ArticlePublic health genomics2026
Engagement and Retention in Precision Public Health: A Cascade Analysis of Two Cluster Randomized Trials.
Article in Public health genomics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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Authors and funding
10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionWhen research fails to reach and engage all populations who might benefit from study findings, it can compromise scientific validity and ultimately health equity. Few studies have systematically examined factors driving study engagement through longitudinal intervention research. This project examined sociodemographic, geographic, and structural influences on engagement and attrition across the participation "cascade" (outreach, enrollment, and retention) for two large-scale multilevel precision medicine and precision prevention trials for smoking and lung cancer screening.
methodsModified Poisson regression models were used to determine the factors associated with study engagement based on sociodemographic and geographical factors at each step in the cascade of participation, from initial outreach through retention at 12 months post-enrollment. Secondary analyses examined the cascade among the subset of patients who had active electronic patient portals and were approached via the portal.
resultsA total of 24,366 patients were approached for participation. Race, social vulnerability index, insurance status, and distance from the study site were significantly associated with engagement at various points in the cascade. Black patients were more likely than white patients to be reached (48.9% vs. 47.1%; p = 0.022) and to complete eligibility screening (52.8% vs. 38.4%; p < 0.001), but less likely to consent to participate (56.7% vs. 69.8%; p < 0.001) and complete genetic testing (58.5% vs. 69.8%; p = 0.003). Patterns of engagement through electronic patient portal versus nonelectronic recruitment channels also differed by race- and place-based factors, with black patients being less likely than white patients to respond in the portal (8.8% vs. 15.5%; p < 0.001), and patients who reside farther from the study site being more likely to respond in the portal compared to those who live closer (14.9% vs. 12.5%; p < 0.001).
conclusionsThese findings highlight the need for tailored, stage-specific engagement strategies to ensure representative participation in genomic and behavioral intervention research to advance the integration of genomics into public health practice.
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