General Practice Recruitment Research Articles

The impact of the COVID-19 pandemic on students' views of a career in general practice.

General Practice (GP) is an essential part of healthcare systems in the UK and internationally but continues to struggle with recruitment. Despite these concerns about GP recruitment, few studies have explored factors that influence medical students' career choices around primary care. We aimed to re-visit factors previously proposed following new ways of working adopted since the COVID-19 pandemic, including the impact of these changes on learning experiences in primary care. A qualitative study using focus groups across three English medical schools. Eight focus groups involving thirty-three final and penultimate year medical students. Qualitative data analysed using a framework approach. Transcripts coded independently by two researchers from a different institution before themes identified. Six themes were identified: students' prior career aspirations, their experience of the medical school curriculum, conceptualisation of general practice, future career predictions, views on the school's curriculum philosophy and the influence of the COVID-19 pandemic. The curriculum philosophy of each school appeared was important in this journey and changes since the COVID-19 had an impact on all themes. Our study has confirmed previous findings that clinical experiences, the perceived narrative of the school, work-life balance and working environment remain important to students in making career plans. However, in addition, we have found the changing landscape in general practice since the covid pandemic, including remote consulting, workload, continuity of care and team-working are additional factors that concern students.

Team climate, job satsfaction and burnout: results from a national survey of staff in general practice in England.

Measures are needed to address recruitment and retention problems in general practice. A good team climate (relational processes of team working) can mitigate the effects of pressured work environments, but little is known about it in British general practice. To assess team climate, explore practice characteristics and workforce combinations associated with favourable team climates, and analyse associations between practice team climate and job satisfaction, intention to remain in post, burnout and measures of practice performance. An online questionnaire distributed to practices (for all their staff) via Clinical Research Networks, mid 2022, comprising validated measures: 14 item Team Climate Inventory (TCI) and single items on job satisfaction and emotional exhaustion/burnout; a question on intention to remain in post; participant role, age group, gender. Anonymous completion; submission through the Oxford RCGP RSC. Responses received from 4.8% of national staff headcount, n = 9835, (21.6% GP, 22.9% nurse/direct patient care, 55.5% non-clinical). Mean TCI score, 3.73 (scale 1-5 best); 78.3% were satisfied in their jobs; 26.1% reported high burnout. GPs perceived significantly better team climate, and reported lower job satisfaction, higher burnout (especially male GPs) and lower intention to quit than other groups. After adjusting for practice and workforce characteristics, team climate was better in smaller practices and associated with more job satisfaction, less burnout, increased intention to remain and improved patient-reported experiences; climate was unrelated to QOF performance. Team climate could be used to improve morale and patient experience. Micro teams might be beneficial in larger practices.

Process evaluation of the Safer Prescribing and Care for the Elderly (SPACE) cluster randomised controlled trial in New Zealand general practice.

Introduction The Safer Prescribing and Care for the Elderly (SPACE) cluster randomised controlled trial in 39 general practices found that a search of the practice database to identify and generate for each general practitioner (GP) a list of patients with high-risk prescribing, pharmacist-delivered one-on-one feedback to GPs, and electronic tick-box for GPs to select action for each patient (Patient letter; No letter but possible medication review when patient next in; No action), prompted safer prescribing at 6 months but not at 1 year. Aim This process evaluation explores research participation, intervention uptake and effect on GPs. Methods Mixed methods were used including quantitative data (log of practice recruitment, demographic data, intervention delivery and GP responses including tick-box selections) and qualitative data (trial pharmacist reflective journal). Data were analysed using descriptive statistics and general inductive analysis, respectively. Results Recruitment of general practices was challenging, with only 39% of eligible practices agreeing to participate. Those who declined were often 'too busy'. Engagement was also challenging, especially in larger practices, with the trial pharmacist managing to meet with only 64% of GPs in the intervention group. The GPs who did engage were positive about the intervention, but elected to send letters to only 23% of patients with high-risk prescribing, either because the high-risk prescribing had already stopped, the GP did not agree the prescribing was 'high-risk' or the GP was concerned a letter would upset the patient. Conclusions Effectiveness of the SPACE cluster randomised controlled trial could be improved by changes including ensuring searches are current and relevant, repeating cycles of search and feedback, and integrating pharmacists into general practices.

General Practice and Digital Methods to Recruit Stroke Survivors to a Clinical Mobility Study: Comparative Analysis.

BackgroundParticipant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials.ObjectiveThe objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study.MethodsRecruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b.ResultsOur results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad.ConclusionsDigital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies.

Medical applicant general practice experience and career aspirations: a questionnaire study

BackgroundIncreasing access to general practice work experience placements for school students is a strategy for improving general practice recruitment, despite limited evidence and concerns surrounding equity of access to general practice experiences.AimsTo examine the association between undertaking general practice experience and the perceptions of general practice as an appealing future career among prospective medical applicants. To identify socioeconomic factors associated with obtaining general practice experience.Design & settingCross-sectional questionnaire study in the UK.MethodParticipants were UK residents aged ≥16 years and seriously considering applying to study medicine in 2019/2020. They were invited to take part via the University Clinical Aptitude Test (UCAT). Questionnaire data were analysed using a linear regression of general practice appeal on general practice experience, adjusting for career motivations and demographics, and a logistic regression of general practice experience on measures of social capital and demographics.ResultsOf 6391 responders, 4031 were in their last year of school. General practice experience predicted general practice appeal after adjusting for career motivation and demographics (b = 0.37, standard error [SE] = 0.06, P<0.00001). General practice experience was more common among students at private (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.31 to 2.08, P<0.0001) or grammar schools (OR = 1.33, 95% CI = 1.02 to 1.72, P = 0.03) and in the highest socioeconomic group (OR = 1.62, 95% CI = 1.28 to 2.05, P<0.0001), and less likely among students of ‘other’ ethnicity (OR = 0.37, 95% CI = 0.20 to 0.67, P = 0.0011).ConclusionHaving general practice experience prior to medical school was associated with finding general practice appealing, which supports its utility in recruitment. Applicants from more deprived backgrounds were less likely to have had a general practice experience, possibly through lack of accessible opportunities.

Career destinations of graduates from a medical school with an 18-week longitudinal integrated clerkship in general practice: a survey of alumni 6 to 8\xa0years after graduation

BackgroundThere is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice.AimThe aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice.Design and settingThis study was conducted in a single graduate entry medical school at the University of Limerick, Ireland.ParticipantsMedical school alumni 6–8 years after graduation.MethodA survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone.ResultsThere were a total of 175 alumni for the period 2011 to 2013. Data was collected on 92% (161/175) through an online survey, follow-up email and telephone interview, and was triangulated with searches of professional registration databases and information from key informants. Between 6 and 8 years after graduation, a total of 43% of alumni were engaged in general practice as a career.ConclusionThe reform of the delivery of general practice within medical school curricula should be considered by medical schools, curriculum designers and policy-makers as part of an overall strategy to address the recruitment and retention of general practitioners as part of the global healthcare workforce.

Strategies for recruitment in general practice settings: the iSOLVE fall prevention pragmatic cluster randomised controlled trial

BackgroundFalls are common among older people, and General Practitioners (GPs) could play an important role in implementing strategies to manage fall risk. Despite this, fall prevention is not a routine activity in general practice settings. The iSOLVE cluster randomised controlled trial aimed to evaluate implementation of a fall prevention decision tool in general practice. This paper sought to describe the strategies used and reflect on the enablers and barriers relevant to successful recruitment of general practices, GPs and their patients.MethodsRecruitment was conducted within the geographical area of a Primary Health Network in Northern Sydney, Australia. General practices and GPs were engaged via online surveys, mailed invitations to participate, educational workshops, practitioner networks and promotional practice visits. Patients 65 years or older were recruited via mailed invitations, incorporating the practice letterhead and the name(s) of participating GP(s). Observations of recruitment strategies, results and enabling factors were recorded in field notes as descriptive and narrative data, and analysed using mixed-methods.ResultsIt took 19 months to complete recruitment of 27 general practices, 75 GPs and 560 patients. The multiple strategies used to engage general practices and GPs were collectively useful in reaching the targeted sample size. Practice visits were valuable in engaging GPs and staff, establishing interest in fall prevention and commitment to the trial. A mix of small, medium and large practices were recruited. While some were recruited as a whole-practice, other practices had few or half of the number of GPs recruited. The importance of preventing falls in older patients, simplicity of research design, provision of resources and logistic facilitation of patient recruitment appealed to GPs. Recruitment of older patients was successfully achieved by mailed invitations which was a strategy that was familiar to practice staff and patients. Patient response rates were above the expected 10% for most practices. Many practices (n = 17) achieved the targeted number of 20 or more patients.ConclusionsRecruitment in general practice settings can be successfully achieved through multiple recruitment strategies, effective communication and rapport building, ensuring research topic and design suit general practice needs, and using familiar communication strategies to engage patients.Trial registrationThe trial was prospectively registered on 29 April 2015 with the Australian New Zealand Clinical Trial Registry www.anzctr.org.au (trial ID: ACTRN12615000401550).

UK longitudinal integrated clerkships: where are we now?

ABSTRACTIn this article, we discuss whether it is possible for UK institutions to influence the international longitudinal integrated clerkship (LIC) narrative, in the context of supplying future clinicians to a fragmented health service that is battling a General Practice recruitment crisis. Perhaps more importantly, we will discuss whether the ‘LIC model’ fits the UK undergraduate framework. We intend to present some emerging evidence of LICs in the UK, informed by a UK-wide survey and observations from a 2019 UK LIC think tank and then discuss whether the global CLIC definition applies to the UK context with possible ways forward.

General practice recruitment - a survey of awareness and influence of the Scottish Targeted Enhanced Recruitment Scheme (TERS)

ABSTRACTThe World Health Organisation reported that health-care systems worldwide have problems with the recruitment and retention of general practitioners (GPs) into clinical practice, particularly to rural and under-served areas. A recent survey of United Kingdom (UK) trainees found that they valued posts with good training conditions, were in desirable locations and gave opportunities for their partner. The Scottish Government has set a target to increase the number of GPs in Scotland by 800 in the next 10 years. In recent years, GP speciality training recruitment has been challenging with significant vacancies in some training programmes, primarily in rural areas, or urban areas with a history of poorer recruitment. Recruitment incentive schemes are in operation in different countries in the UK. The Scottish Government introduced a Targeted Enhanced Recruitment Scheme (TERS), offering a £20,000 payment to GPST trainees accepting a targeted post. This study aimed to evaluate awareness and influence of the TERS initiative on programme choice in Scotland in August 2017. A survey was developed and sent to GP trainees taking up a GPST post in August 2017. Ninety-five out of 245 doctors responded (response rate of 39%). Almost two-thirds (65.3%) were aware of TERS at the time of application and this was via word of mouth and from the National Recruitment Office website. Only 21% of GPSTs aware of TERS were influenced by it in their choice of training location. The locations of family, spouse or partner, and of pre-existing geographical preferences were more influential than TERS.

Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care.

BackgroundE-mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care.ObjectiveThis paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods.MethodsRecruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required sample size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests.ResultsBetween November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance.ConclusionsTime, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.

Correction: Motivation for Specialisation in General Practice - A Quantitative Study of NRW's Medical Students in Support of Targeted Recruitment

AIM OF STUDY Due to forecasted shortage of general practitioners, we conducted an online survey of all medical students in North-Rhine-Westphalia to identify and quantify determinants in medical students' decision to specialize in general practice (GP). METHODOLOGY To identify the motives driving the choice of GP as a career, responses of 3976 participants (22.6% of medical students invited) were subjected to factor analysis. Relationships between extracted factors and career choice were ascertained via regression analysis adjusted for population characteristics. All participants who had positioned themselves distinctly for/against GP were included in regression analysis (n=2862). RESULTS Four of five identified factors were significantly associated with the intended choice of GP. "Comprehensive patient contact" (OR 4.02; 95% CI [3.5-4.6]), and "flexible working hours" (OR 1.35; 95% CI [1.2-1.5]) represent factors associated with choosing GP despite the perception of "superior career opportunities, income and status in other specializations" (OR 1.14; 95% CI [1.0-1.3]). Meanwhile, preference for "specialization, research and teamwork in other disciplines" (OR 0.55; 95% CI [0.5-0.6]) obstructs the intended choice of GP. CONCLUSION GP recruitment can profit from focused sponsorship of students' interest in patient contact within GP clerkships, appropriate GP teaching structure at the universities, enhanced research and teamwork opportunities, and increased flexibility of working hours.

Motivation for Specialisation in General Practice - A Quantitative Study of NRW's Medical Students in Support of Targeted Recruitment

Due to forecasted shortage of general practitioners, we conducted an online survey of all medical students in North-Rhine-Westphalia to identify and quantify determinants in medical students' decision to specialize in general practice (GP). To identify the motives driving the choice of GP as a career, responses of 3976 participants (22.6% of medical students invited) were subjected to factor analysis. Relationships between extracted factors and career choice were ascertained via regression analysis adjusted for population characteristics. All participants who had positioned themselves distinctly for/against GP were included in regression analysis (n=2862). Four of five identified factors were significantly associated with the intended choice of GP. "Comprehensive patient contact" (OR 4.02; 95% CI [3.5-4.6]), and "flexible working hours" (OR 1.35; 95% CI [1.2-1.5]) represent factors associated with choosing GP despite the perception of "superior career opportunities, income and status in other specializations" (OR 1.14; 95% CI [1.0-1.3]). Meanwhile, preference for "specialization, research and teamwork in other disciplines" (OR 0.55; 95% CI [0.5-0.6]) obstructs the intended choice of GP. GP recruitment can profit from focused sponsorship of students' interest in patient contact within GP clerkships, appropriate GP teaching structure at the universities, enhanced research and teamwork opportunities, and increased flexibility of working hours.

Mentored Training Positions for Early-Career General Practitioners.

Novel early-career general practitioner jobs were introduced in NHS Tayside, Scotland with 2 purposes: first, to develop the skills and confidence of recently qualified general practitioners (GPs), and second, to address well-known issues of recruitment and retention in general practice.1 In this

Discontinuation of the PACE Plus trial: problems in patient recruitment in general practice

BackgroundThe PACE Plus trial was a multi-center, double-blinded, superiority randomized controlled trial (RCT) conducted in patients from Dutch general practice to investigate the efficacy of paracetamol and NSAIDs in acute non-specific low back pain (LBP). Because insufficient numbers of patients could be recruited (only four out of the required 800 patients could be recruited over a period of 6 months), the trial was prematurely terminated in February 2017, 6 months after the start of recruitment. This article aims to transparently communicate the discontinuation of PACE Plus and to make recommendations for future studies.MethodsGeneral Practitioners (GPs) from 36 participating practices received a one-question survey in which they were asked to give the three most important factors that in their opinion contributed to failure of patient recruitment.ResultsGPs of 33 out of 36 (92%) participating practices sent a response. A total of 81 factors were reported. These have been categorized into patient factors (26 out of 81 comments, 32%), GP factors (39 out of 81 comments, 48%) and research factors (16 out of 81 comments, 20%).DiscussionPatient recruitment in the PACE Plus trial may have failed due to inefficient medication distribution, recruitment of incident rather than prevalent cases, a design that was too complicated, adequate self-management of LBP, patient expectations different from the trial’s scope and lack of time of participating GPs. Substantial differences in design may explain why the preceding PACE trial did manage to successfully complete patient recruitment.ConclusionAlthough the PACE Plus trial was terminated as a result of insufficient patient inclusion, the research questions addressed in this trial remain relevant but unanswered. We hope that lessons learned from the discontinuation of PACE Plus and corresponding recommendations may be helpful in the design of upcoming research projects in LBP in general practice.Trial registrationDutch Trial Registration NTR6089, registered September 14th 2016.

General practice tasters for foundation doctors.

General practice (GP) is currently not viewed positively as a career choice, compared with other specialties, with GP training programmes struggling to fill posts. Opportunities to change this mindset in the early years of training are limited. Trainees may find themselves applying for entry into GP specialty training just 3-4months after completing Foundation Year1 (FY1), yet there are few GP attachments during FY1 that can provide experience of primary care and positively inform career choice. To help ameliorate the current crisis in GP, recruitment and retention initiatives are needed to provide relevant experience of GP early in medical careers so that more doctors can make an informed decision to choose GP as a career. FY1 doctors have been given the opportunity to shadow final-year GP specialty trainees (GPST3) in clinical practice (for between 3 and 5days). The voluntary scheme has run successfully since 2014. This paper describes the taster programme and its evaluation. The programme has been positively received by both FY1s and GPST3 mentors. The GPST3s are enthusiastic about GP, which appeared to 'rub off' on the FY1s. FY1s find it helpful to have a trainee's perspective, gaining an overview of what to expect, including the opportunities available to them. General practice is currently notviewed positively as a career choice IMPLICATIONS: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and can have a positive impact on GP recruitment. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.

Local approaches to the general practice recruitment crisis

With many parts of the UK struggling to hire enough GPs, Anne Gulland looks at three areas that have taken matters into their own hands

Recruitment and retention in general practice nursing: What about pay?

As the employees of independent contractors, most nurses working in general practice are not subject to Agenda for Change. This article looks at a pay framework that has been developed for nurses and healthcare assistants in Lambeth, South London When Agenda for Change was introduced in 2004, many nurses saw an increase in pay, alongside the potential for annual incremental pay rises and the ability to progress through pay bands with appropriate study and the undertaking of additional responsibilities. As practice nurses are the employees of independent contractors, most were not enrolled in Agenda for Change. They now have no nationally recognised payscale and have to negotiate pay, terms and conditions on an individual basis. The lead nurses in Lambeth, South London decided to develop a pay framework that mapped to the general practice nurse career framework. This was fully endorsed by Lambeth Clinical Commissioning Group and Community Education Providers Network and was launched in June 2017. In January 2018, a pay framework was also launched for healthcare assistants in Lambeth. The framework aims to allow general practice to compete with all healthcare sectors and to make general practice an attractive and viable career option.

The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial.

Background:Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed.Objective:To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care.Design:A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs)Discussion:Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation.Trial Registration:ISRCTN12765345.

The Impact of Participant Characteristics on Use and Satisfaction of a Web-Based Computer-Tailored Chronic Obstructive Pulmonary Disease Self-Management Intervention: A Process Evaluation

BackgroundA randomized controlled trial (RCT) showed that a Web-based computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease (COPD) did not have a significant treatment effect. Process evaluation measures such as application use and satisfaction with the intervention can help understand these results.ObjectivesThe aim of this paper is to uncover reasons for suboptimal application use, evaluate satisfaction with the intervention, and investigate which participant characteristics predict application use and user satisfaction.MethodsParticipants were recruited through 2 different channels: an online panel and general practice. The intervention group received the intervention, which consisted of 2 modules (smoking cessation and physical activity). The control group received no intervention. The study employed a mixed methods design. Quantitative and qualitative data were gathered assessing participant characteristics, application use, reasons for not using the application, and satisfaction with the intervention.ResultsThe RCT included 1325 participants. The proportion of individuals who participated was significantly higher in the online group (4072/6844, 59.5%) compared to the general practice group (43/335, 12.8%) (P<.001). Application use was low. Of all participants in the intervention group, 52.9% (348/658) initiated use of one or both modules, 36.0% (237/658) completed an intervention component (prolonged use), and 16.6% (109/658) revisited one of the modules after completing an intervention component (sustained use). Older age, established diagnosis of COPD, or experiencing breathlessness predicted sustained use. Participant satisfaction with the 2 modules was 6.7 (SD 1.6) on a scale from 0 to 10. The interviews revealed that a computer application was believed not to be sufficient and the help of a health care professional was necessary. Participants with a greater intention to change were more satisfied with the application.ConclusionsThe application was not used sufficiently. Study materials should be further tailored to younger individuals, those at risk for COPD, and those who do not experience breathlessness in order to increase sustained use among them. Involvement of a health care professional could improve satisfaction with the intervention and potentially increase engagement with the intervention materials. However, to make this possible, recruitment in general practice needs to be improved. Recommendations are made for improving the study design, strengthening the intervention (eg, practice facilitation), and linking the computer application to interaction with a health care provider.

Recruitment of general practices: Is a standardised approach helpful in the involvement of healthcare professionals in research?

Introduction:Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R-factors as determinants for successfully recruiting healthcare professionals: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect.Method:This is a process evaluation of the seven R-factors. We applied these factors to guide the design of our recruitment strategy as well as to make adjustments when recruiting general practices in a guideline implementation study. In the guideline implementation study, we studied the effect of outreach visits, quality reports, and new patient stratification tools for low back pain patients.Results:During a period of 15 months, we recruited 60 practices, which was fewer than planned (100 practices). In this evaluation, five of Solberg’s seven R-factors were successfully addressed and two factors were not. The need to involve (reciprocity) end users in the development of new software and the amount of time needed to conduct recruitment (resolution) were underestimated.Conclusion:The framework of the seven R-factors was a feasible tool in our recruitment process. However, we suggest further investigation in developing systematic approaches to support the recruitment of healthcare professionals to research.