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Cross-Sudworth F, Dharni N, Kenyon S, Lilford R, Taylor B. Exploring implementation of intrapartum trial evidence: a qualitative study with clinicians and clinical academics. Implement Sci Commun 2024; 5:103. [PMID: 39334313 PMCID: PMC11429658 DOI: 10.1186/s43058-024-00647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Implementing research evidence into clinical practice is challenging. This study aim was to explore implementation of two intrapartum trials with compelling findings: BUMPES (position in second stage of labour in nulliparous women with epidural), and RESPITE (remifentanil intravenous patient-controlled analgesia). METHODS A qualitative interview study set in UK National Health Service Trusts and Universities. Purposively sampled investigators from RESPITE and BUMPES trials and clinicians providing intrapartum care: midwives, anaesthetists, and obstetricians, were recruited using existing networks and snowball sampling. Semi-structured virtual interviews were conducted. Thematic analysis was underpinned by Capability Opportunity Motivation Behaviour Change Framework. RESULTS Twenty-nine interview participants across 19 maternity units: 11 clinical academics, 10 midwives, 4 obstetricians, 4 anaesthetists. Most (25/29) were aware of one or both trials. BUMPES had been implemented in 4/19 units (one original trial site) and RESPITE in 3/19 units (two trial sites). Access to sufficient resources, training, exposure to interventions, support from leaders, and post-trial dissemination and implementation activities all facilitated uptake of interventions. Some clinicians were opposed to the intervention or disagreed with trial conclusions. However competing priorities in terms of staff time and a plethora of initiatives in maternity care, emerged as a key barrier to implementation. CONCLUSIONS Compelling trial findings were not implemented widely, and numerous barriers and facilitators were identified. Large-scale improvement programmes and evidence-based national guidelines may mean single trials have limited potential to change practice. There is a need to examine how intervention implementation is prioritised to optimise safety outcomes in the context of workforce restrictions, limited resources and large arrays of competing priorities including statutory requirements, that have increased in maternity care.
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Affiliation(s)
- Fiona Cross-Sudworth
- Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Nimarta Dharni
- Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sara Kenyon
- Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard Lilford
- Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Beck Taylor
- Warwick Medical School, University of Warwick, University Road, Coventry, CV4 7AL, UK
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McMullan C, Haroon S, Turner G, Aiyegbusi OL, Subramanian A, Hughes SE, Flanagan S, Nirantharakumar K, Davies EH, Frost C, Jackson L, Guan N, Alder Y, Chong A, Buckland L, Jeyes F, Stanton D, Calvert M. Key considerations for digital decentralised clinical trials from a feasibility study assessing pacing interventions for long COVID. Sci Rep 2024; 14:22083. [PMID: 39333196 PMCID: PMC11436957 DOI: 10.1038/s41598-024-61827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/10/2024] [Indexed: 09/29/2024] Open
Abstract
Post COVID-19 condition or long COVID is highly prevalent and often debilitating, with key symptoms including fatigue, breathlessness, and brain fog. There is currently a lack of evidence-based treatments for this highly complex syndrome. There is a need for clinical trial platforms to rapidly evaluate nonpharmacological treatments to support affected individuals with symptom management. We co-produced a mixed methods feasibility study to evaluate a multi-arm digital decentralised clinical trial (DCT) platform to assess non-pharmacological interventions for Long COVID, using pacing interventions as an exemplar. The study demonstrated that the platform was able to successfully e-consent participants, randomise them into one of four intervention arms, capture baseline data, and capture outcomes relevant to a health economic evaluation. The study also highlighted several challenges, including difficulties with recruitment, imposter participants, and high attrition rates. We highlight how these challenges can potentially be mitigated to make a fully powered DCT more feasible.
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Affiliation(s)
- Christel McMullan
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcome Research, Institute for Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Grace Turner
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | | | - Sarah E Hughes
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | | | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Naijie Guan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yvonne Alder
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Amy Chong
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Lewis Buckland
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Felicity Jeyes
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - David Stanton
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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High J, Grant K, Hope A, Shepstone L, West C, Colles A, Naughton F. Effects of an Increased Financial Incentive on Follow-up in an Online, Automated Smoking Cessation Trial: A randomized Controlled Study Within a Trial. Nicotine Tob Res 2024; 26:1259-1263. [PMID: 38513087 PMCID: PMC11339161 DOI: 10.1093/ntr/ntae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Poor retention in clinical trials can impact on statistical power, reliability, validity, and generalizability of findings and is a particular challenge in smoking cessation studies. In online trials with automated follow-up mechanisms, poor response also increases the resource need for manual follow-up. This study compared two financial incentives on response rates at 6 months follow up, in an online, automated smoking cessation feasibility trial of a cessation smartphone app (Quit Sense). AIMS AND METHODS A study within a trial (SWAT), embedded within a host randomized controlled trial. Host trial participants were randomized 1:1 to receive either a £10 or £20 voucher incentive, for completing the 6-month questionnaire. Stratification for randomization to the SWAT was by minimization to ensure an even split of host trial arm participants and by 6-week response rate. Outcome measures were: Questionnaire completion rate, time to completion, number of completers requiring manual follow-up, and completeness of responses. RESULTS Two hundred and four participants were randomized to the SWAT. The £20 and £10 incentives did not differ in completion rate at 6 months (79% vs. 74%; p = .362) but did reduce the proportion of participants requiring manual follow-up (46% vs. 62%; p = .018) and the median completion time (7 days vs. 15 days; p = .008). Measure response completeness rates were higher among £20 incentive participants, though differences were small for the host trial's primary smoking outcome. CONCLUSIONS Benefits to using relatively modest increases in incentive for online smoking cessation trials include more rapid completion of follow-up questionnaires and reduced manual follow-up. IMPLICATIONS A modest increase in incentive (from £10 to £20) to promote the completion of follow-up questionnaires in online smoking cessation trials may not increase overall response rates but could lead to more rapid data collection, a reduced need for manual follow-up and reduced missing data among those who initiate completing a questionnaire. Such an improvement may help to reduce bias, increase validity and generalizability, and improve statistical power in smoking cessation trials. TRIAL REGISTRATION Host trial ISRCTN12326962, SWAT repository store ID 164.
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Affiliation(s)
- Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Aimie Hope
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
- Addiction Research Group, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Claire West
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
- Addiction Research Group, University of East Anglia, Norwich, UK
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Hung M, Mohajeri A, Almpani K, Carberry G, Wisniewski JF, Janes K, Janes B, Hardy C, Zakeri G, Raymond B, Trinh H, Bretner J, Cheever VJ, Garibyan R, Bachstein P, Licari FW. Successes and Challenges in Clinical Trial Recruitment: The Experience of a New Study Team. Med Sci (Basel) 2024; 12:39. [PMID: 39189202 PMCID: PMC11348161 DOI: 10.3390/medsci12030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
Participant recruitment is one of the most challenging aspects of a clinical trial, directly impacting both the study's duration and the quality of its results. Therefore, reporting successful recruitment strategies is crucial. This study aimed to document the recruitment tactics and experiences of a research team during a university-based randomized clinical trial, conducted as part of a clinical research immersion program. Recruitment took place from October 2021 to October 2022. Before the study commenced, study team members received formal training in clinical trial participant recruitment from the Principal Investigator. The recruitment strategies were integrated into initial study design, which was approved by the Institutional Review Board. A multimodal approach was employed, incorporating both direct and indirect recruitment methods. These strategies successfully met the enrollment target within the twelve-month period. Throughout the process, team members acquired valuable knowledge in recruitment design and implementation, along with transferable interpersonal and networking skills. In-person recruitment was the most efficient and cost-effective strategy, followed by personal referrals. The primary challenge was accommodating participants' availability. Other study teams should consider these recruitment strategies during their study designs. Additionally, the knowledge and skills gained by this study team underscore the value of experiential learning in research education.
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Affiliation(s)
- Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
- Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA
- College of Engineering, University of Utah, Salt Lake City, UT 84108, USA
- Department of Educational Psychology, University of Utah, Salt Lake City, UT 84108, USA
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| | - Amir Mohajeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Konstantinia Almpani
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Gabriel Carberry
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - John F. Wisniewski
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Kade Janes
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Brooklyn Janes
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Chase Hardy
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Golnoush Zakeri
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Ben Raymond
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Heather Trinh
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Jordan Bretner
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Val J. Cheever
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Rafael Garibyan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Perry Bachstein
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Frank W. Licari
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
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Vani MF, Marashi M, O’Loughlin EK, Smith-Turchyn J, Sabiston CM. Resistance Training in Women Diagnosed with Breast Cancer: A Pilot Single Arm Pre-Post Intervention. Cancers (Basel) 2024; 16:2829. [PMID: 39199600 PMCID: PMC11352337 DOI: 10.3390/cancers16162829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
Background: Resistance training (RT) yields physical and psychological benefits for women living with and beyond breast cancer (WBC). This study examined the feasibility of a virtually delivered 8-week socially supportive RT intervention among WBC and assessed changes in physical activity and body image. Methods: A pilot single-arm 8-week pre-post intervention study design was implemented. Forty-one WBC were matched as exercise partners and asked to complete two RT sessions per week-one with a qualified exercise professional (QEP) and one with their peer. Data were collected at baseline (T1), post-intervention (T2), and 20 weeks post-baseline (T3). Results: The enrolment rate was 42%, the attendance rate for the QEP sessions was 63.8% and 40.0% for the peer sessions, and the retention rate was 87%. No adverse events were reported. Total weekly minutes of RT significantly (p < 0.05) increased by 42 minutes/week during the intervention and significantly decreased by 25 min/week at follow-up. Upper and lower body muscle strength increased (p < 0.01) during the intervention. Increased RT was associated with favorable activity self-perceptions. Conclusions: This pilot intervention study was feasible, safe, and demonstrated preliminary evidence for increasing RT time and strength among WBC. Virtually delivered socially supportive RT interventions can improve access for WBC.
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Affiliation(s)
- Madison F. Vani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (M.F.V.); (M.M.); (E.K.O.)
| | - Maryam Marashi
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (M.F.V.); (M.M.); (E.K.O.)
| | - Erin K. O’Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (M.F.V.); (M.M.); (E.K.O.)
- Centre de Recherche du Centre Hospitalier de L’université de Montréal (CRCHUM), Montréal, QC H2X 0A9, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (M.F.V.); (M.M.); (E.K.O.)
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6
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Sibley AL, Noar SM, Muessig KE, O'Shea NG, Paquette CE, Spears AG, Miller WC, Go VF. An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study. JMIR Res Protoc 2024; 13:e59224. [PMID: 39121478 PMCID: PMC11344186 DOI: 10.2196/59224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/27/2024] [Accepted: 06/18/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. OBJECTIVE This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. METHODS We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one's recovery, (3) maintaining one's recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one's substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. RESULTS This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. CONCLUSIONS To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. TRIAL REGISTRATION ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59224.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Nisha G O'Shea
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Catherine E Paquette
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | | | - William C Miller
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
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Scourfield J, Evans R, Pallmann P, Petrou S, Robling M, Au KM, Jones-Williams D, Lugg-Widger F, Meindl M, Schroeder EA, Wood S, Wilkins D. Family group conferencing for children and families: Evaluation of implementation, context and effectiveness (Family VOICE). Study protocol. PLoS One 2024; 19:e0300834. [PMID: 38843190 PMCID: PMC11156304 DOI: 10.1371/journal.pone.0300834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Family group conferences (FGCs) in child welfare bring immediate and wider family members together to decide on the best way to meet a child's needs. Unlike professionally led meetings, the aim is for decisions to be made by or with family members. Qualitative and mixed-method research with FGC participants tends to show positive experiences: most participants feel their voices are heard; FGCs facilitate family-driven solutions and closer relationships-within families and with social workers. Although there is existing literature on FGCs, there is a paucity of robust comparative UK evaluations, i.e., randomised controlled trials or quasi-experimental studies. Comparative studies internationally have focused on a narrow range of outcomes, not recognised the importance of context, and paid little attention to the quality of delivery. Some qualitative studies have considered process and context but there is scant measurement of these. The aims of this study are, firstly, to establish how FGCs improve outcomes for families and what factors vary their quality, and, secondly, to assess longer-term outcomes in terms of service use and associated costs. METHODS Given the importance of process and context, evaluation informed by realist and complex systems approaches is needed. This multi-method evaluation includes a survey of FGC services in all UK local authorities (n = 212) to map service provision; co-design of programme theory and evaluation measures with family members who have experienced an FGC (n = 16-24) and practitioners (n = 16-24) in two sites; a prospective single-arm study of FGC variability and outcomes after six months; and comparison of service use and costs in FGC participants (n≥300 families) and a control group (n≥1000) after two years using a quasi-experiment. DISCUSSION This is a pragmatic evaluation of an existing intervention, to identify what mechanisms and contexts influence effective process and longer-term outcomes. The study is registered with Research Registry (ref. 7432).
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Affiliation(s)
- Jonathan Scourfield
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), United Kingdom
| | - Philip Pallmann
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Kar-Man Au
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Delyth Jones-Williams
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Melissa Meindl
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Elizabeth-Ann Schroeder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sophie Wood
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - David Wilkins
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Baillot A, Asselin M, Bernard P, Lapointe J, Bond DS, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I). Obes Surg 2024; 34:1639-1652. [PMID: 38483742 DOI: 10.1007/s11695-024-07161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. METHODS This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. RESULTS Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. CONCLUSION Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.
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Affiliation(s)
- Aurélie Baillot
- École Interdisciplinaire de Santé, Université du Québec en Outaouais, 283 Boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada.
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services, Sociaux de L'Outaouais, Gatineau, Québec, Canada.
| | | | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Dale S Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, USA
| | - Ahmed Jérôme Romain
- Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - André Tchernof
- Institut Universitaire de Cardiologie et de Pneumologie de Québec et École de Nutrition, Université Laval, Québec, Québec, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec À Chicoutimi, Chicoutimi, Québec, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jennifer Brunet
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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9
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Hu S, Guinan E, Mockler D, O'Neill L. Retention rates and reasons for non-retention in exercise oncology trials in the post-treatment phase-a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01569-4. [PMID: 38570403 DOI: 10.1007/s11764-024-01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Retention is a key marker of trial success. Poor retention can induce bias, reduce statistical power and minimise the validity of trials. This review examined retention rates in exercise trials in cancer survivors, reasons for non-retention and retention strategies utilised. METHODS A systematic review was conducted using a predefined search strategy in EMBASE RCTs, MEDLINE OVID, CINAHL, Web of Science-Core Collection and Cochrane Central Register of Controlled Trials (CENTRAL). The search was conducted on 27/03/2023. Title and abstract screening, full text review and data extraction were completed in duplicate. RESULTS Of 17,524 studies identified, 67 trials involving 6093 participants were included. The median overall retention rate immediately post-intervention was 89.85%, range (52.94-100%) and mean 87.36% (standard deviation 9.89%). Trials involving colorectal cancer survivors only had the highest median retention rate (94.61%), followed by breast (92.74%), prostate (86.00%) and haematological cancers (85.49%). Studies involving mixed cancer cohorts had the lowest retention rate (80.18%). The most common retention strategies were wait-list control groups, regular check-ins/reminders and free exercise equipment. Common reasons for non-retention were lost to follow-up, health problems, personal reasons including family/work commitments and travel burden, and disease progression. CONCLUSIONS Retention rates in exercise oncology trials are approximately 90% immediately post-interventions. Our previous work highlighted variable suboptimal recruitment rates of median 38% (range 0.52-100%). Recruitment rather than retention should be prioritised for methodology research in exercise oncology. IMPLICATIONS FOR CANCER SURVIVORS Optimising the quality of exercise oncology trials is critical to informing high quality survivorship care. PROSPERO registration number: CRD42023421359.
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Affiliation(s)
- S Hu
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, University of Dublin, Dublin 8, Ireland
| | - E Guinan
- Trinity St. James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - D Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - L O'Neill
- Trinity St. James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Wexler RS, Fox DJ, ZuZero D, Bollen M, Parikshak A, Edmond H, Lemau J, Montenegro D, Ramirez J, Kwin S, Thompson AR, Carlson HL, Marshall LM, Kern T, Mist SD, Bradley R, Hanes DA, Zwickey H, Pickworth CK. Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial. Pain Rep 2024; 9:e1132. [PMID: 38500566 PMCID: PMC10948133 DOI: 10.1097/pr9.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/04/2023] [Accepted: 11/23/2023] [Indexed: 03/20/2024] Open
Abstract
Introduction Lumbosacral radiculopathy (LR), also known as sciatica, is a common type of radiating neurologic pain involving burning, tingling, and numbness in the lower extremities. It has an estimated lifetime prevalence as high as 43%. Objectives The objective of this randomized controlled trial was to evaluate the impact of virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) on patients with LR during the COVID-19 pandemic. Methods Potentially eligible patients were identified using electronic health record queries and phone screenings. Participants were then randomized to MORE or treatment-as-usual (TAU) for 8 weeks, with pain intensity assessed daily. At baseline and follow-up visits, participants completed questionnaires assessing the primary outcome, disability, as well as quality of life, depression, mindful reinterpretation of pain, and trait mindfulness. Results In our study, patients undergoing virtual delivery of MORE had greater improvements in daily pain intensity (P = 0.002) but not in disability (P = 0.09), depression (P = 0.26), or quality of life (P = 0.99 and P = 0.89, SF-12 physical and mental component scores, respectively), relative to TAU patients. In addition, patients in MORE experienced significantly greater increases in mindful reinterpretation of pain (P = 0.029) and trait mindfulness (P = 0.035). Conclusion Among patients with lumbar radiculopathy, MORE significantly reduced daily pain intensity but did not decrease disability or depression symptoms. Given the long duration of symptoms in our sample, we hypothesize the discrepancy between changes in daily pain intensity and disability is due to fear avoidance behaviors common in patients with chronic pain. As the first trial of a mindfulness intervention in patients with LR, these findings should inform future integrative approaches to LR treatment, particularly when considering the increasing use of virtual interventions throughout the COVID-19 pandemic.
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Affiliation(s)
- Ryan S. Wexler
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Center for Research and Training, Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Devon J. Fox
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Danielle ZuZero
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Melissa Bollen
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Anand Parikshak
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Hannah Edmond
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Johnny Lemau
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Diane Montenegro
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Jillian Ramirez
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Sophia Kwin
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Austin R. Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Hans L. Carlson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Lynn M. Marshall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Kern
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Scott D. Mist
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Douglas A. Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Heather Zwickey
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Courtney K. Pickworth
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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Dunn A, Alvarez J, Arbon A, Bremner S, Elsby-Pearson C, Emsley R, Jones C, Lawrence P, Lester KJ, Morson N, Perry N, Simner J, Thomson A, Cartwright-Hatton S. Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: An embedded randomized controlled trial. Contemp Clin Trials Commun 2024; 38:101267. [PMID: 38419810 PMCID: PMC10899055 DOI: 10.1016/j.conctc.2024.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Background The use of a second informant (co-respondent) is a common method of identifying potential bias in outcome data (e.g., parent-report child outcomes). There is, however, limited evidence regarding methods of increasing response rates from co-respondents. The use of financial incentives is associated with higher levels of engagement and follow-up data collection in online surveys. This study investigated whether financial incentives paid to index participants in an online trial of a parenting-focused intervention, would lead to higher levels of co-respondent data collection. Methods A study within a trial (SWAT) using a parallel group RCT design. Participants in the host study (an RCT of an online intervention) were randomised into one of two SWAT arms: received/did not receive a £15 voucher when referred co-respondent completed baseline measures. Primary outcome was completion (No/Yes) of Spence Children's Anxiety Scale (SCAS or SCAS-Pre) at baseline. Additional analysis explored impact of incentives on data quality. Results Intention to treat analysis of 899 parents (183 co-respondents) in the no-incentive arm, and 911 parents (199 co-respondents) in incentive arm. Nomination of co-respondents was similar between incentive arms. The RR for the incentive arm compared to the no incentive arm was 1.13 (95% CI: 0.91 to 1.41, p = 0.264) indicating that incentives did not impact completion of outcomes by consented co-respondents. There were no indications of different data quality between arms. Discussion The finding that payment of financial incentives to index participant does not lead to greater levels of co-respondent outcome completion suggests that careful consideration should be made before allocating resources in this way in future trials. Trial registration The host study was registered at Study Record | ClinicalTrials.gov and the SWAT study was registered in the SWAT Store | The Northern Ireland Network for Trials Methodology Research (qub.ac.uk): SWAT number 143: Filetoupload,1099612,en.pdf (qub.ac.uk).
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Affiliation(s)
- Abby Dunn
- University of Sussex, Falmer, United Kingdom
| | | | - Amy Arbon
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | | | | | | | | | | | - Nicky Perry
- Brighton and Sussex Medical School, Brighton, United Kingdom
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12
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Long C, Williams AO, McGovern AM, Jacobsen CM, Hargens LM, Duval S, Jaff MR. Diversity in randomized clinical trials for peripheral artery disease: a systematic review. Int J Equity Health 2024; 23:29. [PMID: 38350973 PMCID: PMC10865563 DOI: 10.1186/s12939-024-02104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Significant race and sex disparities exist in the prevalence, diagnosis, and outcomes of peripheral artery disease (PAD). However, clinical trials evaluating treatments for PAD often lack representative patient populations. This systematic review aims to summarize the demographic representation and enrollment strategies in clinical trials of lower-extremity endovascular interventions for PAD. METHODS Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched multiple sources (Medline, EMBASE, Cochrane, Clinicaltrials.gov, WHO clinical trial registry) for randomized controlled trials (RCTs), RCT protocols, and peer-reviewed journal publications of RCTs conducted between January 2012 and December 2022. Descriptive analysis was used to summarize trial characteristics, publication or study protocol characteristics, and the reporting of demographic characteristics. Meta-regression was used to explore associations between demographic characteristics and certain trial characteristics. RESULTS A total of 2,374 records were identified. Of these, 59 met the inclusion criteria, consisting of 35 trials, 14 publications, and 10 protocols. Information regarding demographic representation was frequently missing. While all 14 trial publications reported age and sex, only 4 reported race/ethnicity, and none reported socioeconomic or marital status. Additionally, only 4 publications reported clinical outcomes by demographic characteristics. Meta-regression analysis revealed that 6% more women were enrolled in non-European trials (36%) than in European trials (30%). CONCLUSIONS The findings of this review highlight potential issues that may compromise the reliability and external validity of study findings in lower-extremity PAD RCTs when applied to the real-world population. Addressing these issues is crucial to enhance the generalizability and impact of clinical trial results in the field of PAD, ultimately leading to improved clinical outcomes for patients in underrepresented populations. REGISTRATION The systematic review methodology was published in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022378304).
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Affiliation(s)
- Chandler Long
- Duke Vascular and Endovascular Surgery, Duke University Medical Center, Duke University, Durham, NC, 27707, USA
| | - Abimbola O Williams
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA.
| | - Alysha M McGovern
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Caroline M Jacobsen
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Liesl M Hargens
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
| | - Sue Duval
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Michael R Jaff
- Health Economics & Market Access, Boston Scientific, Marlborough, MA, 01752, USA
- Peripheral Interventions, Boston Scientific, Maple Grove, MN, 55133, USA
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13
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Wyant K, Moshontz H, Ward SB, Fronk GE, Curtin JJ. Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study. JMIR Mhealth Uhealth 2023; 11:e41833. [PMID: 37639300 PMCID: PMC10495858 DOI: 10.2196/41833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/14/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. OBJECTIVE We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. METHODS Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants' choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. RESULTS Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). CONCLUSIONS These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement.
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Affiliation(s)
- Kendra Wyant
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Hannah Moshontz
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Stephanie B Ward
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Gaylen E Fronk
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - John J Curtin
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
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14
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Gaunt DM, Papastavrou Brooks C, Pedder H, Crawley E, Horwood J, Metcalfe C. Participant retention in paediatric randomised controlled trials published in six major journals 2015-2019: systematic review and meta-analysis. Trials 2023; 24:403. [PMID: 37316945 DOI: 10.1186/s13063-023-07333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The factors which influence participant retention in paediatric randomised controlled trials are under-researched. Retention may be more challenging due to child developmental stages, involving additional participants, and proxy-reporting of outcomes. This systematic review and meta-analysis explores the factors which may influence retention in paediatric trials. METHODS Using the MEDLINE database, paediatric randomised controlled trials published between 2015 and 2019 were identified from six general and specialist high-impact factor medical journals. The review outcome was participant retention for each reviewed trial's primary outcome. Context (e.g. population, disease) and design (e.g. length of trial) factors were extracted. Retention was examined for each context and design factor in turn, with evidence for an association being determined by a univariate random-effects meta-regression analysis. RESULTS Ninety-four trials were included, and the median total retention was 0.92 (inter-quartile range 0.83 to 0.98). Higher estimates of retention were seen for trials with five or more follow-up assessments before the primary outcome, those less than 6 months between randomisation and primary outcome, and those that used an inactive data collection method. Trials involving children aged 11 and over had the higher estimated retention compared with those involving younger children. Those trials which did not involve other participants also had higher retention, than those where they were involved. There was also evidence that a trial which used an active or placebo control treatment had higher estimated retention, than treatment-as-usual. Retention increased if at least one engagement method was used. Unlike reviews of trials including all ages of participants, we did not find any association between retention and the number of treatment groups, size of trial, or type of treatment. CONCLUSIONS Published paediatric RCTs rarely report the use of specific modifiable factors that improve retention. Including multiple, regular follow-ups with participants before the primary outcome may reduce attrition. Retention may be highest when the primary outcome is collected up to 6 months after a participant is recruited. Our findings suggest that qualitative research into improving retention when trials involve multiple participants such as young people, and their caregivers or teachers would be worthwhile. Those designing paediatric trials also need to consider the use of appropriate engagement methods. RESEARCH ON RESEARCH (ROR) REGISTRY: https://ror-hub.org/study/2561.
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Affiliation(s)
- Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Cat Papastavrou Brooks
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- NIHR Applied Research Collaboration West, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
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15
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Corcoran L, Friedenreich CM, McNeely ML, Culos-Reed NS, Bell G, Dickau L, Courneya KS, Vallance JK. A qualitative study examining newly diagnosed breast cancer patients' experiences of participating in the Alberta Moving Beyond Breast Cancer (AMBER) prospective cohort study. BMC Cancer 2023; 23:500. [PMID: 37268901 DOI: 10.1186/s12885-023-10967-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Decisions to participate in cancer trials are associated with uncertainty, distress, wanting to help find a cure, the hope for benefit, and altruism. There is a gap in the literature regarding research examining participation in prospective cohort studies. The aim of this study was to examine the experiences of newly diagnosed women with breast cancer participating in the AMBER Study to identify potential strategies to support patients' recruitment, retention, and motivation. METHODS Newly diagnosed breast cancer patients were recruited from the Alberta Moving Beyond Breast Cancer (AMBER) cohort study. Data were collected using semi-structured conversational interviews with 21 participants from February to May 2020. Transcripts were imported into NVivo software for management, organization, and coding. Inductive content analysis was undertaken. RESULTS Five main concepts associated with recruitment, retention, and motivation to participate were identified. These main concepts included: (1) personal interest in exercise and nutrition; (2) investment in individual results; (3) personal and professional interest in research; (4) burden of assessments; (5) importance of research staff. CONCLUSIONS Breast cancer survivors participating in this prospective cohort study had numerous reasons for participating and these reasons could be considered in future studies to enhance participant recruitment and retention. Improving recruitment and retention in prospective cancer cohort studies could result in more valid and generalizable study findings that could improve the care of cancer survivors.
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Affiliation(s)
- Lynn Corcoran
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | - Gordon Bell
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada.
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Participant Recruitment Issues in Child and Adolescent Psychiatry Clinical Trials with a Focus on Prevention Programs: A Meta-Analytic Review of the Literature. J Clin Med 2023; 12:jcm12062307. [PMID: 36983307 PMCID: PMC10055793 DOI: 10.3390/jcm12062307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: There is a strong need to conduct rigorous and robust trials for children and adolescents in mental health settings. One of the main barriers to meeting this requirement is the poor recruitment rate. Effective recruitment strategies are crucial for the success of a clinical trial, and therefore, we reviewed recruitment strategies in clinical trials on children and adolescents in mental health with a focus on prevention programs. Methods: We reviewed the literature by searching PubMed/Medline, the Cochrane Library database, and Web of Science through December 2022 as well as the reference lists of relevant articles. We included only studies describing recruitment strategies for pediatric clinical trials in mental health settings and extracted data on recruitment and completion rates. Results: The search yielded 13 studies that enrolled a total of 14,452 participants. Overall, studies mainly used social networks or clinical settings to recruit participants. Half of the studies used only one recruitment method. Using multiple recruitment methods (56.6%, 95%CI: 24.5–86.0) resulted in higher recruitment. The use of monetary incentives (47.0%, 95%CI: 24.6–70.0) enhanced the recruitment rate but not significantly (32.6%, 95%CI: 15.7–52.1). All types of recruitment methods showed high completion rates (82.9%, 95%CI: 61.7–97.5) even though prevention programs showed the smallest recruitment rate (76.1%, 95%CI: 50.9–94.4). Conclusions: Pediatric mental health clinical trials face many difficulties in recruitment. We found that these trials could benefit from faster and more efficient recruitment of participants when more than one method is implemented. Social networks can be helpful where ethically possible. We hope the description of these strategies will help foster innovation in recruitment for pediatric studies in mental health.
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Laterza R, Del Bianco D, Velea R, Ferrari O, De Sabbata L, Benedetti E. Towards the engagement of citizens in SOSTs decision-making: participatory models setting a common ground for border surveillance and respect of fundamental rights. Findings from ARESIBO H2020 project. OPEN RESEARCH EUROPE 2023; 3:15. [PMID: 39211898 PMCID: PMC11358682 DOI: 10.12688/openreseurope.15079.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 09/04/2024]
Abstract
ARESIBO is an H2020 project aiming to improve the efficiency of border surveillance systems by providing the operational teams, as well as the tactical command and control level with accurate and comprehensive information related to border control by different perspectives. Human Rights Groups' (HRGs) and Civil Society Organisations' (CSOs) involvement and participation in decision making related Surveillance-Oriented Security Technologies (SOSTs) for border surveillance is considered as a key-factor to ensure the coexistence of two only apparently opposite needs: security and respect of fundamental rights (i.e., privacy, refugees etc.). Starting from this general approach, the paper represents the second part of a research diptych dedicated to present the main achievements and methods proposed by ARESIBO to enhance participation in border surveillance. It outlines the ARESIBO Participatory Model (APM) as a tool to improve HRGs, CSOs, and ultimately citizens' involvement related to border surveillance in general and the adoption of specific SOSTs for borders' control. The first part of the paper introduces some key elements included in the ARESIBO desk research that led to the elaboration of the APM (i.e., literature review, semantic analysis), describing who were the targets of that approach (i.e., stakeholders, end-users, actors). After a contextualization on the three interlaced dimensions of surveillance, security and privacy related borders' control, the paper presents the three components of the methodological framework within which this citizens' involvement process has been developed (i.e., ARESIBO Participation Framework, ARESIBO Participation Strategy, ARESIBO Participation Action Plan). In the conclusions, by outlining the first partial application of the model within the ARESIBO framework, the paper argues that APM can represent a pilot for a more structured and duplicable participatory model, also through additional research regarding participatory models applied to SOSTs development processes.
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Affiliation(s)
- Riccardo Laterza
- Institute of International Sociology of Gorizia – ISIG, Gorizia, 34170, Italy
| | - Daniele Del Bianco
- Institute of International Sociology of Gorizia – ISIG, Gorizia, 34170, Italy
| | - Ramona Velea
- Institute of International Sociology of Gorizia – ISIG, Gorizia, 34170, Italy
| | - Olivia Ferrari
- Institute of International Sociology of Gorizia – ISIG, Gorizia, 34170, Italy
| | - Lorenzo De Sabbata
- Institute of International Sociology of Gorizia – ISIG, Gorizia, 34170, Italy
| | - Ezio Benedetti
- Department of Social and Political Sciences, University of Trieste, Trieste, 34127, Italy
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Kraft SA, Rohrig A, Williams A, Shah SK. Better recognition for research participants: what society should learn from covid-19. BMJ 2023; 380:e071178. [PMID: 36649969 PMCID: PMC11200266 DOI: 10.1136/bmj-2022-071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Abie Rohrig
- Department of Philosophy, Swarthmore College, Swarthmore, Pennsylvania, USA
- Research Ethics Team, 1Day Sooner, Delaware, USA
| | - Anthony Williams
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA States
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Jong ST, Stevenson R, Winpenny EM, Corder K, van Sluijs EMF. Recruitment and retention into longitudinal health research from an adolescent perspective: a qualitative study. BMC Med Res Methodol 2023; 23:16. [PMID: 36647003 PMCID: PMC9841671 DOI: 10.1186/s12874-022-01802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND High quality longitudinal studies investigating changes in health behaviours over the transition into early adulthood are critical. However, recruiting and retaining adolescents is challenging. This study explored adolescents' perspectives of signing up to and continuing involvement in a hypothetical longitudinal health research study. METHODS Forty-eight individuals (15-20y) participated in nine in-person focus groups about recruitment and retention in research. Participants were (a) school students in the last year of compulsory school (Year 11, 15-16y), (b) school/college students in Sixth Form (Year 13, 17-18y), (c) Further Education students studying after secondary education, but not higher education (16-18y) and (d) young adults not in education, employment, or training (18-20y) across England. Thematic analysis resulted in seven themes. RESULTS Driving factors for sign-up included social connection e.g., joining with peer groups, personalised feedback, and incentives, primarily financial. Key barriers were lack of interest, the perception of commitment, and timing of recruitment. Young people preferred recruitment processes via social media with messages tailored to their motivations, monthly data collection of maximally 20-30 min, and hybrid data collection with some in-person contact with a consistent, non-judgemental researcher. The provision of autonomy, choice, and financial incentives were perceived to promote retention. CONCLUSIONS Adolescent recruitment and retention strategies need to align with contemporary interests and motivations. Studies should involve adolescents early to develop a planned, systematic approach to participant sign-up and follow-up. Effective and ineffective recruitment and retention strategies should be reported as part of study findings. Future research should trial how perceived barriers to study engagement can be overcome.
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Affiliation(s)
- Stephanie T. Jong
- grid.470900.a0000 0004 0369 9638UKCRC Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, United Kingdom ,grid.8273.e0000 0001 1092 7967School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Rebecca Stevenson
- grid.470900.a0000 0004 0369 9638UKCRC Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, United Kingdom
| | - Eleanor M. Winpenny
- grid.470900.a0000 0004 0369 9638UKCRC Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, United Kingdom
| | - Kirsten Corder
- grid.470900.a0000 0004 0369 9638UKCRC Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, United Kingdom
| | - Esther M. F. van Sluijs
- grid.470900.a0000 0004 0369 9638UKCRC Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, United Kingdom
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Lander J, Heiberger A, Von Sommoggy J, Schulz AA, Dresch C, Altawil H, Schmitt G, Wirtz MA. Intentional and actional components of engaged participation in public health research studies: qualitative synthesis of a recruitment and retention process into the theory-informed INTACT-RS framework. BMC Med Res Methodol 2023; 23:17. [PMID: 36647023 PMCID: PMC9841138 DOI: 10.1186/s12874-023-01838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ensuring motivated and successful study participation is a key challenge in the design and conduct of health research studies. Previously, recruitment barriers and facilitators have been identified mainly from experience, and rarely based on theoretical approaches. We developed a framework of intentional and actional components of engaged participation in public health research studies (INTACT-RS), informed by psychological behavioral models. We aimed a) to identify precise indicators for each framework component and b) to better understand which components and decision processes are essential for study participants. METHODS Within a multicenter research network, we applied various approaches to recruit parents of newborns, pediatricians, and midwives. All recruitment processes were documented from the perspective of both participants and researchers. We used different qualitative and quantitative data material, which we applied in a multistage process according to the basic principles of qualitative content analysis. RESULTS INTACT-RS encompasses pre-intentional, intentional and actional phases with a total of n = 15 components covering all aspects of an individual's involvement with a research study. During intention formation, an understanding of efforts and benefits, why participation is valuable beyond contributing to research, and how others perceive the study, were particularly important to (potential) participants. Subsequently (intentional phase), participants consider how and when participation is compatible with their own resources, ability and availability, and hence seek for close communication with, and flexibility and support from the research team. During and after (initial) participation (actional phase), participants' assessment of whether expectations and interests have been met impact crucial further steps, especially the willingness to continue and to recommend participation to others. A strong topic-wise and or supportive participation interest as well as active, continuous exchange with the researchers appeared to be central determinants of study completion and data validity. CONCLUSIONS A theoretical framework is now available to plan and conduct recruitment of different target groups, which accounts for essential motivational and volitional decision-making processes. Based on empirically specified constructs, possible barriers can be addressed even before the initial recruitment process. Therefore, recommendations for scientific practice have been formulated.
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Affiliation(s)
- Jonas Lander
- grid.10423.340000 0000 9529 9877Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andrea Heiberger
- grid.461778.b0000 0000 9752 9146Research Methods in Health Sciences, Faculty for Mathematics, Natural Sciences and Technology, University of Education Freiburg, Freiburg, Germany
| | - Julia Von Sommoggy
- grid.7727.50000 0001 2190 5763Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Anja Alexandra Schulz
- grid.461778.b0000 0000 9752 9146Research Methods in Health Sciences, Faculty for Mathematics, Natural Sciences and Technology, University of Education Freiburg, Freiburg, Germany
| | - Carolin Dresch
- grid.461778.b0000 0000 9752 9146Research Methods in Health Sciences, Faculty for Mathematics, Natural Sciences and Technology, University of Education Freiburg, Freiburg, Germany
| | - Hala Altawil
- grid.10423.340000 0000 9529 9877Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gwendolyn Schmitt
- grid.461778.b0000 0000 9752 9146Public Health & Health Education, Faculty for Mathematics, Natural Sciences and Technology, University of Education Freiburg, Freiburg, Germany
| | - Markus Antonius Wirtz
- grid.461778.b0000 0000 9752 9146Research Methods in Health Sciences, Faculty for Mathematics, Natural Sciences and Technology, University of Education Freiburg, Freiburg, Germany
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21
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Litterbach EK, Laws R, Zheng M, Campbell KJ, Spence AC. "That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children. Appetite 2023; 180:106377. [PMID: 36410562 DOI: 10.1016/j.appet.2022.106377] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children. METHODS Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm. RESULTS Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations. CONCLUSIONS This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.
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Affiliation(s)
- Eloise-Kate Litterbach
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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22
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Griffith Fillipo IR, Pullmann MD, Hull TD, Zech J, Wu J, Litvin B, Chen S, Arean PA. Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types. Front Digit Health 2022; 4:963741. [PMID: 36148211 PMCID: PMC9485564 DOI: 10.3389/fdgth.2022.963741] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Numerous studies have found that long term retention is very low in remote clinical studies (>4 weeks) and to date there is limited information on the best methods to ensure retention. The ability to retain participants in the completion of key assessments periods is critical to all clinical research, and to date little is known as to what methods are best to encourage participant retention. To study incentive-based retention methods we randomized 215 US adults (18+ years) who agreed to participate in a sequential, multiple assignment randomized trial to either high monetary incentive (HMI, $125 USD) and combined low monetary incentive ($75 USD) plus alternative incentive (LMAI). Participants were asked to complete daily and weekly surveys for a total of 12 weeks, which included a tailoring assessment around week 5 to determine who should be stepped up and rerandomized to one of two augmentation conditions. Key assessment points were weeks 5 and 12. There was no difference in participant retention at week 5 (tailoring event), with approximately 75% of the sample completing the week-5 survey. By week 10, the HMI condition retained approximately 70% of the sample, compared to 60% of the LMAI group. By week 12, all differences were attenuated. Differences in completed measures were not significant between groups. At the end of the study, participants were asked the impressions of the incentive condition they were assigned and asked for suggestions for improving engagement. There were no significant differences between conditions on ratings of the fairness of compensation, study satisfaction, or study burden, but study burden, intrinsic motivation and incentive fairness did influence participation. Men were also more likely to drop out of the study than women. Qualitative analysis from both groups found the following engagement suggestions: desire for feedback on survey responses and an interest in automated sharing of individual survey responses with study therapists to assist in treatment. Participants in the LMAI arm indicated that the alternative incentives were engaging and motivating. In sum, while we were able to increase engagement above what is typical for such study, more research is needed to truly improve long term retention in remote trials.
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Affiliation(s)
- Isabell R. Griffith Fillipo
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- University of Washington SMART Center, Seattle, WA, United States
| | - Thomas D. Hull
- Research and Development, Talkspace, New York, NY, United States
| | - James Zech
- Research and Development, Talkspace, New York, NY, United States
| | - Jerilyn Wu
- Research and Development, Talkspace, New York, NY, United States
| | - Boris Litvin
- Research and Development, Talkspace, New York, NY, United States
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
| | - Patricia A. Arean
- Department of Psychiatry and Behavioral Sciences, CREATIV Lab, University of Washington, Seattle, WA, United States
- Correspondence: Patricia A. Areán
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23
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Oetzmann C, White KM, Ivan A, Julie J, Leightley D, Lavelle G, Lamers F, Siddi S, Annas P, Garcia SA, Haro JM, Mohr DC, Penninx BWJH, Simblett SK, Wykes T, Narayan VA, Hotopf M, Matcham F. Lessons learned from recruiting into a longitudinal remote measurement study in major depressive disorder. NPJ Digit Med 2022; 5:133. [PMID: 36057688 PMCID: PMC9440458 DOI: 10.1038/s41746-022-00680-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
The use of remote measurement technologies (RMTs) across mobile health (mHealth) studies is becoming popular, given their potential for providing rich data on symptom change and indicators of future state in recurrent conditions such as major depressive disorder (MDD). Understanding recruitment into RMT research is fundamental for improving historically small sample sizes, reducing loss of statistical power, and ultimately producing results worthy of clinical implementation. There is a need for the standardisation of best practices for successful recruitment into RMT research. The current paper reviews lessons learned from recruitment into the Remote Assessment of Disease and Relapse- Major Depressive Disorder (RADAR-MDD) study, a large-scale, multi-site prospective cohort study using RMT to explore the clinical course of people with depression across the UK, the Netherlands, and Spain. More specifically, the paper reflects on key experiences from the UK site and consolidates these into four key recruitment strategies, alongside a review of barriers to recruitment. Finally, the strategies and barriers outlined are combined into a model of lessons learned. This work provides a foundation for future RMT study design, recruitment and evaluation.
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Affiliation(s)
- Carolin Oetzmann
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Katie M White
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Alina Ivan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Julie
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Leightley
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Grace Lavelle
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Femke Lamers
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sara Siddi
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | | | - Sara Arranz Garcia
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sara K Simblett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Falmer, East Sussex, UK
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24
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Różyńska J. The ethical anatomy of payment for research participants. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:449-464. [PMID: 35610403 PMCID: PMC9427899 DOI: 10.1007/s11019-022-10092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
In contrast to most publications on the ethics of paying research subjects, which start by identifying and analyzing major ethical concerns raised by the practice (in particular, risks of undue inducement and exploitation) and end with a set of-more or less well-justified-ethical recommendations for using payment schemes immune to these problems, this paper offers a systematic, principle-based ethical analysis of the practice. It argues that researchers have a prima facie moral obligation to offer payment to research subjects, which stems from the principle of social beneficence. This principle constitutes an ethical "spine" of the practice. Other ethical principles of research ethics (respect for autonomy, individual beneficence, and justice/fairness) make up an ethical "skeleton" of morally sound payment schemes by providing additional moral reasons for offering participants (1) recompense for reasonable expenses; and (2a) remuneration conceptualized as a reward for their valuable contribution, provided (i) it meets standards of equality, adequacy and non-exploitation, and (ii) it is not overly attractive (i.e., it does not constitute undue inducement for participation or retention, and does not encourage deceptive behaviors); or (2b) remuneration conceptualized as a market-driven price, provided (i) it is necessary and designed to help the study achieve its social and scientific goals, (ii) it does not reinforce wider social injustices and inequalities; (iii) it meets the requirement of non-exploitation; and (iv) it is not overly attractive. The principle of justice provides a strong ethical reason for not offering recompenses for lost wages (or loss of other reasonably expected profits).
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Affiliation(s)
- Joanna Różyńska
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Krakowskie Przedmiescie 3, 00-047, Warsaw, Poland.
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25
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Clinical Trials in Pancreatitis: Opportunities and Challenges in the Design and Conduct of Patient-Focused Clinical Trials in Recurrent Acute and Chronic Pancreatitis: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2022; 51:715-722. [PMID: 36395394 PMCID: PMC9697224 DOI: 10.1097/mpa.0000000000002105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT Recurrent acute pancreatitis and chronic pancreatitis represent high morbidity diseases, which are frequently associated with chronic abdominal pain, pancreatic insufficiencies, and reduced quality of life. Currently, there are no therapies to reverse or delay disease progression, and clinical trials are needed to investigate potential interventions that would address this important gap. This conference report provides details regarding information shared during a National Institute of Diabetes and Digestive and Kidney Diseases-sponsored workshop on Clinical Trials in Pancreatitis that sought to clearly delineate the current gaps and opportunities related to the design and conduct of patient-focused trials in recurrent acute pancreatitis and chronic pancreatitis. Key stakeholders including representatives from patient advocacy organizations, physician investigators (including clinical trialists), the US Food and Drug Administration, and the National Institutes of Health convened to discuss challenges and opportunities with particular emphasis on lessons learned from trials in participants with other painful conditions, as well as the value of incorporating the patient perspective throughout all stages of trials.
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26
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Testing a Pediatric Palliative Care Education Workplace Intervention. J Hosp Palliat Nurs 2022; 24:E166-E171. [PMID: 35470315 DOI: 10.1097/njh.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric palliative care is aimed at pain and symptom management, reducing hospitalization, promoting psychosocial care, and improving quality of life for children with serious illness. As a professional caregiver, nurses play an essential role in the provision of appropriate pediatric palliative care in clinical care settings. The purpose of this quality improvement study was to improve pediatric nurses' awareness and perceptions of palliative care. A 1-group pretest-posttest design was used in the study. A 20-minute education video was used as an intervention to enhance nurses' awareness and perception about pediatric palliative care. Twenty-one pediatric medical-surgical nurses participated in the intervention. Posttest results indicated raised awareness about palliative care, more nurses were able to define palliative care correctly, and nurses were more likely to encourage a palliative care consult. Future studies are needed using larger sample sizes with robust measures to further evaluate the effectiveness of the intervention on enhancing pediatric palliative care awareness among nurses.
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Tecson KM, Kluger AY, Cassidy-Bushrow AE, Liu B, Coleman CM, Jones LK, Jefferson CR, VanWormer JJ, McCullough PA. Usefulness of Statins as Secondary Prevention Against Recurrent and Terminal Major Adverse Cardiovascular Events. Am J Cardiol 2022; 176:37-42. [PMID: 35606173 DOI: 10.1016/j.amjcard.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/01/2022]
Abstract
Clinical guidelines recommend statins for patients with atherosclerotic cardiovascular disease (ASCVD), but many remain untreated. The goal of this study was to assess the impact of statin use on recurrent major adverse cardiovascular events (MACE). This study used medical records and insurance claims from 4 health care systems in the United States. Eligible adults who survived an ASCVD hospitalization from September 2013 to September 2014 were followed for 1 year. A multivariable extended Cox model examined the outcome of time-to-first MACE, then a multivariable joint marginal model investigated the association between post-index statin use and nonfatal and fatal MACE. There were 8,168 subjects in this study; 3,866 filled a statin prescription ≤90 days before the index ASCVD event (47.33%) and 4,152 filled a statin prescription after the index ASCVD event (50.83%). These post-index statin users were younger, with more co-morbidities. There were 763 events (315/763, 41.3% terminal) experienced by 686 (8.4%) patients. The adjusted overall MACE risk reduction was 18% (HR 0.82, 95% CI 0.70 to 0.95, p = 0.007) and was more substantial in the first 180 days (HR 0.72, 95% CI 0.60 to 0.86, p <0.001). There was a nonsignificant 19% reduction in the number of nonfatal MACE (rate ratio 0.81, 95% CI 0.49 to 1.32, p = 0.394) and a 65% reduction in the risk of all-cause death (HR 0.35, 95% CI 0.22 to 0.56, p <0.001). In conclusion, we found a modest increase in statin use after an ASCVD event, with nearly half of the patients untreated. The primary benefit of statin use was protection against early death. Statin use had the greatest impact in the first 6 months after an ASCVD event; therefore, it is crucial for patients to quickly adhere to this therapy.
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Affiliation(s)
- Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas.
| | - Aaron Y Kluger
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Bin Liu
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Chad M Coleman
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania
| | - Celeena R Jefferson
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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28
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Macaulay L, O'Dolan C, Avenell A, Carroll P, Cotton S, Dombrowski S, Elders A, Goulao B, Gray C, Harris FM, Hunt K, Kee F, MacLennan G, McDonald MD, McKinley M, Skinner R, Torrens C, Tod M, Turner K, van der Pol M, Hoddinott P. Effectiveness and cost-effectiveness of text messages with or without endowment incentives for weight management in men with obesity (Game of Stones): study protocol for a randomised controlled trial. Trials 2022; 23:582. [PMID: 35869503 PMCID: PMC9306253 DOI: 10.1186/s13063-022-06504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity increases the risk of type 2 diabetes, heart disease, stroke, mobility problems and some cancers, and its prevalence is rising. Men engage less than women in existing weight loss interventions. Game of Stones builds on a successful feasibility study and aims to find out if automated text messages with or without endowment incentives are effective and cost-effective for weight loss at 12 months compared to a waiting list comparator arm in men with obesity. METHODS A 3-arm, parallel group, assessor-blind superiority randomised controlled trial with process evaluation will recruit 585 adult men with body mass index of 30 kg/m2 or more living in and around three UK centres (Belfast, Bristol, Glasgow), purposively targeting disadvantaged areas. Intervention groups: (i) automated, theory-informed text messages daily for 12 months plus endowment incentives linked to verified weight loss targets at 3, 6 and 12 months; (ii) the same text messages and weight loss assessment protocol; (iii) comparator group: 12 month waiting list, then text messages for 3 months. The primary outcome is percentage weight change at 12 months from baseline. Secondary outcomes at 12 months are as follows: quality of life, wellbeing, mental health, weight stigma, behaviours, satisfaction and confidence. Follow-up includes weight at 24 months. A health economic evaluation will measure cost-effectiveness over the trial and over modelled lifetime: including health service resource-use and quality-adjusted life years. The cost-utility analysis will report incremental cost per quality-adjusted life years gained. Participant and service provider perspectives will be explored via telephone interviews, and exploratory mixed methods process evaluation analyses will focus on mental health, multiple long-term conditions, health inequalities and implementation strategies. DISCUSSION The trial will report whether text messages (with and without cash incentives) can help men to lose weight over 1 year and maintain this for another year compared to a comparator group; the costs and benefits to the health service; and men's experiences of the interventions. Process analyses with public involvement and service commissioner input will ensure that this open-source digital self-care intervention could be sustainable and scalable by a range of NHS or public services. TRIAL REGISTRATION ISRCTN 91974895 . Registered on 14/04/2021.
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Affiliation(s)
- Lisa Macaulay
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK.
| | - Catriona O'Dolan
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Alison Avenell
- Health Services Research Unit, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paula Carroll
- Department Sport & Exercise Science, Waterford Institute of Technology, Main Campus Cork RoadCo. Waterford, Waterford City, Ireland
| | - Seonaidh Cotton
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Stephan Dombrowski
- Faculty of Kinesiology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, G4 0BA, Glasgow, UK
| | - Beatriz Goulao
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS, UK
| | - Fiona M Harris
- School of Health & Life Sciences, University of the West of Scotland, High Street, Paisley, Renfrewshire, PA1 2BE, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, Pathfoot Building, University of Stirling, Stirling, FK9 4LA, UK
| | - Frank Kee
- Centre for Public Health, UKCRC Centre of Excellence for Public Health Research (NI), Institute Clinical Sciences A, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
| | - Graeme MacLennan
- CHaRT, HRSU, 3Rd Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Michelle McKinley
- Queen's University Belfast, University Road, Belfast, BT7 1NN, Northern Ireland
| | | | - Claire Torrens
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Martin Tod
- Men's Health Forum, 49-51 East Rd, Hoxton, London, N1 6AH, UK
| | - Katrina Turner
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Pat Hoddinott
- NMAHP Research Unit, Stirling University, Pathfoot Building, Stirling, FK9 4LA, UK
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Porras-Segovia A, Díaz-Oliván I, Barrigón ML, Moreno M, Artés-Rodríguez A, Pérez-Rodríguez MM, Baca-García E. Real-world feasibility and acceptability of real-time suicide risk monitoring via smartphones: A 6-month follow-up cohort. J Psychiatr Res 2022; 149:145-154. [PMID: 35276631 DOI: 10.1016/j.jpsychires.2022.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022]
Abstract
Active and passive Ecological Momentary Assessment of suicide risk is crucial for suicide prevention. We aimed to assess the feasibility and acceptability of active and passive smartphone-based EMA in real-world conditions in patients at high risk for suicide. We followed 393 patients at high risk for suicide for six months using two mobile health applications: the MEmind (active) and the eB2 (passive). Retention with active EMA was 79.3% after 1 month and 22.6% after 6 months. Retention with passive EMA was 87.8% after 1 month and 46.6% after 6 months. Satisfaction with the MEmind app, uninstalling the eB2 app and diagnosis of eating disorders were independently associated with stopping active EMA. Satisfaction with the eB2 app and uninstalling the MEmind app were independently associated with stopping passive EMA. Smartphone-based active and passive EMA are feasible and may increase accessibility to mental healthcare.
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Affiliation(s)
- Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Maria Luisa Barrigón
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Artés-Rodríguez
- Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Rey Juan Carlos, Móstoles, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBERSAM, Spain; Departamento de Psiquiatría, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Central de Villalba, Madrid, Spain; Universidad Católica del Maule, Talca, Chile; Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, France.
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The effectiveness of incentives for research participation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0267534. [PMID: 35452488 PMCID: PMC9032371 DOI: 10.1371/journal.pone.0267534] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/10/2022] [Indexed: 01/21/2023] Open
Abstract
Background Recruitment plays a vital role in conducting randomized control trials (RCTs). Challenges and failure of proper recruitment lead to early termination of trials. Monetary incentives have been suggested as a potential solution to these challenges. Therefore, we aimed to do a systematic review and analysis to evaluate the effect of incentives on the number of participants willing to consent to and participate in RCTs. Methods Electronic databases were systematically searched from inception to September 23rd, 2021, using the following keywords: payments, incentive, response, participation, enrollment, randomized, randomization, and RCT. The Cochrane Risk of Bias tool was used to assess the quality of the included trials. Risk ratios (RRs) were calculated with their corresponding 95% confidence interval (CI). All analyses were done with the random-effects model. We used Revman software to perform the analysis. Results Six RCTs with 6,253 Participants met the inclusion criteria. Our analysis showed significant improvement in response rate (RR: 1.27; 95% CI: 1.04, 1.55; P = 0.02) and consent rates (RR: 1.44; 95% CI: 1.11, 1.85; P = 0.006) when an incentive payment was offered to participants. Even a small amount of incentive showed significant improvement in both consent (RR: 1.33; 95% CI: 1.03, 1.73; P = 0.03) and response rates (RR: 1.26; 95% CI: 1.08, 1.47; P = 0.004). Conclusion In conclusion, our meta-analysis demonstrated statistically significant increases in the rate of consent and responses from participants when offered even small monetary value incentives. These findings suggest that incentives may be used to reduce the rate of recruitment failure and subsequent study termination. However, further RCTs are needed to establish a critical threshold beyond which incentive amount does not alter response rates further and the types of RCTs in which financial incentives are likely to be effective.
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You W, Yuan Y, Boyle KJ, Michaud TL, Parmeter C, Seidel RW, Estabrooks PA. Examining Ways to Improve Weight Control Programs' Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives. PHARMACOECONOMICS - OPEN 2022; 6:193-210. [PMID: 34757584 PMCID: PMC8864042 DOI: 10.1007/s41669-021-00310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Both theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities. METHODS A discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial. RESULTS There were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts. CONCLUSIONS We confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.
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Affiliation(s)
- Wen You
- Department of Public Health Science, School of Medicine, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA USA
| | | | - Kevin J. Boyle
- Department of Agricultural and Applied Economics, Willis Blackwood Real Estate, Virginia Tech, Blacksburg, VA USA
| | - Tzeyu L. Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
| | - Chris Parmeter
- Department of Economics, University of Miami, Miami, FL USA
| | - Richard W. Seidel
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Paul A. Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
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Kearney A, Ashford PA, Butlin L, Conway T, Cragg WJ, Devane D, Gardner H, Gaunt DM, Gillies K, Harman NL, Hunter A, Lane AJ, McWilliams C, Murphy L, O'Nions C, Stanhope EN, Vellinga A, Williamson PR, Gamble C. Developing an online, searchable database to systematically map and organise current literature on retention research (ORRCA2). Clin Trials 2022; 19:71-80. [PMID: 34693794 PMCID: PMC8847754 DOI: 10.1177/17407745211053803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing recruitment and retention challenges in trials is a key priority for methods research, but navigating the literature is difficult and time-consuming. In 2016, ORRCA (www.orrca.org.uk) launched a free, searchable database of recruitment research that has been widely accessed and used to support the update of systematic reviews and the selection of recruitment strategies for clinical trials. ORRCA2 aims to create a similar database to map the growing volume and importance of retention research. METHODS Searches of Medline (Ovid), CINAHL, PsycINFO, Scopus, Web of Science Core Collection and the Cochrane Library, restricted to English language and publications up to the end of 2017. Hand searches of key systematic reviews were undertaken and randomised evaluations of recruitment interventions within the ORRCA database on 1 October 2020 were also reviewed for any secondary retention outcomes. Records were screened by title and abstract before obtaining the full text of potentially relevant articles. Studies reporting or evaluating strategies, methods and study designs to improve retention within healthcare research were eligible. Case reports describing retention challenges or successes and studies evaluating participant reported reasons for withdrawal or losses were also included. Studies assessing adherence to treatments, attendance at appointments outside of research and statistical analysis methods for missing data were excluded. Eligible articles were categorised into one of the following evidence types: randomised evaluations, non-randomised evaluations, application of retention strategies without evaluation and observations of factors affecting retention. Articles were also mapped against a retention domain framework. Additional data were extracted on research outcomes, methods and host study context. RESULTS Of the 72,904 abstracts screened, 4,364 full texts were obtained, and 1,167 articles were eligible. Of these, 165 (14%) were randomised evaluations, 99 (8%) non-randomised evaluations, 319 (27%) strategies without evaluation and 584 (50%) observations of factors affecting retention. Eighty-four percent (n = 979) of studies assessed the numbers of participants retained, 27% (n = 317) assessed demographic differences between retained and lost participants, while only 4% (n = 44) assessed the cost of retention strategies. The most frequently reported domains within the 165 studies categorised as 'randomised evaluations of retention strategies' were participant monetary incentives (32%), participant reminders and prompts (30%), questionnaire design (30%) and data collection location and method (26%). CONCLUSION ORRCA2 builds on the success of ORRCA extending the database to organise the growing volume of retention research. Less than 15% of articles were randomised evaluations of retention strategies. Mapping of the literature highlights several areas for future research such as the role of research sites, clinical staff and study design in enhancing retention. Future studies should also include cost-benefit analysis of retention strategies.
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Affiliation(s)
- Anna Kearney
- Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Laura Butlin
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Thomas Conway
- HRB-Trials Methodology Research Network and Evidence Synthesis Ireland
| | - William J Cragg
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Declan Devane
- HRB-Trials Methodology Research Network, School of Nursing and Midwifery, NUI Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Athene J Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Louise Murphy
- National University of Ireland Galway, Galway, Ireland
| | - Carrie O'Nions
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Edward N Stanhope
- University College Birmingham, Birmingham, UK.,Staffordshire University, Stoke-on-Trent, UK
| | - Akke Vellinga
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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Supervised Aerobic Exercise Training and Increased Lifestyle Physical Activity to Reduce Cardiovascular Disease Risk for Women With Polycystic Ovary Syndrome: A Randomized Controlled Feasibility Trial. J Phys Act Health 2022; 19:436-445. [DOI: 10.1123/jpah.2022-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
Background: Polycystic ovary syndrome (PCOS) is a complex, heterogeneous endocrinopathy. Women with PCOS often present with cardiovascular disease risk factors. Physical activity (PA) interventions reduce cardiovascular disease risk factors in women with PCOS. However, sedentary behaviors have a distinct deleterious effect on cardiometabolic health. Increasing PA and reducing sedentary behaviors may be a worthwhile therapeutic target to improve cardiovascular health in this population. This study investigated the feasibility of 2 PA interventions to decrease cardiovascular disease risk in women with PCOS. Methods: This was a feasibility randomized controlled trial of 2 PA interventions in 36 women with PCOS. Participants were randomized to a supervised exercise intervention (n = 12), a lifestyle physical activity group intervention aimed at reducing sedentary behaviors (n = 12), or a control group (n = 12), for 12 weeks. Primary outcomes included the feasibility and acceptability of the interventions and procedures. Results: Recruitment rate was 56%. Adherence rate was 53% and 100% to the exercise intervention and lifestyle PA intervention, respectively. Secondary outcome data indicate a reduction in oxidized low-density lipoprotein concentrations in the exercise group, and weight loss in both intervention groups. Conclusions: The procedures for recruitment, allocation, and outcome measurements were acceptable. However, before progression to a full-scale trial, adherence to the exercise program should be addressed.
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Sousa H, Ribeiro O, Paúl C, Costa E, Frontini R, Miranda V, Oliveira J, Ribeiro F, Figueiredo D. "Together We Stand": A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers. Healthcare (Basel) 2021; 9:healthcare9111585. [PMID: 34828630 PMCID: PMC8624118 DOI: 10.3390/healthcare9111585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility was based on screening, eligibility, content, retention, completion, and intervention adherence rates. Acceptability was assessed at post-intervention through a focus group interview. Self-reported anxiety and depression and patients’ inter-dialytic weight gain (IDWG) were also measured. The screening (93.5%), retention (85.7%), and completion (100%) rates were satisfactory, whereas eligibility (22.8%), consent (18.4%), and intervention adherence (range: 16.7–50%) rates were the most critical. Findings showed that participants appreciated the intervention and perceived several educational and emotional benefits. The results from the Wilcoxon Signed-Rank Test showed that a significant decrease in anxiety symptoms (p = 0.025, r = 0.646) was found, which was followed by medium to large within-group effect sizes for changes in depression symptoms (p = 0.261, r = 0.325) and patients’ IDWG (p = 0.248, r = 0.472), respectively. Overall, the results indicated that this family-based psychoeducational intervention is likely to be feasible, acceptable, and effective for patients undergoing HD and their family caregivers; nonetheless, further considerations are needed on how to make the intervention more practical and easily implemented in routine dialysis care before proceeding to large-scale trials.
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Affiliation(s)
- Helena Sousa
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS.UA), Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal;
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO—REQUIMTE), Faculty of Pharmacy, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal;
| | - Roberta Frontini
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, 2410-541 Leiria, Portugal;
| | | | - Jaime Oliveira
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Fernando Ribeiro
- Campus Universitário de Santiago, Institute for Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), Campus Universitário de Santiago, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence:
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Jung SY, Kim T, Hwang HJ, Hong K. Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios. J Med Internet Res 2021; 23:e26802. [PMID: 34515640 PMCID: PMC8477294 DOI: 10.2196/26802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/12/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite the fact that the adoption rate of electronic health records has increased dramatically among high-income nations, it is still difficult to properly disseminate personal health records. Token economy, through blockchain smart contracts, can better distribute personal health records by providing incentives to patients. However, there have been very few studies regarding the particular factors that should be considered when designing incentive mechanisms in blockchain. Objective The aim of this paper is to provide 2 new mathematical models of token economy in real-world scenarios on health care blockchain platforms. Methods First, roles were set for the health care blockchain platform and its token flow. Second, 2 scenarios were introduced: collecting life-log data for an incentive program at a life insurance company to motivate customers to exercise more and recruiting participants for clinical trials of anticancer drugs. In our 2 scenarios, we assumed that there were 3 stakeholders: participants, data recipients (companies), and data providers (health care organizations). We also assumed that the incentives are initially paid out to participants by data recipients, who are focused on minimizing economic and time costs by adapting mechanism design. This concept can be seen as a part of game theory, since the willingness-to-pay of data recipients is important in maintaining the blockchain token economy. In both scenarios, the recruiting company can change the expected recruitment time and number of participants. Suppose a company considers the recruitment time to be more important than the number of participants and rewards. In that case, the company can increase the time weight and adjust cost. When the reward parameter is fixed, the corresponding expected recruitment time can be obtained. Among the reward and time pairs, the pair that minimizes the company’s cost was chosen. Finally, the optimized results were compared with the simulations and analyzed accordingly. Results To minimize the company’s costs, reward–time pairs were first collected. It was observed that the expected recruitment time decreased as rewards grew, while the rewards decreased as time cost grew. Therefore, the cost was represented by a convex curve, which made it possible to obtain a minimum—an optimal point—for both scenarios. Through sensitivity analysis, we observed that, as the time weight increased, the optimized reward increased, while the optimized time decreased. Moreover, as the number of participants increased, the optimization reward and time also increased. Conclusions In this study, we were able to model the incentive mechanism of blockchain based on a mechanism design that recruits participants through a health care blockchain platform. This study presents a basic approach to incentive modeling in personal health records, demonstrating how health care organizations and funding companies can motivate one another to join the platform.
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Affiliation(s)
- Se Young Jung
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Taehyun Kim
- Department of Mathematics, Pohang University of Science and Technology, Pohang-si, Republic of Korea
| | - Hyung Ju Hwang
- Department of Mathematics, Pohang University of Science and Technology, Pohang-si, Republic of Korea
| | - Kyungpyo Hong
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Yeung KF, Gandhi M, Lam AYR, Julianty S, Chia AYM, Tan GCS, Goh SY, Ho ETL, Koh AFY, Tan GSW, Shum EJW, Finkelstein EA, Jafar TH, Teoh YL, van Dam RM, Whitton C, Thumboo J, Bee YM. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) program: study protocol for a randomized controlled trial. Trials 2021; 22:522. [PMID: 34362409 PMCID: PMC8349028 DOI: 10.1186/s13063-021-05500-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based diabetes prevention programs varied widely in effectiveness, and the intervention strategy consisting of lifestyle interventions, stepwise addition of metformin, and financial incentives has not been studied in real-world clinical practice settings. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial is a pragmatic trial that aims to compare the effectiveness of a community-based stepwise diabetes prevention program with added financial incentives (intervention) versus the standard of care (control) in reducing the risk of type 2 diabetes over 3 years among overweight or obese individuals with pre-diabetes. METHODS This is an open-label, 1:1 randomized controlled trial which aims to recruit 846 adult individuals with isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or both IFG and IGT from Singapore. Intervention arm participants attend 12 group-based sessions (2 nutrition workshops, 9 exercise sessions, and a goal-setting workshop) delivered at community sites (weeks 1 to 6), receive weekly physical activity and nutrition recommendations delivered by printed worksheets (weeks 7 to 12), and receive monthly health tips delivered by text messages (months 4 to 36). From month 6 onwards, intervention arm participants who remain at the highest risk of conversion to diabetes are prescribed metformin. Intervention arm participants are also eligible for a payment/rewards program with incentives tied to attendance at the group sessions and achievement of the weight loss target (5% of baseline weight). All participants are assessed at baseline, month 3, month 6, and every 6 months subsequently till month 36. The primary endpoint is the proportion of participants with diabetes at 3 years. Secondary endpoints include the mean change from baseline at 3 years in fasting plasma glucose, 2-hour plasma glucose, HbA1c, body weight, body mass index, physical activity, and dietary intake. DISCUSSION The Pre-DICTED trial will provide evidence of the effectiveness and feasibility of a community-based stepwise diabetes prevention program with added financial incentives for individuals with pre-diabetes in Singapore. The study will provide data for a future cost-effectiveness analysis, which will be used to inform policymakers of the value of a nationwide implementation of the diabetes prevention program. TRIAL REGISTRATION ClinicalTrials.gov NCT03503942 . Retrospectively registered on April 20, 2018. Protocol version: 5.0 Date: 1 March 2019.
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Affiliation(s)
- Kar-Fu Yeung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- The Center for Child Health Research, Tampere University, Tampere, Finland
| | - Amanda Yun Rui Lam
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
| | - Selly Julianty
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
- Regional Health System Office, SingHealth, Singapore, Singapore
| | | | - Gilbert Choon Seng Tan
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
- SingHealth Polyclinics, Singapore, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
| | - Emily Tse Lin Ho
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Regional Health System Office, SingHealth, Singapore, Singapore
| | - Angela Fang Yung Koh
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Gavin Siew Wei Tan
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore
- Surgical Retinal Department, Singapore National Eye Centre, Singapore, Singapore
| | | | - Eric A Finkelstein
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Tazeen H Jafar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yee Leong Teoh
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Diabetes Centre, Singapore, Singapore.
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Rogers CR, Matthews P, Brooks E, Le Duc N, Washington C, McKoy A, Edmonson A, Lange L, Fetters MD. Barriers to and Facilitators of Recruitment of Adult African American Men for Colorectal Cancer Research: An Instrumental Exploratory Case Study. JCO Oncol Pract 2021; 17:e686-e694. [PMID: 33974818 DOI: 10.1200/op.21.00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Racial and ethnic minorities remain underrepresented in research and clinical trials. Better understanding of the components of effective minority recruitment into research studies is critical to understanding and reducing health disparities. Research on recruitment strategies for cancer-specific research-including colorectal cancer (CRC)-among African American men is particularly limited. We present an instrumental exploratory case study examining successful and unsuccessful strategies for recruiting African American men into focus groups centered on identifying barriers to and facilitators of CRC screening completion. METHODS The parent qualitative study was designed to explore the social determinants of CRC screening uptake among African American men 45-75 years of age. Recruitment procedures made use of community-based participatory research strategies combined with built community relationships, including the use of trusted community members, culturally tailored marketing materials, and incentives. RESULTS Community involvement and culturally tailored marketing materials facilitated recruitment. Barriers to recruitment included limited access to public spaces, transportation difficulties, and medical mistrust leading to reluctance to participate. CONCLUSION The use of strategies such as prioritizing community relationship building, partnering with community leaders and gatekeepers, and using culturally tailored marketing materials can successfully overcome barriers to the recruitment of African American men into medical research studies. To improve participation and recruitment rates among racial and ethnic minorities in cancer-focused research studies, future researchers and clinical trial investigators should aim to broaden recruitment, strengthen community ties, offer incentives, and use multifaceted approaches to address specific deterrents such as medical mistrust and economic barriers.
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Affiliation(s)
- Charles R Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Phung Matthews
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Ellen Brooks
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Nathan Le Duc
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Chasity Washington
- Population Sciences Department, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alicia McKoy
- Population Sciences Department, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Al Edmonson
- A Cut Above the Rest Barbershop, Columbus, OH
| | - LaJune Lange
- International Leadership Institute, Minneapolis, MN
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
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Arasu K, Chang CY, Wong SY, Ong SH, Yang WY, Chong MHZ, Mavinkurve M, Khoo EJ, Chinna K, Weaver CM, Chee WSS. Design and strategies used for recruitment and retention in a double blind randomized controlled trial investigating the effects of soluble corn fiber on bone indices in pre-adolescent children (PREBONE-Kids study) in Malaysia. Contemp Clin Trials Commun 2021; 22:100801. [PMID: 34195468 PMCID: PMC8233130 DOI: 10.1016/j.conctc.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recruitment and retention in longitudinal nutrition intervention studies among children is challenging and scarcely reported. This paper describes the strategies and lessons learned from a 1-year randomized double-blind placebo-controlled trial among pre-adolescent children on the effects of soluble corn fiber (SCF) on bone indices (PREBONE-Kids). Methods Participants (9–11 years old) were recruited and randomized into 4 treatment groups (600 mg calcium, 12 g SCF, 12 g SCF plus 600 mg calcium and placebo). Interventions were consumed as a fruit-flavored powdered drink for 1-year. School-based recruitment was effective due to support on study benefits from parents and teachers, peer influence and a 2-weeks study run-in for participants to assess their readiness to commit to the study protocol. Retention strategies focused on building rapport through school-based fun activities, WhatsApp messaging, providing health screening and travel reimbursements for study measurements. Compliance was enhanced by providing direct on-site school feeding and monthly non-cash rewards. Choice of 2 flavors for the intervention drinks were provided to overcome taste fatigue. Satisfaction level on the manner in which the study was conducted was obtained from a voluntary sub-set of participants. Results The study successfully enrolled 243 participants within 6 months and retained 82.7% of the participants at the end of 1 year, yielding a drop-out rate of 17.3%. Compliance to the intervention drink was 85% at the start and remained at 78.7% at the end of 1 year. More than 95% of the participants provided good feedback on intervention drinks, rapport building activities, communication and overall study conduct. Conclusion Successful strategies focused on study benefits, rapport building, frequent communication using social media and non-cash incentives helped improved compliance and retention rate. The lessons learned to maintain a high retention and compliance rate in this study provide valuable insights for future studies in a similar population. PREBONE-Kids contributes to evidence on the effect of soluble corn fiber on bone indices in pre-adolescent Asian children. School-based recruitment, study nature, perceived benefits and study run-in were effective strategies for recruitment. Rapport building, direct on-site feeding and rewarding protocol adherence were critical for good retention and compliance.
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Key Words
- 25-OHD, serum 25-hydroxyvitamin D
- BAP, bone-specific alkaline phosphatase
- BMC, bone mineral content
- BMD, bone mineral density
- CTX, carboxy-terminal collagen crosslinks
- Calcium
- Compliance
- DXA, dual-energy X-ray absorptiometry
- MET, total metabolic equivalent
- OC, osteocalcin
- P1NP, procollagen type 1 amino-terminal propeptide
- PBM, peak bone mass
- Pre-adolescent children
- SCF, soluble corn fibre
- Soluble corn fiber
- Study retention
- iPTH, intact parathyroid hormone
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Affiliation(s)
- Kanimolli Arasu
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Chung Yuan Chang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Soon Yee Wong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Shu Hwa Ong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Wai Yew Yang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Megan Hueh Zan Chong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Meenal Mavinkurve
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Erwin Jiayuan Khoo
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Karuthan Chinna
- Faculty of Health & Medical Sciences, School of Medicine, Taylor's University, No 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Winnie Siew Swee Chee
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
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McManus E, Elliott J, Meacock R, Wilson P, Gellatly J, Sutton M. The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme. HEALTH ECONOMICS 2021; 30:1393-1416. [PMID: 33786914 DOI: 10.1002/hec.4262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Despite widespread use, evidence is sparse on whether financial incentives in healthcare should be linked to structure, process or outcome. We examine the impact of different incentive types on the quantity and effectiveness of referrals made by general practices to a new national prevention programme in England. We measured effectiveness by the number of referrals resulting in programme attendance. We surveyed local commissioners about their use of financial incentives and linked this information to numbers of programme referrals and attendances from 5170 general practices between April 2016 and March 2018. We used multivariate probit regressions to identify commissioner characteristics associated with the use of different incentive types and negative binomial regressions to estimate their effect on practice rates of referral and attendance. Financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Compared to practices without financial incentives, neither structure nor process incentives were associated with statistically significant increases in referrals or attendances, but outcome incentives were associated with 84% more referrals and 93% more attendances. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.
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Affiliation(s)
- Emma McManus
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Services, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jack Elliott
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Services, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rachel Meacock
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Services, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Services, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Vorderstrasse A, Reagan L, D'Eramo Melkus G, Nowlin SY, Birdsall SB, Burd A, Cho YH, Jang M, Johnson C. Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment. Contemp Clin Trials 2021; 105:106399. [PMID: 33857681 PMCID: PMC8172527 DOI: 10.1016/j.cct.2021.106399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.
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Affiliation(s)
- Allison Vorderstrasse
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01003-9299, USA
| | - Louise Reagan
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-3237, USA.
| | - Gail D'Eramo Melkus
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Sarah Y Nowlin
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Stacia B Birdsall
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Andrew Burd
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA
| | - Yoon Hee Cho
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Myoungock Jang
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Constance Johnson
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; Jane and Robert Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave. SON-539D, Houston, TX 77030, USA
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Wong CA, Song WB, Jiao M, O'Brien E, Ubel P, Wang G, Scales CD. Strategies for research participant engagement: A synthetic review and conceptual framework. Clin Trials 2021; 18:457-465. [PMID: 34011179 DOI: 10.1177/17407745211011068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research participant engagement, which we define as recruitment and retention in clinical trials, is a costly and challenging issue in clinical research. Research teams have leveraged a variety of strategies to increase research participant engagement in clinical trials, although a framework and evidence for effective participant engagement strategies are lacking. We (1) developed a novel conceptual framework for strategies used to recruit and retain participants in clinical trials based on their underlying behavioral principles and (2) categorized empirically tested recruitment and retention strategies in this novel framework. METHODS We conducted a synthetic analysis of interventions tested in studies from two Cochrane reviews on clinical trial recruitment and retention, which included studies from 1986 to 2015. We developed a conceptual framework of behavioral strategies for increasing research participant engagement using deductive and inductive approaches with the studies included in the Cochrane reviews. Reviewed interventions were then categorized using this framework. We examined the results of reviewed interventions and categorized the effects on clinical trial recruitment and retention as significantly positive, null, or significantly negative; summary statistics are presented for the frequency and effects of each behavioral strategy type. RESULTS We analyzed 141 unique interventions across 96 studies: 91 interventions targeted clinical trial research participant recruitment and 50 targeted retention. Our framework included 14 behavioral strategies to improve research participant engagement grouped into four general approaches: changing attitudes by appealing to social motivators, changing attitudes by targeting individual psychology, reducing barriers and cognitive burdens, and providing incentives. The majority of interventions (54%) aimed to reduce barriers or cognitive burdens, with improving comprehension (27%) as the most common specific strategy identified. For recruitment, the most common behavioral strategies tested were building legitimacy or trust (38%) and framing risks and benefits (32%), while financial or material incentives (32%) and reducing financial, time, and social barriers (32%) were most common for retention interventions. Among interventions tested in randomized controlled trials, 51% had a null effect on research participant engagement, and 30% had a statistically significant positive effect. DISCUSSION Clinical researchers have tested a wide range of interventions that leverage distinct behavioral strategies to achieve improved research participant recruitment and retention. Common behavioral strategies include building legitimacy or trust between research teams and participants, as well as improving participant comprehension of trial objectives and procedures. The high frequency of null effects among tested interventions suggests challenges in selecting the optimal interventions for increasing research participant engagement, although the proposed behavioral strategy categories can serve as a conceptual framework for developing and testing future interventions.
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Affiliation(s)
- Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Pediatrics, Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, NC, USA
| | - William B Song
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Megan Jiao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Emily O'Brien
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Peter Ubel
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Fuqua School of Business, Duke University, Durham, NC, USA.,Sanford School of Health Policy, Duke University, Durham, NC, USA
| | - Gary Wang
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Charles D Scales
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Staff and participant perceptions of optimal recruitment and retention strategies for biomedical cohort studies in the Caribbean. Cancer Causes Control 2021; 32:849-857. [PMID: 33961148 PMCID: PMC8103112 DOI: 10.1007/s10552-021-01438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/22/2021] [Indexed: 11/13/2022]
Abstract
Purpose To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations. Methods Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts. Results Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups. Conclusion Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.
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Recruitment strategies for a pragmatic cluster randomized oral health trial in pediatric primary care settings. Contemp Clin Trials Commun 2021; 21:100748. [PMID: 33665473 PMCID: PMC7905074 DOI: 10.1016/j.conctc.2021.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/25/2021] [Accepted: 02/09/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To describe multilevel recruitment strategies for an ongoing clinical trial in pediatric primary care settings, and assess adoption and reach of these strategies via the RE-AIM framework. Methods This study is part of a larger pragmatic cluster randomized clinical trial focused on the effectiveness of interventions on the practice, provider, and caregiver levels on dental utilization for Medicaid-enrolled 3-6 year old children. Pediatric practices were recruited according to the proportion of Medicaid-eligible children, geographic region, and County. In accordance with the RE-AIM framework, providers reached were those approached directly and consented, and those who participated in the intervention training adopted to deliver the intervention. Caregivers reached were those approached and consented at their child's well-child visit to participate in the trial. Results Recruitment goals were met over a 21 month period, with an overall enrollment of 18 practices, 62 providers, and 1024 caregivers-child dyads. The majority of practices enrolled were small, suburban, and located in an urban county. The participation rates among approached providers and caregivers was 93% and 84% respectively. Enablers for recruitment was the one-on-one interaction with the provider and caregivers. Barriers to recruitment for caregivers included no-shows and cancellations at well-child visits. Adoption of intervention among providers was high, and caregiver reached were representative of the eligible target population. Conclusions Active approaches to recruitment, such as utilizing opinion leaders, in-person recruitment, and building relationships with practice staff, can result in successful enrollment and imp lementation of a multi-level intervention in pediatric primary care settings.
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Moore SA, O'Kell A, Borghese H, Garabed R, O'Meara H, Baneux P. A CTSA One Health Alliance guidance on institutional review of veterinary clinical studies. BMC Vet Res 2021; 17:83. [PMID: 33596904 PMCID: PMC7890984 DOI: 10.1186/s12917-021-02790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/04/2021] [Indexed: 12/03/2022] Open
Abstract
Harmonized institutional processes and reviewer training are vital to maintain integrity and ethical rigor of the veterinary clinical research pipeline and are a prerequisite to future work that might establish centralized or single-site ethical and regulatory review to ease initiation of multi-center studies. Funded by a CTSA One Health Alliance (COHA) pilot award, a diverse working group of veterinary clinicians and institutional representatives was convened in February 2020 to develop a guidance document detailing broadly agreed upon practices for ethical review and approval of veterinary clinical studies conducted in the United States.The working group defined key areas of need for consensus, developed a set of associated guidelines, and circulated these for review by COHA's fifteen member institutions. Six focus areas were identified by the working group and included vital items of protocol review, composition of the review committee, post-approval monitoring and adverse event reporting, consideration of special circumstances such as satellite sites and the use of healthy veterinary subjects in research, and the informed consent process.This document outlines a broadly agreed-upon framework through which to approach vital items associated with veterinary clinical study protocol review and approval. These approaches represent current best practice in the review and approval of veterinary clinical studies, and can serve as a guidance for veterinary clinician-scientists and regulatory experts, to ensure robust and ethically conducted studies that can contribute to the advancement of both animal and human health.
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Affiliation(s)
- S A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St, Columbus, OH, 43210, USA.
| | - A O'Kell
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - H Borghese
- The Ohio State University College of Veterinary Medicine, Blue Buffalo Veterinary Clinical Trials Office, Columbus, USA
| | - R Garabed
- Department of Veterinary Preventive Medicine, The Ohio State University College of Veterinary Medicine, Columbus, USA
| | - H O'Meara
- The Ohio State University, Office of Responsible Research Practices, Columbus, USA
| | - P Baneux
- Cornell University, Attending veterinarian, Director Center for Animal Resources and Education, Ithaca, USA
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Chandler R, Guillaume D, Parker AG, Mack A, Hamilton J, Dorsey J, Hernandez ND. The impact of COVID-19 among Black women: evaluating perspectives and sources of information. ETHNICITY & HEALTH 2021; 26:80-93. [PMID: 33153287 PMCID: PMC8542278 DOI: 10.1080/13557858.2020.1841120] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/19/2020] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) has burgeoned into a pandemic that highlights the countless social and health disparities that have existed in Black communities within the United States for centuries. Recent epidemiological data show that Black communities are being disproportionately impacted by COVID-19, resulting in higher morbidity and mortality rates compared to other racial and ethnic groups. For Black women in particular, a long-standing history of systemic racism and marginalization has resulted in increased vulnerability and susceptibility to certain adverse health outcomes. Recent data show that COVID-19 knowledge rates among Black participants are low, and that Black women who become infected with COVID-19 have higher risks of complications and mortality compared to their non-Black counterparts. Given this data, there is a need to explore where and how Black women are obtaining information that pertains to COVID-19, along with the impacts that COVID-19 may be having on their daily lives. DESIGN We conducted interviews with 15 Black women who are clients at a community-based family service center to assess their understanding of COVID-19, determine how they were obtaining COVID-19 information, and evaluate the various impacts that COVID-19 was having on their lives. An initial codebook was developed based on the recorded interviews which included deductive and inductive codes. A thematic analysis of the data was then conducted using MaxQDA (Verbi Software), focusing on Black women's experiences related to COVID-19. RESULTS The majority of participants were using a combination of social media platforms and news sources to obtain information about COVID-19. Most participants (79%) expressed confusion, misunderstanding, and mistrust of the information that they were receiving about COVID-19. CONCLUSION In addressing COVID-19-related health disparities within Black communities, it is imperative for trusted entities and organizations within Black communities to provide accurate and tailored information regarding this novel virus.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea G. Parker
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Amber Mack
- Healthy Mothers and Healthy Babies Coalition of Georgia, Atlanta, GA, USA
| | - Jill Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jemea Dorsey
- The Center for Black Women’s Wellness, Atlanta, GA, USA
| | - Natalie D. Hernandez
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Georgia Clinical and Translational Science Alliance, Atlanta, GA, USA
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Langford AT. Health Communication and Decision Making about Vaccine Clinical Trials during a Pandemic. JOURNAL OF HEALTH COMMUNICATION 2020; 25:780-789. [PMID: 33719877 PMCID: PMC8765457 DOI: 10.1080/10810730.2020.1864520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has magnified the importance of clinical trials for finding a safe and effective vaccine to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Although communication about vaccines and vaccine hesitancy were challenges long before COVID-19, the twin facts of a pandemic and an "infodemic" of health information, misinformation, and disinformation have raised new challenges for vaccine-related communication and decision-making. The goal of this commentary is to highlight strategies to improve communication and decision-making for adults considering participation in COVID-19 vaccine clinical trials. First, I present a general conceptual model for clinical trial participation that can be applied to various vaccine and other clinical trial contexts. Next, I introduce the ASK (Assume, Seek, Know) approach for enhancing clinical trial participation: (1) assume that all patients will want to know their options, (2) seek the counsel of stakeholders, and (3) know your numbers. The ideas presented in this commentary are intended to enhance vaccine-specific clinical trial communication, decision-making, and literacy, while dually offering strategies and resources that may help reduce vaccine hesitancy and increase vaccine uptake over time.
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Affiliation(s)
- Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Verghese TS, Merriel A, Leighton L, Latthe P. Willingness of postmenopausal women to participate in a study involving local vaginal oestrogen treatment as an adjunct to pelvic organ prolapse surgery: a qualitative study. Int Urogynecol J 2020; 32:413-421. [PMID: 32839831 PMCID: PMC7838130 DOI: 10.1007/s00192-020-04480-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
Background Pelvic organ prolapse (POP) negatively affects many women’s quality of life. The ability to develop improved therapeutic approaches for POP patients is hampered by low patient recruitment and retention rates in clinical trials. Objective Our objective was to explore the motivational factors and barriers to recruitment and participation in clinical trials among postmenopausal women with POP who are intending to have surgical management. Design Qualitative study based on in-depth face-to-face interviews with postmenopausal women attending urogynaecology clinics in the UK intending to have surgical management for pelvic organ prolapse. These women were eligible to participate in the on-going clinical trial on the use of local vaginal oestrogen as an adjunct to surgical treatment. Twenty-two postmenopausal women aged 52–76 years were interviewed. Interviews were analysed using thematic analysis method. Results Many women participated because of altruistic motivations; however, we found that clarity of information provided, timing of approach and acceptability of study design played a pivotal role in women. Of the women who declined participation, the following themes emerged: uncertainty of the investigational product, fear of experimentation, logistical concerns and regret that their condition was trivialised at an early stage. Conclusion We have gained a valuable insight into women’s views and experience in the decision making process. Understanding the elements that will enhance trial participation such as clarity of information provided, balance between professional guidance whilst maintaining equipoise, easy access to trial teams and timing of approach will ultimately enable us to improve our recruitment to clinical trials.
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Affiliation(s)
- Tina Sara Verghese
- Clinical Research Fellow Institute of Metabolism and System Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Abigail Merriel
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Pallavi Latthe
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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