How to engage occupational physicians in recruitment of research participants: a mixed-methods study of challenges and opportunities

"I'll leave that to the case managers." Healthcare Service Providers' Perceptions of Organizational Readiness for Change in a Randomized Controlled Trial-A Qualitative Analysis Exploring Implementation Success

Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive-inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner's model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.

Recruitment of Healthcare Providers into Research Studies

Recruitment of a sufficient number of healthcare providers (HCPs), such as nurses and nurse practitioners (NPs), as participants is essential to generate high quality research to address issues significant for clinical practice. Often the recruitment process reported in research studies is very brief and does not capture the reality of the challenges of obtaining an adequate sample. This manuscript describes the challenges that we experienced in trying to recruit a sufficient number of HCPs, specifically NPs, into a randomized controlled trial. Based on our experience, as well as a review of the literature on recruiting HCPs, we share recommendations for researchers trying to recruit busy professionals as participants. Key findings were not just about reaching the target participants, but actually using strategies to stimulate their interest and persuading them to be involved from the beginning. Important things to consider for successful recruitment are making an effort to meet with professionals face-to-face and building relationships with administrators and other staff within organizations. Other lessons learned were to ensure to allot extra time for recruitment to allow for unanticipated challenges and to utilize multimodal strategies simultaneously to ensure a more timely execution of the recruitment process.

Habiliter l’ergothérapeute-chercheur à résoudre les enjeux éthiques de la recherche

La recherche est une occupation propice à l’émergence d’enjeux éthiques, en outre parce qu’elle est liée à des conflits d’intérêts parfois difficiles à gérer et se réalise dans un contexte hautement compétitif qui valorise la performance. Alors que les enjeux éthiques de la pratique clinique de l’ergothérapie commencent à être documentés, les enjeux éthiques vécus par les chercheurs en ergothérapie et les moyens qu’ils utilisent pour gérer ces enjeux ne sont quasiment pas documentés. Cet article présente les résultats d’une étude qualitative qui a documenté les moyens (macro, méso et micro) qui sont proposés par des ergothérapeutes-chercheurs pour résoudre les enjeux éthiques de la recherche. Onze ergothérapeutes (n=11) ont participé à la recherche et partagent les moyens qu’ils utilisent ou envisagent pour gérer les enjeux éthiques de la recherche qu’ils vivent comme chercheur. Les moyens proposés par les ergothérapeutes rejoignent plusieurs moyens suggérés dans les écrits, quoique certains moyens proposés dans les écrits relatifs à la relation à établir avec les participants de recherche soient peu abordés par les participants, ce qui est surprenant compte tenu des valeurs humanistes au fondement de la profession d’ergothérapeute. Au final, cet article qui présente une synthèse à la fois des moyens répertoriés dans des écrits pour résoudre les enjeux éthiques de la recherche et ceux discutés par les participants vise à habiliter l’ergothérapeute-chercheur à résoudre les enjeux que pose la recherche académique tout en restant fidèle aux valeurs de la profession.

Occupational Physicians' Perspectives on Determinants of Employee Participation in a Randomized Controlled Musculoskeletal Health Promotion Measure: A Qualitative Study

Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians' experiences with employee participation in a randomized controlled workplace measure for musculoskeletal disorders (MSDs) in Germany. We conducted eight semi-structured telephone interviews with occupational physicians. Interviews were transcribed verbatim and analyzed using a combination of conventional and directed content analysis. Findings were mapped based on Andersen's behavioral model of health services use, resulting in four categories and 10 subcategories. (a) Contextual factors of the measure comprised impacts of the healthcare system and company environment, (b) individual factors of measure participation comprised demographic, social, belief, and MSD need characteristics, (c) health behavior during the measure included OPs' communication, employees' personal practices and measure participation, and (d) outcomes of participation included health status, satisfaction, and dissatisfaction with the measure. Findings imply occupational physicians' and employees' views should be investigated on a broader scale. Researchers should use present statements for the development of intervention studies, while political and managerial authorities can improve organizational conditions of prevention based on these findings.

Effect of an eHealth Intervention to Reduce Sickness Absence Frequency Among Employees With Frequent Sickness Absence: Randomized Controlled Trial

Background

Frequent sickness absence—that is, 3 or more episodes of sickness absence in 1 year—is a problem for employers and employees. Many employees who have had frequent sickness absence in a prior year also have frequent sickness absence in subsequent years: 39% in the first follow-up year and 61% within 4 years. Moreover, 19% have long-term sickness absence (≥6 weeks) in the first follow-up year and 50% within 4 years. We developed an electronic health (eHealth) intervention, consisting of fully automated feedback and advice, to use either as a stand-alone tool (eHealth intervention–only) or combined with consultation with an occupational physician (eHealth intervention–occupational physician).

Objective

This study aimed to evaluate the effect of the eHealth intervention, with or without additional occupational physician consultation, to reduce sickness absence frequency for employees with frequent sickness absence, versus care as usual (CAU).

Methods

This study was a three-armed randomized controlled trial. Employees with frequent sickness absence received invitational letters, which were distributed by their employers. The primary outcome measure was the number of register-based sickness absence episodes 12 months after completing the baseline questionnaire. Secondary outcome measures were register-based total sickness absence days and self-assessed burnout, engagement, and work ability. In a process evaluation 3 months after baseline, we examined adherence to the intervention and additional actions such as general practitioner and occupational physician visit, communication with the manager, and lifestyle change.

Results

A total of 82 participants were included in the analyses, 21 in the eHealth intervention–only group, 31 in the eHealth intervention–occupational physician group, and 30 in the CAU group. We found no significant difference in sickness absence frequency between the groups at 1-year follow-up. Sickness absence frequency decreased in the eHealth intervention–only group from 3 (interquartile range, IQR 3-4) to 1 episode (IQR 0.3-2.8), in the eHealth intervention–occupational physician group from 4 (IQR 3-5) to 3 episodes (IQR 1-4), and in the CAU group from 3 (IQR 3-4) to 2 episodes (IQR 1-3). For secondary outcomes, we found no significant differences between the intervention groups and the control group. The process evaluation showed that only 3 participants from the eHealth intervention–occupational physician group visited the occupational physician on invitation.

Conclusions

Among employees with frequent sickness absence, we found no effect from the eHealth intervention as a stand-alone tool in reducing sickness absence frequency, nor on total sickness absence days, burnout, engagement, or work ability. This might be due to low adherence to the intervention because of insufficient urgency to act. We cannot draw any conclusion on the effect of the eHealth intervention tool combined with an occupational physician consultation (eHealth intervention–occupational physician), due to very low adherence to the occupational physician consultation. An occupational physician consultation could increase a sense of urgency and lead to more focus and appropriate support. As this was the first effectiveness study among employees with frequent sickness absence, strategies to improve recruitment and adherence in occupational eHealth are included.

Trial Registration

Netherlands Trial Register NTR4316; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4316 (Archived by WebCite at http://www.webcitation.org/713DHhOFU).