Our success recruiting 3,722 participants suggests that a multifactorial methodology facilitates recruitment in multiracial studies that seek to enroll both low- and high-SES cohorts. There are peculiar environmental challenges in conducting research from a base in an urban community. Nevertheless, the value gained from this type of study far outweighs the challenges presented by the environment. Recruiting a socioeconomically and racially diverse cohort into a noninterventional research study requires paying particular attention to the recruitment design. We identified known recruitment barriers as well as other challenges unique to our study population. We developed a multilevel and multifactorial recruitment methodology that focused on overcoming the barriers, some of which we anticipated and others we did not anticipate. We overcame these barriers by engaging in continuous reexamination of the issues presented by each neighborhood and finding solutions to them. This fluid methodological approach makes the HANDLS study design unique because the solutions to recruitment barriers varied from neighborhood to neighborhood.
