Using mail to reach patients seen at an urban health care facility.

Urban American Indians/Alaska Natives (AI/ANs) are highly mobile, and little is known about ways to include them in research or clinical activities. We evaluated postal mailings as a means of reaching patients seen at an urban Indian health care facility (60% of whom were AI/AN) and identified factors associated with receipt of mail. As part of a clinical trial, a Native art calendar was sent via first class mail to 5,633 clients seen at the urban Indian clinic during the prior two years. A multi-step address verification process was conducted, including telephone contacts, Web searches, and in-person visits. Logistic regressions examined the association of client characteristics with accurate addresses. Based on initial mailings and in-person location efforts, we estimated that only 61% of clients actually received the calendars. The multi-step address verification process was significantly less likely to identify working addresses for clients who were AI/AN and clients who were seen more than 3 months before the study. Reaching urban AI/ANs for research activities and health care is difficult. Innovative strategies are needed to locate this highly mobile and understudied population.