Open Access Research article

A process evaluation: Does recruitment for an exercise program through ethnically specific channels and key figures contribute to its reach and receptivity in ethnic minority mothers?

Marieke A Hartman123*, Vera Nierkens1, Stephan W Cremer2, Karien Stronks1 and Arnoud P Verhoeff24

Author Affiliations

1 Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ 1105 Amsterdam, the Netherlands

2 Department of Epidemiology, Documentation, and Health Promotion, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, WT 1018 Amsterdam, the Netherlands

3 Department of Behavioral Sciences and Health Promotion, University of Texas School of Public Health, 7000 Fannin, Houston, TX 77054, USA

4 Department of Sociology and Anthropology, University of Amsterdam, Oudezijdse Achterburgwal 185, DK 1012 Amsterdam, the Netherlands

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BMC Public Health 2013, 13:768  doi:10.1186/1471-2458-13-768

Published: 19 August 2013



Ethnic minority women from low-income countries who live in high-income countries are more physically inactive than ethnic majority women in those countries. At the same time, they can be harder to reach with health promotion programs. Targeting recruitment channels and execution to ethnic groups could increase reach and receptivity to program participation. We explored using ethnically specific channels and key figures to reach Ghanaian, Antillean, and Surinamese mothers with an invitation for an exercise program, and subsequently, to determine the mothers’ receptivity and participation.


We conducted a mixed methods process evaluation in Amsterdam, the Netherlands. To recruit mothers, we employed ethnically specific community organizations and ethnically matched key figures as recruiters over Dutch health educators. Reach and participation were measured using reply cards and the attendance records from the exercise programs. Observations were made of the recruitment process. We interviewed 14 key figures and 32 mothers to respond to the recruitment channel and recruiter used. Content analysis was used to analyze qualitative data.


Recruitment through ethnically specific community channels was successful among Ghanaian mothers, but less so among Antillean and Surinamese mothers. The more close-knit an ethnic community was, retaining their own culture and having poorer comprehension of the Dutch language, the more likely we were to reach mothers through ethnically specific organizations. Furthermore, we found that using ethnically matched recruiters resulted in higher receptivity to the program and, among the Ghanaian mothers in particular, in greater participation. This was because the ethnically matched recruiter was a familiar, trusted person, a translator, and a motivator who was enthusiastic, encouraging, and able to adapt her message (targeting/tailoring). Using a health expert was preferred in order to increase the credibility and professionalism of the recruitment.


Recruitment for an exercise program through ethnically specific organizations seems to contribute to its reach, particularly in close-knit, highly organized ethnic communities with limited fluency in the local language. Using ethnically matched recruiters as motivator, translator, and trusted person seems to enhance receptivity of a health promotion program. An expert is likely to be needed for effective information delivery.

Recruitment; Recruiter; Channel segmentation; Community health worker; Ethnic minorities/migrants; Health promotion; Cultural targeting; Exercise/physical activity