Enhanced Recruitment Strategies Research Articles

Reasons for acceptance or nonparticipation in iAdhere: a trial of latent TB infection treatment.

<sec><title>BACKGROUND</title>Understanding the motivations behind clinical trial participation can help enhance recruitment strategies and determine the generalizability of trial results. This study focuses on the reasons for participating in or declining the Tuberculosis Trials Consortium Study 33 (iAdhere), a clinical trial on the treatment of latent tuberculosis infection (LTBI).</sec><sec><title>METHODS</title>A quantitative evaluation was conducted among screened patients to ascertain their reasons for participating or not in the iAdhere trial. The study gathered data from enrolled participants and those who chose not to enroll.</sec><sec><title>RESULTS</title>Among 1,002 enrolled individuals, 290 participants provided 749 reasons for enrolling. The most common reasons included access to shorter treatment regimens (56%), avoiding progression to TB disease (45%), and improving health (21%). Of the 670 eligible persons who chose not to enroll, 551 individuals provided 800 reasons, with the most common being a preference for standard therapy (17%), disinterest in study medication or TB therapy (both 13%), and the inconvenience of daily observed treatment (12%).</sec><sec><title>CONCLUSION</title>The desire for shorter treatment options and preventing active disease motivates participation in LTBI trials. The diverse reasons for declining enrolment suggest the importance of developing targeted recruitment strategies. These findings support exploring shorter treatment regimens and can guide future recruitment efforts.</sec>.

One size does not fit all for URiM applicants: a comparison of NPM program size on URiM applications.

Neonatal-perinatal medicine (NPM) lacks a racially and ethnically diverse physician workforce. Fewer trainees from groups underrepresented in medicine (URiM) are entering NPM due to declining match rates in general pediatrics, financial burdens from delaying workforce entry, and ineffective recruitment into NPM. Annual surveys from the Organization of Neonatology Training Program Directors (ONTPD) were analyzed to assess URiM recruitment trends between 2021 and 2023. Concerningly, the number of URiM candidates applying to NPM fellowship programs remains low, highlighting the need for investment in pathway programming and enhanced recruitment strategies to diversify the NPM workforce. A multifaceted approach, including promoting early interest in pediatrics, minimizing financial disincentives, collecting robust URiM trainee and workforce data, and creating inclusive, diverse educational environments will be critical to increasing URiM representation in NPM and ultimately improving health outcomes for neonates.

Electroconvulsive Therapy Versus Aripiprazole Addition to Clozapine in Patients with Clozapine-Resistant Symptoms (EMECLO): A Protocol of a Single-Blind, Multicenter, Randomized-Controlled Feasibility Trial.

Currently, guidance on the most effective treatment for patients with clozapine-resistant schizophrenia-spectrum disorders (SSD) is lacking. While augmentation strategies to clozapine with aripiprazole and electroconvulsive therapy (ECT) have been demonstrated to be effective in patients with clozapine-resistant schizophrenia spectrum disorders (CRS), head-to-head comparisons between these addition strategies are unavailable. We therefore aim to examine the feasibility of a larger randomized, single-blind trial comparing the effectiveness, cost-effectiveness, and safety of aripiprazole addition vs. ECT addition in CRS. In this multi-center, randomized, single-blind feasibility study, the feasibility of recruiting 20 participants with CRS who will be randomized to either aripiprazole or bilateral ECT addition will be assessed. The main endpoint is the number of patients willing to be randomized. The number of screened individuals and reasons to decline participation will be recorded. Effects will be estimated for the benefit of the foreseen larger trial. To that end, differences between both arms in symptom severity will be assessed using blinded video assessments. In addition, tolerability (e. g., cognitive functioning), safety, quality of life, recovery, and all-cause discontinuation will be compared. The follow-up period is 16 weeks, after which non-responders will be given the option to switch to the other treatment. Strengths of this feasibility trial include maintaining blinding with video assessment, a possibility to switch groups in case of non-response, and a broad set of outcome measures. Identification of factors contributing to non-participation and drop-out will generate valuable information on trial feasibility and may enhance recruitment strategies in a follow-up RCT. The study has been approved by the Medical Research Ethics Committee of the Amsterdam University Medical Center, location AMC, and was registered on 1 May 2022 in the EU Clinical Trials Register (EudraCT) under the trial name 'EMECLO' (2021-006333-19).

Unveiling Student Segments: Leveraging Clustering Analysis of Registration Data for Enhanced Recruitment Strategies

Recruiting the right students is crucial for higher education institutions to achieve their goals of attracting talented individuals and fostering academic success. This study aims to investigate the effectiveness of data-driven recruitment strategies in identifying target student populations and tailoring recruitment efforts accordingly. By utilizing K-means clustering analysis on a dataset of student profiles, this research identifies distinct clusters based on factors such as province of residence, parent occupation, and parent revenue. The findings reveal valuable insights into the characteristics and preferences of different student clusters, enabling the development of targeted recruiting strategies. The results indicate that a significant number of students in specific clusters are from Songkhla Province, have parents predominantly engaged in the private sector, agriculture, and fishery occupations, and come from families with moderate income levels. Building upon these findings, several recommendations for recruiting strategies are proposed. These include focusing marketing efforts in the identified regions, forging partnerships with local businesses, offering financial aid programs, and establishing connections with agricultural and fishing communities. This can involve targeted online advertisements, promotional campaigns in local schools, and active participation in career fairs or educational expos held in Songkhla Province. This study contributes to the field of higher education recruitment by leveraging data-driven approaches to identify target student populations and develop tailored strategies.

Engaging Participants Through Hybrid Community-Centered Approaches: Lessons Learned During the COVID CommUNITY Public Health Research Program.

Community-centered research studies can improve trust, cultural appropriateness, and accurate findings through meaningful, in-depth engagement with participants. During the COVID-19 pandemic, researchers shifted to implement pandemic-specific guidelines on top of already existing safety practices; these adjustments gave insight into bettering the structure of forthcoming research studies. At the Population Health Research Institute (PHRI)/McMaster University, the COVID CommUNITY study staff took field notes from their experience at the Ontario (ON) and British Columbia (BC) sites navigating an observational prospective cohort study during the pandemic. These field notes are outlined below to provide insight into culturally responsive, trust-centered, and communication-focused strategies used to improve hybrid research. A significant challenge the team overcame was obtaining blood sample collections by executing socially distanced sample collections outside of participants' homes, coined "Porch Pickups." Data collection was made more accessible through phone surveys and frequent virtual contact. To enhance recruitment strategies for sub-communities of the South Asian population, staff focused on cultural interests and "gift-exchange" incentives. Cultural awareness was prioritized through correct name pronunciation, conducting data collection in participant preferred languages, and using flexible approaches to data collection. These strategies were developed through weekly team meetings where improvement strategies were discussed, and concerns were addressed in real-time.

The importance of diversity in clinical research.

Clinical research is a fundamental part of the healthcare system and is critical to improving care, making it safe and effective. Research participants should be diverse as this reduces bias and helps to better understand illness and treatment and how it affects different groups of people. However, due to health inequalities and barriers to research participation, clinical research still lacks diversity. Data from the US Food and Drug Administration showed that 76% of research participants were White and the remaining 24% were from an ethnic minority. In the UK, only 5% of ethnic minorities have ever participated in clinical trials. Recently, with the COVID-19 vaccine trials, out of 270 000 participants, only 11 000 and 1200 participants were from Asian and Black backgrounds, respectively. The research participation of under-represented groups requires co-development with community members. This proactive approach helps establish trust and enhance recruitment strategies that build a positive legacy for under-represented groups.

Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention

BackgroundEmergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors.MethodsRecruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity.ResultsIn response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials.ConclusionsEDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment.Trial registrationClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.

Barriers and facilitators to recruitment and enrollment of HIV-infected individuals with opioid use disorder in a clinical trial

BackgroundThe CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study.Main textMethods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study staff that encourage eligible patient participation. Interviews were transcribed and thematically analyzed using a content analysis approach. Results: All respondents reported that barriers to recruitment and enrollment included challenging patient social and structural factors (e.g., homelessness or living environments with high substance use, criminal justice involvement), difficulty locating patients with unsuppressed HIV viral load and OUD within the HIV clinic, time-consuming study enrollment processes, and stigma around HIV and OUD which inhibited treatment seeking. Some respondents observed that distrust of research and researchers impeded recruitment activities in the community. A specific medication-related barrier was patient fear of opioid abstinence required prior to XR-NTX induction. Facilitators of recruitment included use of trusted peer outreach/recruitment workers in the community, hospitalizations that offered windows of opportunities for screening and XR-NTX induction, providing participant transportation, and partnerships with harm reduction organizations for referrals.ConclusionsThough study personnel encountered barriers to recruitment in the CHOICES study, persons with untreated HIV and OUD can be enrolled in multisite clinical trials by using enhanced recruitment strategies that extend outside of the HIV clinic. Employing peer outreach workers and collaborating with syringe service programs may be especially helpful in facilitating recruitment and merit inclusion in similar study protocols.

Work-family culture within hospitals: An interdepartmental analysis of employee engagement and retention.

Helping employees balance their work and family needs is increasingly pivotal for attracting, engaging, and retaining key talent in health care. Yet, emerging theory and anecdotal evidence suggest that, within organizations, there is considerable variation between departments or units regarding how employees' lives outside work are supported. Despite top management's efforts to develop a unified organizational work-family culture, departments have a tendency to take on their own culture, norms, and traditions such that some are more supportive than others. We investigate whether more positive work-family cultures improve functioning within hospital departments. We surveyed 680 hospital employees nested within 60 departments at a hospital located in the southeastern United States. Departments with a more (vs. less) positive work-family culture tend to have higher levels of (a) employee engagement, (b) pride in their organization, (c) confidence in management and leadership, and (d) intention to remain with the organization. Our analyses were robust when splitting the sample between clinical (e.g., nurses and physicians) and nonclinical (e.g., office, clerical, and support services) roles. Our study sheds further light on the importance of a positive work-family culture within hospitals. The key to instilling a positive, organization-wide work-family culture may be through a department-by-department focus. Benefits of positive work-family cultures within departments can extend beyond job-related attitudes and can potentially enhance recruitment strategies, improve a hospital's external image to the public, and lead to improvements in patient care and more positive patient experiences.

Action 3:30R: protocol for a cluster randomised feasibility study of a revised teaching assistant-led extracurricular physical activity intervention for 8- to 10-year-olds

BackgroundApproximately half of 7-year-old children do not meet physical activity (PA) recommendations. Interventions targeting primary school children’s afterschool discretionary time could increase PA. Teaching assistants (TAs) are a school resource and could be trained to deliver after-school PA programmes. Building on earlier work, this paper describes the protocol for a cluster randomised feasibility study of a teaching assistant-led after-school intervention aimed at increasing PA levels of year 4 and 5 children (8–10 years old).MethodsPhase 1—pre-baseline: 12 schools will be recruited. In all schools, self-reported PA will be measured in all consenting year 3 and 4 children. In four schools, pupils will additionally wear a waist-worn Actigraph accelerometer for 7 days.Phase 2—baseline: schools will be randomised to one of two enhanced recruitment strategies being tested for children: (1) a club briefing and (2) the briefing plus a taster Action 3:30 session. Up to 30 children per school will be able to attend Action 3:30 sessions and will provide baseline data on height, weight, psychosocial variables and accelerometer-measured PA.Phase 3—intervention and follow-up: Schools randomised into intervention or control arm. Intervention schools (n = 6) will receive a 15-week after-school programme when children are in years 4 and 5, run by TAs who have attended a 25-h Action 3:30 training programme. Control schools (n = 6) will continue with normal practice. Follow-up measures will be a repeat of baseline measures at the end of the 15-week intervention.Phase 4—process evaluation: session attendance, perceived enjoyment and perceived exertion will be assessed during the intervention, as well as the economic impact on schools. Post-study qualitative assessments with TAs, school contacts and pupils will identify how the programme could be refined. Accelerometer-determined minutes of moderate-to-vigorous physical activity (MVPA) per day will be calculated as this is likely to be the primary outcome in a future definitive trial.DiscussionThe Action 3:30 cluster randomised feasibility trial will assess the public health potential of this intervention approach and provide the information necessary to progress to a definitive cluster randomised controlled trial.Trial registrationISRCTN34001941. Registered 01/12/2016.

STRATEGIES TO ENHANCE RECRUITMENT METHODS IN PHANTOM LIMB PAIN CLINICAL TRIALS.

Phantom Limp Pain (PLP) was first described in 1551. To date, its mechanisms and novel interventions remain mostly untested. Only limited conclusions can be drawn from few and small randomized clinical trials (RCTs) on PLP. In this scenario, recruitment strategies are crucial in order to overcome inherent challenges to recruit PLP subjects for clinical trials. Although there are many methods to enhance recruitment and also retention, in this article we discuss these methods based on a common topic: dissemination. We summarize and discuss 10 strategies of recruitment related to the dissemination of information based on the notion that an increase in trial awareness may lead to both increased recruitment and also increased external generalizability. In addition, in our discussion we included insights based on our experience recruiting PLP patients for our large NIH-sponsored clinical trial. Although specific regulatory considerations need to be considered when choosing the methods of recruitment, which may vary across different countries and Institutional Review Boards (IRBs), these strategies may be applicable to most of research settings.

Recruitment of Family Child Care Homes for an Obesity Prevention Intervention Study.

ObjectiveCritical to the success of any intervention study is successful recruitment. The aim of this paper was to examine the recruitment process of a randomized controlled trial evaluating an intervention conducted with family child care home providers. Specifically, the recruitment challenges, the efforts employed to address the challenges, and their impact on participant recruitment are discussed.MethodsThe study’s original recruitment protocol was employed during waves 1 and 2 (out of 5). However, recruitment tracking showed a failure to meet enrollment targets, particularly in wave 2. Low enrollment prompted an all-day retreat to discuss potential revisions and enhancements to recruitment strategies. Four strategies to enhance the recruitment protocol emerged from the retreat: improving recruitment materials to enhance communication, increasing engagement with community partners, addressing provider concerns about participation and study burden, and facilitating parent engagement.ResultsThe study successfully recruited 166 family child care home providers across the 5 waves. There was a significant impact on the recruitment of waves 3–5 versus waves 1–2 using the enhanced recruitment protocol. There was a dramatic increase in those who “consented” (43% vs. 60%, respectively) and a corresponding decrease in the percent of “interested and eligible” who then “failed to consent” (57% vs. 40%, respectively).ConclusionResults of these enhanced recruitment strategies demonstrate the many lessons learned about successful recruitment of a difficult-to-reach population, family child care homes; specifically, the importance of building relationships, communicating clearly, and identifying key motivators.

Abstract W P9: SAMMPRIS, WASID, and the Non-Linearity of Stroke Risk: Is There Room for Further Trials of Intervention for Intracranial Stenosis?

Background: SAMMPRIS concluded that aggressive medical management (AMM) was superior to early percutaneous transluminal angioplasty and stenting (PTAS) plus AMM for patients with symptomatic severe intracranial stenosis. WASID and SAMMPRIS have shown that the risk of recurrent stroke after the initial event is early, non-linear, and markedly diminishes over one year irrespective of treatment. We therefore investigated the feasibility of demonstrating benefit for a new endovascular intervention (nEI) for these patients within this narrow time window. Methods: We compared 1-year stroke/death rates in patients treated with AMM versus a hypothesized nEI. The 1-year stroke/death rate for AMM was derived from the SAMMPRIS trial. A minimal 30-day stroke/death rate for a nEI was set to 3% using data from endovascular treatment of unruptured intracranial aneurysms. The subsequent stroke/death rate over the ensuing 11 months was varied above and below the rates achieved in SAMMPRIS, and the sample size for a future 1-sided superiority trial was calculated at 0.05 alpha and 80% power. Results: For a nEI with the same 31-365 days stroke/death rate as SAMMPRIS AMM (5.3%) but an improved 30-day stroke/death rate of 3%, a total of 1,484 subjects would be required to show significant benefit over AMM. At the SAMMPRIS recruitment rate of 187 patients/year, it would take 7.9 years to recruit 1,484 patients. Varying the 31-365 days stroke/death rate for nEI from 3% to 8%, and keeping 0-30 days stroke/death rate constant at 3%, (1 year total nEI stroke/death rate ranging from 6% to 11%), the total sample size required to show significant benefit at 1 year over AMM (1 year stroke/death rate of 12.2%) would be 518 and 17,600 respectively. This trial would take approximately 2.8 years and 94.1 years to recruit the eligible subjects at the SAMMPRIS rate, respectively. Conclusion: Identification of higher-risk subgroups, demonstration of decreased 30-day endovascular complication rates, and enhanced recruitment strategies will be necessary before institution of trials of new endovascular interventions for symptomatic intracranial stenosis.

Psychology of Success: Overcoming Barriers to Pursuing Further Education

Of the many barriers that prevent adults from continuing their education, psychological barriers are least often addressed by educators. This is an important area of concern because psychological factors influence how prospective students respond to other barriers. This qualitative study was conducted to describe how adults negotiate education-related challenges as they make their way to an adult education program at a technical college. Drawing on Bandura and others, this study considers goal setting, motivation, and self-efficacy in relation to social context. The findings illustrate how psychological factors are influenced by friends and family members. Educators can utilize this principle to enhance recruitment strategies and student support.

Identification and recruitment of low-income pregnant smokers: Who are we missing?

Extensive research has demonstrated the health consequences of smoking during pregnancy for both the mother and child. The majority of women, however, continue to smoke throughout the pregnancy and, of those who do quit, the majority return to smoking during the pregnancy or shortly after delivering the child. To best address this important public health problem, three critical goals must be accomplished: (1) development of effective interventions to help women quit smoking during pregnancy; (2) development of effective interventions to help women stay smoke-free during and after pregnancy; and (3) identification of effective methods of reaching women who smoke during pregnancy. Recruitment is the first window of opportunity to maximize our public health impact with pregnant women. Effective recruitment of women across all stages of change is needed, including both preaction stages and action stages. The current article examines the smoking habits of a large sample of low-income pregnant women. It compares those who enrolled in an intervention trial with those who did not enroll on a number of sociodemographic and individual characteristics, smoking patterns, and stage of change. The participants included 2280 pregnant women. Significant differences were found between enrollment groups on a number of variables, including stage of change [ χ 2(4)=54.74, P<.001], gestational age [ t(955)=11.93, P<.001], and multiple smoking pattern variables ( P<.001). In addition, a trend was found for ethnicity [ χ 2(5)=11.15, P<.05]. The findings of this study may help guide the development of enhanced recruitment strategies to expand our reach and thus our impact in this special population of smokers.