Research involving participants with chronic diseases: overcoming recruitment obstacles

Use of the chronic illness research recruitment taxonomy to evaluate recruitment strategies in an eHealth feasibility study

Background

Chronic illness research has many challenges making research recruitment difficult. Despite reports of facilitators and barriers to research recruitment challenges remain. The reporting of research strategies and their impact on recruitment and subsequent randomised control trials is not sufficient. A newly developed chronic illness research recruitment taxonomy (CIRRT) details factors and elements observed to impact recruitment around the components of Project, People, and Place. This paper aims to use the chronic illness research recruitment taxonomy to report and evaluate the recruitment strategies, impact they had on recruitment, and alterations to an eHealth feasibility study.

Methods

Retrospective mixed method approach was used to inductively code the research team meeting minutes during the recruitment period. The coding was then abductively matched to the chronic illness research recruitment taxonomy and gaps in the CIRRT noted. Dated coding data were integrated with recruitment progress to explore the impact of research recruitment strategies.

Results

Meeting minutes (n = 66) were analysed, recruitment strategies identified and matched to CIRRT. The reporting and identification of the recruitment strategies was aided by CIRRT use. By integrating the codes that aligned with CIRRT with recruitment progress was observed to be impacted by staffing and researcher visits.

Conclusions

CIRRT may be a useful tool in the evaluation and reporting of research recruitment strategies. Altering the roles of nurses involved and researcher visits to recruiting sites may positively impact on chronic illness research recruitment.

Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial

Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient's hospitalization. We found rates of family caregiver recruitment for in-person versus virtual were 28% and 23%, respectively (p = 0.01). Differences existed across groups with family caregivers recruited virtually being more likely to be younger, white, have greater than high school education, and not be a spouse or significant other to the care recipient, such as a child. Future work is still needed to identify the modality and timing of family caregiver recruitment to maximize rates and enhance the representativeness of the population for equitable impact.

Invisible population: Understanding recruitment barriers of a nurse-led support programme for families with caregiving children in Austria

Aims

To evaluate why no families could be recruited for a nurse-led and family-centred support programme in Austria which aimed to prevent an age-inappropriate caring role for young carers.

Design

A qualitative study incorporating qualitative e-interviews and telephone interviews.

Method

Twenty-one interviews were conducted with statistically significant project stakeholders (N = 17) and with adult family members of children with caring responsibilities (N = 4). Data collection and analysis were guided by the "Social Marketing Framework." Relevant statements were assigned to the main categories: product; price; promotion; place; and working with partners.

Results

The lack of awareness towards young carers, the unfamiliar, open outcome approach of the intervention, the inappropriate language used in promotional materials and the families' fear of stigma while seeking support were identified as central obstacles for successful recruitment of families and implementation of the support programme.

Lessons learnt in recruiting disadvantaged families to a birth cohort study

BACKGROUND

Dental decay in early childhood can be prevented by a model based on shared care utilising members of primary care team such as Child and Family Health Nurses (CFHNs) in health promotion and early intervention. The aims of this study were to identify the facilitators and barriers faced by CFHNs in recruiting research participants from disadvantaged backgrounds to a birth cohort study in South Western Sydney, Australia.

METHODS

Child and Family Health Nurses recruited mothers-infants dyads (n = 1036) at the first post-natal home visit as part of Healthy Smiles Healthy Kids Study, an ongoing birth cohort study in South Western Sydney. The nurses (n = 19) were purposively selected and approached for a phone based in-depth semi-structured interview to identify the challenges faced by them during the recruitment process. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis.

RESULTS

The nurses found the early phase of parenting was an overwhelming stage for parents as they are pre-occupied with more immediate issues such as settling and feeding a newborn. They highlighted some key time-points such as during pregnancy and/or around the time of infant teething may be more appropriate for recruiting families to dental research projects. However, they found it easier to secure the family's attention by offering incentives, gifts and invitations for free oral health services. The use of web-based approaches and maintaining regular contact with the participants was deemed crucial for long-term research. Cultural and linguistic barriers were seen as an obstacle in recruiting ethnic minority populations and the need for cultural insiders in the research team was deemed important to resolve the challenges associated with conducting research with diverse cultures. Finally, nurses identified the importance of inter-professional collaboration to provide easier access to recruiting research participants.

CONCLUSIONS

This study highlighted the need for multiple time-points and incentives to facilitate recruitment and retention of disadvantaged communities in longitudinal research. The need for cultural insiders and inter-professional collaboration in research team are important to improve research participation.

A randomized control trial feasibility evaluation of an mHealth intervention for wheelchair skill training among middle-aged and older adults

BACKGROUND

Providing mobility skills training to manual wheelchair (MWC) users can have a positive impact on community participation, confidence and quality of life. Often such training is restricted or not provided at all because of the expense of, and limited access to, occupational and physical therapists before and after discharge. This is particularly true among middle-aged and older adults, who often have limited access to rehabilitation services and require more time to learn motor skills. A monitored MWC skills training home program, delivered using a computer tablet (mHealth), was developed as an alternative approach to service delivery. The purpose of this study was to evaluate the feasibility of implementing this mHealth MWC skills training program among middle-aged and older adults.

METHODS

A 2 × 2 factorial design randomized controlled trial (RCT) was used to compare the mHealth intervention and control groups, with additional wheeling time as a second factor. Community-dwelling MWC users aged 55 and older, who had used their MWC for less than two years and propelled with two hands, were recruited. Feasibility outcomes related to process, resources, management and treatment criteria were collected.

RESULTS

Eighteen participants were recruited, with a retention rate of 94%. Mean (±SD) duration for the first and second in-person training sessions were 90.1 ± 20.5 and 62.1 ± 5.5 min, respectively. In the treatment group, 78% achieved the minimum amount of home training (i.e., 300 min) over four weeks and 56% achieved the preferred training threshold (i.e., 600 min). Trainers reported only seven minor protocol deviations. No tablets were lost or damaged and there was one incident of tablet malfunction. No injuries or adverse incidents were reported during data collection or training activities. Participants indicated 98% agreement on the post-treatment benefit questionnaire.

DISCUSSION

Overall, the study protocol enabled implementation of the intervention in a safe, efficient and acceptable manner. Participant recruitment proved to be challenging, particularly gaining access to individuals who might benefit. Resource issue demands were acceptable for administration of the intervention; data collection was more time-consuming than anticipated but could be reduced with minor revisions. Participant retention and home program treatment adherence was high; both participant and trainer burden was acceptable. Treatment group participants reported a positive experience and clinical benefits from training program. The findings suggest a full-scale RCT evaluating the clinical impact of the Enhancing Participation In the Community by improving Wheelchair Skills (EPIC Wheels) intervention is warranted, provided the recruitment issues are addressed through collaborative partnerships and active recruitment strategies.

Understanding the Natural Progression of Spina Bifida: Prospective Study

BACKGROUND

Spina bifida (SB) is monitored through birth defects surveillance across the United States and in most developed countries. Although much is known about the management of SB and its many comorbid conditions in affected individuals, there are few systematic, longitudinal studies on population-based cohorts of children or adults. The natural history of SB across the life course of persons with this condition is not well documented. Earlier identification of comorbidities and secondary conditions could allow for earlier intervention that might enhance the developmental trajectory for children with SB.

OBJECTIVE

The purpose of this project was to assess the development, health, and condition progression by prospectively studying children who were born with SB in Arizona and Utah. In addition, the methodology used to collect the data would be evaluated and revised as appropriate.

METHODS

Parents of children with SB aged 3-6 years were eligible to participate in the study, in English or Spanish. The actual recruitment process was closely documented. Data on medical history were collected from medical records; family functioning, child behaviors, self-care, mobility and functioning, and health and well-being from parent reports; and neuropsychological data from testing of the child.

RESULTS

In total, 152 individuals with SB were identified as eligible and their parents were contacted by site personnel for enrollment in the study. Of those, 45 (29.6%) declined to participate and 6 (3.9%) consented but did not follow through. Among 101 parents willing to participate, 81 (80.2%) completed the full protocol and 20 (19.8%) completed the partial protocol. Utah enrolled 72.3% (73/101) of participants, predominately non-Hispanic (60/73, 82%) and male (47/73, 64%). Arizona enrolled 56% (28/50) of participants they had permission to contact, predominately Hispanic (18/28, 64%) and male (16/28, 57%).

CONCLUSIONS

We observed variance by site for recruitment, due to differences in identification and ascertainment of eligible cases and the required institutional review board processes. Restriction in recruitment and the proportion of minorities likely impacted participation rates in Arizona more than Utah.

Psychometric Testing of the Life Changes in Epilepsy Scale

Purpose: Three aims were addressed: (a) Evaluate properties of the items comprising the Life Changes in Epilepsy Scale-Pilot (LCES-P), (b) use item analysis to optimize the scale, (c) evaluate construct and criterion-related validity of the optimized LCES. Methods: The LCES-P was administered to 174 adults with epilepsy. Item analysis and exploratory factor analysis were performed. Internal consistency reliability, construct validity, and criterion-related validity were evaluated. Results: 17 items were retained in the optimized LCES. Internal consistency reliability was supported. Path analysis was used to evaluate construct validity. Criterion-related validity was supported by correlations with the Medical Outcomes SF-36 Survey (SF-36) General Health subscale and a criterion variable. Conclusions: The optimized version of the LCES can serve as a valuable outcome measure in clinical and research environments.

Perceived Changes in Sleep in Adults With Epilepsy

BACKGROUND

Epilepsy is the most common chronic neurological disease in the United States, and 70% of diagnoses occur in late adolescence or adulthood. A disease of the brain, epilepsy can affect sleep. Lack of adequate or high-quality sleep can cause decrements in quality of life. Adults living with epilepsy are at especially high risk for sleep alterations, and these changes in sleep can worsen their epilepsy. The purpose of the study was to describe the perceived effect of epilepsy on sleep in adults who developed epilepsy in late adolescence or adulthood. Research questions included (a) "In adults with epilepsy, what is the perceived change in ability to sleep well because of having epilepsy?"; (b) "In adults with epilepsy, is there a significant relationship between perceived changes in ability to sleep well and perceived changes in overall life because of having epilepsy?"; and (c) "In adults with epilepsy, is there a significant relationship between perceived changes in ability to sleep well because of having epilepsy and total Life Changes in Epilepsy Scale (LCES) scores?".

METHODS

One hundred seventy-four adults with epilepsy were recruited. Utilizing data collected via the LCES, a quantitative descriptive/correlational design was utilized. Analyses were carried out to answer each research question.

RESULTS

The mean score for the sleep item of the LCES was 2.76 (SD = 1.31), indicating an overall negative change in ability to sleep well. There was a statistically significant, strong positive relationship between the sleep and overall life changes items of the LCES (Pearson r = .476, p < .0000) and also between the sleep item and total LCES scores (Pearson r = .620, p < .0000).

IMPLICATIONS

Findings from this study contribute to the extant literature by revealing epilepsy-related changes in sleep as perceived by adults living with epilepsy specifically because of having epilepsy. On the basis of findings rendered from this sample, having epilepsy can lead to perceived negative changes in a person's ability to sleep well, and these negative changes are significantly correlated with negative overall life changes. Recommendations for clinical practice and research can be made based on current results.

Recruitment challenges in clinical research including cancer patients and their caregivers. A randomized controlled trial study and lessons learned

BACKGROUND

To test seven different strategies for recruitment in a randomized controlled trial, to report documented response data from each strategy, and to discuss recruitment challenges.

METHODS

We used 5 opt-in (potential participants have to do something active to contact or be contacted by the researcher) and 2 opt-out (potential participants have the option to decline being contacted about a study) recruitment strategies from February 2013 until July 2014 to contact 1562 cancer patient candidates for participation in a randomized controlled trial. For each of these cancer patients a caregiver was also invited to take part in the study.

RESULTS

Of the 1562 candidates, 22.6 % were ineligible on initial contact, 56.7 % declined to participate on initial contact, and 8.9 % agreed orally to participate but did not complete the enrollment. The 2 opt-out strategies, on-site recruitment and routine care letters recruitment, yielded the highest number of recruited participants with 79 dyads and 58 dyads respectively, constituting 42.7 % and 31.4 % of the total number of enrolled candidates. The 5 opt-in recruitment approaches yielded 49 dyads for the study. Almost half of these dyads were recruited using the approach termed "relying on providers at the hospital."

CONCLUSIONS

In this study, opt-out recruitment strategies appeared to be the most effective.

TRIAL REGISTRATION

Registration number NCT01867723 , registered February 2012.

Patients' recall of diagnostic and treatment information improves with use of the Pain Explanation and Treatment Diagram in an outpatient chronic pain clinic

Educating patients about their condition and treatment plan is an essential component of successful treatment. Patients need to understand their condition, recall treatment suggestions and comply with the treatment protocol. Unfortunately, the method of patient education most commonly used by physicians is verbal teaching and discussion, which leads to poor patient recall. The authors of this article developed the Pain Explanation and Treatment Diagram, a worksheet that the clinician completes with the patient during their first consultation to function as a record of their diagnosis, pain risk factors and an action plan for when pain occurs. In this study, patient recall, among other variables, was assessed as a function of time since first appointment.

BACKGROUND:

To maximize the benefit of therapies, patients must understand their condition, recall treatment suggestions and comply with treatments. The Pain Explanation and Treatment Diagram (PETD) is a one-page worksheet that identifies risk factors (health-related habits, sleep, exercise, ergonomics and psychosocial factors) involved in chronic pain. Clinician and patient complete the PETD together, and the clinician notes recommended treatments and lifestyle changes.

OBJECTIVES:

To examine the effect of use of the PETD on patient recall of diagnostic and treatment information on the sheet.

METHODS:

The present study was a cross-sectional analysis. Patients with chronic musculoskeletal pain seen by one physiatrist at an outpatient pain clinic in a university-affiliated hospital between 2009 and 2012 (all of whom received the PETD) were eligible. A structured telephone interview lasting approximately 1 h was used to determine recall of PETD diagnostic and treatment information.

RESULTS:

Of the 84 eligible patients, 46 were contacted and 29 completed the telephone interview. Participants recalled an average of 12.2% (95% CI 7.8% to 17.4%) of items without prompting and 48.5% (95% CI 42.0% to 53.5%) when prompted. Participants who referred to the PETD at home (n=13) recalled significantly more items than those who did not (n=15) (17.6% [95% CI 11.1% to 23.9%] versus 5.2% [95% CI 3.0% to 14.5%], P=0.004); when prompted, the rates increased to 54.3% (95% CI 48.3% to 61.2%) and 41.2% (95% CI 34.7% to 50.7%), respectively (P=0.032).

CONCLUSIONS:

The PETD is a promising, feasible and inexpensive tool that can improve patients’ recall of diagnostic- and treatment-related information.

Patient-centered outcomes in older adults with epilepsy

PURPOSE

Older adults have the highest incidence of new-onset epilepsy, yet there is a lack of self-management interventions to ensure that this population achieves desirable outcomes. In order to develop patient-centered interventions for older adults with epilepsy, self-management outcomes of importance to these patients must first be explored. The purpose of this study was to describe what outcomes older adults diagnosed with epilepsy late in life hope to achieve in self-managing their condition.

METHOD

Qualitative description was used. 20 older adults took part in semi-structured interviews. Data were analyzed using conventional content analysis.

RESULTS

Six themes emerged - Maintaining Normalcy, We Want to be Involved, Well-Equipped, Seizure Freedom, Fitting Epilepsy in with Other Conditions, Incongruence with Provider Goals.

CONCLUSION

These results add to the extant literature, and provide knowledge on which patient-centered epilepsy self-management interventions can be developed. In addition, these results can inform the development of a patient-centered outcome measure for older adults with epilepsy. Such a measure could be used in conjunction with existing measures related to disease status (seizure frequency, etc.) to ensure that outcomes pertinent to both patients and providers are targeted and measured.

Problems, needs, and useful strategies in older adults self-managing epilepsy: implications for patient education and future intervention programs

OBJECTIVE

The purpose of this study was to determine, in a sample of older adults diagnosed with epilepsy, perceived self-management problems and needs encountered since diagnosis, as well as strategies used to address problems and needs.

METHODS

Qualitative description was used. Twenty older adults engaged in face-to-face interviews. Interviews were analyzed via content analysis.

RESULTS

Participants reported problems, needs, and strategies in six categories: Information, Physical and Emotional Symptoms, Memory and Concentration, Medications, Commitments, and Relationships.

CONCLUSION

Participants noted some problems and needs previously documented in the literature, though current results have built upon extant literature to reveal etiologies of and contexts surrounding problems and needs; new findings were also revealed. This knowledge can be used by health-care providers in counseling and educating older adults with epilepsy and can inform formal self-management interventions.

PRACTICE IMPLICATIONS

Determining needs from the patient's perspective is consistent with today's focus on patient-centered care. Current findings have led to an organizing framework for problems and needs of older adults with epilepsy. More research is needed to develop the framework so that it can serve as a template for an intervention. In the interim, findings can inform educational practices of those caring for this population.