Barriers to recruitment, retention and intervention delivery in a randomized trial among patients with firearm injuries

Abstract

Background We discuss barriers to recruitment, retention, and intervention delivery in a randomized controlled trial (RCT) of patients presenting with firearm injuries to a Level 1 trauma center. The intervention was adapted from the Critical Time Intervention and included a six-month period of support in the community after hospital discharge to address recovery goals. This study was one of the first RCTs of a hospital- and community-based intervention provided solely among patients with firearm injuries. Main text Barriers to recruitment included limited staffing, coupled with wide variability in length of stay and admission times, which made it difficult to predict the best time to recruit. At the same time, more acutely affected patients needed more time to stabilize in order to determine whether eligibility criteria were met. Barriers to retention included insufficient patient resources for stable housing, communication and transportation, as well as limited time for patients to meet with study staff to respond to follow-up surveys. These barriers similarly affected intervention delivery as patients who were recruited, but had fewer resources to help with recovery, had lower intervention engagement. These barriers fall within the broader context of system avoidance (e.g., avoiding institutions that keep formal records). Since the patient sample was racially diverse with the majority of patients having prior criminal justice system involvement, this may have precluded active participation from some patients, especially those from communities that have been subject to long and sustained history of trauma and racism. We discuss approaches to overcoming these barriers and the importance of such efforts to further implement and evaluate hospital-based violence intervention programs in the future. Conclusion Developing strategies to overcome barriers to data collection and ongoing participant contact are essential to gathering robust information to understand how well violence prevention programs work and providing the best care possible for people recovering from injuries. Trial registration ClinicalTrials.govNCT02630225. Registered 12/15/2015.

A phenomenological study identifying facilitators and barriers to Black and Latinx youth's engagement in hospital‐based violence intervention programs

“…Research focusing on youth is critical to illuminate experiences that may be distinct from adult populations. Of the limited number of studies examining facets of recruitment and retention, sample age ranges vary between youth (Bernardin et al, 2021 ; Myers et al, 2017 ; Snider et al, 2010 ), and young adult or adult populations (Decker et al, 2020 ; Floyd et al, 2021 ; Jacob et al, 2021 ; Richardson et al, 2021 ). Studies focusing on youth of colour have uncovered factors (e.g.…”

“…perceived discriminatory attitudes from medical personnel) that may negatively impact their hospital experience and engagement in HVIPs (Snider et al, 2010 ). Challenges to engaging youth upon discharge also exist, such as unstable means of communication (Floyd et al, 2021 ) or financial barriers (Richardson et al, 2021 ).…”

A Technology-Enhanced Intervention for Violence and Substance Use Prevention Among Young Black Men: Protocol for Adaptation and Pilot Testing

“…Outside the juvenile and criminal justice systems, racial and ethnic minority youth report critical barriers to obtaining behavioral health services across the continuum of prevention, treatment, and recovery. These barriers include but are not limited to neighborhood disadvantage, racism, homelessness or temporary housing, unemployment, discrimination, peer and gang pressures, transportation issues, program fees, the lack of culturally relevant services, and competing demands on time to attend clinic or group-based rehabilitation sessions [16][17][18].…”

“…Similarly, violence prevention programs in hospital EDs, schools, juvenile justice facilities, child welfare systems, faith-based and street outreach initiatives continue to have substantial wraparound effects in reducing violence [19,20]. However, in resource-limited communities, these programs lack 24/7 staff coverage, follow-up services, and trauma-informed training and report high employee turnover [16][17][18]21]. Furthermore, injured young Black men perceive hospital violence intervention programs-and other formal institutions-as places of interface with law enforcement and thus avoid using these services [16,[22][23][24], even though EDs are increasingly recognized as a critical intervention venue for youth at risk for future violent injury [4].…”

“…However, in resource-limited communities, these programs lack 24/7 staff coverage, follow-up services, and trauma-informed training and report high employee turnover [16][17][18]21]. Furthermore, injured young Black men perceive hospital violence intervention programs-and other formal institutions-as places of interface with law enforcement and thus avoid using these services [16,[22][23][24], even though EDs are increasingly recognized as a critical intervention venue for youth at risk for future violent injury [4].…”