Abstract:Research workers taking part identified factors which might be important in recruitment, several of which they expressed little confidence in addressing. Understanding how to improve recruitment is crucial if current efforts to strengthen primary care research are to bear fruit.
“…Research on strategies to improve retention of participants in primary care trials is limited and commonly grouped with recruitment strategies 14 15. Trial retention is important because loss to follow-up can lead to incomplete data for the primary outcome, bias results and impact the generalisability of trial findings.…”
ObjectiveTo explore the strategies used to improve retention in primary care randomised trials.DesignQualitative in-depth interviews and thematic analysis.Participants29 UK primary care chief and principal investigators, trial managers and research nurses.MethodsIn-depth face-to-face interviews.ResultsPrimary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.ConclusionsThe findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.
“…Research on strategies to improve retention of participants in primary care trials is limited and commonly grouped with recruitment strategies 14 15. Trial retention is important because loss to follow-up can lead to incomplete data for the primary outcome, bias results and impact the generalisability of trial findings.…”
ObjectiveTo explore the strategies used to improve retention in primary care randomised trials.DesignQualitative in-depth interviews and thematic analysis.Participants29 UK primary care chief and principal investigators, trial managers and research nurses.MethodsIn-depth face-to-face interviews.ResultsPrimary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.ConclusionsThe findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.
“…The three recruitment strategies incorporated many of the factors that the literature states are effective in improving recruitment rates, such as establishing good relationships with practices, simplifying referrals, being flexible, using multiple strategies to recruit, good trial organisation, offering enhanced care by using nurses with specialties in the illness investigated, and visiting families shortly after enrolment [4][5][6][7][8][9][11][12][13][14]18,21]. Our trial experience supports observations made by other trialists regarding the value of different recruitment strategies and methods [4][5][6][7][8][9][11][12][13][14]18,21,23,27]. However, these factors also may have been features of trials that failed to reach their recruitment targets, highlighting the need for more evidence to inform strategy selection [10] and to identify the most productive and successful recruitment strategies.…”
Section: Comparison With Previous Literaturementioning
confidence: 99%
“…Some reports highlight alternative methods regarding how to improve recruitment including using qualitative methods [15,16] and working closely with country-wide clinical research networks [10]. However, primary care trialists often report challenges in engaging both participants and GP practices [5][6][7][8][9]11]; thus, there is a pressing need for more evidence-based strategies [2,4,5,10,17].…”
Trial recruiter expertise and deployment of several interdependent, illness-specific strategies were key factors in achieving rapid recruitment of young children to a community-based randomised controlled trial (RCT). The 'remote' recruitment strategy was shown to be more cost-effective compared to 'community' and 'local' strategies in the context of this trial. Future trialists should report recruitment costs to facilitate a transparent evaluation of recruitment strategy cost-effectiveness.
“…This approach has been successfully applied in public health and health care to set priorities, develop consensus statements and research agendas, and advance new guidelines. [16][17][18] It is an ordered, transparent, and replicable way of generating and synthesizing ideas and can integrate both evidence and opinion. 16,17,19 A hybrid of the Delphi process and focus groups, 20 the advantages of the NGT include capacity to translate qualitative data to quantitative data and assurance of equal participation of every voice (via anonymous rating and ranking), thus limiting the impact of individuals on other's final judgments.…”
mentioning
confidence: 99%
“…16,17,19 A hybrid of the Delphi process and focus groups, 20 the advantages of the NGT include capacity to translate qualitative data to quantitative data and assurance of equal participation of every voice (via anonymous rating and ranking), thus limiting the impact of individuals on other's final judgments. 17,18,20 To evaluate gaps in research regarding response to syndromic surveillance, we undertook the final step of a multiphase study. 4,10,21 Earlier phases of our work (which we have reported on previously) included the following aims: to describe existing infrastructure and challenges associated with methods of response to alerts generated by syndromic surveillance systems and to provide a pilot guidance framework for developing written response protocols.…”
Prioritized research needs clustered around the common theme of how best to integrate diverse types and sources of information to inform action; thus, the major challenge that health departments are facing appears to be how to process abundant alert data from dissimilar sources. The nominal group technique in this study provided a method for systems' monitors to communicate their needs to the research community and can influence the commissioning of research by funding institutions.
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