarding the generalizability of our findings inevitably arise given the
large percentage (over half) of eligible women who
reported a willingness to participate but who did not
enroll in the study. Unfortunately, PARTNERS
screening data are insufficient to adequately comment on differences between couples who participated and those who did not. Further, we have no
data on those who were exposed to project information but chose not to receive additional
information or be screened. This limits our ability
to adequately discuss selectivity bias that may have
been introduced.
Even without this information, however, we
might reasonably speculate bias based on demographic and risk characteristics, as identified by
Wu et al. [20] in their evaluation of enrollment
characteristics of women and their partners recruited for a couples intervention. In addition, our
sample may further reflect bias based on relationship characteristics. For example, it is likely that
couples in more stable relationships, who may have
an easier time communicating about topics relevant
to HIV prevention, were more easily recruited to
participate. Likewise, couples who were not already
motivated to change may have declined to participate, leaving couples in both study conditions
already motivated to make the changes we suggested. Alternatively, women in new or less stable
relationships may have been uncomfortable talking
to their partners about the study or may have been
unsuccessful in persuading them to join the study.

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providing take-home materials to address questions
and facilitate communication between partners
about the project is another important strategy we
adopted that supports women in negotiations with
their partners regarding participation without approaching both partners together.
Greater attention to logistical barriers complicated by coordinating schedules for two partners
was also required. Although logistical barriers were
offset by providing transportation, child care and
payment for participation in project activities, this
type of compensation was not always sufficient for
couples. Staff flexibility (e.g. nights and weekend
hours) and frequent personal contact with participants throughout the course of their participation
not only addressed complicated logistical barriers
but also demonstrated our interest in and commitment to the participants.
Mid-term changes to recruitment and retention
strategies appear to have improved our ability to
enroll couples into the PARTNERS project. Due to
a continuous process of assessing and addressing
barriers to recruitment and retention, it was not
possible to assess the effectiveness of each specific
change in improving recruitment and retention.
Increases over time, however, in both the number
of groups scheduled and the number of participants
per group suggest that improvements may have
resulted from changes to recruitment efforts. In
addition, the reputation of the program in the
community and experience of project personnel,
which developed over time, likely facilitated improved recruitment and retention; however, recruitment and retention of couples remained a challenge
and an important focus throughout the course of the
project.
An increased recognition of the need to address
relationship factors in interventions and to intervene
with both members of a couple reflects a relatively
new direction in HIV prevention efforts, one that has
not been fully explored. Difficulties in recruiting and
retaining couples at risk for HIV and other STDs are
evident in reports from El-Bassel et al. [8] as well as
from the PARTNERS project. These challenges
suggest several implications for future HIV intervention research with couples.

Recruiting and Retaining Couples for Interventions

Acknowledgements
This research was conducted as a part of the
PARTNERS project, which was supported by
cooperative agreements #U30/CCU 915062-10 and #U30/CCU 615166-1-0 with the US Centers
for Disease Control and Prevention (CDC). Members of the PARTNERS project include S.M.H., PI
for the Los Angeles (CA) site; H.C.H., PI for the

Oklahoma City (OK) site, and Christine Galavotti,
J.M.K. and K.A.P.-D., CDC project officers. The
authors thank the recruitment and retention teams
from both Los Angeles and Oklahoma City sites for
their participation in interviews and focus groups
and their tireless efforts in the field.

Conflict of interest statement
None declared.

References
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Unfortunately, we do not have data to address
whether less stable or less motivated couples were
less likely to participate or whether the intervention
would have had different effects on them. Qualitative research and focus groups with young couples
may be useful in providing additional insight regarding what motivates different types of couples (e.g.
more or less stable) to participate in such programs.
Finally, findings from the couple intervention
study by El-Bassel et al. [8] suggest that an
intervention focusing on relationship factors may
be just as effective when implemented with one
partner as with both partners. This is an intriguing
finding because it suggests that it may be possible to
benefit from addressing relationship factors while
minimizing recruitment barriers. Unfortunately, the
PARTNERS project design did not enable us to
assess the trade-offs between recruiting and intervening with one partner and recruiting and
intervening with a couple. The question of whether
a relationship-based intervention for one partner
may be equally effective as a relationship-based
couples intervention deserves additional research
that addresses questions of recruitment and retention as well as effectiveness.
In conclusion, issues related to intervening with
both members of a couple for HIV prevention are
complex and require additional attention. Our ability
to uncover and address many of the barriers related
to recruiting and retaining couples was only possible
through a review and discussion of tracking data
with project staff. Reviewing the data, discussing
reasons for the patterns and talking with potential
participants are critical for ensuring recruitment success and addressing future couples intervention efforts.

K. A. Pappas-DeLuca et al.

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