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Edwards L, Salisbury C, Horspool K, Foster A, Garner K, Montgomery AA. Increasing follow-up questionnaire response rates in a randomized controlled trial of telehealth for depression: three embedded controlled studies. Trials 2016; 17:107. [PMID: 26912230 PMCID: PMC4765058 DOI: 10.1186/s13063-016-1234-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attrition is problematic in trials, and may be exacerbated in longer studies, telehealth trials and participants with depression - three features of The Healthlines Study. Advance notification, including a photograph and using action-oriented email subject lines might increase response rates, but require further investigation. We examined the effectiveness of these interventions in three embedded Healthlines studies. METHODS Based in different trial sites, participants with depression were alternately allocated to be pre-called or not ahead of the 8-month follow-up questionnaire (Study 1), randomized to receive a research team photograph or not with their 12-month questionnaire (Study 2), and randomized to receive an action-oriented ('ACTION REQUIRED') or standard ('Questionnaire reminder') 12-month email reminder (Study 3). Participants could complete online or postal questionnaires, and received up to five questionnaire reminders. The primary outcome was completion of the Patient Health Questionnaire (PHQ-9). Secondary outcome measures were the number of reminders and time to questionnaire completion. RESULTS Of a total of 609 Healthlines depression participants, 190, 251 and 231 participants were included in Studies 1-3 (intervention: 95, 126 and 115), respectively. Outcome completion was ≥90 % across studies, with no differences between trial arms (Study 1: OR 0.38, 95 % CI 0.07-2.10; Study 2: OR 0.84, 95 % CI 0.26-2.66; Study 3: OR 0.53 95 % CI 0.19-1.49). Pre-called participants were less likely to require a reminder (48.4 % vs 62.1 %, OR 0.41, 95 % CI 0.21-0.78), required fewer reminders (adjusted difference in means -0.67, 95 % CI -1.13 to -0.20), and completed follow-up quicker (median 8 vs 15 days, HR 1.35, 95 % CI 1.00-1.82) than control subjects. There were no significant between-group differences in Studies 2 or 3. CONCLUSIONS Eventual response rates in this trial were high, with no further improvement from these interventions. While the photograph and email interventions were ineffective, pre-calling participants reduced time to completion. This strategy might be helpful when the timing of study completion is important. Researchers perceived a substantial benefit from the reduction in reminders with pre-calling, despite no overall decrease in net effort after accounting for pre-notification. TRIAL REGISTRATION Current Clinical Trials ISRCTN14172341.
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Affiliation(s)
- Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Kimberley Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, The University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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102
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Johnson NA, Kypri K, Latter J, McElduff P, Attia J, Saitz R, Saunders JB, Wolfenden L, Dunlop A, Doran C, McCambridge J. Effect of telephone follow-up on retention and balance in an alcohol intervention trial. Prev Med Rep 2016; 2:746-9. [PMID: 26844146 PMCID: PMC4721312 DOI: 10.1016/j.pmedr.2015.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telephone follow-up on retention, identify participant characteristics predictive of questionnaire completion during or after telephone follow-up, and estimate the effect of including participants who provided follow-up data during or after telephone follow-up on balance between randomly allocated groups in a trial estimating the effect of electronic alcohol screening and brief intervention on alcohol consumption in hospital outpatients with hazardous or harmful drinking. METHOD Trial participants were followed up 6 months after randomization (June-December 2013) using e-mails containing a hyperlink to a web-based questionnaire when possible and by post otherwise. Telephone follow-up was attempted after two written reminders and participants were invited to complete the questionnaire by telephone when contact was made. RESULTS Retention before telephone follow-up was 62.1% (520/837) and 82.8% (693/837) afterward: an increase of 20.7% (173/837). Therefore, 55% (95% CI 49%-60%) of the 317 participants who had not responded after two written reminders responded during or after the follow-up telephone call. Age < 55 years, a higher AUDIT-C score and provision of a mobile/cell phone number were predictive of questionnaire completion during or after telephone follow-up. Balance between randomly allocated groups was present before and after inclusion of participants who completed the questionnaire during or after telephone follow-up. CONCLUSION Telephone follow-up improved retention in this randomized trial without affecting balance between the randomly allocated groups.
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Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Joanna Latter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, and Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Boston Medical Center, Boston, MA 02118, USA
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, QLD 4006, Australia; Disciplines of Psychiatry and Addiction Medicine, University of Sydney, Sydney, NSW 2006, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Local Health District Population Health, Wallsend, NSW 2287, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW 2300, Australia
| | - Christopher Doran
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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McCarthy O, French RS, Roberts I, Free C. Simple steps to develop trial follow-up procedures. Trials 2016; 17:28. [PMID: 26767413 PMCID: PMC4714530 DOI: 10.1186/s13063-016-1155-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Loss to follow-up in randomised controlled trials reduces statistical power and increases the potential for bias. Almost half of all trials fail to achieve their follow-up target. Statistical methods have been described for handling losses to follow-up and systematic reviews have identified interventions that increase follow-up. However, there is little guidance on how to develop practical follow-up procedures. This paper describes the development of follow-up procedures in a pilot randomised controlled trial of a sexual health intervention that required participants to provide and return questionnaires and chlamydia test samples in the post. We identified effective methods to increase follow-up from systematic reviews. We developed and tested prototype procedures to identify barriers to follow-up completion. We asked trial participants about their views on our follow-up procedures and revised the methods accordingly. RESULTS We identified 17 strategies to increase follow-up and employed all but five. We found that some postal test kits do not fit through letterboxes and that that the test instructions were complicated. After identifying the appropriate sized test kit and simplifying the instructions, we obtained user opinions. Users wanted kits to be sent in coloured envelopes (so that they could identify them easily), with simple instructions and questionnaires and wanted to be notified before we sent the kits. We achieved 92 % (183/200) overall follow-up for the postal questionnaire at 1 month and 82 % (163/200) at 12 months. We achieved 86 % (171/200) overall follow-up for the postal chlamydia test at 3 months and 80 % (160/200) at 12 months. CONCLUSIONS By using established methods to increase follow-up, testing prototype procedures and seeking user opinions, we achieved higher follow-up than previous sexual health trials. However, it is not possible to determine if the increase in response was due to our follow-up procedures. TRIAL REGISTRATION Current Controlled Trials ISRCTN02304709 Date of registration: 27 March 2013.
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Affiliation(s)
- Ona McCarthy
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Rebecca S French
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Ian Roberts
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
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Madurasinghe VW. Guidelines for reporting embedded recruitment trials. Trials 2016; 17:27. [PMID: 26767365 PMCID: PMC4714476 DOI: 10.1186/s13063-015-1126-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment to clinical trials is difficult with many trials failing to recruit to target and within time. Embedding trials of recruitment interventions within host trials may provide a successful way to improve this. There are no guidelines for reporting such embedded methodology trials. As part of the Medical Research Council funded Systematic Techniques for Assisting Recruitment to Trials (MRC START) programme designed to test interventions to improve recruitment to trials, we developed guidelines for reporting embedded trials. Methods We followed a three-phase guideline development process: (1) pre-meeting literature review to generate items for the reporting guidelines; (2) face-to-face consensus meetings to draft the reporting guidelines; and (3) post-meeting feedback review, and pilot testing, followed by finalisation of the reporting guidelines. Results We developed a reporting checklist based on the Consolidated Standards for Reporting Trials (CONSORT) statement 2010. Embedded trials evaluating recruitment interventions should follow the CONSORT statement 2010 and report all items listed as essential. We used a number of examples to illustrate key issues that arise in embedded trials and how best to report them, including (a) how to deal with description of the host trial; (b) the importance of describing items that may differ in the host and embedded trials (such as the setting and the eligible population); and (c) the importance of identifying clearly the point at which the recruitment interventions were embedded in the host trial. Conclusions Implementation of these guidelines will improve the quality of reports of embedded recruitment trials while advancing the science, design and conduct of embedded trials as a whole. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1126-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vichithranie W Madurasinghe
- Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
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105
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Conducting Behavioral Intervention Research in Rural Communities: Barriers and Strategies to Recruiting and Retaining Heart Failure Patients in Studies. NURSING AND HEALTH CARE (WINFIELD, ILL.) 2016; 1:101. [PMID: 29215663 PMCID: PMC5713645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Heart failure is a major public health problem, and self-management is the primary approach to control the progression of heart failure. The low research participation rate among rural patients hinders the generation of new evidence for improving self-management in rural heart failure patients. PURPOSE The purpose of this study is to identify the barriers and strategies in the recruitment and retention of rural heart failure patients in behavioral intervention programs to promote self-management adherence. METHOD This is a descriptive study using data generated from a randomized controlled trial. RESULTS Eleven common barriers were identified such as the inability to perceive the benefits of the study, the burden of managing multiple comorbidities, and the lack of transportation to appointments. Possible gateways to improve recruitment and retention include using recruiters from the local community and promoting provider engagement with research activities. Multiple challenges inhibited rural heart failure patients from participating in and completing the behavioral intervention study. CONCLUSION AND IMPLICATIONS Anticipation of those barriers, and identifying strategies to remove those barriers, could contribute to an improvement in the rural patients' participation and completion rates, leading to the generation of new evidence and better generalizability of the evidence.
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106
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Noble AJ, Marson AG, Tudur-Smith C, Morgan M, Hughes DA, Goodacre S, Ridsdale L. 'Seizure First Aid Training' for people with epilepsy who attend emergency departments, and their family and friends: study protocol for intervention development and a pilot randomised controlled trial. BMJ Open 2015; 5:e009040. [PMID: 26209121 PMCID: PMC4521519 DOI: 10.1136/bmjopen-2015-009040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/30/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People with chronic epilepsy (PWE) often make costly but clinically unnecessary emergency department (ED) visits. Offering them and their carers a self-management intervention that improves confidence and ability to manage seizures may lead to fewer visits. As no such intervention currently exists, we describe a project to develop and pilot one. METHODS AND ANALYSIS To develop the intervention, an existing group-based seizure management course that has been offered by the Epilepsy Society within the voluntary sector to a broader audience will be adapted. Feedback from PWE, carers and representatives from the main groups caring for PWE will help refine the course so that it addresses the needs of ED attendees. Its behaviour change potential will also be optimised. A pilot randomised controlled trial will then be completed. 80 PWE aged ≥16 who have visited the ED in the prior 12 months on ≥2 occasions, along with one of their family members or friends, will be recruited from three NHS EDs. Dyads will be randomised to receive the intervention or treatment as usual alone. The proposed primary outcome is ED use in the 12 months following randomisation. For the pilot, this will be measured using routine hospital data. Secondary outcomes will be measured by patients and carers completing questionnaires 3, 6 and 12 months postrandomisation. Rates of recruitment, retention and unblinding will be calculated, along with the ED event rate in the control group and an estimate of the intervention's effect on the outcome measures. ETHICS AND DISSEMINATION Ethical approval: NRES Committee North West-Liverpool East (Reference number 15/NW/0225). The project's findings will provide robust evidence on the acceptability of seizure management training and on the optimal design of a future definitive trial. The findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN13 871 327.
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Affiliation(s)
- A J Noble
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - A G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - C Tudur-Smith
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - M Morgan
- Institute of Pharmaceutical Science, King's College London, Liverpool, UK
| | - D A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - S Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - L Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
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107
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Starr K, McPherson G, Forrest M, Cotton SC. SMS text pre-notification and delivery of reminder e-mails to increase response rates to postal questionnaires in the SUSPEND trial: a factorial design, randomised controlled trial. Trials 2015; 16:295. [PMID: 26152519 PMCID: PMC4494692 DOI: 10.1186/s13063-015-0808-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes are vital in informing randomised controlled trials (RCTs) and health-care interventions and policies from the patient's perspective. However, participant non-response may introduce bias and can affect the generalisability of the trial. This study evaluates two interventions aimed at increasing response rates to postal questionnaires within a large, UK-wide RCT: pre-notification via short messenger service (SMS) text prior to sending the initial mailing of trial questionnaires versus no pre-notification; for non-responders to the initial mailing of the questionnaires, an e-mail reminder (containing a hyperlink to complete the questionnaire online) versus a postal reminder. METHODS This study is a 2 × 2 partial factorial design RCT nested within an RCT of medical expulsive therapy for ureteric stone disease. Participants who supplied a mobile telephone number were randomly assigned to receive an SMS text pre-notification of questionnaire delivery or no pre-notification. Those who supplied an e-mail address were randomly assigned to receive a questionnaire reminder by e-mail or post. Participants could be randomly assigned to the pre-notification comparison or the reminder comparison or both. The primary outcome measure was response rate at each questionnaire time point. RESULTS Four hundred eighteen participants were randomly assigned to the SMS pre-notification comparison (80% were male, and the mean age was 41 years with a standard deviation (SD) of 11.1). The intervention had no effect on response rate at either questionnaire time point. In subgroup analyses, SMS pre-notification increased response rates in women but only at the first questionnaire time point. One hundred nineteen participants were randomly assigned to the reminder comparison (80% were male, and the mean age was 42 years with an SD of 12.1). There was no difference in response rate in those who received an e-mail reminder compared with those who received a postal reminder. CONCLUSIONS SMS text pre-notification of questionnaire delivery and email delivery of questionnaire reminders did not improve response rates. There was some evidence to suggest that SMS text pre-notification may be effective in women, and further studies to investigate this may be warranted. E-mail reminders for participants to return their postal questionnaire could be advantageous given that response rates were similar following either type of reminder and the low cost of delivering an e-mail compared with a postal reminder. This is a substudy of the SUSPEND trial (ISCTRN69423238) (18 Nov. 2010).
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Affiliation(s)
- Kathryn Starr
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Mark Forrest
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Seonaidh C Cotton
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
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108
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Allotey PA, Reidpath DD, Evans NC, Devarajan N, Rajagobal K, Bachok R, Komahan K. Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia. Glob Health Action 2015; 8:28219. [PMID: 26140728 PMCID: PMC4490796 DOI: 10.3402/gha.v8.28219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/25/2015] [Accepted: 06/08/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. METHODS A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. RESULTS Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
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Affiliation(s)
- Pascale A Allotey
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia;
| | - Daniel D Reidpath
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
| | - Natalie C Evans
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands
| | - Nirmala Devarajan
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
| | - Kanason Rajagobal
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
| | - Ruhaida Bachok
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
| | - Kridaraan Komahan
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
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Robinson KA, Dinglas VD, Sukrithan V, Yalamanchilli R, Mendez-Tellez PA, Dennison-Himmelfarb C, Needham DM. Updated systematic review identifies substantial number of retention strategies: using more strategies retains more study participants. J Clin Epidemiol 2015; 68:1481-7. [PMID: 26186981 DOI: 10.1016/j.jclinepi.2015.04.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/17/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The retention of participants in studies is important for the validity of research. We updated our prior systematic review (2005) to assess retention strategies for in-person follow-up in health care studies. METHODS We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane Controlled Trials Register, Cochrane Methodology Register, and Embase (August 2013) for English-language reports of studies that described retention strategies for in-person follow-up in health care studies. We abstracted each retention strategy, and two authors independently classified each retention strategy with one of the themes developed in our prior review. RESULTS We identified 88 studies (67 newly identified studies), six of which were designed to compare retention strategies, whereas the remainder described retention strategies and retention rates. There were 985 strategies abstracted from the descriptive studies (617 from new studies), with a median (interquartile range) number of strategies per study of 10 (7 to 17) and a median (interquartile range) number of themes per study of 6 (4 to 7). Financial incentives were used in 47 (57%) of the descriptive studies. We classified 28% of the strategies under the theme of "contact and scheduling methods," with 83% of the identified studies using at least one strategy within this theme. The number of strategies used was positively correlated with retention rate (P = 0.027), but the number of themes was not associated with retention rate (P = 0.469). CONCLUSION The number of studies describing retention strategies has substantially increased since our prior review. However, the lack of comparative studies and the heterogeneity in the types of strategies, participant population and study designs, prohibits synthesis to determine the types of cohort retention strategies that were most effective. However, using a larger number of retention strategies, across five or six different themes, appears to retain more study participants.
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Affiliation(s)
- Karen A Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA.
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Vineeth Sukrithan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Ramakrishna Yalamanchilli
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Pedro A Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Cheryl Dennison-Himmelfarb
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
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Treweek S, Altman DG, Bower P, Campbell M, Chalmers I, Cotton S, Craig P, Crosby D, Davidson P, Devane D, Duley L, Dunn J, Elbourne D, Farrell B, Gamble C, Gillies K, Hood K, Lang T, Littleford R, Loudon K, McDonald A, McPherson G, Nelson A, Norrie J, Ramsay C, Sandercock P, Shanahan DR, Summerskill W, Sydes M, Williamson P, Clarke M. Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform. Trials 2015; 16:261. [PMID: 26044814 PMCID: PMC4475334 DOI: 10.1186/s13063-015-0776-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge ( www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - David Crosby
- Medical Research Council, Methodology Research Programme (MRC MRP), London, UK.
| | - Peter Davidson
- Consultant in Public Health and Head of Health Technology Assessment, National Institute for Health Research, Evaluation, Trials, and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK.
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Lelia Duley
- Nottingham Clinical Trials Unit (NCTU), Nottingham Health Science Partners, C Floor, South Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Janet Dunn
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Carrol Gamble
- North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kerry Hood
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Cardiff, UK.
| | - Trudie Lang
- The Global Health Network, Oxford University Centre for Tropical Medicine, University of Oxford, Oxford, UK.
| | | | - Kirsty Loudon
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Gladys McPherson
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, CF14 4YS, UK.
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Sandercock
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
| | | | | | - Matt Sydes
- Medical Research Council, Clinical Trials Unit (MRC CTU), London, UK.
| | - Paula Williamson
- North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building Daulby Street, Liverpool, L69 3GA, UK.
| | - Mike Clarke
- Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
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Taggart L, Coates V, Clarke M, Bunting B, Davies M, Carey M, Northway R, Brown M, Truesdale-Kennedy M, Martin-Stacey L, Scott G, Karatzias T. A study protocol for a pilot randomised trial of a structured education programme for the self-management of type 2 diabetes for adults with intellectual disabilities. Trials 2015; 16:148. [PMID: 25872928 PMCID: PMC4404014 DOI: 10.1186/s13063-015-0644-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world. One such national education programme in the United Kingdom is the DESMOND Programme, which has been shown to be robust and effective for patients in general. However, these programmes are not generally targeted to people with intellectual disabilities (ID), and robust evidence on their effects for this population is lacking. We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID. This protocol is for a pilot trial to determine whether a large-scale randomised trial is feasible, to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes, in particular as a means to reduce glycated haemoglobin (Hb1Ac), improve psychological wellbeing and quality of life and promote a healthier lifestyle. This protocol describes the rationale, methods, proposed analysis plan and organisational and administrative details. METHODS/DESIGN This trial is a two arm, individually randomised, pilot trial for adults with ID and type 2 diabetes, and their family and/or paid carers. It compares the DESMOND-ID programme with usual care. Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom. Family and/or paid carers may also participate in the study. Participants will be randomly assigned to one of two conditions using a secure computerised system with robust allocation concealment. A range of data will be collected from the adults with ID (biomedical, psychosocial and self-management strategies) and from their carers. Focus groups with all the participants will assess the acceptability of the intervention and the trial. DISCUSSION The lack of appropriate structured education programmes and educational materials for this population leads to secondary health conditions and may lead to premature deaths. There are significant benefits to be gained globally, if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments. TRIAL REGISTRATION Registered with International Standard Randomised Controlled Trial (identifier: ISRCTN93185560 ) on 10 November 2014.
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Affiliation(s)
- Laurence Taggart
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Vivien Coates
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Mike Clarke
- MRC Hub for Trials Methodology Research, Queen's University Belfast, Malone Road, Belfast, BT7 1NN, Northern Ireland.
| | - Brendan Bunting
- Institute of Psychology, Ulster University, Northland Road, Derry, BT48 7JL, Northern Ireland.
| | - Melanie Davies
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Marian Carey
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Ruth Northway
- University of South Wales, Glyntaff Campus, Cardiff, CF37 4BD, Wales.
| | - Michael Brown
- Edinburgh Napier University, Sighthill Campus, Bankhead Avenue, Edinburgh, EH11 4DE, Scotland.
| | - Maria Truesdale-Kennedy
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Lorraine Martin-Stacey
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Gillian Scott
- Northern Health and Social Care Trust, Ulster, Rathlea House, Mountfern Complex, 8A Rugby Ave, Coleraine, BT52 1JL, Northern Ireland.
| | - Thanos Karatzias
- Edinburgh Napier University, Sighthill Campus, Bankhead Avenue, Edinburgh, EH11 4DE, Scotland.
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Tilbrook HE, Becque T, Buckley H, MacPherson H, Bailey M, Torgerson DJ. Randomized trial within a trial of yellow 'post-it notes' did not improve questionnaire response rates among participants in a trial of treatments for neck pain. J Eval Clin Pract 2015; 21:202-4. [PMID: 25399758 DOI: 10.1111/jep.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 01/07/2023]
Abstract
RATIONALE Attrition is a threat to the validity of randomized trials. Few randomized studies have been conducted within randomized trials to test methods of reducing attrition. AIM To test whether using yellow post-it notes on follow-up questionnaires in the ATLAS treatment trial for neck pain reduces attrition. METHOD Nested trial within a trial. ATLAS participants were randomized to have their 6-month follow-up questionnaire have a 3' yellow post-it note with a handwritten message encouraging return of questionnaire. RESULTS 499 participants were independently randomized using simple allocation to receive the post-it notes or not. Two hundred fifteen of the 256 (84.0%) participants in the intervention group returned their questionnaire compared with 205 of the 243 (84.4%) in the control group. There was no difference in time to response. CONCLUSION Yellow post-it notes do not enhance questionnaire return rates for participants in a randomized trial of neck pain.
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113
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Hindmarch P, Hawkins A, McColl E, Hayes M, Majsak-Newman G, Ablewhite J, Deave T, Kendrick D. Recruitment and retention strategies and the examination of attrition bias in a randomised controlled trial in children's centres serving families in disadvantaged areas of England. Trials 2015; 16:79. [PMID: 25886131 PMCID: PMC4359386 DOI: 10.1186/s13063-015-0578-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Failure to retain participants in randomised controlled trials and longitudinal studies can cause significant methodological problems. We report the recruitment and retention strategies of a randomised controlled trial to promote fire-related injury prevention in families with pre-school children attending children's centres in disadvantaged areas in England. METHODS Thirty-six children's centres were cluster randomised into one of three arms of a 12-month fire-related injury prevention trial. Two arms delivered safety interventions and there was one control arm. Retention rates compared the numbers of participants responding to the 12-month questionnaire to the number recruited to the trial. Multivariable random effects logistic regression was used to explore factors independently associated with participant retention. RESULTS The trial exceeded its required sample size through the use of multiple recruitment strategies. All children's centres remained in the study, despite increased reorganisation. Parent retention was 68% at 12 months, ranging from 65% to 70% across trial arms and from 62% to 74% across trial sites. There was no significant difference in the rates of retention between trial arms (p = 0.58) or between trial sites (p = 0.16). Retention was significantly lower amongst mothers aged 16-25 years than older mothers [adjusted odds ratio (AOR) 0.57, 95% CI 0.41, 0.78], those living in non-owner occupied accommodation than in owner occupied accommodation (AOR 0.53, 95% CI 0.38, 0.73) and those living in more disadvantaged areas (most versus least disadvantaged quintiles AOR 0.50, 95% CI 0.30, 0.82). CONCLUSIONS Studies recruiting disadvantaged populations should measure and report attrition by socioeconomic factors to enable determination of the extent of attrition bias and estimation of its potential impact on findings. Where differential attrition is anticipated, consideration should be given to over-sampling during recruitment and targeted and more intensive strategies of participant retention in these sub-groups. In transient populations collection of multiple sources of contact information at recruitment and throughout the study may aid retention. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01452191 ; Date of registration: 10 October 2011, ISRCTN65067450.
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Affiliation(s)
- Paul Hindmarch
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Adrian Hawkins
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Elaine McColl
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1-3 Brixton Road, London, SW9 6DE, UK.
| | - Gosia Majsak-Newman
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Joanne Ablewhite
- Division of Primary Care, School of Medicine, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK.
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Rick J, Graffy J, Knapp P, Small N, Collier DJ, Eldridge S, Kennedy A, Salisbury C, Treweek S, Torgerson D, Wallace P, Madurasinghe V, Hughes-Morley A, Bower P. Systematic techniques for assisting recruitment to trials (START): study protocol for embedded, randomized controlled trials. Trials 2014; 15:407. [PMID: 25344684 PMCID: PMC4230578 DOI: 10.1186/1745-6215-15-407] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials play a central role in evidence-based practice, but recruitment of participants, and retention of them once in the trial, is challenging. Moreover, there is a dearth of evidence that research teams can use to inform the development of their recruitment and retention strategies. As with other healthcare initiatives, the fairest test of the effectiveness of a recruitment strategy is a trial comparing alternatives, which for recruitment would mean embedding a recruitment trial within an ongoing host trial. Systematic reviews indicate that such studies are rare. Embedded trials are largely delivered in an ad hoc way, with interventions almost always developed in isolation and tested in the context of a single host trial, limiting their ability to contribute to a body of evidence with regard to a single recruitment intervention and to researchers working in different contexts. Methods/Design The Systematic Techniques for Assisting Recruitment to Trials (START) program is funded by the United Kingdom Medical Research Council (MRC) Methodology Research Programme to support the routine adoption of embedded trials to test standardized recruitment interventions across ongoing host trials. To achieve this aim, the program involves three interrelated work packages: (1) methodology - to develop guidelines for the design, analysis and reporting of embedded recruitment studies; (2) interventions - to develop effective and useful recruitment interventions; and (3) implementation - to recruit host trials and test interventions through embedded studies. Discussion Successful completion of the START program will provide a model for a platform for the wider trials community to use to evaluate recruitment interventions or, potentially, other types of intervention linked to trial conduct. It will also increase the evidence base for two types of recruitment intervention. Trial registration The START protocol covers the methodology for embedded trials. Each embedded trial is registered separately or as a substudy of the host trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Bower P, Brueton V, Gamble C, Treweek S, Smith CT, Young B, Williamson P. Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities. Trials 2014; 15:399. [PMID: 25322807 PMCID: PMC4210542 DOI: 10.1186/1745-6215-15-399] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite significant investment in infrastructure many trials continue to face challenges in recruitment and retention. We argue that insufficient focus has been placed on the development and testing of recruitment and retention interventions. METHODS In this current paper, we summarize existing reviews about interventions to improve recruitment and retention. We report survey data from Clinical Trials Units in the United Kingdom to indicate the range of interventions used by these units to encourage recruitment and retention. We present the views of participants in a recent workshop and a priority list of recruitment interventions for evaluation (determined by voting among workshop participants). We also discuss wider issues concerning the testing of recruitment interventions. RESULTS Methods used to encourage recruitment and retention were categorized as: patient contact, patient convenience, support for recruiters, monitoring and systems, incentives, design, resources, and human factors. Interventions felt to merit investigation by respondents fell into three categories: training site staff, communication with patients, and incentives. CONCLUSIONS Significant resources continue to be invested into clinical trials and other high quality studies, but recruitment remains a significant challenge. Adoption of innovative methods to develop, test, and implement recruitment interventions are required.
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Affiliation(s)
- Peter Bower
- />National Institute for Health Research School for Primary Care Research, North West Hub for Trials Methodology Research, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Valerie Brueton
- />MRC Clinical Trials Unit at University College London, 125 Kingsway, London, WC2B 6NH UK
| | - Carrol Gamble
- />North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Shaun Treweek
- />Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Catrin Tudur Smith
- />North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Bridget Young
- />North West Hub for Trials Methodology Research and Department of Psychological Sciences, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Paula Williamson
- />North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
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Brueton VC, Tierney JF, Stenning S, Meredith S, Harding S, Nazareth I, Rait G. Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis. BMJ Open 2014; 4:e003821. [PMID: 24496696 PMCID: PMC3918995 DOI: 10.1136/bmjopen-2013-003821] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To quantify the effect of strategies to improve retention in randomised trials. DESIGN Systematic review and meta-analysis. DATA SOURCES Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units. REVIEW METHODS Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy. RESULTS 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a 'package' of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); 'enhanced' letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04). CONCLUSIONS Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.
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Brueton VC, Stevenson F, Vale CL, Stenning SP, Tierney JF, Harding S, Nazareth I, Meredith S, Rait G. Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews. BMJ Open 2014; 4:e003835. [PMID: 24464427 PMCID: PMC3902408 DOI: 10.1136/bmjopen-2013-003835] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the strategies used to improve retention in primary care randomised trials. DESIGN Qualitative in-depth interviews and thematic analysis. PARTICIPANTS 29 UK primary care chief and principal investigators, trial managers and research nurses. METHODS In-depth face-to-face interviews. RESULTS Primary 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. CONCLUSIONS The 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.
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Treweek S, Lockhart P, Pitkethly M, Cook JA, Kjeldstrøm M, Johansen M, Taskila TK, Sullivan FM, Wilson S, Jackson C, Jones R, Mitchell ED. Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis. BMJ Open 2013; 3:bmjopen-2012-002360. [PMID: 23396504 PMCID: PMC3586125 DOI: 10.1136/bmjopen-2012-002360] [Citation(s) in RCA: 371] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. OBJECTIVE To identify interventions designed to improve recruitment to randomised controlled trials, and to quantify their effect on trial participation. DESIGN Systematic review. DATA SOURCES The Cochrane Methodology Review Group Specialised Register in the Cochrane Library, MEDLINE, EMBASE, ERIC, Science Citation Index, Social Sciences Citation Index, C2-SPECTR, the National Research Register and PubMed. Most searches were undertaken up to 2010; no language restrictions were applied. STUDY SELECTION Randomised and quasi-randomised controlled trials, including those recruiting to hypothetical studies. Studies on retention strategies, examining ways to increase questionnaire response or evaluating the use of incentives for clinicians were excluded. The study population included any potential trial participant (eg, patient, clinician and member of the public), or individual or group of individuals responsible for trial recruitment (eg, clinicians, researchers and recruitment sites). Two authors independently screened identified studies for eligibility. RESULTS 45 trials with over 43 000 participants were included. Some interventions were effective in increasing recruitment: telephone reminders to non-respondents (risk ratio (RR) 1.66, 95% CI 1.03 to 2.46; two studies, 1058 participants), use of opt-out rather than opt-in procedures for contacting potential participants (RR 1.39, 95% CI 1.06 to 1.84; one study, 152 participants) and open designs where participants know which treatment they are receiving in the trial (RR 1.22, 95% CI 1.09 to 1.36; two studies, 4833 participants). However, the effect of many other strategies is less clear, including the use of video to provide trial information and interventions aimed at recruiters. CONCLUSIONS There are promising strategies for increasing recruitment to trials, but some methods, such as open-trial designs and opt-out strategies, must be considered carefully as their use may also present methodological or ethical challenges. Questions remain as to the applicability of results originating from hypothetical trials, including those relating to the use of monetary incentives, and there is a clear knowledge gap with regard to effective strategies aimed at recruiters.
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Affiliation(s)
- Shaun Treweek
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Pauline Lockhart
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Marie Pitkethly
- Scottish School of Primary Care, University of Dundee, Dundee, UK
| | - Jonathan A Cook
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Marit Johansen
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Taina K Taskila
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Frank M Sullivan
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Sue Wilson
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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