Abstract
BackgroundDeclining participation rates are impeding health research. Little is known about factors influencing the decision to participate in low- and middle-income countries (LMIC). Therefore, this paper reports on the various individual factors and their with contextual factors in influencing participation in research among pregnant women and the recommendations to enhance their recruitment in Lebanon.MethodsThis study used a qualitative research design drawing on focus groups and in-depth interviews. The Theoretical Domain Framework guided data collection and analysis. The three participant groups included: Group 1-Pregnant women (n = 25) attending public pre-natal events and antenatal clinics in Beirut; Group 2-Pregnant women (n = 6) already enrolled in the ongoing Mother and Infant Nutritional Assessment birth cohort study; Group 3-Key informants (n = 13) including health care workers involved in recruiting pregnant women. Conversations were audio recorded, transcribed, translated into English, and thematically analyzed.ResultsThree main factors influencing participation were revealed, with each factor encompassing several sub-themes: (1) personal factors (altruism, self-confidence, personal interest in the topic, previous understanding of the nature and purpose of research, education level, and previous research experience), (2) contextual factors (societal factors, family and friends), and (3) study characteristics (burden of the study, ethical considerations, incentives, and research interpersonal skills and physician endorsement to participate). The results suggested a dynamic interaction among the identified factors, forming two intersecting axes, with a four-quadrant configuration. The y- and x-axes represented personal factors and contextual factors, respectively. Individuals positioned on the lower-left quadrant were the least likely to participate; those on the upper-right quadrant were the most likely to participate; while those on the upper-left and lower-right quadrants were indecisive. Study characteristics seemed to affect the decision of pregnant women to participate situated in any of the four quadrants. Specific recommendations to improve participation were also identified.ConclusionsOur findings suggested an interaction of personal factors, contextual factors, and study characteristics affecting subjects’ participation. This interaction integrates factors into a novel dynamic framework that could be used in future studies. The recommendations identified may help improve participation of pregnant women in health research hence enhancing the quality and generalizability of research findings in LMIC.
Highlights
Declining participation rates are impeding health research
Our findings suggested an interaction of personal factors, contextual factors, and study characteristics affecting subjects’ participation
The focus group approach was used for the pregnant women attending public pre-natal events, while the in-depth interview approach was implemented with pregnant women attending antenatal clinics; 2) Group 2- Pregnant women who were already enrolled in the Mother and Infant Nutrition Assessment (MINA) birth cohort study and are attending antenatal clinics in Beirut; 3) Group 3- key informants (KIs) including health care workers involved in recruiting pregnant women at MINA birth cohort study recruitment sites
Summary
Declining participation rates are impeding health research. Little is known about factors influencing the decision to participate in low- and middle-income countries (LMIC). This paper reports on the various individual factors and their with contextual factors in influencing participation in research among pregnant women and the recommendations to enhance their recruitment in Lebanon. During the last couple of decades mounting evidence suggested gestation as a critical window during the lifespan whereby environmental exposures and lifestyle behaviours of pregnant women may have significant effect on the growth and development pattern of the offspring and on disease risk later in life [1,2,3,4]. Advancements in the formulation of these recommendations, policies and interventions require strong evidence for their feasibility, efficacy and cost effectiveness. Such evidence ought to be based on rigorous population-based research such as birth cohorts and randomized clinical trials conducted among pregnant women. A lower number of study participants could lead to an underpowered study, where clinically important effects fail to reach significance [11]
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