Keep in mind that there will be imperfect attendance and attrition. In our previous studies of in-person group visit at health centers, 40-75% of enrolled patients attended each month. For virtual group visits, 25-50% of enrolled patients attended each month.

Expect that you will need to reach out to many more patients than you intend to enroll. In our previous studies, 10-40% of patients who were contacted by clinic staff and invited to join diabetes group visits ended up enrolling in the program.

You will want to make sure you have a large enough pool of patients from which to recruit. If possible, run a query in your EHR or diabetes registry using the criteria for your target population. Remember, when you start recruiting, you are likely to find that some of these patients have left the clinic, do not respond to messages, or have outdated contact information.

For example, if you are aiming to have at least 6 patients at each session, you might want to enroll a group of 10-15 patients. To find 10-15 patients interested in enrolling, you might need to talk to 50 patients. To reach 50 patients, you might need to start with a pool of at least 75.

Which recruitment methods will you use?

Choose a method or combination of methods that will work for your team, health center, and patients. Example materials can be found in our resources section. Here are some potential strategies:

• Pull a list of all eligible patients who meet your target criteria from the EHR or diabetes registry. Reach out to them by phone, text message, patient portal, or mail with information about the program.
• Review patients scheduled in the clinic each day and identify who meets your target criteria. Plan to talk with them about the program or have an informational handout ready for them when they come in for their appointment.
• Introduce PCPs and staff to the program at a clinic meeting. Tell them how they can refer patients. Repeat this information in a follow-up email or put a flyer in the staff room so they have it for future reference.
• Put flyers or brochures about the program in patient waiting areas and clinic rooms. Include a phone number and email address patients can contact if they are interested in participating or learning more.

Decide who is responsible for recruitment activities and how you will track of which patients have been contacted, modes of contact, and responses. Tracking will keep your team organized, make the process more efficient, and allow you to review which methods are most successful. You can also make note of patients who are not currently available but express interest in participating in the future.

How will you motivate patients to enroll?

The main reasons that health center patients in our studies decided to participate in diabetes group visits were:

• • Seeking support and motivation from peers with similar experiences
  • Wanting to learn more about diabetes self-management
  • Trying to control their diabetes in order to improve their health and quality of life
  • Following advice from a trusted health care provider to enroll in the program
  • Looking for guidance on healthy cooking and eating

There are three key components to motivation.

1. 1. Conviction. Patients need to believe that participation in the group visit program is important and will lead to a desired outcome. Some health centers found they had greater success when recruitment was done by someone the patient knew because the patient could trust their recommendation and messaging could be tailored to highlight how the program aligned with the patient’s own goals, values, and priorities.
   2. Confidence. Patients need to believe they will be able to successfully participate in the group visit program. As your team prepares for recruitment, anticipate what barriers patients might have and if there are things you can do to address them. For example, you might consider offering transportation for in-person visits or technical assistance for virtual visits.
   3. Autonomy. Patients need to feel like the decision to participate is their own rather than imposed upon them. Some health centers found they had greater success when recruitment was done in person at appointments, perhaps because patients had already chosen to engage with the clinic and think about their health at that. Regardless of the mode of contact, honor patients’ autonomy and self-determination. For example, ask their permission to share information with them about the program.