Challenges and strategies for recruitment and retention of vulnerable research participants: promoting the benefits of participation

Perceptions of Caring Recruitment Among Older Adults: African Americans and Non-Latinx Whites

BACKGROUND

African Americans (AAs) are underrepresented in health-related research studies. Few studies have investigated how behaviors of study recruiters affect recruitment of older AAs versus non-Latinx Whites (NLWs).

OBJECTIVES

The aim of this study was to explore whether caring behaviors influence AA and NLW older adults' decision to participate in hypothetical, high-commitment, health-related research studies and differences in participants' enrollment decisions by race.

METHODS

Using a descriptive, cross-sectional study design, guided by Kristen Swanson's middle-range theory of caring, a research-savvy sample of 60 AA and 60 NLW adults (age > 65 years) were randomly assigned one of two written vignettes. The concept of caring behaviors was manipulated and illustrated in a hypothetical recruitment scenario. A participant feedback survey was used to assess (a) participants' perceptions of caring and uncaring behaviors exhibited by the fictitious research recruiter, (b) differences in their willingness to participate based on vignette type, and (c) participants' judgment of the research recruiter as being caring or uncaring. A chi-square test assessed the association among categorical variables (caring behavior and participants' race).

RESULTS

Participants who received the vignette with the high caring recruiter were more than twice as likely to agree to participate in the study than those who received the vignette with the low caring recruiter. AA and NLW participants did not differ in their likelihood to agree to participate. Participants who received the caring vignette and judged the recruiter as caring were 5 times as likely to agree to participate in the high-commitment study than those who received the uncaring vignette ( p < .001). Associations did not vary by race.

DISCUSSION

This experimental study of equally recruited older adults from an existing longitudinal study revealed that caring behaviors in recruitment strategies are associated with an increased likelihood of participation in high-commitment research with older adults. The research-savvy AA participants were just as likely to participate in the hypothetical high-commitment research as their NLW peers when the fictional research recruiter was perceived as having caring behaviors. When targeting specific populations, it is essential to employ nuanced recruitment approaches where the study recruiters are attuned to caring behaviors.

Tailoring research recruitment strategies to survey harder-to-reach populations: A discussion paper

AIMS

A discussion of the challenges of recruiting participants from harder-to-reach populations for quantitative survey studies and potential avenues for tailored strategies to address these challenges.

DESIGN

Discussion paper.

DATA SOURCES

The search was conducted on August 2, 2021, in the CINAHL and PubMed databases, and in Google scholar. The initial search identified 5880 articles, and the final analysis included 44 articles that met the inclusion criteria. Articles were retained if they addressed methodological challenges or strategies for recruitment and concerned research with harder-to-reach populations.

IMPLICATIONS FOR NURSING

This article draws on the literature regarding the challenges of recruiting research participants from harder-to-reach populations and known strategies for overcoming them. These strategies include, for example, establishing a trusting relationship between the researcher and the participant community and gaining in-depth knowledge of the target population. These challenges and strategies for recruiting participants from these populations are discussed specifically in the context of quantitative survey research.

CONCLUSION

Nurse researchers conducting quantitative survey studies with participants from harder-to-reach populations must tailor their recruitment strategies to the target population and, most importantly, be flexible and creative in their recruitment methods.

IMPACT

The article discusses the challenges of recruiting participants from harder-to-reach populations and strategies to overcome them in quantitative survey studies. Successful recruitment requires researchers to develop a thorough understanding of the harder-to-reach population, develop partnerships to locate and access potential participants, build trust with the community, tailor their language, minimize participation risk and resource constraints, recognize the cognitive and physical demands required, and be flexible and creative in developing recruitment strategies. This knowledge can enable the inclusion of more people from harder-to-reach populations in survey studies and provide evidence that can inform research and practice to provide healthcare tailored to their needs and ultimately help improve their health and well-being.

Research as an essentiality beyond one's own competence: an interview study on frail older people's view of research

BACKGROUND

There is an increased interest to make the voices of frail older people heard in research by actively involving them in research processes. Involving frail older people in research could, however, be perceived as challenging by researchers. To actively involve frail older people in research processes in a meaningful way, the knowledge about their own views on what research is must be widened and deepened.

METHODS

Individual interviews were conducted with 17 frail older men and women with former experience of participation in research studies. Qualitative data were analysed using content analysis.

RESULTS

Frail older people's views on what research means are described through the main category; An essentiality beyond one's own competence, which describes research as a complex process that is important for society but difficult to understand. This is described in the sub-categories; A driving force for societal development, A benefit when based on lived experience, A source of knowledge difficult to access and understand, and A respected job filled with responsibilities.

CONCLUSION

Different views on research from the perspective of frail older people show that research is viewed as a complex yet important phenomenon to frail older people. Research was also seen as a natural part in society. Research was viewed as difficult to access and understand. Thus, researchers must train themselves to communicate research findings to the public in an understandable way. To create common understandings through information and education, researchers might be better placed to involve frail older people in a meaningful way and thereby also have the possibility to develop good working practice and relationships with those involved.

Caring in the recruitment of older African American adults with chronic health disease: An integrative review

OBJECTIVES

The aim of this integrative review is to accrue a comprehensive understanding of caring behavioral characteristics in the recruitment of older African-American adults into health-related research studies centered on chronic diseases.

METHODS

Combined methodologies, Whittemore & Knafl and Kable, Pich & Maslin-Prothero in accordance with preferred items for systematic reviews and meta-analysis, were used to guide the data collection and to report the findings. The data were analyzed based upon recruitment categorization and Kristen Swanson's middle-range theory of caring.

RESULTS

Ten out of 260 publications comprised the final sample. They were analyzed and then aggregated by chronic illnesses, recruitment activities, contact level, and Swanson's five caring behavioral concepts. Select cancers, diabetes, hypertension, and Alzheimer's disease were the chronic illness foci of eight publications. Cardiovascular disease and stroke were the focus of two publications. Only three studies utilized all five Swanson's caring concepts, and the frequently used concept throughout all 10 studies was enabling.

DISCUSSION

Recruitment approaches employed to accrue older African-American adults into chronic illness-related research studies necessitate proactive recruitment strategies that incorporate caring behaviors. Future researchers ought to develop multi-modality recruitment strategies to improve older African-American adults' representation.

Design, analysis, and reporting of pilot studies in HIV: a systematic review and methodological study

Background

Pilot studies are essential in determining if a larger study is feasible. This is especially true when targeting populations that experience stigma and may be difficult to include in research, such as people with HIV. We sought to describe how pilot studies have been used to inform HIV clinical trials.

Methods

We conducted a methodological study of pilot studies of interventions in people living with HIV published until November 25, 2020, using Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL). We extracted data on their nomenclature, primary objective, use of progression criteria, sample size, use of qualitative methods, and other contextual information (region, income, level, type of intervention, study design).

Results

Our search retrieved 10,597 studies, of which 248 were eligible. The number of pilot studies increased steadily over time. We found that 179 studies (72.2%) used the terms “pilot” or “feasibility” in their title, 65.3% tested feasibility as a primary objective, only 2% used progression criteria, 23.9% provided a sample size estimation and only 30.2% used qualitative methods.

Conclusions

Pilot studies are increasingly being used to inform HIV research. However, the titles and objectives are not always consistent with piloting. The design and reporting of pilot studies in HIV could be improved.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00934-9.

Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis

Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. Materials and Methods: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. Results: ‘Design and recruitment’ and ‘engagement and co-production’ thematic areas are presented considering the factors related to researcher–communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. Conclusions: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice.

Progression of self-management learning experiences of young adults following an allogeneic hematopoietic stem cell transplantation: A qualitative study

PURPOSE

Hematological diseases are among the most common forms of cancer that can affect young adults. Hematopoietic stem cell transplantation is a common intervention to treat blood-related cancers such as leukemia and lymphoma. Allogeneic stem cell transplants can provoke many acute and chronic symptoms. Young adult cancer survivors are expected to develop expertise to self-manage these symptoms. However, learning self-management can be quite challenging for young adults. This paper aims to describe the symptoms self-management learning experiences of young adults following an allogeneic stem cell transplant.

METHOD

A qualitative descriptive study was conducted to describe self-management learning experiences of young adults (18-39 years old) following an allogeneic stem cell transplant. Semi-structured interviews were conducted (n = 7, mean age 26 years old, mean time since allogeneic stem cell transplant was 14,71 months). Iterative qualitative content analysis was performed.

RESULTS

Participants who had undergone an allogeneic stem cell transplant described learning self-management as a progressive process, with expertise having to be developed through experience. Certain factors could positively or negatively affect the learning process and hence the development of this self-management expertise. With time, these young adults developed interoceptive ability and body awareness related to their symptoms, which influenced their self-management.

CONCLUSIONS

Following an allogeneic stem cell transplant, young adults need to be supported during their survivorship to develop self-management expertise. Nurses must adapt care according to patients' level of expertise to promote autonomy, development of interoceptive ability, and acquisition of self-management skills.

Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives

OBJECTIVES

General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people's opinions and experiences related to GPs' practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people's perspectives. This study aimed to explore young people's views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs.

DESIGN, SETTING AND PARTICIPANTS

Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16-24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis.

RESULTS

Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist-disliking the terms 'risk' and 'risk assessment', and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs' attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations.

CONCLUSIONS

Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.

Operationalizing reflexivity to improve the rigor of palliative care research

Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research.

Successful recruitment methods in the community for a two-site clinical trial

Effective screening and recruitment are essential to the success of randomized clinical trials. This report is to describe key screening and recruitment strategies in a two site randomized clinical trial (RCT) conducted in community settings with a vulnerable chronically ill population and to suggest valuable approaches when planning trials. Differences between sites in a complex study with two considerably different environments (academic versus home care) and their participant pools presented challenges which required different screening and recruitment methods. A high level of communication between sites, creative problem solving and the ability to be flexible when problems were encountered were needed for successful screening and recruitment.