Ruth Mackenzie-Stewart,Cassandra de Lacy-Vawdon,Niamh Murphy,Ben J Smith
Engaging adults in organized physical activity: a scoping review of recruitment strategies
engagement,evaluation,health behavior,participation,physical activity
Summary Scaling up established physical activity (PA) opportunities for broader population reach requires practitioners to carefully consider strategies implemented to recruit and attract new participants to their PA programs. This scoping review examines the effectiveness of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic databases were searched for articles published between March 1995 and September 2022. Qualitative, quantitative and mixed methods papers were included. Recruitment strategies were assessed against Foster et al. (Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011;8:137–137.) assessment of quality for reporting recruitment and the determinants of recruitment rates were examined. 8394 titles and abstracts were screened; 22 articles were assessed for eligibility; 9 papers were included. Three of the 6 quantitative papers adopted a combination of passive and active recruitment strategies and 3 relied solely on active strategies. All 6 quantitative papers reported on recruitment rates; 2 evaluated the efficacy of recruitment strategies based on the achieved levels of participation. The evaluation evidence on how individuals are successfully recruited into organized PA programs, and how recruitment strategies influence or address inequities in PA participation, is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the reporting and measurement of recruitment strategies into PA programs is essential to better understand which strategies are attracting various population groups thus allowing program implementers to employ recruitment strategies best suited to the needs of their community while making efficient use of program funding.
Engaging adults in organized physical activity: a scoping review of recruitment strategies

Scaling up established physical activity (PA) opportunities for broader population reach requires practitioners to carefully consider strategies implemented to recruit and attract new participants to their PA programs. This scoping review examines the effectiveness of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic databases were searched for articles published between March 1995 and September 2022. Qualitative, quantitative and mixed methods papers were included. Recruitment strategies were assessed against Foster et al. (Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011;8:137–137.) assessment of quality for reporting recruitment and the determinants of recruitment rates were examined. 8394 titles and abstracts were screened; 22 articles were assessed for eligibility; 9 papers were included. Three of the 6 quantitative papers adopted a combination of passive and active recruitment strategies and 3 relied solely on active strategies. All 6 quantitative papers reported on recruitment rates; 2 evaluated the efficacy of recruitment strategies based on the achieved levels of participation. The evaluation evidence on how individuals are successfully recruited into organized PA programs, and how recruitment strategies influence or address inequities in PA participation, is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the reporting and measurement of recruitment strategies into PA programs is essential to better understand which strategies are attracting various population groups thus allowing program implementers to employ recruitment strategies best suited to the needs of their community while making efficient use of program funding.

Physical inactivity is a major risk factor for chronic diseases including heart disease, stroke, diabetes, cancers of the colon and breast, osteoporosis and depression (Bull et al., 2004; Bellew et al., 2020). In Australia 47% of adults have at least one chronic health condition (Australian Bureau of Statistics [ABS], 2018). In 2016 the global age-standardized prevalence of physical inactivity for adults (18 years or older) was reported to be 27.5% (23.4 men; 31.7 women) (Guthold et al., 2018). In Australia the 2017–2018 National Health Survey found among adults aged 18–64 years 22.4% were insufficiently active [participating in any Physical activity (PA) less than 150 min in the previous week], and a further 11.5% were inactive (participating in 0 min of any PA in the previous week) (ABS, 2018). PA participation benefits extend to individuals, communities, and populations beyond chronic disease prevention. Evidence suggests a positive relationship between participation in organized PA demonstrates societal benefits such as feelings of social connectedness and happiness (Pels and Kleinert, 2016; Bellew, 2020; Budzynski-Seymour et al., 2020; Sebastião and Mirda, 2021; Almevall et al., 2022). A high prevalence of physical inactivity places a substantial proportion of the population at increased risk of chronic disease (ABS, 2018); however, it is modifiable and organized PA programs provide one of many avenues for adults to increase their PA. Organized PA programs refers to sports or recreation activities organized by a club or association. Clubs and associations are not limited to sports organizations. Alternative organizations may include social clubs, church groups, old scholars’ associations, or gymnasiums (ABS, 2007). Across communities in developed countries there are a wide range of organized PA programs offering opportunities in both structured and semi-structured environments. These programs range from organized walking groups, circuit training, gyms and recreational PA programs through to social, structured and competitive PA program. Given the wide array of opportunities available a critical question for policy makers and practitioners working across the health, sport, recreation, and community services sectors is how to reach and engage individuals in various forms of organized PA. Numerous studies have reported on recruitment into PA interventions within intervention trials, pilot programs or other forms of research (Rowland et al., 2004; Jancey et al., 2006; UyBico et al., 2007; Mutrie et al., 2010; Foster et al., 2011; Cooke and Jones, 2017; Jong et al., 2020), however, limited attention is paid to recruitment strategies for increasing attendance into established organized PA programs. This presents major challenges for improving implementation and scale-up of evidence from PA intervention trials and pilot programs particularly when considering the need to reduce disparities in participation among disadvantaged and hard-to-reach populations (Reis et al., 2016). Optimizing effectiveness and population impact requires an understanding of strategies for engaging inactive participants into PA programs routinely delivered (Glasgow et al., 1999; Froelicher and Lorig, 2002). Recruitment is widely recognized as fundamental to program delivery influencing individual and population health outcomes including social inclusion and wellbeing (Lindsay Smith et al., 2017). Recruitment of inactive participants into organized PA programs can be ongoing, costly and time-consuming for organizations (Peck et al., 2008). In the context of PA recruitment has been defined as: ‘the process of inviting participation to a formal PA program, intervention, project, or event. This includes the invitation, informing and facilitation of interested adult participants to take part’ (Matthews et al., 2012). Recruitment strategies can be considered active or passive and categorized on a spectrum from universal to purposive (Foster et al., 2011). To address this gap in evidence and determine priorities for future research this review seeks to address the following questions: What recruitment strategies have been reported to promote uptake of ongoing organized PA programs? What are the methods and findings of evaluations of recruitment strategies to enlist adults into ongoing organized PA programs? This review intends to provide health promotion policy makers and practitioners with insight into the status of knowledge concerning recruitment for ongoing organized PA programs and to identify where efforts need to be focussed for increasing PA uptake.

This review identified the nature and extent of existing research and the limitations of the efficacy and determinants of recruitment strategies (Arksey and O’Malley, 2005). This review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR)(Tricco et al., 2018). The scoping review questions and methodology, allowed for the inclusion of quantitative, qualitative, and mixed methods papers (Arksey and O’Malley, 2005; Peters et al., 2021). The outcomes under review are recruitment rates and/or attendance into organized PA programs and the determinants of recruitment rates.

Electronic databases—Ovid Medline, CINAHL Plus, Informit Health Collection, Proquest Health, Psych-Info, Scopus, Cochrane library, Business source ultimate (previously known as Business source complete), SPORTDiscus, Communication and Mass Media Complete, Academic Search Complete, SocINDEX—were searched for peer reviewed papers published between March 1995 and September 2022. To complement the database searches, hand searching and snowballing of citations and references was completed by Authors 1 and 2. The search terms used were divided into three concepts, PA, recruitment strategies and participation, Supplementary file 1 contains the search terms for each concept.

Articles are eligible where: The PA programs and/or recruitment strategies were aimed at adults over the age of 18; The PA programs were delivered in high-income countries; Data on recruitment processes were reported, such as: source of recruitment for program attenders and/or non-attenders, reach of recruitment strategies, recruitment rates by behavioural theory stages and/or self-efficacy, recruitment rates by socio-demographic variables, experiences of recruitment strategies, barriers or facilitators for recruitment strategies, cost effectiveness of recruitment strategies; The paper adopted a qualitative, quantitative, or mixed methods study design; and The paper was peer reviewed, published in English between March 1995 and 2022. Review papers and those reporting on recruitment into time limited pilots and intervention trials and were not maintained post the pilot or intervention period were excluded. Author 1 screened titles, abstracts, and full text articles; Author 2 confirmed inclusion of articles by screening the full text of each article. Authors 1, 2 and 4 agreed on all articles included in this review.

Authors 1 and 4 developed the data extraction tables. For the purposes of data extraction and categorization of recruitment strategies and approaches this review has used revised definitions of active and passive recruitment (Foster et al., 2011). See Supplementary file 3. In addition to extracting whether the recruitment strategies adopted were passive and/or active, Author 2 extracted the following from each of the included articles: study design, population characteristics and size, location of program, recruitment methods, recruitment measures, qualitative variables examined, and recruitment results. Data extracted were reviewed for accuracy by Authors 1 and 4. The following definitions were adopted when examining the potential audience for a recruitment strategy: Random: Everyone in the study/intervention population has an equal chance of being exposed to the recruitment strategy, examples include newspaper articles, local and state-wide publications. Universal: Everyone, including those not in the study population have equal chance of being exposed to the recruitment strategy, examples include public TV including, TV announcements, public service announcements and news coverage. Convenience: Those in the target population will only be exposed to the recruitment strategy if they are conveniently located to accessible to the recruiter, examples include face to face recruitment at a train station or public place. Purposive: The recruiters have defined the target population and employed recruitment strategies specifically to reach the defined population, for example, a GP identifying a patient meeting a specific population profile and is invited to participate. Not Specified: Article does not specify the recruitment strategy used.

The Assessment of Recruitment Reporting Quality Scale (ARRQS) was used to record and rate the reporting of recruitment methods and outcomes in the included studies. The AARQS is a 5-point scale developed in 2011 (Foster et al., 2011) with adaptions made in 2017 (Cooke and Jones, 2017). See Supplementary file 2. Each paper was scored independently by Authors 1 and 2. Scores of the quality of recruitment reporting in each paper are provided in Table 1.

Data extraction and charting data was used to produce a narrative account of the following characteristics: Context and population groups; study designs; recruitment approaches; recruitment measures; other measures; recruitment outcomes; qualitative studies; and a quality assessment of recruitment reporting.

Searching yielded 10 387 citations following removal of duplicates (1944) 8443 were screened, resulting in 22 articles assessed for eligibility. Thirteen were excluded (reasons included: PA intervention pilots, not an organized PA program, did not provide recruitment data or measures, and not an adult population), resulting in 9 papers for inclusion (Clarke and Eves, 1997; Coleman et al., 1997; Spencer et al., 1998; Chang et al., 2009; Bull and Milton, 2010; Matthews et al., 2012; McCann et al., 2013; Kelly et al., 2019; Quirk and Haake, 2019), See Figure 1. Papers originated from the USA (n = 3) (Coleman et al., 1997; Spencer et al., 1998; Chang et al., 2009), the UK (n = 5) (Clarke and Eves, 1997; Bull and Milton, 2010; Matthews et al., 2012; Kelly et al., 2019; Quirk and Haake, 2019), and Australia (n = 1) (McCann et al., 2013). Most participants in the papers included were female, ranging from 57 to 100%; 1 paper explicitly excluded females focussing on inactive males (Kelly et al., 2019), 2 papers did not report the sex of participants (Matthews et al., 2012; Quirk and Haake, 2019). As shown in Tables 1 and 2 quantitative papers reported on recruitment into PA prescription programs in primary care settings (Clarke and Eves, 1997; Bull and Milton, 2010), 1 on recruitment into a diet, PA and stress management program (Chang et al., 2009), 1 on a program conducted at a seniors centre (Coleman et al., 1997), 1 into an aquatic exercise program (Spencer et al., 1998), and 1 into a male only community-based PA program (Kelly et al., 2019). Matthews et al. (Matthews et al., 2012) and McCann et al. (McCann et al., 2013) examined practices and perceptions of recruitment into organized walking groups and a PA and healthy eating program from the viewpoint of program staff, while Quirk and Haake (Quirk and Haake, 2019) examined Outreach Ambassadors (OA) as a recruitment strategy into parkrun, organized mass PA events.

Six of the 9 papers adopted quantitative study designs (Clarke and Eves, 1997; Coleman et al., 1997; Spencer et al., 1998; Chang et al., 2009; Bull and Milton, 2010; Kelly et al., 2019). Spencer et al. (Spencer et al., 1998), Bull and Milton (Bull and Milton, 2010), and Kelly et al. (Kelly et al., 2019), presented results from post only process evaluations using descriptive statistics. Two used randomized controlled trial (RCT) designs (Clarke and Eves, 1997; Chang et al., 2009) of an organized PA program, the interventions participants were recruited into have reportedly been sustained beyond the pilot and trial stages. One paper utilized a cross-sectional design (Clarke and Eves, 1997). Three included papers utilized qualitative study semi-structured interview designs (Matthews et al., 2012; McCann et al., 2013; Quirk and Haake, 2019). Using thematic analysis, Matthews et al. (Matthews et al., 2012) and McCann et al. (McCann et al., 2013) analysed the perspectives of program delivery staff, while Quirk and Haake (Quirk and Haake, 2019) focussed on experiences of the OAs as volunteers’ recruiters.

Recruitment approaches were mapped based on whether contact with the program participant was initiated or program initiated and by the potential reach of the recruitment strategy. The most frequently adopted approach to recruitment was purposive, with 4 papers (Chang et al., 2009; Matthews et al., 2012; McCann et al., 2013; Quirk and Haake, 2019) relying solely on this approach. Clarke and Eves (Clarke and Eves, 1997) adopted the convenience approach to recruitment, while Bull and Milton (Bull and Milton, 2010), Coleman et al. (Coleman et al., 1997), Kelly et al. (Kelly et al., 2019), and Spencer et al. (Spencer et al., 1998) adopted a mix of recruitment approaches. Bull and Milton (Bull and Milton, 2010) used a combination of purposive and convenience recruitment approaches; Spencer et al. (Spencer et al., 1998) and Kelly et al. (Kelly et al., 2019) included purposive, convenience and universal approaches, while Coleman et al. (Coleman et al., 1997) built in purposive, convenience, random and universal approaches. Seven papers (Clarke and Eves, 1997; Coleman et al., 1997; Spencer et al., 1998; Chang et al., 2009; Bull and Milton, 2010; Matthews et al., 2012; Kelly et al., 2019) sought to engage with potential participants directly and in a personal manner (active strategy), three of which complemented this approach with passive recruitment strategies such as public TV broadcasts, media and news coverage, and print materials(Coleman et al., 1997; Spencer et al., 1998; Kelly et al., 2019). See Table 2 summary of passive and active strategies and approaches adopted. All quantitative papers reported recruitment rates (Clarke and Eves, 1997; Coleman et al., 1997; Spencer et al., 1998; Chang et al., 2009; Bull and Milton, 2010; Kelly et al., 2019), however, just Coleman et al. (Coleman et al., 1997) and Spencer et al. (Spencer et al., 1998) evaluated efficacy of recruitment strategies. Coleman et al. (Coleman et al., 1997) described recruitment as the proportion of respondents who became active participants based on the reach of the recruitment strategies. Spencer et al. (Spencer et al., 1998) defined recruitment as the proportion of eligible respondents who enrolled, the only study to appraise recruitment strategies based on cost per participant recruited. Bull and Milton (Bull and Milton, 2010) adopted two measures for reporting recruitment rates; those recruited opportunistically with an estimated number of consultations or ‘opportunities’ in a 12-week recruitment period used as the denominator for calculating recruitment rates. To calculate the recruitment rate for those invited via a disease register, the number of invitations sent out was the denominator, and the number of responses expressing interest as the numerator, however this rate does not represent the proportion of participants going on to commence the PA program following their initial expression of interest to the invitation (Bull and Milton, 2010). Chang et al. (Chang et al., 2009) measured recruitment rate as the number of women providing information for screening as the denominator, and the numerator as the number completing screening. Clarke and Eves (Clarke and Eves, 1997) measured recruitment using the number of participants referred by GPs divided by the number of participants volunteering to participate, while Kelly et al. (Kelly et al., 2019) presented recruitment rates as the proportion of participants recruited for each of the individual recruitment strategies.

Clarke and Eves (Clarke and Eves, 1997) analysed recruitment rates based on participants stage of change for PA [Transtheoretical Model (TTM)], and participant’s decisional balance, self-efficacy, and perceived barriers according to their stage of readiness (precontemplation, contemplation, or preparation). Chang et al. (Chang et al., 2009) included measures of intervention efficacy in addition to recruitment measures. See Table 3 for a summary of intervention type, recruitment variable and measures reported in each study.

Spencer et al. (Spencer et al., 1998) employed a suite of recruitment strategies to engage older people from Washington State in the USA into aquatic exercises programs. Recruitment strategies included Arthritis Foundation recruitment letters (30.5% of those enrolled came from this source), television coverage (16.1% of those enrolled), public service announcements (16.1%), Doctor referrals (12.1%), newspaper advertisements (9.6%), and other methods including word of mouth and flyers in targeted locations (13.8%). They screened 1018 people for eligibility and achieved a recruitment rate of 65% (Spencer et al., 1998). Recruitment per participant from news articles came at a cost of $84, $47 for letters, and flyers were $42, costly options in comparison to free TV coverage, public service announcements and word of mouth (Spencer et al., 1998). Coleman et al. (Coleman et al., 1997) reported on the recruitment of African American adults aged 55 and over for a senior centre-based health promotion program with a PA component in Seattle, USA. A recruitment rate of 46% was achieved, with ‘phonathons’ or ‘call-centre style’ recruitment the most successful strategy (accounting for 33% of those recruited). This was followed by printed materials—flyers and posters (33%), word of mouth (26%), and others (8%). Using community leaders of similar age and ethnicity to the target population for this ‘phonathons’ may have boosted recruitment numbers (Coleman et al., 1997). Chang et al. (Chang et al., 2009) used peer recruiters aiming to engage low-income African American and White obese women into a 10-week PA program located in Michigan, USA. The strong emphasis on peer recruiters being culturally sensitive and using a personal approach to screening and inviting each participant resulted in 66.5% of eligible women enrolling in the PA program (Chang et al., 2009). Bull and Milton (Bull and Milton, 2010) used both opportunistic GP consultations and targeted recruitment letters from a disease register across three sites to recruit into a PA program delivered in a primary care setting in London, UK. Recruitment letters sent from a disease register bore varied results, with recruitment rates across the three sites ranging from 9 to 59%. The targeted letters were more effective than GP referrals conducted opportunistically (Bull and Milton, 2010). Kelly et al. (Kelly et al., 2019) used a combination of gender sensitive recruitment strategies to attract inactive men into a community-based PA program across Ireland. The authors calculated the proportion of participants recruited by each strategy used. Of the 927 participants, 31.2% were recruited using word of mouth and a further 23.3% cited newspaper or social media as their source of recruitment. While local service clubs accounted for 16.2% of recruited participants, local sports partnership for 10.3%, family and friends 8.4%, and health services 5.8% (Kelly et al., 2019). Clarke and Eves (Clarke and Eves, 1997) relied upon GP referrals and achieved a recruitment rate of 58.4% into a three-month prescription exercise program delivered across the UK. The majority of inactive participants recruited were in the contemplation (48.5%) or preparation (44.1%) stages of change for PA; suggesting an individual’s stage of readiness may influence the success of GP referrals as a recruitment strategy (Clarke and Eves, 1997). Without stage of change data reported for those who were invited to participate but not successfully recruited, it is difficult to draw conclusions (Clarke and Eves, 1997).

Thirteen semi-structured interviews with OA for parkrun events across England, UK were reported in one included qualitative paper (Quirk and Haake, 2019). OA were parkrun volunteers with either a long term health condition (LTHC) lived experience or were caring for someone with a LTHC. OA’s engaged with the LTHC community acting as facilitators of recruitment and engagement in parkrun. Quirk and Haake (Quirk and Haake, 2019) do not report the recruitment rates achieved, however, thematic analysis revealed challenging perceptions of who participates in parkrun as essential for the successful recruitment of underrepresented participants living with LTHCs. LTHC groups experience different barriers to participation and without adequate policies, structures (such as courses suitable for those with low vision or using wheelchairs) and diverse communication strategies, recruitment of this hard-to-reach group will be sub-optimal (Quirk and Haake, 2019). Quirk and Haake (Quirk and Haake, 2019) findings emphasized the importance of engaging with stakeholder and advocacy groups to gain recognition of parkrun as a legitimate and inclusive PA opportunity (Quirk and Haake, 2019). Matthews et al. (Matthews et al., 2012) conducted semi-structured interviews and case studies with managers and project coordinators to explore recruitment strategies adopted during implementation of walking programs across the UK. Findings demonstrated choice of recruitment strategy/ies were driven by resources, program aims, skills and knowledge of practitioners (Matthews et al., 2012). Programs with walking as the stated aim often had no targeted approach to recruitment and utilized passive strategies such as displaying promotional materials in local community spaces. Those with health aims or an identified target group adopted active, purposive recruitment strategies (word of mouth and relationship building with target organizations) (Matthews et al., 2012). Matthews et al. (Matthews et al., 2012) found programs using passive recruitment strategies attracted participants already physically active, while those with targeted active recruitment strategies recruited inactive participants—with word of mouth being the most effective (Matthews et al., 2012). Passive recruitment methods such as advertising and newsletters, or a combination of both active and passive methods were more frequently adopted than active recruitment methods alone. McCann et al. (McCann et al., 2013), adopting a similar approach to Matthews et al. (Matthews et al., 2012) conducted semi-structured interviews with those responsible for the delivery of organized PA programs in Australia; finding most program organizers made use of active recruitment strategies such as word of mouth (72%), links with key organizations and groups (64%), referrals (40%), cross promotion of programs (32%), and face to face contact through one off festival, presentations and vox pop surveys at shopping centres (20%); these were often used in conjunction with passive recruitment strategies—namely, printed materials (64%) and the printed news media (52%). There was consensus among program organizers that word of mouth was the most effective recruitment strategy for engaging with ethnic and minority populations (McCann et al., 2013).

The assessment undertaken using AARQS (Foster et al., 2011; Cooke and Jones, 2017) demonstrates the quality of reporting on recruitment for the included five quantitative papers in this review as ‘high’ with four out of the five studies achieving a four out of a possible five on this scale. Just 2 of 6 quantitative papers reported the efficacy of recruitment methods. No papers reported on the time spent planning recruitment, with just 4 papers reporting on the time spent implementing recruitment strategies. Authors 1 and 2 achieved 100% consistency when independently applying AARQS (Foster et al., 2011; Cooke and Jones, 2017). Overall scores for each paper in Table 1.

The purpose of this review was to examine strategies used to recruit adults into established, ongoing organized PA programs. Despite the importance of recruitment for program implementation, scale-up and sustainability, this review yielded just nine relevant studies. Among those, the measures of recruitment were reported inconsistently, and all papers failed to report on every item on the AARQS (Foster et al., 2011; Cooke and Jones, 2017). The variation in measures used to report recruitment rates may be related to the nature of the recruitment strategies adopted (passive or active), whether the strategy was purposive, convenience-based, or universal in scale, and whether a combination of strategies was used. Just one study reported on the reach of the recruitment strategies based on segmentation of the target audience (Clarke and Eves, 1997). This used the TTM, but because participants in the action and maintenance stages were excluded it was unclear if the recruitment strategy was likely to be more successful in reaching inactive or already active participants based on their stage of readiness. Kleis et al. (2021) recently reported in their review of PA interventions that variations in PA program efficacy can partly be explained by high proportions of participants recruited in the action and maintenance stage at baseline. While in an earlier study, using a range of recruitment strategies, the main reason for exclusion from the PA program was participants were already physically active (35% from all recruitment strategies) (Spencer et al., 1998). Future studies focussing on measuring efficacy of recruitment strategies should consider including an assessment of the stage of readiness of participants recruited using various strategies, to provide insights into the extent to which these can successfully reach and engage individuals at varying levels of intention and participation in PA. Building the capacity of practitioners to tailor recruitment strategies for the inactive segments of the population, particularly those experiencing barriers to PA and other forms of disadvantage, may contribute to increasing overall population PA. There is a growing body of evidence that mass PA events (Murphy et al., 2015), organized PA opportunities that are universally available and community wide programs represent strong investments for increasing PA (Bellewet al., 2020; Milton et al., 2021). Yet, there are still gaps in the evidence as to how these various opportunities can effectively recruit inactive and hard-to reach populations (Carroll et al., 2011). Coleman et al. (Coleman et al., 1997) provides some promising results for the use of active telephone follow-up (‘phonathons’) for recruitment into organized PA programs, however, the potential interrelationship between the various recruitment strategies adopted is unclear. It is difficult to ascertain if the recruitment levels reflected the success of the ‘phonathon’ strategy, or the result of participants being exposed to multiple recruitment strategies, thus supporting their readiness to participate when the phone call was received. While this study demonstrated some success with the use of a phonathon, in the modern environment this strategy may not be practical or yield similar results given the large proportion of the population without phones listed in public area-based phone books (Lavrakas, 2008). Despite the ubiquitous use of social media platforms, just one paper mentioned the use of such platforms (Kelly et al., 2019). Two qualitative studies (Matthews et al., 2012; McCann et al., 2013) highlighted the tendency of practitioners to rely on recruitment strategies familiar to them rather than seeking evidence-based options. There appears to be a strong reliance on strategies such as word of mouth, referrals, dissemination of print materials, cross promotion of programs and linking with local organizations (Priest et al., 2008; McCann et al., 2013). The studies included in this review provided limited insights into the suitability of recruitment approaches for those experiencing barriers to PA or other impediments to reach and engagement, particularly those from Culturally and Linguistically Diverse populations, older people, or people from low socio-economic backgrounds (O’Driscoll et al., 2014; Ball et al., 2015; Pels and Kleinert, 2016). Nevertheless, all included studies noted successful recruitment is contingent upon ‘knowing your audience’ and shaping suites of recruitment strategies with acceptability to the demographic features of the participants that you are most interested in attracting to the PA program. The qualitative study conducted by Quirk and Haake (Quirk and Haake, 2019) explored recruitment to parkrun, indicated that understanding the lived experience of those who experience barriers to organized PA can assist in breaking down preconceived ideas and undertaking recruitment in ways that are acceptable and practical.

The search strategy may have omitted articles relevant for inclusion. Due to the heterogeneous nature of the recruitment strategies and outcomes measures, it was not possible to conduct a meta-analysis or a structured assessment of publication bias. Due to the low number of publications included in this review an analysis of recruitment strategies based on adult life stage or age group stratification was not possible and the findings may not be transferable to recruitment of children or young people into organized PA. This review includes publications both pre (prior to March 2019) and post (post March 2019-) COVID pandemic, social distancing restrictions had a profound impact on the PA sector and thus on recruitment strategies available within the context of social distancing.

This review found culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations, while demonstrating inconsistencies in the way recruitment into established organized PA programs are reported in the peer reviewed literature. The adoption of consistent reporting standards and measures for recruitment strategies into PA programs will provide program planners and implementers with a better understanding of the potential efficacy of different recruitment methods. To improve the consistency and standardization of reporting the adoption of Foster et al.’s (Foster et al., 2011) ARRQS with Cooke and Jones’s (Cooke and Jones, 2017) adaptions is recommended to be included in published PA program evaluations. Additionally, where possible, practitioners and evaluators should measure recruitment rates in relation to the size and composition of target populations, stage of readiness for PA and report recruitment processes followed to enable replication and adaption in different contexts. This is especially important for targeting hard-to reach segments of the population that may experience barriers to PA and other social inequities. Building the evidence base concerning recruitment into PA programs is essential for improving effectiveness, tackling inequities in PA participation, and making efficient use of limited community resources.

Supplementary material is available at Health Promotion International online. Supplementary File 1. Search concepts and terms. Supplementary File 2. The Assessment of Recruitment Reporting Quality Scale (ARRQS) (Foster et al., 2011; Cooke and Jones, 2017). Supplementary File 3. Revised recruitment strategies definitions from Foster et al. (Foster et al., 2011). Click here for additional data file. Click here for additional data file. Click here for additional data file.